A survey of crown and fixed partial denture
failures: Length of service and reasons for
replacement
Joanne N. Walton, D.D.S.,* F. Michael Gardner, D.D.S.,** and John R. Agar, D.D.S.***
U.S. Army Dental Activity, Walter Reed Army Medical Center, Washington, D.C.
A lthough the dental literature is replete with studies
concerning possible causes of prosthodontic failure,-
there is a paucity of valid research documenting the
prevalence of such failures. Perhaps the most commonly
quoted article on this subject by Schwartz et al.8 was
published more than 15 years ago. In their study of 406
patients with unserviceable fixed partial dentures (in
which unserviceable was defined as any crown or
fixed partial denture that required either repair or
replacement), the life span and causes of loss of service-
ability were determined. They found that the mean life
span for all restorations was 10.3 years, with caries
accounting for the largest number of failures. These and
other conclusions drawn by Schwartz et al. have provid-
ed dentists with valuable prognostic information and
with information about the most common prosthodontic
pitfalls.
Most articles published since 1970 have concentrated
on isolated problems associated with fixed partial den-
tures. A survey published in the Russian literature in
1979 recorded the reason(s) for removal of crowns and
fixed prostheses at one clinic during a 6-month period,
but this investigation did not segregate single crown and
retainer failures, and it did not examine length of service
as related to crown or retainer type. The greatest
percentage of crowns (25.2%) was removed because of
caries and its complications. Other major causes of
failure listed were fractured solder joint (20.4%), unce-
mented crowns (12.1%), worn occlusal surfaces (7.1%),
ulcers under pontics (6.7%), and periodontal disease
(6.0%). No mean length of service was reported. A study
by Glantz et al.O examined the quality of fixed restora-
Presented at a meeting of the National Capital Area Section of the
American College of Prosthodontists, February 1985.
The opinions expressed herein are those of the authors and are not to
be construed as those of either the Canadian Forces Dental Services
or the U.S. Army Mecfical Department.
*Major, Canadian Forces Dental Services; Senior Resident, Fixed
Prosthodontic Service.
**COL,, DC, USA; Chief, Fixed Prosthodontic Service.
***COL, DC, USA; 123 Medical Detachment (D.S.).
416
tions 5 years after placement and determined that 90% of
crowns and pontics were satisfactory. However, the
investigators did not evaluate known failures, and they
did not compare restoration life spans before failure.
The purpose of the present study was not to duplicate
the work of Schwartz et al., but rather to update it by
examining similar parameters. It was expected that
advances in the state of fixed prosthodontic materials and
methods would mean changes in causes of failure and
length of service of fixed restorations.
METHODS
Data have been collected since 1979 recording the type
of fixed restoration, the time span since placement, and
reason(s) for replacement for 270 patients who reported
to U.S. Army dental facilities at Fort Sill, Okla., the
Pentagon, Washington, D.C., and Walter Reed Army
Medical Center, Washington, D.C., for fixed prostho-
dontic treatment. Patients were either referred to the
fixed prosthodontic service by another dentist or came
directly for evaluation because of an unsatisfactory
restoration. All crowns and fixed partial dentures were
examined by one of the authors who then recorded the
type of restoration, length of service, and the reason
replacement was necessary. Only patients who could
ascertain the length of time that their prosthodontic
restoration had been in place were included. For the
purpose of this investigation, any restoration that
required replacement was considered a failure. Although
it is recognized that a restoration that has served for 20
years or more may not rightly be called a failure, our
interest was more in the reason why the restoration
required replacement and how long it had served.
To allow comparison of our findings with those of
Schwartz et al., failures were classified in two catego-
ries-one listing only the fixed prosthodontic unit that
had failed and the other including all those units that
required replacement because one or more units of a
prosthesis failed. Thus, a three-unit fixed partial den-
ture that had to be redone because of fractured porcelain
on one retainer would be recorded as one unit that failed
because of porcelain failure and three units that had to
OCTOBER 1986 VOLUME 56 NUMBER 4
CROWN AND FIXED PARTJAL DENTURE FAILURES

Table I. Reasons for replacement, by frequency

-__ I_----__--____
No. of units Units Units Mean length
No. of units requiring failed requiring of service
Reasons for replacement failed replacement (%) replacement (%) (yr)
Caries 99 211 22 0 24.3
Porcelain failure 72 156 140 17.9
Uncemented restoration 68 150 1.51 17.2
Poor esthetics 51 52 11.3 Cl.0
Worn /lost resin veneer 49 63 10.8 7.2
Defective margins 47 86 10.4 99
Fractured tooth/root 18 38 3.4 4.4
Periodontal disease/mobility 17 40 .3.#3 4.h
Periapical involvement 12 27 7 -
^,I 3. I
Fractured connector 9 36 2.0 4.1
Miscellaneous (all other causes)* 9 11 2.(j 1.3
Total i-5 870 100 100 X3 yr (mean)

be replaced because of porcelain failure. Of the 424 units
deemed failures, 193 were retainers, 48 were pontics,
and 193 were crowns. However, because of the attach-
ment of other units to some of those that had failed, an
additional 318 retainers and 240 pontics required
replacement. Furthermore, because any one fixed partial
denture may have demonstrated different kinds of failure
in different units (e.g., defective margins on one retainer
and fractured porcelain on another), such prostheses
may have been counted more than once in the number
of units requiring replacement category. This was done
only when one type of failure could not be judged to have
taken precedence over another in leading to the replace-
ment of the prosthesis. Thus in the case of a patient
presenting with a complaint of unacceptable esthetics of
a three-unit ceramic-metal fixed partial denture and the
investigator finding caries at the margin of one of the
retainers, the failures would be recorded as one unit
failing because of caries, three units failing because of
esthetics, three units requiring replacement because of
caries, and three units requiring replacement because of
esthetics. Although this may at first glance appear to be
an arbitrary method of recording and categorizing fail-
ures, it removes some of the subjectivity from the
evaluation of the investigator by not forcing him to
choose one failure over another as the actual cause
necessitating the replacement of a restoration. Such a
method of classification also provides a more realistic
evaluation of why fixed restorations fail, and it further
allows a better comparison between oral disease and
mechanical problems as causes of failure. Thus although
most causes of failure were straightforward, enough
prostheses failed because of more than one cause to yield
a working total of 870 units that required replacement
compared with an actual number of 751 units. The
results reported cannot be construed as showing the
prevalence of failure in fixed prosthodontic treatment,
nor can assumptions be made regarding how long a
successful restoration should last.
REASONS FOR REPLACEMENT AND
LENGTH OF SERVICE
Table I shows the frequency of specific causes of
failure as related to the number of units failed, the
number requiring replacement, and the mean length of
service at the time failure was noted. Caries was the most
frequent cause of failure, accounting for 22.0% of the
individual unit failures and 24.3% of the units requiring
replacement. Units failing because of caries did so after a
mean length of service of 10.9 years, second only to worn
or lost acrylic resin veneers (at 13.1 years) for life span
before failure.
Porcelain failures, which encompassed either frac-
tured porcelain or complete porcelain debond, caused the
failure of 16.0% units and necessitated the replacement
of 17.9% of all units surveyed. The mean life span of
these restorations was only 5.7 years before failure. The
incidence of porcelain failure as the second most common
cause of failure overall is indicative of the vast increase in
the use of this restorative material.
Uncemented restorations, including crowns, retainers,
and posts/cores, accounted for 15.1% of unit failures and
17.2% of units requiring replacement. Failure due to this
cause also occurred after a relatively short length of
service, 5.8 years.
The next mo:st frequent reason for replacement was
poor esthetics a,s reported by patients themselves. The
difference between units failed (11.3%) and units requir-
ing replacement (6.0%) is an indication that most units
replaced were single crowns and perhaps that patients
are more willing to live with less than ideal esthetics in
restorations tha,: will require extensive treatment to

THE JOURNAL OF PROSTHETIC DENTlSTRY 417

 WALTON, GARDNER, AND AGAR

Table II. Oral disease versus mechanical problems: Reasons for replacement, by frequency
Units failed Units requiring Mean length of
wd replacement (%) service (yr)

Oral disease
Caries 22.0 24.3 10.9
Periodontal disease/mobility 3.8 4.6 8.2
Periapical involvement 2.7 3.1 10.4
Total 28.5 32.0 9.7 yr (mean)

Mechanical problems
Porcelain failure 16.0 17.9 5.7
Uncemented restorations 15.1 17.2 5.8
Poor esthetics 11.3 6.0 9.6
Worn/lost resin veneer 10.8 7.2 13.1
Defective margins 10.4 9.9 7.4
Fractured tooth/root 3.9 4.4 10.2
Fractured connector 2.0 4.1 2.3
.Total 69.5 66.7 7.7 yr (mean)

Miscellaneous 2.0 1.3

replace. The mean length of service for restorations
failing because of esthetics was 9.6 years.
Worn or lost resin veneers led to failure in 10.8% of
the units observed and the need for replacement in 7.2%.
These units had the longest mean life span before failure
at 13.1 years.
Defective margins of restorations accounted for 10.4%
of units failed and 9.9% of all units requiring replace-
ment. Failures in restorations as a result of this cause
occurred after an average length of service of 7.4
years.
The next most common reason for failure was a
fracture of either tooth or root. Of the total of 13
reported fractured teeth, only four had been endodonti-
tally treated (two of these had been restored with a post
and core before they were treated with fixed prosthodon-
tics), while all five of the recorded root fractures occurred
on teeth that had been treated with endodontics and a
post and core before they were treated by fixed prostho-
dontics. These restorations failed after a mean length of
service of 10.2 years.
Periodontal disease or mobility was the next most
frequent cause of failure, accounting for 3.8% of unit
failures and 4.6% of all units requiring replacement.
Although not inextricably linked, these two entities are
related to one another and are included together because
neither was significant as an individual cause of failure.
The mean length of service of units failing because of
periodontal disease or mobility was 8.2 years.
Periapical involvement of teeth supporting crowns or
fixed partial dentures was a relatively minor cause of
failure, affecting 2.7% of individual units and 3.1% of
restorations requiring replacement. Such restorations
had a mean length of service of 10 years.
Although fractured connectors led to the failure of
only 2.0% of the units that failed, they necessitated the
replacement of 4.1% of units observed. It seems only
logical that such failures are more likely to occur in
prostheses with longer spans, thus necessitating the
replacement of an increased number of units. There was
also a short mean length of service when this mode of
failure occurred-2.3 years.
Other reasons for replacement, including wear
through the occlusal surface, overcontoured restoration,
fractured amalgam core, and poor occlusal plane,
accounted for such a small number of units failed (2%)
and units needing replacement (1.3%) that they are
included in the miscellaneous category. No mean length
of service was recorded for this group.
The mean length of service in consideration of all the
foregoing modes of failure was 8.3 years, 2 years less
than that quoted in the work of Schwartz et al. Such a
decrease in the face of ever-improving materials and
increased knowledge raises several questions. Are fixed
prosthodontic restorations failing sooner or are problems
with such restorations being detected earlier? The U.S.
Army system of yearly recall of active duty patients may
provide the opportunity for more prompt discovery of
restorations that require replacement. In this study
defective margins were noted as a cause of failure after
an average of 7.4 years of service compared with 9.7
years in the study by Schwartz et al. Whether such
margins were defective at the time of placement is a
matter of opinion, but the earlier poor margins are
discovered, the less likely it is that caries will have caused
serious damage to the abutment tooth. Patients may also
be more willing to seek treatment of restorations that
they consider to require replacement when such treat-
ment would be provided at no cost to them. This may
explain the increased prevalence of poor esthetics in

418 OCTOBER 1986 VOLUME 56 NUMBER 4

CROWN AND FIXED PARTIAL DENTURE FAILURES

particular and even some of the more objective reasons Table III. Crowns: Length of service and
for replacement; what is acceptable when the alternative most common reason(s) for replacement
is an expensive remake of a prosthesis may become less
Most Mean length
acceptable when cost is removed as a factor. Type of common of service
To allow further comparison with results obtained by crown reason(s)+ (yr)
Schwartz et al., the results from Table I were separated
Ceramic-metal Porcelain failure, pool 65
in Table II into failures due to oral disease and failures
esthetics
due to mechanical problems. The former category Complete venf2er Caries, defectiw hl
includes caries, periodontal disease/mobility, and peri- metal margins
apical involvement, while the latter includes porcelain Resin veneer Worn/lost vrnwr 134
failures, uncemented restorations, poor esthetics, worn metal
Porcelain jacket Defective margins, x2
or lost resin veneers, defective margins, fracture of tooth
fractured porcelain
or root, and fracture of connector joints. Only 28.5% of Partial veneer Caries, defective II 0
unit failures in this study and 32% of unit replacements margins
were due to oral disease compared with the figure of
50.9% of Schwartz et al. Likewise, 69.5% of unit failures Mean ).I yr
and 66.7% of replacements were due to mechanical
problems versus 43.6% in the study by Schwartz et al.
Furthermore, the restorations that became unserviceable
because of oral disease tended to do so after an average providing less retentive/resistive preparation surface.
length of service (9.7 years) that exceeded the mean The likelihood of higher DMF indexes of patients
length of service in this study (8.3 years). Those failures requiring this type of restoration and the difficulties in
due to mechanical problems were observed after a mean obtaining adequate impressions or evaluating final sub-
length of service (7.7 years) that was less than that of the gingival margins may account for caries and defective
overall study. Thus although it is still apparent that margins being the two most frequent causes of failure
fixed restorations tend to fail earlier because of mechan- with this type of crown.
ical difficulties as opposed to oral disease, the ratio of Ceramic-metal crowns tended to fail after a mean
failures in these two categories has changed from around length of service of 6.5 years, most commonly because of
1 : 1 to almost 2.5: 1 (mechanical problems versus oral porcelain failure and poor esthetics. Problems inherent
disease). This change may be explained by an overall in the use of porcelain as a veneering material have been
reduction in the incidence of caries in the American reviewed elsewhere] and have led to a great deal of
population and by an increase in the use of ceramic- research into the use of different materials to strengthen
metal restorations, with the attendant mechanical risks. or replace porcelain in which esthetic restorations are
This change in ratio need not be interpreted as an needed. Strict control of laboratory procedures could
indictment of the dental profession for not controlling the obviate failures such as total porcelain debond and
quality of restorations placed. Although it is true that fracture of porcelain that is improperly supported by
retentive and resistive preparations, careful choice of metal framework. Porcelain jacket crowns may have
retainer type (including a discussion of patient esthetic tended to fail after a longer mean duration of service (8.2
demands), and monitoring of auxiliary work quality are years) compared with ceramic-metal restorations
the dentists responsibilities, it is equally apparent that because of the increased care taken wilh preparations
failures such as porcelain fracture and worn resin done for this crown, as well as by the increased skill of
veneers (which together accounted for 25.1% of all units technicians making these technically demanding restora-
requiring replacement) are beyond the dentists con- tions.
trol. Partial veneer crowns had a mean length of service of
Length of service of single crowns by type. Each of 11 years, failing most frequently because of caries and
the five crown types observed in this study is represented defective margins. With the increasing use of ceramic-
in Table III according to the most common reason(s) for type restorations, this type of crown is being used less.
replacement and mean length of service. The complete The longer life span of the partial veneer crown may be
veneer metal crown tended to fail after the shortest indicative of the increased skill its placement demands.
length of service, 6.1 years. This phenomenon may be This greater longevity may also be due to the fact that a
partially explained by the fact that this crown tends to be partial veneer crown is likely to be placed in a more ideal
used most on posterior teeth where access is more situation, that j.s, on an intact tooth in a mouth with a
difficult. It is also indicated for broken-down teeth in lower incidence: of caries.
which partial veneer crowns cannot be used, often Resin veneerled crowns served an average of 13.9 years
requiring margins that are placed further apically, before failure, the longest of any crown tvpe in this

THE JOURNAL OF PROSTHETIC DENTISTRY 419

 WALTON, GARDNER, AND AGAR

Table IV. Retainers: Length of service, by type

No. of retainers Mean length
Retainer type No. of retainers requiring replacement* of service (yr)

Ceramic-metal 85 165 6.3

Complete veneer metal 30 53 7.1
Resin veneer metal 24 30 14.7
Partial veneer 32 48 14.3
Inlay / onlay 10 13 11.2

*Total number of retainers requiring replacement, including those that were the actual site of failure.

Table V. Length of service by prosthesis span Length of service related to length of span. In
addition to being related to type of retainer, the length of
No. of FPDs
Mean years requiring
service of a given fixed partial denture may also be
No. of units of service replacement* related to the span length of the prosthesis. Table V
relates the number of units in a prosthesis to the mean
Single crown 9.1 193
9
years of service and to the number of fixed partial
2-Unit cantilever FPDt 3.7
3-, 4-unit FPD 9.6 28 dentures that required replacement. As in the work of
5-, 6-unit FPD 6.6 13 Schwartz et al., there was no clear-cut relationship
6 unit canine to canine 10.4 9 between the life span and number of units in a fixed
Greater than 6 units 6.8 6 prosthesis. The six-unit canine-to-canine fixed partial
Mean for all FPDs 7.7 yr 258 (total)
denture had the longest life span before failure, averag-
FPD = lixed par&l dentures. ing 10.4 years. The two-unit cantilever fixed partial
*By entire prosthesis. denture had the shortest length of service at 3.7 years,
+Single pomic cantilevered OK single retainer. but the small sample number, as with the canine-
to-canine prosthesis, prevents much extrapolation on
study, and were most likely to require replacement these figures. Fixed partial dentures of five units or
because of a worn or lost resin veneer. This type of more, other than the canine-to-canine type, averaged less
crown has been used infrequently in recent years, and than 7 years of service before failure, perhaps an
those observed in this study were probably representative indication of the increased difficulty of preparation,
of the last few in service that had not yet been fabrication, and maintenance of prostheses of longer
replaced. spans. The average length of service of single crowns was
Length of service of retainers by type. Table IV discussed earlier.
illustrates the relationship between retainer type and
length of service. The ceramic-metal retainer had the SUMMARY
shortest life span before failure (6.3 years) compared 1. The mean length of service of all restorations
with the resin veneer metal retainer, which had an observed in this study was 8.3 years.
average length of service of 14.7 years. The partial 2. Caries was the most common cause of failure,
veneer retainer was close behind at 14.3 years, while the affecting 22.0% of the units failed and leading to the
inlay or onlay type retainer had a surprising life span of necessity for replacement of 24.3% of the units
11.2 years. This is surprising because the inlay, unless observed.
used under the most favorable of circumstances,0 is often 3. Mechanical problems accounted for 69.5% of the
contraindicated as a retainer because of the lack of failed units as opposed to 28.5% for oral disease.
adequate retentive surface area and the possible com- 4. Resin veneer metal crowns provided the longest
pression of the tooth away from the inlay under occlusal service of all crown types observed (13.9 years) and
function, leading to breakdown of the cement. Since the failed most frequently because of worn or lost veneers.
number of inlay or onlay retainers observed in this study The complete veneer metal crown had a life span of 6.1
was relatively small and the life span was relatively long, years and was most likely to fail because of caries or
it appears that the aforementioned favorable conditions defective margins. Ceramic-metal crowns also showed a
applied to these cases. Partial veneer and acrylic resin relatively short period of service at 6.5 years, needing
veneer metal retainers had a comparable length of replacement primarily because of porcelain failure or
service before failure, with means of 14.3 and 14.7 years, poor esthetics.
respectively. The life span of both may be ascribed to 5. The resin-veneer metal crown also provided the
conditions discussed earlier under the length of service of longest service as a retainer, with a mean length of
various crown types. service of 14.7 years. This was closely followed by the

420 OCTOBER 1986 VOLUME 56 NUMBER 4

CROWN AND FIXED PARTIAL DENTURE FAILURES

partial veneer retainer (14.3 years), while the ceramic-

metal retainer had the shortest life span (6.3 years).
6. No apparent relationship was found between the
span of prosthesis and its length of service. The six-unit
canine-to-canine fixed partial denture exhibited the
greatest longevity of the prostheses studied (10.4 years),
while the two-unit cantilever fixed partial denture
provided a mean of only 3.7 years of service before
replacement was required.
REFERENCES
I B,wc:ir) XII. FG1urc.s in cwamometal fixed restorations. J
JKW I ,,I., I IlF.NT 51: 1X6. 1)x4.
7 ISrcr~\ n X1 tI (:;IIISPS ,md prevention of lixed prosthodontit
l.~~lwe. J IKOSTIIEI I)r-h r 30~617, 1973.
3 Elder ton R,J: The cauws 01 failure of restorations: .4 literature
rwiw. ,J IIrnt 4:217. 1976.
3 Lnl~~rrnv~cz (iI: Britl+=\. .Zn analysis of failures. Dent Practit
18:1-o. I!hX.

The effects of surface texture and grooving on the

retention of cast crowns
D. J. Witwer, D.M.D.,* R. J. Storey, B.S.,** and J. A. von Fraunhofer, M.Sc., Ph.D.***
U.S. Army Dental Activity, Fort Knox, Ky., and University of Louisville, School of Ilentistry, Louisville, KY.

lhree primary variables affect the retention of pros- of increasing crown retention are advisable. The addi-
thetic crowns. These are: (1) the convergence of the tion of pin holes, vertical grooving, with or without
preparation walls, (2) the area of retentive surface, and circumferential grooving, of the clinical and prosthetic
(3) the length of the axial walls. Crown retention and crowns can significantly increase retention.. The sur-
resistance to tensile and shear stresses is inversely face roughness of the preparation and the crown interior
proportional to the convergence of the preparation walls, can also affect retention.6 Surface roughness of the
proportional to the area of retentive surface, and preparation may have little effect on retention of the
increase with the length of the axial walls of the cemented crown, but may increase shear bond strength.
preparation., Other studies show that the retentive ability of both zinc
In many clinical situations, however, secondary means phosphate and zinc polycarboxylate cement increases
with substrate roughness.
Luting agents are important factors in crown reten-
(:ommrr.cial material and equipment are identified in this communica- tion. Zinc phosphate cement achieves retention by
tion tu sprcify the experimental procedure. Such identification does mechanical interlocking with irregularities in the tooth
not implv ollicial recommrndation or endorsement or that thr and casting but has no chemical adhesion to tooth
materials are nrccsaarily the best available for the purpose. Further-
mow. rhr opinions expressed herein are those of the authors and are
structure.- Zinc polycarboxylate cement chemically
not to br crmstrued as those of thr LJ.S. Army Medical Depart- bonds to tooth substance by chelation to the calcium
ment ion., I3 The greater chemical reactivity of zinc polycar-
*Xlajor. Cl. S. Army. IX:, (;vneral Dentistry Resident, U.S. Army boxylate cement results in superior retention to gold and
Drnr;tl .Icti\it:. base metal allloys compared with zinc phosphate
**Rcwarch !echnitinn. Department of Restorative Dentiswy. Uniwr-
cement.,- Dije relief has no adverse erects on crown
sity of Louis\ ille, School of Dwtistry.
***Irolew~~ of Biomaierialc Scirnw, Dc~partment of Rrstoratibe retention.
I)twt~stry. llniwrslty of Louic\illc, School of Dentistry. The present istudy was undertaken to determine the

TlfII JOURNAL OF PROSTHtTlC DENTISTRY 421