Resin bonded prosthesis /certified fixed orthodontic courses by Indian dental academy

RESIN BONDED
PROSTHESIS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Contents
Introduction
Acid etching of enamel
Evolution of Resin Bonded Prosthesis
1.
Bonded pontics
2.
Cast perforated-fpd
3.
Etched cast fpd
4.
Macro mehanical retention fpd
5.
Cast mesh fpd
6.
Adhesion bridges
7.
Fibre reinforced composite resin fpd
8.
Fung shells

Advantages
Disadvantages
Indications
Contraindications
Design concepts
Selection of abutments
Impression procedure
Lab procedure
Bonding
Cements
Longevity and scope
Summary and conclusion
Refrences


Introduction


Acid etching of enamel
Buonocore (1955)-showed that acrylic resin can be
attached to human enamel in-vivo simply by
acid etching enamel with 85% phosphoric acid
for 30 secs
 Larege increase in surface area
 Exposure of organic frame work
 Removal of inert enamel
 Absorbed layer of highly polar phosphate
groups

SILVERSTONE:
Loss of surface contour &
Creation of a porous subsurface layer

Use of acid of strength 30-40%
10 micron loss of surface contour and
20 micron depth of histologic change


Types of etching patterns


EVOLUTION OF RESIN
BONDED PROSTHESIS

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
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
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Bonded Pontics
Cast Perforated Resin Retained FPD’s
Etched Cast Resin Retained FPD’s
Macroscopic Mechanical Retention Resin
Retained FPD’s
Cast Mesh FPD’s
Chemical Bonding Resin Retained FPD’s
Fibre Reinforced Composite Resin FPD’s

Bonded Pontics
ACRYLIC RESIN
DENTURE TOOTH
Advocated by Ibsen (1974)
and
Buonocore in (1975)




Composite resin
crowns

SIMONSEN :1978


Natural Tooth
Pontic
Simonsen, Davilla and
Gwinnet


Disadvantages






Composite resins were brittle
They required supporting wire or stainless steel
mesh framework.
Their use is limited to short anterior spans.
Limited lifetime with debonding of resin and
subsequent fracture.


CAST PERFORATED RESIN
BONDED FPD
(ROCHETTE BRIDGE)


HOWE AND
DENEHY (1977)



Perforated lingual
coverage .
Mechanical retention



Replacement of posterior
teeth –Livaditis



Extension –
interproximally and onto
occlusal surfaces.



Tooth modification



Survival rate -3 years

Drawbacks






Failure through the resin projections into the
perforations
Wear of composite resin
Weakening of alloy framework
Thick lingual retainers


Etched Cast Resin Retained FPDs
(Maryland Bridge)
Dunn Reisbick (1976)
 Tanaka et al (1979)
 Livaditis and Thompson (1980)…University
of Maryland













Livaditis and Thompson in 1980 at the
university of Maryland.
Study for etching conditions of non berrylium
Ni-Cr alloys.
Nitric acid : 0.5 N
Current : 250 mA/sq cm
Time : 5 minutes
Immersion in 18% Hcl for 10 minutes
Micromechanical retention

Resin-alloy bond
strength:27.3 M pa


Etching apparatus


Electrodes: 0.036 inches stainless steel
orthodontic wire or a copper wire 12-14 gauge



Electrolytes used vary according to metal type.
Ni-Cr Be alloys : 10% sulphuric acid.
Ni-Cr/Co-Cr : 3.5% nitric acid.



D.C. power supply

Etching Process






Two step etching technique.
Insulation of areas not being etched.
Electrode assembly submerged in a bath of
electrolyte.
The current is adjusted to the calculated level.




.

Etching process


One step etching process








Proposed by Mclaughlin
Electrolyte and cleaning solution were both
combined and placed in the ultra sonic bath.
Time saving – 110 secs
Less equipment required
Etched metal surface was brighter
No difference in bond strength.

DRAWBACKS






Technique sensitive
Lab dependent
Varies with metal type
Prone to contamination
Cannot be done with noble metal alloys


Chemical Etching








Livaditis suggested a non electrolytic technique
for etching a nickel-chromium beryllium alloy
Placed in an etching solution for one hour in a
water bath at 70 degrees centigrade
Doukoudakis proposed the use of a stable aqua
regia gel
Advantage – no special equipment


Macroscopic Mechanical Retention
Resin Retained FPDs








Developed by Moon & Hudgins et al
Virginia Commonwealth university school of
dentistry also called the Virginia bridge
Lost salt technique
Salt crystal size 150-250 microns
Adequate bond strength
Any metal ceramic alloy
Increased thickness of retainers

Cast Mesh FPD


Chemical Bonding Resin Retained
FPDs









Adhesion bridges
Surface treatment of metals
Sand blasting
Tiller et al (1985)
Used alumina (50 microns) for sand blasting
Concluded sandblasting results in a highly activated
metal surface
Demonstrated increased wettability of the surface

Silicoater Classical








Tiller et al (1984)
Procedure – sand blasting of alloy
Flame coating of silicon oxide for 5 minutes
Disadvantage – expensive
Uneven distribution of flame
Chemically unstable silica layers
Protection of the layer formed

Silicoater MD (metal dotted)


Tiller et al (1990)



Baking of chromium oxide dotted silica layer


Rocatec System







Introduced in 1989
Tribochemical application of silica layer by sand
blasting
Sand blasting with 110 microns alumina at a
pressure of 0.25 Mpa
Sand blasting with 110 microns aluminium oxide
modified with silicic acid
Speed and accuracy
thermal stressing avoided

Tin Plating





Done on noble metal alloys
Requires particle abrasion of the alloy surface
Uses a tin amide solution

Fiber Reinforced Composite Resin
FPD






Consists of a fibre reinforced substructure
Veneered with composite material
Increased flexural strength , fracture resistance
& increased tensile strength
Transluscent


Types Of Fibres


Glass



Polyethylene



Polypropylene



carbon

Orientation of the fibre


Unidirectional



Braided



Woven


Non impregnated materials
 Polyethylene weaves- ribbond & connect
 Glass weaves- glasspan
 Hand formed
Pre impregnated & machine formed
 Uni directional & woven glass eg vectris
Pre impregnated & hand formed
 Uni directional glass eg fiberkor

Procedure







Preparation of abutment teeth
Measurement of fiber length
Moistening of fiber
Fiber bar pressed into the preparation &
polymerised with resin
Pontic build up & curing


Fung shells









The slots in the proximal surface of adjacent teeth are
prepared 1.5 mm towards pulp cavity and 0.5 mm
gingivally as an interlocking mechanism. This type of
preparation will prevent gingival movement of the
bridge as well as provide retention.
The bridge post is then inserted into the pontic channel
in the fung shell provided and slide into the prepared
abutment teeth, and adjustments are made accordingly.
The fung shell can be adjusted for proper contact with
tissues with a bur.
The fung shell bridge is cemented using light curing
composite, and finished and polished.

Advantages









It is of lower cost compared to custom made resin –
bonded bridges.
Simple to make, not time consuming hardly takes a few
minutes.
No need of impression making and laboratory work.
Can be given to patient in a single appointment.
Good esthetics no exposure of metal in proximal areas.
Longevity comparable to resin bonded bridges

Advantages
of resin bonded prosthesis


Conservation of tooth structure



Lack of pulpal involvement



No anaesthesia required



Minimum periodontal involvement



Simplified impression procedures



Improved esthetics



Provisionals not usually required



Possibility of rebonding

Disadvantages


Irreversible



Uncertain longevity



No space corrections



Good alignment of abutments is required



Plaque accumulation



Esthetics compromised on posterior teeth



Incisal graying



Dependence on laboratory

Indications


Replacement of missing
anterior teeth in children
and adolescents



Caries free abutment
teeth or unrestored
abutments



Mandibular incisor
replacement



Maxillary incisor
replacement



Periodontal splints



Post orthodontic
stabilisation



Prolonged placement of
interim prosthesis



Prolonged placement of
interim prosthesis



Single posterior tooth
replacement



Significant clinical crown
length



Excellent moisture
control

Contraindications


Parafunctional habits



Long edentulous span



Extensive caries



Restored or damaged abutments



Compromised enamel



Nickel sensitivity



Deep vertical overbite



Incisors with thin faciolingual dimensions

Abutment selection


Caries free



Periodontally sound



Adequate thickness of enamel



One abutment on either side

Posterior design principles


Distinct path of insertion



Proximal resistance form



Proximal wrap around



Maximum bonding area



Occlusal rest



Definite gingival margin



2 plane reduction for maxillary molars



Extension of casting onto occlusal surfaces



Lingual cusp coverage



Onlay on tilted molars

Posterior preparation sequence


Anterior design principles


Vertical path of insertion











Proximal wrap around
Extension of framework
onto uninvolved
marginal ridge
Definite finish line
Cingulum notches or
counter sinks
Grooves
Existing restorations may
be incorporated

Anterior preparation
sequence


Accurate impression procedure

Temporary occlusal stops


Framework fabrication




Duplication of master
cast
Resin coping fabrication


Bonding Procedure


Resin Cements


Greater cohesive strength 5000-10,000 psi



Insoluble in oral fluids



Higher film thickness


Two layer system
 Unfilled resin monomer
 Filled resin
Commonly used resin cements
 Epoxylite cba 9080
 Comspan
 Retain
 Conclude
Single paste composites

Cements with adhesion promoters
PANAVIA
Components: low viscosity paste, radio opaque
composite resin paste
Universal and catalyst
Composition : Bisphenol-A-Polyethoxy
dimetharyclate,
MDP or 10-Methacrloxydecyl dihydrogen
phosphate, 77%silanated organic fillers.

ED PRIMER: A and B liquids
MDP,HEMA & 5NMSA
OXYGUARD IIPolyethylene Glycol
PANAVIA ETCHING AGENT
Phosphoric acid gel




Mixing time : 20-30 sces



Film thickness: 19 microns



Metal surface must be sandblasted or tin coated.



Recent version – PANAVIA F


C&B METABOND
COMPOSITION: Methylmethacrylate polymer
powder
Mma liquid modified with 4-META or
4 Methacryloxyethyl Trimellitic Anhydride.
Tri-n-Butyl Borane catalyst.
Disadvantage-poor hydrolytic stability

Post operative care


Regular recall visits



Check for any debonding



Caries



Periodontal health

Longevity and scope
The most common resinbonded prosthesis complications are
shown below.
Nature of failure
Mean incidence
Debonding
Tooth discoloration
Caries
Porcelain fracture
Periodontal disease

No. of prosthesis studied/affected
7029/1481 21%
343/62 18%
3426/242
7%
1126/38
3%
748/0
0%


Summary


Patient selection



Tooth preparation



Accurate impression



Careful laboratory technique



Use of a good adhesive agent

Conclusion
One of the basic principles of tooth preparation
for fixed prosthodontics is conservation of
tooth structure. This is the primary advantage
of resin-retained fixed partial dentures. Precision
and attention to detail are just as important in
the success of the prosthesis.


Refrences






Malone W.F.P, Roth D.I. Tylman’s Theory
and Practice of fixed Prosthodontics. VIII
Edition, AIPD publications, page 219.
T. Shillinburg. Fundamentals of Fixed
Prosthodontics, II edition, Quintessence
publication, 2001, page 565.
Rosenstiel, Land, Fujimoto. Contemperory
Fixed Prosthodontics, III edition, Mosby
Company, 2001, page 673.







Goodacre C.J, Bernad G, et al. Clinical
complications in Fixed Prosthodontics. J.
Prosthet Dent. 2003; 90, 31-41.
Livaditis G.A. Chemical etching system for
creating micromechanical retention in resinbonded retainers. J Prosthet Dent 1987; 56,
181
Salam Sakal M.A et al. Effect of tooth
preparation design on bond strengths of RBP.J
Prosthet Dent 1997; 77, 243.









Livaditis G.A. Chemical etching system for creating
micromechanical retention in resinbonded retainers.
J Prosthet Dent 1987; 56, 181.
Doukoudakis A et al. A new chemical method for
etching metal frameworks of acid etched prosthesis. J
Prosthet Dent 1987; 58, 421
Richard simonsen. Van thompson.gerald barrack.
Etched cast restorations clinical and laboratory
technique
Gerald mclaughlin:direct bonded retainers


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