Proximal contour modications for xed partial dentures: A clinical report

David A. Kaiser, DDS, MSD,

a
and John D. Jones, DDS
b
The University of Texas Health Science Center, San Antonio, Texas
An often-neglected aspect of xed prosthodontics is the contour of the tooth adjacent to the cast resto-
ration. The adjacent surfaces should be surveyed to reveal compatibility with the path of insertion of
the restoration. Adjacent contacts may have to be altered to permit the placement of the xed partial
denture and to ensure proper contact size/shape and embrasure size. The need for guide planes on
teeth adjacent to xed partial denture abutments in xed prosthodontics is described. (J Prosthet Dent
2003;89:344-5.)
The importance of proximal contour modica-
tions for removable partial dentures is well recog-
nized. Guide planes have been well documented in
the literature as a key to successful treatment in re-
movable partial dentures.
1
Although not emphasized
to the same extent, the advantages of contouring
proximal surfaces provide advantages in patients with
xed partial dentures (FPD).
During the diagnostic phase for a crown or FPD, a
path of insertion must be determined.
2
The interproxi-
mal contact areas should also be analyzed at this time to
determine compatibility with the path of insertion. This
is applicable to a crown or an FPD (tooth supported or
implant supported).
CLINICAL REPORT
In the rst treatment situation, if an overcontoured
tooth is unaltered, the result can be a point contact
adjacent to the restoration. After completion of the res-
toration, a large gingival embrasure results froma failure
to adjust the adjacent tooth (Fig. 1).
In the second treatment situation, the adjacent tooth
contour has been planned and polished to produce an
ideal cleansable gingival embrasure. The nal restora-
tion presents a more ideal gingival embrasure (Fig. 2).
DISCUSSION
Restorations should be contoured to provide
home-care accessibility to promote a healthy environ-
ment for the gingival papilla.
2
The interproximal con-
tact should be an area rather than a point.
3
This con-
tact area should provide stability for teeth, as well as
the proper size embrasure.
4
The embrasure therefore
should not be too small or too large. If it is too large,
food may collect. Also, if the patient cleans with an
interproximal brush, a large embrasure may not com-
press the bristles of the brush and may produce inef-
fective cleaning (Fig. 3).
An analysis of the adjacent tooth contour of a crown
or FPD with a dental surveyor may reveal a situation
(because of tipping or crown contour) that should be
altered. If is not altered to be compatible with the path
of insertion of the restoration, a large embrasure and
point interproximal contact may result. After analysis of
the adjacent tooth and alteration of that surface to pro-
duce a surface compatible with the path of insertion, a
smaller, more cleansable embrasure and area interprox-
imal contact should result.
a
Professor, Department of Prosthodontics.
b
Professor, Department of Prosthodontics.
Fig. 1. A, Analyzing rod represents path of insertion of adja-
cent restoration. Large gingival embrasure will result without
guide plane. B, Large gingival embrasure resulting from min-
imally altered adjacent contour.
344 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 89 NUMBER 4
SUMMARY
Advantages of recontouring tooth surfaces adjacent
to xed prosthodontic restorations have been described.
By analyzing the contour of adjacent teeth with a dental
surveyor prior to fabrication of a crown or FPD, the
tooth may be prepared to allow a proper contact area, as
well as gingival embrasure.
REFERENCES
1. Henderson D, Seward TE. Design and force distribution with removable
partial dentures: a progress report. J Prosthet Dent 1967;17:350-64.
2. Shillingburg HT, Jacobi R, Brackett S, Hobo S, Whitsett LD. Fundamentals
of xed prosthodontics. 3rd ed. Chicago: Quintessence Publishing; 1997. p.
124-6, 338-40.
3. Schluger S, Yuodelis R, Page RC, Johnson RH. Periodontal diseases: Basic
phenomena, clinical management, and occlusal and restorative interrela-
tionships. 2nd ed. Philadelphia: Lea & Febiger; 1989. p. 63-4.
4. Malone WFP, Koth DL. Tylmans theory and practice of xed prosthodon-
tics. 8th ed. St. Louis: Medico Dental Media International; 1989. p. 592-4.
Reprint requests to:
DR DAVID A. KAISER
DEPARTMENT OF PROSTHODONTICS
DENTAL SCHOOL
UT HEALTH SCIENCE CENTER
7703 FLOYD CURL DR
SAN ANTONIO, TX 78284-7912
FAX: 210-567-6376
E-MAIL: kaiser@uthscsa.edu
Copyright 2003 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/2003/$30.00 0
doi:10.1067/mpr.2003.72
Fig. 2. A, Planed and prepared adjacent contour will produce normal, cleansable gingival embrasure. B, Final restoration with
normal gingival embrasure.
Fig. 3. Over-contoured tooth may produce point interproxi-
mal contact with large embrasure (A). Contouring guide
plane on adjacent tooth can create normal relationship (B).
KAISER AND JONES THE JOURNAL OF PROSTHETIC DENTISTRY
APRIL 2003 345