Bridge failure

Bridge Failure

Dr. Aneeqa YaqubDr. Moazam Ali

Manifestations of failure

Pain Inability to function Dissatisfaction with esthetics Broken teeth and/or restoration Inflammatory swelling Bad taste Bad breath Bleeding gums Anxiety

Causes of fixed prosthesis failure

Improper case selection Faulty diagnosis and treatment plan Inaccurate clinical or laboratory procedures Poor patient care and maintenance

following insertion

Classification of fixed prosthesis failure

• Discomfort• Caries• Pulp injury• Periodontal

breakdown• Occlusal

problems• Tooth

perforation• Tooth fracture

Biological

Mechanical

• Looseness or dislodgement

• Prosthesis fracture

• Occlusal wear or perforation

Esthetic

• At the time of cementation

• Delayed esthetic failure

Biological failures

Biological Failures

Periodontal breakdown

Caries

• Inadequate abutment teeth

• Periodontally affected abutment teeth

• Poor oral hygiene• Improperly constructed

prosthesis

• Methods of detection

• Detection • Management

Occlusal problems

Periodontal breakdown

Caries

Occlusal problems

Biological Failures

Discomfort

Tooth perforation

• Pressure on soft tissue• Traumatic occlusion• Torque• Cervical hypersensitivity

Discomfort

Tooth perforation

Biological Failures

Pulp injury

Abutment fracture

• Over heating• Over reduction• Minute pulp

exposure• Inadequate

protection• Recurrent caries

• Coronal• Root

Abutment fracture

Pulp injury

Mechanical failures

Mechanical Failures

Looseness or dislodgement

Prosthesis fracture

Occlusal wear or perforation

• Lack of retentiono Faulty preparationo Improper designo Improper

construction• Recurrent caries• Mobility • Torque• Faulty cementation

• Joint fractures• Facing fractures• All ceramic crown

fractureo Faulty

preparationo Faulty

constructiono Faulty

cementation• Post fracture

Occlusal wear

Prosthesis fracture

Looseness

Esthetic failures

Esthetic Failures

At the time of cementation

Delayed esthetic failures

• Actual failures o Color mismatcho Poor tooth contour,

marginal roughness & extension

o Metal display in partial coverage

o Improper pontic placemento Porcelain fracture during

cementation• Color blindness• Unrealistic complains by the

pt.o Inadequate communicationo Unrealistic expectations of

pt.o Dysmorphophobia

• Gingival recession• Sub pontic tissue

shrinkage• Periodontal surgery• Porosity• Drifting of anterior

teeth• wear

Avoiding failures

Caution at the planning stage Confirmation of diagnosis and treatment

plan for inexperienced operator Expertise of the technician Treatment of preoperative problems Search for the primary cause of failure

rather than the apparent

When the prognosis is questionable ???

The methods used to facilitate re-treatment are: Use of temporary cement Design of prosthesis for possible future addition The placement of a rest seat for possible future use Specified undercut or guide plane of a crown, even

when denture is not planned Planning and noting solder joint placement Recording of shades Recording of cement used Retention of working casts and provisional

restorations

CASE Presentation

Carious Abutments

CASE # 1•75 years old•6- units bridge•Satisfactory for 9 yrs•Prefer not to have a new one•Clinical examination: carious abutments 11, 13

Management•Caries removal•Root canal treatment•Post and core done for each tooth•Bridge lasted for the remaining 6 years

Periodontal Breakdown

CASE # 2•Advanced periodontitis•Complicated by tooth loss and mobility•Had a partial denture (not coping well with it)•Wishes to consider a fixed restoration option•For health reasons implants were not a practical option

Management•Teeth prepared for full crowns•Telescopic crowns with parallel path of insertion cemented permanently• One piece fixed bridge fabricated over the crowns

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