RESEARCH

Failures of crown and fixed partial dentures - A clinical survey

Sudhir Pawar
ABSTRACT
Failure of restorations is an important concern in dentistry. A clinical survey was conducted to assess the various failures associated with crowns and fixed partial dentures. The number of units involved and the type of materials used in fabrication of prosthesis were taken into consideration and the frequency of failures was analyzed. Out of 87 cases surveyed, 68 crowns and 19 fixed partial dentures demonstrated failure. The most common cause of failure in crown and fixed partial dentures was due to the lack of retention.

reporting at our Institute by collecting the data after proper clinical examination and diagnosis.

Method and Materials

A sample questionnaire was prepared in order to collect the relevant data. The questions pertained to the period of the prosthesis in place, the nature of complaint as told by patient in his or her own words, number of units involved, and the type of materials used in fabrication of prosthesis.

Keywords: Crowns, fixed partial dentures, failure.

Results

Introduction

Total number of failures of crowns and fixed partial dentures were 87.The number of failures in Crowns was Demand to replace the lost or missing teeth by means 68 while the number of failures in case of fixed partial of fixed partial denture has been ever increasing. Since dentures was 19. a fixed prosthesis assures the greater retention and stability in addition to comfort, it is more or less The types of failures3 were categorized, tabulated and considered as the next best to replace the lost tooth or 1 their frequency was found out represented in Table 1. teeth and thereby restore their functions. Even if this modality of treatment has one distinct disadvantage of requiring a natural tooth structure to be sacrificed, in Discussion order to prepare the tooth or teeth for receiving the retainers or a restoration as the case may be. Given the The most common cause of failure in crown and fixed other modality of having a fixed prosthesis by means of partial dentures was the lack of retention amounting to taking support from implant is picking up, the same may 45 %, which can be attributed to various causes like not be in the reach of many for reasons like financial improper preparation of tooth with too much taper of affordability, lack of available facilities in nearby proximal walls, one of the proximal walls being too surroundings, as well as non willingness to undergo short, and lack of resistance form.4,5 It can also be surgical procedures and so on. Implant supported attributed to improper cementation and lack of crown or fixed partial denture has a distinct advantage adjustment of occlusion during eccentric mandibular of sparing the natural tooth structure from that of movements6. abutment teeth as required in conventional crown or 2 The most common cause of pain under the restorations fixed partial denture treatment. For the advantages of is due to pulp stimulation by way of lack of cement conventional crown or fixed partial denture, it has a space, and in certain cases due to excessive reduction definite and a larger scope since it can be afforded by leading to fine pulp exposure.4 larger number of people. Keeping this in mind a clinical The breakage of porcelain veneer is due to inadequate survey was undertaken to assess the common causes of space for the sufficient thickness of porcelain or due to failures of crowns and fixed partial denture cases concentration of occlusal stresses from the opposing reporting at our Institute by collecting the data after IJCD JANUARY, 2011 2(1) 120 teeth. Dentistry proper clinical examination and diagnosis. 2011 Int. Journal of Contemporary In 3 cases, it was observed that the restoration had

RESEARCH
S.no 1. 2. 3. 4. 5. 6. 7. Nature of failure Looseness and poor retention./ repeated dislodgement Pain under the restoration i.e. under crown or fixed Partial denture Breakage of restoration / facing / porcelain veneer Breakage of supporting tooth. Esthetic deficiency. Food impaction in embrasure areas / bad odor High spots. No. of Units 39 21 13 03 05 04 02 Percentage 44.82% 24.13% 14.94% 3.44% 5.74% 4.59% 2.30% Type of failure3 Class I / II . Class IV Class III Class V Class III Class III Class I

Table 1: Frequency of various types of failures of crown and fixed partial dentures.

concentration of occlusal stresses from the opposing teeth.5 In 3 cases, it was observed that the restoration had broken with the fracture of abutment tooth at the cervical area. This can be attributed mainly to weakened tooth structure due to root canal treatment and also to excessive reduction of tooth during preparation. Such teeth can break off under heavy masticatory stresses during excursive movements. Esthetic deficiencies mainly related to incorrect proportioning in size and shape of teeth, particularly in anterior fixed partial dentures, and also to the eruption profiles of pontics. The failures related to food impaction and bad odors were due to incorrect design of pontics, lack of tight contact with adjacent teeth, and incorrect gingival margins. Similarly the high spots were due to lack of adjusting occlusion in excursive mandibular movements. It can be safely said that nearly 77% of failures are due to mechanical problems and only about 23 % are due to oral diseases.1

References
1) Joanne N. Walton; F. Michael Gardner; John R. Agar A survey of crown and fixed partial denture failures; J.Prosthet., Dent; October 1986; vol. 56, issue 4; 416- 421. 2) Lindquist F. Karlsson S.- Success rate and failures for fixed partial dentures after 20 years of service; Part 1; Int.J.Prosthodont.;1998;MarApr;11 (2); 133 8. 3) Manappallil J.J. Classification system for conventional crown and fixed partial denture failures; J. Prosthet. Dent.; 2008; Apr.; 99 (4);293 8 . 4) Charles J. Goodacre; Guillermo Bernal, et.al. Clinical complications in fixed prosthodontics; J. of Prosthet. Dent.; 2003, July, 90 (1), 31 41. 5) Alex Selby Fixed prosthodontic failure; A review and discussion of important aspects Australian Dental Journal.; 1994, June, vol. 39, (3); 150 -6. 6) Lamiaa Sayed Kheiralla , Mona Attia , et.al.Failure of crown and fixed partial denture in Fixed Partial Prosthodontics Dept.; Egyptian Dental Journal,2007 , April , Vol.53,(2.1)
About the Author

Summary and Conclusion

The conventional crown and fixed partial denture treatment modality being a very commonly practiced and highly successful in restoring the functions of lost or missing teeth and thereby the comfort of individual a care must be taken to avoid the common causes leading to their failures. In this endeavor, the proper selection of the case, careful diagnosis, meticulous preparation, and a professional construction of prosthesis are mandatory to success and longevity of restoration and maintenance of health of biological investing tissues.

Dr. Sudhir Pawar,

Professor and Head , Dept. of Prosthodontics, Rungta College of Dental Sciences and Research; Bhilai, Chattisgad. 490 024.
email: sudhirpawar56@gmail.com

121

Address for Correspondence IJCD JANUARY, 2011 2(1)

2011 Int. Journal of Contemporary Dentistry