International Journal of Preventive and Clinical Dental Research

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


V Chandrakala1, S Deepmala2, G Srivatsa3,  
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

Correspondence Address:
Dr. V Chandrakala
Department of Prosthodontics, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka
India

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.



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 2022 Sep 25 ];6:17-20
Available from: https://www.ijpcdr.org/text.asp?2019/6/1/17/263455


Full Text



 Introduction



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

[3]

Preservation and improvement of related hard- and soft-tissue structuresPreservation or improvement of oral functionImprovement or restoration of estheticsEnsuring restoration retention, resistance and stabilityProviding restoration with mechanical or structural integrityPreserving or improving patient comfortDesigning restorations for maximum longevity.

 Classification System for Failures in Tooth-Supported Fixed Partial Denture



“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 prognosisSecond: Failure to remove foci of infectionThird: Disregard for tooth formFourth: Absence of proper embrasuresFifth: Interproximal spacesSixth: Faulty occlusion and articulation.

Robert's classification[5]

Cementation failureMechanical breakdown

Flexion, tearing, or fracture of the goldSolder joint failurePontic fractureBonded porcelain failure

Gingival irritation or recessionPeriodontal breakdownCariesNecrosis of the pulp.

Lombardi classification of esthetic errors[6]

Inharmonious dentofacial ratio

Shade disharmonyCompositional incompatibility

Static prosthesis in dynamic mouthInharmonious strength or weakness of dental composition compared to background features

Weak mouth with strong faceStrong mouth with weak face.

Intrinsic dental disharmony

Space allocation errors

Inadequate vertical space allocationExcessive vertical space allocationExcessive horizontal space allocation

Structural line errors

Elevated occlusal planeOcclusal plane drops down posteriorlyAsymmetrical occlusal plane.

Unnatural lines

Reverse smiling lineUnnatural axial inclinationCusp less posterior teethGradation errorsAge–sex personality disharmony.

Single-line errors

Vertical deviationHorizontal deviationLine conflict.

Imbalance

Midline errorImbalance of directionsArtifact errorDiastema error.

Barreto[7] classification – 1984

Biologic – caries, fractures, and generalized periodontal disturbancesEsthetics – shapes, contours, and surface characteristicsBiophysical – physical properties and chemical composition of porcelain and metalBiomechanical – faulty designs, misplaced finish lines, rough or sharp surfaces, and undercuts on the bonding surface cause porcelain to be dislodged.

Thayer[8] classification – 1984

CariesCement failuresPreparation fractures and acrylic veneer wear/lossPorcelain fracturesSolder joint or major connector failurePeriodontal involvement.

Selby[9] classification – 1984

Biologic

CariesPeriodontal diseaseEndodontic or periapical problems.

Mechanical

Loss of retentionFracture or loss of porcelainWear or loss of acrylic veneerWear or perforation of goldFracture of metal frameworkFracture of solder jointsFracture of abutment tooth or rootDefective marginsPoor contourPoor esthetics.

Wise [10] classification – 1999

General pathosisPeriodontal problemsCariesPulpal changesErosionCracked teethSubpontic inflammationTemporomandibular joint disordersOcclusal problems.

Smith[11] classification – 1985

Loss of retentionMechanical failures of crown and bridge componentsChanges on abutment toothDesign failuresInadequate clinical or laboratory technique

Marginal deficienciesDefectsPoor shape and color

Occlusal problems.

John. F. Johnston [12] classification – 1986

Biological failures

CariesRoot cariesPeriodontal diseaseOcclusal problemsGingival irritationGingival recessionPulp and periapical healthTooth perforation.

Mechanical failures

Loss of retentionCementation failureAcrylic veneer wear or lossPorcelain fractureMetal-ceramic porcelain failuresPorcelain jacket crown failures.

Esthetic failures

Improper shade selectionExcessive metal thickness and exposureThick opaque layer application 7 overglazingDark space in cervical thirdFailure of translucencyImproper contouringDiscoloration of facing.

Facing failures

Manappallil[3] classification – 2008

Class I – Cause of failure is correctable without replacing restorationClass II – Cause of failure is correctable without replacing restoration; however, supporting tooth structure or foundation requires repair or reconstructionClass III – Failure requiring restoration replacement only. Supporting tooth structure and/or foundation acceptableClass IV – Failure requiring restoration replacement in addition to repair or reconstruction of supporting tooth structure and/or foundationClass 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 restorationClass VI – Severe failure with loss of supporting tooth or inability to reconstruct using original tooth support. Conventional fixed prosthodontic replacement is not possible.

 Discussion



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



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.

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