Abutment selection in fixed partial denture

GUIDED BY:DR. A S KAUL DEPT. OF PROSTHODONTICS K.D DENTAL COLLEGE MATHURA

PRESENTED BY: Preety dagar Date :-1st august 11

Contents :

Definition Introduction Factors influencing abutment selection Root and their supporting structure Biological consideration

Special problems
Summary

Bibliography

Definition :ABUTMENT

A tooth, a portion of a tooth, or that portion of a dental implant that serves to support and/or retain a prosthesis (GPT-8)

Introduction

Every restoration must be able to withstand the constant occlusal forces to which it is subjected. This is of particular significance when designing and fabricating a fixed partial denture,
since the forces that would normally be absorbed by the missing tooth are transmitted, through the pontic, connectors, and retainers, to the abutment teeth.

Abutment teeth are therefore called upon to withstand the forces normally directed to the-missing teeth, in addition to those usually applied to the abutments.

Whether a tooth can be used as an abutment or not

Vitality of tooth
If it is endodontically treated Pulp capped teeth

?????

Whenever possible, an abutment should be a vital tooth.

it should be asymptomatic, with radiographic evidence of good seal and complete obturation of the canal, to be used as an abutment.

should not be used as an FPD abutment unless they are endodontically treated.
The tooth must have some sound, surviving coronal tooth structure to insure longevity. However, some compensation can be made through the use of a dowel core, or a pin retained amalgam or a composite core.

Less coronal structure

Mobility

Normally, abutment teeth should not exhibit any mobility, since they will be carrying an extra load

 The supporting tissues surrounding the abutment teeth must be healthy and free from inflammation before any prosthesis can be contemplated..

 The roots and the supporting tissues of the abutment teeth should be evaluated for three factors:

Crownroot ratio.

Root configuration.

Periodontal ligament area.

Crown-root ratio:
Definition:- The physical relationship between the portion of the tooth within alveolar bone compared with the portion not within the alveolar bone, as determined by radiograph . (GPT -8)

As the level of alveolar bone moves apically, the lever arm of that portion out of bone increases, and the chances for harmful lateral forces is increased.

Different crown-root ratio for a tooth to be utilized as a FPD abutment

(Reynolds JM in 1968)

:-

Ideal crown-root ratio :- 1:2

:- 2:3

Optimum crown-root ratio Minimum acceptable ratio

:-1:1 under normal circumstances

However

, there are situations in which a crown root ratio greater than 1:1 might be considered adequate.
the occlusion opposing a FPD is composed of artificial teeth, occlusal force will be diminished, with less stress on the abutment teeth

If

Klaffenbach AO (1936): reported that the occlusal force exerted against prosthetic appliances has been shown to be considerably less than that against natural teeth

Force(lb)

 Penny RE, Kraal JH (1979): reported that an abutment tooth with a less than desirable crown-root ratio is more likely to successfully support a fixed partial denture if the opposing occlusion is composed of mobile, periodontally involved teeth than if the opposing teeth are periodontally sound.

The crown-root ratio alone is not an adequate criteria for evaluating a prospective abutment tooth.

Root configuration : This is an important point in the assessment of

an abutments suitability from a periodontal standpoint.
Roots that are broader labiolingually than they are mesiodistally are preferable to roots that are round in cross-section.

 Multirooted posterior teeth with widely separated roots will offer better periodontal support than roots that converge, fuse,or generally present a conical configuration.

The tooth with conical roots can be used as an abutment for a short span FPD if all other factors are optimal.

 A single rooted tooth with evidence of irregular configuration or with some curvature in the apical third of the root is preferable to the tooth that has a nearly perfect taper.

Periodontal ligament area :Larger

teeth have a greater surface area and are better able to bear added stress. The areas of the root surfaces of the various teeth have been reported by Jepsen (1963).

Comparative root surface areas of maxillary teeth.

Comparative root surface areas of mandibular teeth.

 When

supporting bone has been lost because of periodontal disease, the involved teeth have a lessened capacity to serve as abutments. KL, Kreici RF, (1986): reported that millimeter per millimeter, the loss of periodontal support from root resorption is only one-third to one-half as critical as the loss of alveolar crestal bone. length of the pontic span that can be successfully restored is limited, in part, by the abutment teeth and their ability to accept the additional load.

Kalkwarf

The

 Here we must take into accounts Antes law, - Irwin H Ante which states, in fixed dental prosthodontics, the combined pericemental area of all abutment teeth supporting a fixed dental prosthesis should be equal to or greater than the pericemental area of the tooth or teeth to be replaced . (GPT 8 )

 Ante`s law is used to asses the prognosis of fixed partial denture

According to this premise, one missing tooth can be successfully replaced if the abutment teeth are healthy.

The combined root surface area of the second premolar and the second molar (A2p+A2m) is greater than that of the first molar being replaced (A1m).

If two teeth are missing, a fixed partial denture probably can replace the missing teeth, but the limit is being approached .

The combined root surface area of the first premolar and the second molar abutment (A1p+A2m) is approximately equal to that of the teeth being replaced (A2p+A1m)

 When the root surface area of the teeth to be replaced by pontics surpasses that of the abutment teeth, a generally unacceptable situation exists

The combined root surface area of the canine and the second molar (Ac+A2m) is exceeded by that of the teeth being replaced (A1p+A2p+A1m)

It is possible for fixed partial dentures to replace more than two teeth, the most common examples being anterior fixed partial dentures replacing the four incisors. Canine to second molar fixed partial dentures also are possible (if all other conditions are ideal) in the maxillary arch, but not as often in the mandibular arch.

However, any fixed prosthesis replacing more than two teeth should be considered a high risk.

Biomechanical Considerations Bending or deflection

Secondary abutment

 In addition to the increased load placed on the periodontal ligament by a long span fixed partial denture, longer spans are less rigid.

Bending or deflection varies directly with the cube of the length and inversely with the cube of the occlusogingival thickness of the pontic.

Bending =

( length ) (O-G thickness)

 There is one unit of deflection (X) for a given span length (p).

Compared with a fixed partial denture having a single tooth pontic span, a two tooth pontic span will bend 8-times as much.

A three tooth pontic span bends 27-times as much as a single pontic.

There is one unit of deflection (X) for a span with a given thickness (t).

pontic with a given occlusogingival dimension will bend eight times as much if the pontic thickness is halved.

A long-span fixed partial denture on short mandibular teeth could have disappointing results.

Longer pontic spans also have the potential for producing more torquing forces on the fixed partial denture.

To minimize flexing caused by long and/or thin spans

Pontic designs with a greater occlusogingival dimension should be selected.

 All fixed partial dentures, long or short, flex to some extent.

Because of the forces being applied through the pontics to the abutment teeth,
the forces on castings serving as retainers for fixed partial dentures are different in magnitude and direction from those applied to single restorations.

The dislodging forces on a fixed partial denture retainer tend to act in a mesiodistal direction, restoration :- buccolingual direction of

Single

forces

Preparations should be modified accordingly to produce greater resistance and structural durability.

Multiple

grooves, including some on the buccal and lingual surfaces, are commonly employed for this purpose .

 The walls of facial and lingual grooves counteract mesiodistal torque resulting from force applied to the pontic.

Double abutments are sometimes used as a means of overcoming problems created by unfavorable crown-root ratios and long spans.

There are several criteria that must be met if a secondary abutment is to strengthen the fixed partial denture and not became a problem itself.
A secondary abutment must have at least as much root surface area and as favorable a crown-root ratio as the primary abutment it is intended to bolster.

As an example, a canine can be used as a secondary abutment, but it would be unwise to use a lateral incisor as a secondary abutment to a canine primary abutment. The retainers on secondary abutments must be at least as retentive as the retainers on the primary abutments .

When the pontic flexes

tensile forces will be applied to the retainers on the secondary abutments

With primary abutment acting as fulcrums

There

also must be sufficient crown length and space between adjacent abutments to prevent impingement on the gingiva under the connector.

Arch curvature has its effect on the stresses occurring in a fixed partial denture.

Gaining additional retention in the opposite direction from the lever arm and at a distance from the inter abutment axis equal to the length of the lever arm

When pontics lie outside the inter abutment axis line, the pontics act as a lever arm, which can produce a torquing movement.

Some measure must be taken to offset the torque. This can best be accomplished by

This is a common problem in replacing all four maxillary incisors with a fixed partial denture

Special Problems
Pier abutment Tilted molar abutment

Canine replacement fixed partial denture Cantilever fixed partial denture

Pier Abutments:An edentulous space can occur on both sides of a tooth, creating alone, freestanding pier abutment.
Physiologic tooth movement, arch position of the abutments, and a disparity in the retentive capacity of the retainers can make a rigid fiveunit fixed partial denture a less than ideal plan of treatment.

Parfitt GJ (1960): studies that periodontometry had shown that the FACIOLINGUAL MOVEMENT :-56 to 108um, and INTRUSION :- 28 UM.

Teeth

in different segments of the arch move in different directions.

Because

of the curvature of the arch, the faciolingual movement of an anterior tooth occurs at a considerable angle to the faciolingual movement of a molar.

 It has been found that:As a result of the middle abutment acting as a fulcrum

forces are transmitted to the terminal retainers

causing failure of the weaker retainer

Stand lee JR , Caputo AA (1988): suggested that tension between the terminal retainers and their respective abutments, rather than a pier fulcrum, is the mechanism of failure.

Intrusion of the abutments under the loading could lead to failure between any retainer and its respective abutment.

The loosened casting will leak around the margin caries is likely to become extensive before discovery.

 The retention on a smaller anterior tooth is usually less than that of a posterior tooth because of its generally smaller dimensions. Since there are limits to increasing a retainers capacity to withstand displacing forces ,

some means must be used to neutralize the effects of those forces

The use of a NONRIGID CONNECTOR has been recommended to reduce this hazard.

In spite of an apparently close fit, the movement in a nonrigid connector is enough to prevent the transfer of stress from the segment being loaded to the rest of the fixed partial denture.

The nonrigid connector is a broken-stress

mechanical union of retainer and pontic.

 The most commonly used nonrigid design consists :T-shaped key :-attached to the pontic
Keyway :- placed within a retainer.

 Sutherland JK, Holland GA & Sluder TB (1980): reported that a nonrigid fixed partial denture transfers shear stress to supporting bone rather than concentrating it in the connectors . It appears to minimize mesiodistal torquing of the abutments while permitting them to move independently. Landry KE, Johnson PR ,Parks VJ, Pelleu GB (1987): reported that a rigid fixed partial denture distributes the load more evenly than a nonrigid design, making it preferable for teeth with decreased periodontal attachment.

 The location of the stress-breaking device in the five-unit pier-abutment restoration is Important.

It usually is placed on the middle abutment,

since placement of it on either of the terminal abutments could result in the pontic acting as a lever arm.

Key way of the connector within the normal distal contours of the pier abutment

Key pontic.

mesial side of the distal

 Nearly 98% of posterior teeth tilt mesially

when subjected to occlusal forces.

If the key way of the connector is placed on the distal side of the pier abutment Mesial movement seats the key into the key way more solidly.

 Placement of the keyway on the mesial side

Causes the key to be unseated during its mesial movements. this could produce a pathologic mobility in the canine or failure of the canine retainer.

Tilted Molar Abutment: A common problem that occurs with some frequency is the mandibular second molar abutment that has tilted mesially into the space formerly occupied by the first molar.

It is impossible to prepare the abutment teeth for a fixed partial denture along the long axes of the respective teeth and achieve a common path of insertion.

When a mandibular molar tilts mesially , there is discrepancy between the long axis of molar and of premolar

There is further complication if the third molar is present. It will usually have drifted and tilted with the second molar. Because the path of insertion for the fixed partial denture will be dictated by the smaller premolar abutment,
it is probable that the path of insertion will be nearly parallel to the former long axis of the molar abutment before it tilted mesially.
As a resu lt, th e mesia l su rf ace o f th e tip p e d th ir d m o la r will e n c r o ac h u p o n th e p a th o f in s e r tio n o f th e f ix e d p a r tial d e n tu r e, th e r e b y p r e v e n ting it f r o m s e a tin g c o m p le tely.

If the encroachment is slight

Restoring or recontouring the mesial surface of the third molar.

If the tilting is severe

Uprighting of the molar by orthodontic treatment.

If orthodontic correction is not possible, or if it is possible to achieve only a partial correction, a fixed partial denture can still be made. It has been suggested that the long axis of the prospective abutments should converge by no more than 25 to 30 degrees.

 A proximal half crown sometimes can be used as a retainer on the distal abutment. If there is a severe marginal ridge height discrepancy between the distal of the second molar and the mesial of the third molar as a result of tipping, the proximal half crown is contraindicated.

 A telescope crown and coping can also be used as a retainer on the distal abutment. A full crown preparation with heavy reduction is made to follow the long axis of the tilted molar.
An inner coping is made to fit the tooth preparation(The marginal adaptation for this restoration is provided by the coping). Proximal half crown serve as the retainer which is fitted over the coping.

This

restoration allows for total coverage of the clinical crown while compensating for the discrepancy between the paths of insertion of the abutments.

The nonrigid connector is another solution to the problem of the tilted fixed partial denture abutment. A full crown preparation is done on the molar, with its path of insertion parallel with the long axis of that tilted tooth.

A box form is placed in the distal surface of the premolar to accommodate a keyway in the distal of the premolar crown.

 It

is tempting to place the connector on the mesial aspect of the tipped molar, but this could lead to even greater tipping of the tooth.

nonrigid connector for the tipped molar abutment is most useful when the molar exhibits a marked lingual as well as mesial inclination.

Canine-Replacement Fixed Partial Dentures

Fixed partial dentures replacing canines can be difficult because the canine often lies outside the interabutment axis.
The prospective abutments are the lateral incisor, usually the weakest tooth in the entire arch, and the first premolar, the weakest posterior tooth.
A fixed partial denture replacing a maxillary canine is subjected to more stresses than that replacing a mandibular canine, since forces are transmitted outward (labially) on the maxillary arch

 On the mandibular canine the forces are directed inward (lingually).

Any fixed partial denture replacing a canine should be considered a complex fixed partial denture. No fixed partial denture replacing a canine should replace more than one additional tooth.

Cantilever Fixed Partial Dentures

A cantilever fixed partial denture is one that has an abutment or abutments at one end only, with the other end of the pontic remaining unattached.

This is a potentially destructive design with the lever arm created by the pontic, and it is frequently misused.

When a cantilever pontic is employed to replace a missing tooth, forces applied to the pontic have an entirely different effect on the abutment tooth. The pontic acts as a lever that tends to be depressed under forces with a strong occlusal vector.

Ewing JE (1957): suggested that abutment teeth for cantilever fixed partial dentures should be evaluated with an eye toward lengthy roots with a favorable configuration, long clinical crowns, crown-root ratios, and healthy periodontium. Wright (1986): reported that cantilever fixed partial dentures should replace only one tooth and have at least two abutments.

A cantilever can be used for replacing a maxillary lateral incisor. There should be no occlusal contact on the pontic in either centric or lateral excursions.

The canine must be used as an abutment, and it can serve in the role of solo abutment only if it has a long root and good bone support. There should pontic against other metallic central incisor and abutment. be a rest on the mesial of the a rest preparation in an inlay or restoration on the distal of the to prevent rotation of the pontic

A cantilever pontic can also be used to replace a missing first

premolar. This scheme will work best if occlusal contact is

limited to the distal fossa.

Full veneer retainers are required on both the second premolar and first molar. These teeth must exhibit excellent

bone support. This design is attractive if the canine is

unmarred and if a full veneer restoration is required for the first molar in any event.

SUMMARY : When planning and treating cases involving fixed

prosthodontic restorations, it is important that all the applicable parameters are taken into account.

The prosthodontist must not focus too much on the

finer details of constructing a perfect restoration, or risk creating a failure because proper engineering principles was not used.

If success is to be attained the prosthodontist must

take into account the opposing occlusion, periodontal bone loss, attachment apparatus, length of span, crown

root ratio and inclination of abutment teeth.

Bibliography :

Shillingburg HT et al. Fundamentals of fixed prosthodontics. 3st ed.

Rosenstiel SF, Land MF, Fujimoto J. contemporary fixed prosthodontics. 3rd ed. Reynold JM. Abutment selection for fixed prosthodontics. J Prosthet Dent. 1968;19:483488

Penny RE, Kraal JH. Crown-to-root ratio: Its significance in restorative Dentistry J Prosthet Dent.1979;42: 34-38