Research Article

Unconventional Fixed Partial Denture: A Simple

Solution for Aesthetic Rehabilitation
Amrita Grover1, Pankaj Madhukar2, Piyush Tandan3, Surbhi Malhotra4
Abstract
One of the most challenging and complex treatment modalities is replacement of a single anterior tooth.
This can be overcome by different treatment options such as implant-supported restorations as well as
conventional fixed partial denture or the unconventional treatments such as resin-bonded fixed partial
dentures. Loop connector fixed partial denture may be the simplest and best solution to maintain the
diastema and provide optimum restoration of aesthetics. The cantilever fixed partial denture is defined
as a fixed restoration which has one or more abutments at one end while the other end is unsupported.
This article describes the procedure for the application of a loop connector and cantilever fixed partial
denture to restore anterior teeth esthetically.

Keywords: Aesthetics, Fixed Prosthodontics, Cantilever, Loop Connector

Introduction
A variety of factors affecting esthetics may motivate a patient to seek prosthodontic treatment. While the restoration of
maxillary anterior teeth can tax the creative ability of the dentist, any dental procedure can have esthetic repercussions.
An unusually wide or large restoration will not only affect occlusal function but will also produce an unnatural appearance.1
Replacement of missing anterior teeth is a complex, challenging procedure for prosthodontists in order to achieve ideal
esthetic results meeting the exacting demands of the patients.

The clinical situation is further worsened with a previous existing diastema or drifting of teeth into the edentulous
space.2 Spacing between teeth or diastema is a common esthetic problem. Drifting of teeth into the edentulous area
may reduce the available pontic space; whereas a diastema existing before extraction may result in excessive mesio-
distal width to the pontic space. In these situations, the simplest approach would be to maintain the existing diastema.
Although rarely used, loop connectors are sometimes required to address this problem of excessive mesio-distal width
pontic space.1 Patients with missing teeth along with diastema have limited treatment options to restore the edentulous
space. The diastema can be managed with implant-supported prostheses, conventional fixed partial denture or with
loop connectors. The use of a conventional fixed dental prosthesis to replace the missing tooth may result in too wide
anterior teeth, an over-contoured emergence profile, which in turn results in poor esthetics.2 Closing diastema with
conventional fixed dental prosthesis without considering golden proportion would fail to create an esthetically pleasing
appearance and has detrimental effects on the periodontium/ attachment apparatus.3 So, the final outcome should be
considered thoroughly before it is decided to close the diastema with the prosthesis. Maximum esthetic results may
be obtained if natural anatomic forms of the teeth are protected and the diastema is maintained with minimal over-
contouring of the adjacent teeth. Drifting of teeth into the edentulous area may reduce the available pontic space;
whereas a diastema existing before an extraction may result in excessive mesiodistal dimension to the pontic space. Loop
connector fixed partial denture may be the simplest and best solution to maintain the diastema and provide optimum

1
PG Student, 2,3Professor, Department of Prosthodontics and Crown and Bridge and Implants, Manav Rachna Dental College,
Faridabad, India.
4
M.D.S. Prosthodontics and Crown and Bridge and Implants.

Correspondence: Ms. Amrita Grover, Department of Prosthodontics and Crown and Bridge and Implants, Manav Rachna Dental
College, Faridabad, India.

E-mail Id: amritagrover28@gmail.com

How to cite this article: Grover A, Madhukar P, Tandan P et al. Unconventional Fixed Partial Denture: A Simple Solution for Aesthetic
Rehabilitation. J Adv Res Dent Oral Health 2017; 2(1&2): 16-19.

ISSN: 2456-141X

© ADR Journals 2017. All Rights Reserved.

J. Adv. Res. Dent. Oral Health 2017; 2(1&2)
restoration with acceptance of maximum aesthetics.2,3 This
article describes the procedure for the fabrication of a loop
connector fixed partial denture to restore an excessively
wide anterior edentulous space in a patient with existing
spacing between the maxillary anterior teeth.
Similarly, cantilever fixed partial dentures are considered
a viable choice in dentistry when treatment is planned
carefully and the prosthesis is designed appropriately
under favorable intraoral conditions. The cantilever fixed
partial denture is defined as a fixed restoration, which has
one or more abutments at one end while the other end is
unsupported. Varied and extensive clinical experience is
certainly of great value in treatment planning, which proved
that the influence of cantilever fixed partial denture was
investigated on periodontal health and concluded that they
are not different from conventional fixed partial dentures
when oral hygiene is maintained and closely monitored.3
The use of a 2-unit cantilever fixed partial denture to
replace the maxillary lateral incisors using the canine as a
single abutment is recommended. The longevity of anterior
2-unit cantilever prostheses is not widely covered in dental
literature. The following factors are applied when making
a physiologic appraisal before employing the cantilever
principle: good periodontal attachment (covering maximum
root), good alveolar support, favorable root length, shape
and crown length, favorable arch-to-arch relationship, and
favorable tooth-to-tooth relationship. The same factors
certainly enter into diagnosis and treatment planning with
fixed and removable partial dentures.4
Case Report 1
A 49-year-old male patient reported to the Department
of Prosthodontics, with a missing left maxillary central
incisor. The anterior edentulous space was large around
9–10 mm; there was generalized spacing between all the
anterior teeth. The left lateral incisor was above the occlusal
plane with an open bite relationship. A conventional fixed
partial denture could not be planned without orthodontic
correction of the large space. A single tooth implant was a
viable alternative as it would allow a restoration, maintaining
both the mesial and distal diastemas. However, an implant
would entail surgery and a more protracted treatment.3 The
patient was neither willing for orthodontic treatment nor
surgery for implant placement, and wanted an immediate
fixed alternative for the left central incisor. There were
only two treatment options left: a loop connector fixed
partial denture or a spring cantilever (which is a variation
of loop connector) fixed partial denture. However, a spring
cantilever fixed partial denture for replacing an anterior
tooth while maintaining the diastemas is indicated when a
posterior tooth needs crowning as well.5 It is also difficult
to clean and maintain, as compared to a loop connector
fixed partial denture. In this case, the patient did not require
any posterior crowns and the right central incisor and the
17
Grover A et al.
left lateral incisor needed certain esthetic corrections.
Therefore, it was decided to fabricate a loop connector fixed
partial denture with the right central incisor and the left
lateral incisor as the abutment teeth, maintaining diastemas
between the pontic and the retainers on either side.
After taking an informed consent, a loop connector
was decided as the treatment choice. During the first
appointment, diagnostic impressions were made and a
mockup was done on the diagnostic cast. Abutment teeth
were prepared, which had three vertical stops or counter
sinks about 0.5 mm of depth were prepared on the lingual
surfaces, which aided preventing displacement of the
prosthesis. A rubber base impression (Aquasil LV, Dentsply
Intl) was made, two sets of cast were poured, one for
laboratory procedures and one for mounting respectively.
Shade selection for the porcelain fused to metal pontic was
also determined. The frame work design was outlined on
maxillary cast and the wax patterns (using mock up wax)
for two lingual loop connectors were incorporated into the
design of metal frame work. The palatal loops connecting
the pontic to the retainers on the right central incisor and
the left lateral incisor were made with inlay wax. Care was
taken to keep the loops away from the rugae. The wax
pattern was casted and the loop was about 1.5 to 2 mm
thick. In the next appointment, try-in of the frame work
was done to ensure proper fit and lack of palatal tissue
impingement. Before the final seating of the prosthesis,
the esthetic appearance of the prosthesis was shown to the
patient. The abutment teeth were properly isolated and
retracted and the resin bonded system (Calibra®, Dentsply
Intl) was used to lute the frame work to the abutment teeth.
The final prosthesis was firmly cemented and adjusted.
Case Report 2
A 36-year-old female patient reported to the Department of
Prosthodontics, MRDC, with a missing left maxillary lateral
incisor. The patient presented with a faulty prosthesis
and wanted replacement of the missing tooth. Due to all
the favorable factors, an unconventional cantilever fixed
partial denture was decided since it was a cost-effective
and feasible treatment, also since the vital abutment
tooth had favorable periodontal status, supportive for the
cantilever prosthesis. Therefore, it was decided to fabricate
cantilever prosthesis with the help of the supporting
canine as abutment teeth, to maintain the support for
the prosthesis.
After removal of the faulty prosthesis and oral prophylaxis,
tooth preparation was done on the canine. Polyvinyl
siloxanes (Aquasil soft putty and Aquasil LV, Dentsply Intl)
impression was made, and the tooth was properly retracted
using magic foam cord gingival retraction system. The
impression was poured with the die stone and the die
preparation followed by ditching was done to expose the
ISSN: 2456-141X
Grover A et al.
restoration margins. The rest of the laboratory procedures
were common with conventional metal ceramic fixed partial
denture fabrication. In the next appointment, the metal
coping fit was checked followed by final cementation with
the resin bonded (Calibra® Dentsply Intl) to lute the final
prosthesis. The excess material was removed followed by
final adjustment and finishing.
Discussion
In a loop connector fixed partial denture, the connector
consists of a loop on the lingual aspect of the prosthesis
that connects adjacent retainers and/or pontic. The loop
may be cast from sprue wax that is circular in cross section
or shaped from platinum-gold-palladium (Pt-Au-Pd) alloy
wire.6 The choice is entirely up to the prosthodontist or the
dental laboratory. Therefore, meticulous design is important
to ensure that plaque control is not impeded. As mentioned
earlier, a spring cantilever fixed partial denture could have
been another less time-consuming alternative. The palatal
connector in spring cantilever fixed partial denture is a
type of loop connector. However, the connector here is a
long, thin and resilient bar, closely adapted to the palate
so that it is partly supported by soft tissue.7 It connects the
pontic to a posterior tooth or teeth requiring full coverage
crowns. In a rare instance, healthy and sound, posterior
teeth have been used as abutments to replace a maxillary
anterior tooth with diastema, using a resin-bonded spring
cantilever fixed partial denture.8 The long palatal connector
in spring cantilever fixed partial denture may deform, if
thin, and produce coronal displacement of the pontic; it
may interfere with speech and is often poorly tolerated.9
For these reasons, this design is seldom used. In the above
case, the loop connector fixed partial denture not only
addressed the problem of excessive mesio-distal width
pontic space, but it also corrected the axial alignment
of the right central incisor and the occlusal plane with
respect to the left lateral incisor. It is also easy to clean
and maintain. The connectors should not be overly thick
and should have an intimate contact with the underlying
mucosa; otherwise, there are chances that the patient
may develop the deleterious habit of pushing the tip of
the tongue into the gap between the loop and the mucosa.
The cantilevered fixed partial dentures can be more
successful in anterior quadrant than posterior, because
the forces are less in anterior region than posterior one.
The cantilevered fixed partial denture requires at least
two abutment teeth. The only documented exception
permitting a single abutment is the replacement of a
maxillary lateral incisor with the canine as an abutment.
This anterior cantilever can be the ideal indication for
cantilever fixed partial denture. Anterior cantilever fixed
prostheses are indicated for open bite conditions or where a
normal degree of vertical and horizontal overlap is present.
However, anterior cantilever fixed partial dentures are
ISSN: 2456-141X
J. Adv. Res. Dent. Oral Health 2017; 2(1&2)
not indicated where excessive vertical overlap is present,
because the anterior teeth are subject to excessive loading
in protrusive and lateral excursions. Cantilever prostheses
are not indicated for patients with Class III malocclusions
who exhibit excessive wear patterns on anterior teeth. The
success of the cantilever fixed partial denture depends
largely on proper occlusion and the health of the supporting
periodontium and abutment teeth. The clinical assessment
was consistent on these aspects
Conclusion
It can be concluded that the current, optimal treatment
for replacing missing teeth is a fixed partial denture
secured at both ends. Conventional fixed partial denture
connectors are understandably more rigid as compared
to loop connectors. This flexibility of loop connectors
can relatively be overcome by using shorter lengths and
increasing the diameter of the loop, and if possible, still
keeping their form as round as possible.10 Although they
are less used, loop connectors are required when an
existing diastema is to be maintained in a planned fixed
prosthesis, as in the above case. Cantilever prosthesis can
be highly effective in replacing missing teeth, restoring oral
function and aesthetics and result in high levels of patient
satisfaction. This paper has described a minimally invasive,
cost-effective and long-lasting treatment modality for
anterior missing teeth, provided a thorough case analysis
is done to indicate the best support design. Given the
thorough patient assessment and the use of careful clinical
techniques, it can be often used specially in cases of lateral
replacement of a maxillary 2-unit cantilever fixed partial
denture, which is presented in this clinical report. The
loop connector and cantilever fixed partial denture offers
a simple solution to a prosthodontic dilemma involving an
anterior edentulous space.
Conflict of Interest: None
References
1. Tylman’s Theory and Practice of Fixed Prosthodontics.
8th Edn. St Louis: Ishiyaku Euroamerica Inc 1989; 12-13.
2. Madhav VNV, Jadhav R. Treatment options for
replacement of missing central incisor. TPDI 2011;
2(1): 6-7.
3. Smith BG. Planning and making crowns and bridges.
3rd Edn. Taylor and Francis 1998; 178.
4. Sharma A, Rahul GR, Soorya T et al. Assessment of
various factors for feasibility of fixed cantilever bridge:
A review study. ISRN Dent 2012; 25; 98-91.
5. Breeding LC, Dixon DL. Transfer of gingival contours
to a master cast. J Prosthet Dent 1996; 75: 341-43.
6. Stephen F, Rosenstiel, Land MF et al. Contemporary
Fixed Prosthodontics. 3rd Edn. St Louis: Mosby 1995;
564-65.
7. Bartlett DW, Fischer NF. Clinical Problem Solving in
18
J. Adv. Res. Dent. Oral Health 2017; 2(1&2) Grover A et al.

Prosthodontics. 1st Edn. Churchill Livingstone 2003; 47.
8. Taggart JA. Resin bonded spring cantilever bridge.
Restorative Dent 1990; 6: 4-5.
9. Mitchell DA, Mitchell L, Brunton P. Oxford Handbook
of Clinical Dentistry. 3rd Edn. Oxford University Press
2005; 298.
10. Rosenstiel S, Land MF, Fujimoto J. Connectors for
partial fixed dental prosthesis. Contemporary fixed
prosthodontics. 4th Edn. Elsevier 2007: 843869.
Date of Submission: 2017-05-16
Date of Acceptance: 2017-05-26

19 ISSN: 2456-141X