Adv Hum Biol 2014; 4(3):37-43. Clinical Evaluation Of .

ResearchArticleAHBAdvances inHuman BiologyAdv Hum Biol 2014; 4(3):37-43.Clinical Evaluation of Fixed Dental Prosthesis Failures inIndian Population: An In Vivo StudyDipti S Shah1 Kalpesh Vaishnav2 Sareen Duseja3 Ravi Joshi4*1Professorand Head, Department of Prosthodontics, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.Department of Prosthodontics, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.3Reader, Department of Prosthodontics, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.4Post Graduate Student, Department of Prosthodontics, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.2Professor,ABSTRACTAim: The purpose of this study was to evaluate the prevalence of causes of fixed dental prosthesis failures inIndian population.Materials and method: A total of 158 patients were selected for the study who reported to the OPD of theDepartment of prosthodontics, Karnavati School of Dentistry, with complaints related to fixed dental prosthesis(FDP). Site and condition of the prosthesis and its abutments were evaluated and the cause of failure wasclassified accordingly by John J. Manappallil’s classification.Results: Majority of failures (32.27%) were found to be class III failure followed by class VI failure (24.05 %).13.29 % failures were Class IV, 12.65 % failures were identified as class II, 12.02 % failures as class V and 5.69 %failures were categorized in class I failure.Conclusion: Though earlier literature reported caries as the most common cause of fixed dental prosthesisfailure, however present study reported class III failures, which include unserviceable restorations due todefective margins, technical failures or esthetic considerations as the most common cause. Therefore properdesign of prosthesis is of utmost importance and should be kept in mind during fabrication of FDP.Keywords: Abutments, Fixed partial denture, Prosthesis failure.INTRODUCTION“Technology in the hands of a skilledoperator makes it possible to do more work of aneven higher quality. But in the hands of one who hasnot mastered the skills of his or her profession, thattechnology merely enables one to do tremendousdamage.” - Herbert T. Shillingburg1Fixed prosthodontictreatmentinvolvesthereplacement and restoration ofteeth by artificial substitutesthat are not readily removablefrom the mouth. Its focus is to restore function,esthetics and comfort. To achieve predictablesuccess in this technically exacting and demandingfield, meticulous attention must be given to eachand every detail: from the initial patient interviewand diagnosis, through the active treatment phasesand to a planned schedule of follow-up care.Otherwise, the result is likely to be unsatisfactoryand frustrating for both dentist and the patient2.Most of the time, complications areconditions that occur during or after anappropriately performed fixed prosthodontictreatment procedures3. An objective evaluation ofReceived: June. 1, 2014: Accepted: Aug. 26, 2014*Correspondence: Dr. Ravi Joshi.Address: A-11, New Golden Park, Agola Road, Abu-Highway, Palanpur, Gujarat, India.E-mail: ravijoshi 2007@yahoo.co.inCopyright 2014 Association of Clinicianswww.aihbonline.compISSN 2321-8568eeISSN 2348-4691ISSN3898-6473

AHBAdvances inHuman Biologyan existing restoration is necessary before arrivingto a conclusion that it is defective and requireseither replacement or repair. Some failures are theresult of poor patient care while others occur as aresult of defective design or inadequate execution ofthe clinical or laboratory procedures. The dentalliterature is replete with problems and failuresrelated to traditional fixed prosthodontic treatment.These include clinical studies on long-term survivalof FDP and reasons for loss of serviceability. In spiteof the large number of studies, criteria for gradingor classifying the type and severity of the failuresare inadequate. The cause may be that signs andsymptoms of failures are varied and often complex4.Knowledge regarding the clinical complications thatcan occur in fixed prosthodontics enhances theclinician's ability to complete a thorough diagnosis,develop the most appropriate treatment plan,communicate realistic expectations to patients andplan the time intervals needed for post-treatmentcare3.Table 1: John J. Manappallil’s classification.ClassClass 1Class 2Class 3Class 4Class 5Class 6DescriptionCause of failure is correctable without replacingrestoration. (Figure1, Figure 2)Cause of failure is correctable without replacingrestoration; however, supporting tooth structure orfoundation requires repair or reconstruction.(Figure 3)Failure requiring restoration replacement only.Supporting tooth structure and/or foundationacceptable. (Figure 4 , Figure 5)Failure requiring restoration replacement inaddition to repair or reconstruction of supportingtooth structure and/or foundation. (Figure 6,Figure 7)Severe failure with loss of supporting tooth orinability to reconstruct using original toothsupport. Fixed prosthodontic replacement remainspossible through use of other or additionalsupport for redesigned restoration. (Figure 8,Figure 9, Figure 10)Severe failure with loss of supporting tooth orinability to reconstruct using original toothsupport. Conventional fixed prosthodonticreplacement is not possible. (Figure 11, Figure12, Figure 13)Dipti S Shah et alMATERIALS AND METHODA total of 158 patients were selected forthe study who reported to the OPD of theDepartment of Prosthodontics with problemsrelated to Fixed Dental Prosthesis (FDP). Amongthese patients, 65 (41%) were males and 93 (59%)were females ranging from 20 to 66 years of age.The number of retainers, pontic and type ofrestorations were recorded.Type of pontic design and condition ofabutment were evaluated after removal of FDP,material used for fixed dental prosthesis (castmetal, gold, acrylic, porcelain fused to metal, allceramic ) also were recorded. Site of the prosthesisand its condition was evaluated and the cause offailure was classified accordingly. Failures can begrouped into 6 categories according to classificationof “John J. Manappallil”4 with severity increasingfrom Class I to Class VI. (Table 1)RESULTSMajority of failures (32.27%) were found tobe class III failures which include unserviceablerestorations due to defective margins, technicalfailures, or esthetic considerations. 24.05 % failurewere class VI that include failing long-span FPDswith supporting teeth that may be serviceable.13.29 % failures were Class IV which includefailures associated with caries, fracture ofsupporting tooth structure, or a defectivefoundation. 12.65 % failures were identified as classII which include failures and loss of supportingtooth structure resulting from caries or fracture.Fractures can also occur during attempts to removea restoration.Table 2: Distribution of patients according to frequency andpercentage from class I to 3.3V1912.0VI3824.1Total158100.038

AHBAdvances inHuman BiologyDipti S Shah et alFig 1: Class I failure. Porcelain fused to metal crown lackingocclusal contact. Crown replacement was not required sinceit was possible to remove and improve existing crown.Fig 4: Class III Failure requiring restoration replacementonly. Condition of supportingstructure was satisfactorywithout additional treatment.Fig 2: Crown in place with improved occlusal contact.Fig 5: Failure occurs due to wrong pontic design (saddle/ridge lap pontic).Fig 3: Class II failure, which involve repair or reconstructionof abutment tooth and, it is correctable without replacingexisting restoration.Fig 6: Class IV Failure requiring restoration replacement dueto fracture of retainer in addition to repair or reconstruction ofabutment teeth.39

AHBAdvances inHuman BiologyDipti S Shah et alFig 7: Both maxillary lateral incisors require reconstruction.Fig 10: Failure of FDP with abutment tooth.Fig 8: Class V failure with loss of supporting teeth.Fig 11: Class VI Failure in which Cantilever is given with thesupport of mandibular right second premolar and first molar.Fig 9: Inability to reconstruct FDP using original toothsupport. FDP remain possible through use of additional toothsupport.Fig 12: Conventional fixed prosthodontic replacement is notpossible in distal extension case.40

AHBAdvances inHuman BiologyDipti S Shah et alintheirprosthetictreatmentplanning.Furthermore, a more reliable prognosis might bepossible. In recent years, several investigators havetaken great interest in investigating the life spanand long-term quality of fixed dentures5. Ananalysis of all failure types, point to the directionthat adherence to the basic principles of toothpreparation namely biological, mechanical andesthetic that considerably improves the prognosis,is of almost importance in predicting the success offinal restoration.Fig 13: Removal of cantilever.Graph 1: Bar chart of percentage of failure divided in class Ito VI according to John J. Manappallil’s classification.12.02 % failures were class V which includedsupport structures that can no longer provideadequate support for the existing restoration due toextensive fracture, carious destruction, periodontalproblems or other complications. Only 5.69 %failures were categorized in class I failures, whichinclude the loss of a cement bond (Graph 1 andTable 2).DISCUSSIONFixed prosthodontic failures are varied andoften complex in cause and effect. When a problemoccurs, the design and condition of the restorationand associated structures must be considered4.When a crown or FPD fails, the primary question iswhether the problem can be easily resolved, . A mild failure may be consideredone that is generally correctable without having toremake the restoration. More severe failures canresult in the loss of supporting teeth. Knowledge ofthe background factors and conditions that causeFDP to become unserviceable should help dentistsThe primary advantages of John J.Manappallil’s classification system are that it issimple, practical and applicable in all failuresituations concerning FDP. The system identifiesfailure by the degree of severity and considersconventional retreatment possibilities3.Class I failures are correctable throughocclusal adjustment or composite resin repairswithout requiring replacement of the restoration. Ina Class II failure, the restoration itself is acceptable;however, the supporting tooth structure orfoundation (core restoration, or post and core)requires repair or reconstruction. Restorationreplacement is required with Class III failure;however, the supporting tooth structure orfoundation remains intact and would provideacceptable support for a replacement restoration. InClass IV situations, the restoration requiresreplacement, and the supporting tooth structure orfoundation is deficient. In a Class V failure, supportstructures can no longer provide adequate supportfor the existing restoration due to extensivefracture, carious destruction, periodontal problems,or other complications. A Class VI failure is the mostsevere failure; in this situation, a conventional fixedreplacement is no longer possible because ofabutment failure and the lack of additional supportfor use in a redesigned restoration.Earlier literature has evaluated caries asthe most common cause for fixed dental prosthesisfailure6-11. Some studies have shown thatperiodontal disease is most common cause forbridge failure12, but according to this research studyunserviceable restorations due to erations were the most common causeamong studied Indian population.41