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Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 17-20

Different classification system for failures in tooth supported fixed partial denture: a systematic review


1 Reader, Department of Prosthodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
2 Senior Lecturer, Department of Prosthodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
3 Professor, Department of Prosthodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India

Date of Web Publication26-Jul-2019

Correspondence Address:
Dr. V Chandrakala
Department of Prosthodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_15_19

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  Abstract 


Fixed prosthodontic treatment can offer exceptional satisfaction for both patient and dentist but failure may occur at any time right from diagnosis to treatment phase which can be frustrating. The dental literature is lacking in classification of failures in Fixed partial dentures. The cause may be that signs and symptoms of failures are varied and often complex and there is the additional problem of reaching a common interpretation among investigators on the definition of failure. When dealing with failed or failing fixed restorations, proper knowledge of diagnosis, assessment of the clinical condition and technical skills are absolutely necessary. Hence it is important to be aware of obvious and subtle indications of prosthesis failure and have a working knowledge of the procedure that are necessary to remember the situation. This review focusses on classification systems of failures associated with tooth supported fixed partial denture proposed by different authors.

Keywords: Classification systems, failure in fixed partial denture, objectives of fixed prosthodontic treatment, prosthesis failure


How to cite this article:
Chandrakala V, Deepmala S, Srivatsa G. Different classification system for failures in tooth supported fixed partial denture: a systematic review. Int J Prev Clin Dent Res 2019;6:17-20

How to cite this URL:
Chandrakala V, Deepmala S, Srivatsa G. Different classification system for failures in tooth supported fixed partial denture: a systematic review. Int J Prev Clin Dent Res [serial online] 2019 [cited 2019 Oct 22];6:17-20. Available from: http://www.ijpcdr.org/text.asp?2019/6/1/17/263455




  Introduction Top


Fixed prosthodontic treatment can offer exceptional satisfaction for both the patient and dentist. To achieve such success, however, requires meticulous attention to every detail from initial patient interview, through the active treatment phase, to a planned schedule of follow-up care. Fixed prosthodontic failures can be frustrating and complex in terms of both diagnosis and treatment and may occur at any time. Hence, it is important to be aware of obvious and subtle indications of prosthesis failure and have a working knowledge of the procedure that are necessary to remember the situation.[1]

Before calling any fixed tooth-supported prosthesis as “Failing” or “Failed” implant, there are certain objectives which a fixed prosthesis should fulfill. Failing to fulfill these objectives leads to failures in fixed prosthodontic treatment.[2]


  Objectives of Fixed Prosthodontic Treatment Top
[3]

  • Preservation and improvement of related hard- and soft-tissue structures
  • Preservation or improvement of oral function
  • Improvement or restoration of esthetics
  • Ensuring restoration retention, resistance and stability
  • Providing restoration with mechanical or structural integrity
  • Preserving or improving patient comfort
  • Designing restorations for maximum longevity.



  Classification System for Failures in Tooth-Supported Fixed Partial Denture Top


“Tinker”[4] was the first one to summarize the causes of FPD failures as early as in 1920. Chief among the causes for such disappointing results were:

  • First: Faulty or no attempt at diagnosis and prognosis
  • Second: Failure to remove foci of infection
  • Third: Disregard for tooth form
  • Fourth: Absence of proper embrasures
  • Fifth: Interproximal spaces
  • Sixth: Faulty occlusion and articulation.


Robert's classification[5]

  • Cementation failure
  • Mechanical breakdown


    • Flexion, tearing, or fracture of the gold
    • Solder joint failure
    • Pontic fracture
    • Bonded porcelain failure


  • Gingival irritation or recession
  • Periodontal breakdown
  • Caries
  • Necrosis of the pulp.


Lombardi classification of esthetic errors[6]

  1. Inharmonious dentofacial ratio


    • Shade disharmony
    • Compositional incompatibility


      • Static prosthesis in dynamic mouth
      • Inharmonious strength or weakness of dental composition compared to background features


        • Weak mouth with strong face
        • Strong mouth with weak face.


    • Intrinsic dental disharmony


      • Space allocation errors


        • Inadequate vertical space allocation
        • Excessive vertical space allocation
        • Excessive horizontal space allocation


      • Structural line errors


        • Elevated occlusal plane
        • Occlusal plane drops down posteriorly
        • Asymmetrical occlusal plane.


    • Unnatural lines


      • Reverse smiling line
      • Unnatural axial inclination
      • Cusp less posterior teeth
      • Gradation errors
      • Age–sex personality disharmony.


    • Single-line errors


      • Vertical deviation
      • Horizontal deviation
      • Line conflict.


    • Imbalance


      • Midline error
      • Imbalance of directions
      • Artifact error
      • Diastema error.


Barreto[7] classification – 1984

  1. Biologic – caries, fractures, and generalized periodontal disturbances
  2. Esthetics – shapes, contours, and surface characteristics
  3. Biophysical – physical properties and chemical composition of porcelain and metal
  4. Biomechanical – faulty designs, misplaced finish lines, rough or sharp surfaces, and undercuts on the bonding surface cause porcelain to be dislodged.


Thayer[8] classification – 1984

  • Caries
  • Cement failures
  • Preparation fractures and acrylic veneer wear/loss
  • Porcelain fractures
  • Solder joint or major connector failure
  • Periodontal involvement.


Selby[9] classification – 1984

Biologic

  • Caries
  • Periodontal disease
  • Endodontic or periapical problems.


Mechanical

  • Loss of retention
  • Fracture or loss of porcelain
  • Wear or loss of acrylic veneer
  • Wear or perforation of gold
  • Fracture of metal framework
  • Fracture of solder joints
  • Fracture of abutment tooth or root
  • Defective margins
  • Poor contour
  • Poor esthetics.


Wise [10] classification – 1999

  1. General pathosis
  2. Periodontal problems
  3. Caries
  4. Pulpal changes
  5. Erosion
  6. Cracked teeth
  7. Subpontic inflammation
  8. Temporomandibular joint disorders
  9. Occlusal problems.


Smith[11] classification – 1985

  1. Loss of retention
  2. Mechanical failures of crown and bridge components
  3. Changes on abutment tooth
  4. Design failures
  5. Inadequate clinical or laboratory technique


    1. Marginal deficiencies
    2. Defects
    3. Poor shape and color


  6. Occlusal problems.


John. F. Johnston [12] classification – 1986

Biological failures

  • Caries
  • Root caries
  • Periodontal disease
  • Occlusal problems
  • Gingival irritation
  • Gingival recession
  • Pulp and periapical health
  • Tooth perforation.


Mechanical failures

  • Loss of retention
  • Cementation failure
  • Acrylic veneer wear or loss
  • Porcelain fracture
  • Metal-ceramic porcelain failures
  • Porcelain jacket crown failures.


Esthetic failures

  • Improper shade selection
  • Excessive metal thickness and exposure
  • Thick opaque layer application 7 overglazing
  • Dark space in cervical third
  • Failure of translucency
  • Improper contouring
  • Discoloration of facing.


Facing failures

Manappallil[3] classification – 2008

  • Class I – Cause of failure is correctable without replacing restoration
  • Class II – Cause of failure is correctable without replacing restoration; however, supporting tooth structure or foundation requires repair or reconstruction
  • Class III – Failure requiring restoration replacement only. Supporting tooth structure and/or foundation acceptable
  • Class IV – Failure requiring restoration replacement in addition to repair or reconstruction of supporting tooth structure and/or foundation
  • Class V – Severe failure with loss of supporting tooth or inability to reconstruct using original tooth support. Fixed prosthodontic replacement remains possible through the use of other or additional support for redesigned restoration
  • Class VI – Severe failure with loss of supporting tooth or inability to reconstruct using original tooth support. Conventional fixed prosthodontic replacement is not possible.



  Discussion Top


Fixed prosthodontic failures are varied and often complex in cause and effect. A Medline and an extensive hand search performed for the last 50 years showed that the most common complications associated with conventional fixed partial dentures were caries (18% of abutments and 8% of prostheses), need for endodontic treatment (11% of abutments and 8% of prostheses), loss of retention (7% of prostheses), esthetics (6% of prostheses), periodontal disease (4% of prostheses), tooth fracture (3% of prostheses), and prosthesis/porcelain fracture (2% of prostheses). The best way to lessen the fixed dental prosthesis failures is to have a sound knowledge of diagnosis and treatment procedures, but many times, failures too occur even after meticulous attention paid. Hence, it is important to know about various classification systems available in the literature for better management of failures wisely in tooth-supported fixed partial denture.[13],[14],[15],[16],[17],[18]


  Conclusion Top


The classification systems presented in this review for failures in tooth-supported fixed partial denture identify trends that can be effectively and wisely used to develop treatment plans that optimize success and to communicate appropriate expectations to patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dykema RW, Goodacre CJ, Phillips RW. Johnston's Modern Practice in Fixed Prosthodontics. 3rd ed. Philadelphia, London: W B Saunders Co.; 1986.  Back to cited text no. 1
    
2.
Simpson RL. Failures in crown and bridge prosthodontics. J Am Dent Assoc 1953;47:154-9.  Back to cited text no. 2
    
3.
Manappallil JJ. Classification system for conventional crown and fixed partial denture failures. J Prosthet Dent 2008;99:293-8.  Back to cited text no. 3
    
4.
Tinker ET. Fixed bridge-work. J Natl Dent Assoc 1920;7:579-95.  Back to cited text no. 4
    
5.
Roberts DH. The failure of retainers in bridge prostheses. An analysis of 2,000 retainers. Br Dent J 1970;128:117-24.  Back to cited text no. 5
    
6.
Lombardi RE. A method for the classification of errors in dental esthetics. J Prosthet Dent 1974;32:501-13.  Back to cited text no. 6
    
7.
Barreto MT. Failures in ceramometal fixed restorations. J Prosthet Dent 1984;51:186-9.  Back to cited text no. 7
    
8.
Thayer KE. Textbook of Fixed Prosthodontics. 2nd ed. Chicago, Year Book Medical Publishers, Inc. 1984.  Back to cited text no. 8
    
9.
Selby A. Fixed prosthodontic failure. A review and discussion of important aspects. Aust Dent J 1994;39:150-6.  Back to cited text no. 9
    
10.
Wise MD. Failure in the restored dentition; management and Treatment. Quintessence: London. 1995;397-412.  Back to cited text no. 10
    
11.
Smith B, Howe L. Planning and Making Crowns and Bridges. 4th ed.: CRC Press; 2013.  Back to cited text no. 11
    
12.
Dykema RW, Goodacre CJ, Phillips RW. Johnston's Modern Practice in Fixed Prosthodontics. 4th ed. Philadelphia, London: W B Saunders Co.; 1986.  Back to cited text no. 12
    
13.
Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications in fixed prosthodontics. J Prosthet Dent 2003;90:31-41.  Back to cited text no. 13
    
14.
Hursey RJ. A clinical survey of the failure of crown and bridges. S C Dent J 1958;16:4-11.  Back to cited text no. 14
    
15.
Lundqvist P, Nilson H. A clinical re-examination of patients treated with pinledge-crowns. J Oral Rehabil 1982;9:373-87.  Back to cited text no. 15
    
16.
Cheung GS. A preliminary investigation into the longevity and causes of failure of single unit extracoronal restorations. J Dent 1991;19:160-3.  Back to cited text no. 16
    
17.
Palmqvist S, Swartz B. Artificial crowns and fixed partial dentures 18 to 23 years after placement. Int J Prosthodont 1993;6:279-85.  Back to cited text no. 17
    
18.
Milleding P, Haag P, Neroth B, Renz I. Two years of clinical experience with procera titanium crowns. Int J Prosthodont 1998;11:224-32.  Back to cited text no. 18
    




 

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   Abstract
  Introduction
   Classification S...
  Discussion
  Conclusion
   Objectives of Fi...
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