This document discusses bridge failures in dentistry. It identifies the main manifestations of failure as pain, inability to function, dissatisfaction with aesthetics, and other issues. Failures are classified as biological, mechanical, or esthetic. Biological failures include issues like caries, periodontal breakdown, pulp injury, and tooth perforation. Mechanical failures involve looseness, fracture of the prosthesis, and occlusal wear. Esthetic failures occur at cementation or later due to issues like gingival recession or color mismatch. The document provides examples and descriptions of various types of failures and recommends avoiding failures by careful planning, addressing preoperative problems, and designing prostheses to allow for future treatment if needed. It also presents two
2. Manifestations of failure
Pain
Inability to function
Dissatisfaction with esthetics
Broken teeth and/or restoration
Inflammatory swelling
Bad taste
Bad breath
Bleeding gums
Anxiety
3. 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
4. Classification of fixed prosthesis failure
Biological Esthetic
Mechanical
• Discomfort • At the time of
• Caries cementation
• Pulp injury • Delayed
• Periodontal • Looseness or esthetic failure
breakdown dislodgement
• Occlusal • Prosthesis
problems fracture
• Tooth • Occlusal wear
perforation or perforation
• Tooth fracture
13. Mechanical Failures
Occlusal wear or perforation
Looseness or dislodgement
• Lack of retention
Prosthesis fracture o Faulty preparation
o Improper design
• Joint fractures o Improper
• Facing fractures construction
• All ceramic crown • Recurrent caries
fracture • Mobility
o Faulty • Torque
preparation • Faulty cementation
o Faulty
construction
o Faulty
cementation
• Post fracture
16. Esthetic Failures
Delayed esthetic failures
• Gingival recession
At the time of cementation • Sub pontic tissue
shrinkage
• Actual failures • Periodontal surgery
o Color mismatch • Porosity
o Poor tooth contour, marginal • Drifting of anterior
roughness & extension teeth
o Metal display in partial • wear
coverage
o Improper pontic placement
o Porcelain fracture during
cementation
• Color blindness
• Unrealistic complains by the pt.
o Inadequate communication
o Unrealistic expectations of pt.
o Dysmorphophobia
17.
18. 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
19. 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
21. CASE # 1
•75 years old
•6- units bridge
Carious
•Satisfactory for 9 yrs
•Prefer not to have a new
Abutments
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
22.
23. CASE # 2
•Advanced periodontitis
Periodontal
•Complicated by tooth loss
and mobility
•Had a partial denture (not
coping well with it) Breakdown
•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
