Reisn bonded prosthesis / dental implant courses by Indian dental academy

RESINRESIN
BONDEDBONDED
PROSTHESISPROSTHESIS
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.com

ContentsContents
IntroductionIntroduction
Acid etching of enamelAcid etching of enamel
Evolution of Resin Bonded ProsthesisEvolution of Resin Bonded Prosthesis
1.1. Bonded ponticsBonded pontics
2.2. Cast perforated-fpdCast perforated-fpd
3.3. Etched cast fpdEtched cast fpd
4.4. Macro mehanical retention fpdMacro mehanical retention fpd
5.5. Cast mesh fpdCast mesh fpd
6.6. Adhesion bridgesAdhesion bridges
7.7. Fibre reinforced composite resin fpdFibre reinforced composite resin fpd
8.8. Fung shellsFung shells

AdvantagesAdvantages
DisadvantagesDisadvantages
IndicationsIndications
ContraindicationsContraindications
Design conceptsDesign concepts
Selection of abutmentsSelection of abutments
Impression procedureImpression procedure
Lab procedureLab procedure
BondingBonding
CementsCements
Longevity and scopeLongevity and scope
Summary and conclusionSummary and conclusion
RefrencesRefrences

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

SILVERSTONE:SILVERSTONE:
Loss of surface contour &Loss of surface contour &
Creation of a porous subsurface layerCreation of a porous subsurface layer
Use of acid of strength 30-40%Use of acid of strength 30-40%
10 micron loss of surface contour and10 micron loss of surface contour and
20 micron depth of histologic change20 micron depth of histologic change

Types of etching patternsTypes of etching patterns

EVOLUTION OF RESIN
BONDED PROSTHESIS
 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 PonticsBonded Pontics
ACRYLIC RESINACRYLIC RESIN
DENTURE TOOTHDENTURE TOOTH
Advocated by Ibsen (1974)
and
Buonocore in (1975)

 Composite resinComposite resin
crownscrowns
SIMONSEN :1978SIMONSEN :1978

Natural Tooth
Pontic
Simonsen, Davilla and
Gwinnet

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

CAST PERFORATED RESINCAST PERFORATED RESIN
BONDED FPDBONDED FPD
(ROCHETTE BRIDGE)(ROCHETTE BRIDGE)

 Perforated lingualPerforated lingual
coverage .coverage .
 Mechanical retentionMechanical retention
HOWE AND
DENEHY (1977)

 Replacement of posteriorReplacement of posterior
teeth –Livaditisteeth –Livaditis
 Extension –Extension –
interproximally and ontointerproximally and onto
occlusal surfaces.occlusal surfaces.
 Tooth modificationTooth modification
 Survival rate -3 yearsSurvival rate -3 years

DrawbacksDrawbacks
 Failure through the resin projections into theFailure through the resin projections into the
perforationsperforations
 Wear of composite resinWear of composite resin
 Weakening of alloy frameworkWeakening of alloy framework
 Thick lingual retainersThick lingual retainers

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

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

Resin-alloy bond
strength:27.3 M pa

Etching apparatusEtching apparatus
 ElectrodesElectrodes: 0.036 inches stainless steel: 0.036 inches stainless steel
orthodontic wire or a copper wire 12-14 gaugeorthodontic wire or a copper wire 12-14 gauge
 ElectrolytesElectrolytes used vary according to metal type.used vary according to metal type.
Ni-Cr Be alloys : 10% sulphuric acid.Ni-Cr Be alloys : 10% sulphuric acid.
Ni-Cr/Co-Cr : 3.5% nitric acid.Ni-Cr/Co-Cr : 3.5% nitric acid.
 D.C. power supplyD.C. power supply

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

Etching processEtching process ..

One step etching processOne step etching process
 Proposed byProposed by MclaughlinMclaughlin
 Electrolyte and cleaning solution were bothElectrolyte and cleaning solution were both
combined and placed in the ultra sonic bath.combined and placed in the ultra sonic bath.
 Time saving – 110 secsTime saving – 110 secs
 Less equipment requiredLess equipment required
 Etched metal surface was brighterEtched metal surface was brighter
 No difference in bond strength.No difference in bond strength.

DRAWBACKSDRAWBACKS
 Technique sensitiveTechnique sensitive
 Lab dependentLab dependent
 Varies with metal typeVaries with metal type
 Prone to contaminationProne to contamination
 Cannot be done with noble metal alloysCannot be done with noble metal alloys

Chemical EtchingChemical Etching
 Livaditis suggested a non electrolytic techniqueLivaditis suggested a non electrolytic technique
for etching a nickel-chromium beryllium alloyfor etching a nickel-chromium beryllium alloy
 Placed in an etching solution for one hour in aPlaced in an etching solution for one hour in a
water bath at 70 degrees centigradewater bath at 70 degrees centigrade
 Doukoudakis proposed the use of a stable aquaDoukoudakis proposed the use of a stable aqua
regia gelregia gel
 Advantage – no special equipmentAdvantage – no special equipment

Macroscopic Mechanical RetentionMacroscopic Mechanical Retention
Resin Retained FPDsResin Retained FPDs
 Developed byDeveloped by Moon & HudginsMoon & Hudgins et alet al
 Virginia Commonwealth university school ofVirginia Commonwealth university school of
dentistry also called thedentistry also called the Virginia bridgeVirginia bridge
 Lost salt techniqueLost salt technique
 Salt crystal size 150-250 micronsSalt crystal size 150-250 microns
 Adequate bond strengthAdequate bond strength
 Any metal ceramic alloyAny metal ceramic alloy
 Increased thickness of retainersIncreased thickness of retainers

Cast Mesh FPDCast Mesh FPD

Chemical Bonding Resin RetainedChemical Bonding Resin Retained
FPDsFPDs
 Adhesion bridgesAdhesion bridges
 Surface treatment of metalsSurface treatment of metals
 Sand blastingSand blasting
 Tiller et al (1985)Tiller et al (1985)
 Used alumina (50 microns) for sand blastingUsed alumina (50 microns) for sand blasting
 Concluded sandblasting results in a highly activatedConcluded sandblasting results in a highly activated
metal surfacemetal surface
 Demonstrated increased wettability of the surfaceDemonstrated increased wettability of the surface

Silicoater ClassicalSilicoater Classical
 Procedure – sand blasting of alloyProcedure – sand blasting of alloy
 Flame coating of silicon oxide for 5 minutesFlame coating of silicon oxide for 5 minutes
 Disadvantage – expensiveDisadvantage – expensive
 Uneven distribution of flameUneven distribution of flame
 Chemically unstable silica layersChemically unstable silica layers
 Protection of the layer formedProtection of the layer formed

Silicoater MDSilicoater MD (metal dotted(metal dotted))
 Baking of chromium oxide dotted silica layerBaking of chromium oxide dotted silica layer

Rocatec SystemRocatec System
 Introduced in 1989Introduced in 1989
 Tribochemical application of silica layer by sandTribochemical application of silica layer by sand
blastingblasting
 Sand blasting with 110 microns alumina at aSand blasting with 110 microns alumina at a
pressure of 0.25 Mpapressure of 0.25 Mpa
 Sand blasting with 110 microns aluminium oxideSand blasting with 110 microns aluminium oxide
modified with silicic acidmodified with silicic acid
 Speed and accuracySpeed and accuracy
 thermal stressing avoidedthermal stressing avoided

Tin PlatingTin Plating
 Done on noble metal alloysDone on noble metal alloys
 Requires particle abrasion of the alloy surfaceRequires particle abrasion of the alloy surface
 Uses a tin amide solutionUses a tin amide solution

Fiber Reinforced Composite ResinFiber Reinforced Composite Resin
FPDFPD
 Consists of a fibre reinforced substructureConsists of a fibre reinforced substructure
 Veneered with composite materialVeneered with composite material
 Increased flexural strength , fracture resistanceIncreased flexural strength , fracture resistance
& increased tensile strength& increased tensile strength
 TransluscentTransluscent

 GlassGlass
 PolyethylenePolyethylene
 PolypropylenePolypropylene
 carboncarbon
Types Of FibresTypes Of Fibres

Orientation of the fibreOrientation of the fibre
 UnidirectionalUnidirectional
 BraidedBraided
 WovenWoven

Non impregnated materialsNon impregnated materials
 Polyethylene weaves- ribbond & connectPolyethylene weaves- ribbond & connect
 Glass weaves- glasspanGlass weaves- glasspan
 Hand formedHand formed
Pre impregnated & machine formedPre impregnated & machine formed
 Uni directional & woven glass eg vectrisUni directional & woven glass eg vectris
Pre impregnated & hand formedPre impregnated & hand formed
 Uni directional glass eg fiberkorUni directional glass eg fiberkor

ProcedureProcedure
 Preparation of abutment teethPreparation of abutment teeth
 Measurement of fiber lengthMeasurement of fiber length
 Moistening of fiberMoistening of fiber
 Fiber bar pressed into the preparation &Fiber bar pressed into the preparation &
polymerised with resinpolymerised with resin
 Pontic build up & curingPontic build up & curing

Fung shellsFung shells

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

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

of resin bonded prosthesisof resin bonded prosthesis
 Conservation of tooth structureConservation of tooth structure
 Lack of pulpal involvementLack of pulpal involvement
 No anaesthesia requiredNo anaesthesia required
 Minimum periodontal involvementMinimum periodontal involvement

 Simplified impression proceduresSimplified impression procedures
 Improved estheticsImproved esthetics
 Provisionals not usually requiredProvisionals not usually required
 Possibility of rebondingPossibility of rebonding

 IrreversibleIrreversible
 Uncertain longevityUncertain longevity
 No space correctionsNo space corrections
 Good alignment of abutments is requiredGood alignment of abutments is required

 Plaque accumulationPlaque accumulation
 Esthetics compromised on posterior teethEsthetics compromised on posterior teeth
 Incisal grayingIncisal graying
 Dependence on laboratoryDependence on laboratory

IndicationsIndications
 Replacement of missingReplacement of missing
anterior teeth in childrenanterior teeth in children
and adolescentsand adolescents
 Caries free abutmentCaries free abutment
teeth or unrestoredteeth or unrestored
abutmentsabutments
 Mandibular incisorMandibular incisor
replacementreplacement

 Maxillary incisorMaxillary incisor
 Periodontal splintsPeriodontal splints
 Post orthodonticPost orthodontic
stabilisationstabilisation
 Prolonged placement ofProlonged placement of
interim prosthesisinterim prosthesis

 Prolonged placement ofProlonged placement of
interim prosthesisinterim prosthesis
 Single posterior toothSingle posterior tooth
 Significant clinical crownSignificant clinical crown
lengthlength
 Excellent moistureExcellent moisture
controlcontrol

ContraindicationsContraindications
 Parafunctional habitsParafunctional habits
 Long edentulous spanLong edentulous span
 Extensive cariesExtensive caries
 Restored or damaged abutmentsRestored or damaged abutments

 Compromised enamelCompromised enamel
 Nickel sensitivityNickel sensitivity
 Deep vertical overbiteDeep vertical overbite
 Incisors with thin faciolingual dimensionsIncisors with thin faciolingual dimensions

Abutment selectionAbutment selection
 Caries freeCaries free
 Periodontally soundPeriodontally sound
 Adequate thickness of enamelAdequate thickness of enamel
 One abutment on either sideOne abutment on either side

Posterior design principlesPosterior design principles
 Distinct path of insertionDistinct path of insertion
 Proximal resistance formProximal resistance form
 Proximal wrap aroundProximal wrap around
 Maximum bonding areaMaximum bonding area
 Occlusal restOcclusal rest
 Definite gingival marginDefinite gingival margin

 2 plane reduction for maxillary molars2 plane reduction for maxillary molars
 Extension of casting onto occlusal surfacesExtension of casting onto occlusal surfaces
 Lingual cusp coverageLingual cusp coverage
 Onlay on tilted molarsOnlay on tilted molars

Posterior preparation sequencePosterior preparation sequence

Anterior design principlesAnterior design principles
 Vertical path of insertionVertical path of insertion

 Proximal wrap aroundProximal wrap around
 Extension of frameworkExtension of framework
onto uninvolvedonto uninvolved
marginal ridgemarginal ridge
 Definite finish lineDefinite finish line
 Cingulum notches orCingulum notches or
counter sinkscounter sinks
 GroovesGrooves
 Existing restorations mayExisting restorations may
be incorporatedbe incorporated

Anterior preparationAnterior preparation
sequencesequence

Accurate impression procedureAccurate impression procedure
Temporary occlusal stopsTemporary occlusal stops

Framework fabricationFramework fabrication
 Duplication of masterDuplication of master
castcast
 Resin coping fabricationResin coping fabrication

BondingBonding ProcedureProcedure

Resin CementsResin Cements
 Greater cohesive strength 5000-10,000 psiGreater cohesive strength 5000-10,000 psi
 Insoluble in oral fluidsInsoluble in oral fluids
 Higher film thicknessHigher film thickness

Two layer systemTwo layer system
 Unfilled resin monomerUnfilled resin monomer
 Filled resinFilled resin
Commonly used resin cementsCommonly used resin cements
 Epoxylite cba 9080Epoxylite cba 9080
 ComspanComspan
 RetainRetain
 ConcludeConclude
Single paste compositesSingle paste composites

Cements with adhesion promotersCements with adhesion promoters
PANAVIAPANAVIA
ComponentsComponents: low viscosity paste, radio opaque: low viscosity paste, radio opaque
composite resin pastecomposite resin paste
Universal and catalystUniversal and catalyst
Composition :Composition : Bisphenol-A-PolyethoxyBisphenol-A-Polyethoxy
dimetharyclate,dimetharyclate,
MDP orMDP or 10-Methacrloxydecyl dihydrogen10-Methacrloxydecyl dihydrogen
phosphate,phosphate, 77%silanated organic fillers.77%silanated organic fillers.

ED PRIMER:ED PRIMER: A and B liquidsA and B liquids
MDP,HEMA & 5NMSAMDP,HEMA & 5NMSA
OXYGUARD II-OXYGUARD II-
Polyethylene GlycolPolyethylene Glycol
PANAVIA ETCHING AGENTPANAVIA ETCHING AGENT
Phosphoric acid gelPhosphoric acid gel

 Mixing time : 20-30 scesMixing time : 20-30 sces
 Film thickness: 19 micronsFilm thickness: 19 microns
 Metal surface must be sandblasted or tin coated.Metal surface must be sandblasted or tin coated.
 Recent version –Recent version – PANAVIA FPANAVIA F

COMPOSITIONCOMPOSITION: Methylmethacrylate polymer: Methylmethacrylate polymer
powderpowder
Mma liquid modified with 4-META orMma liquid modified with 4-META or
4 Methacryloxyethyl Trimellitic Anhydride.4 Methacryloxyethyl Trimellitic Anhydride.
Tri-n-Butyl Borane catalyst.Tri-n-Butyl Borane catalyst.
DisadvantageDisadvantage-poor hydrolytic stability-poor hydrolytic stability
C&B METABONDC&B METABOND

Post operative carePost operative care
 Regular recall visitsRegular recall visits
 Check for any debondingCheck for any debonding
 CariesCaries
 Periodontal healthPeriodontal health

Longevity and scopeLongevity and scope
The most common resin- bonded prosthesis complications areThe most common resin- bonded prosthesis complications are
shown below.shown below.
Nature of failure No. of prosthesis studied/affectedNature of failure No. of prosthesis studied/affected
Mean incidenceMean incidence
Debonding 7029/1481Debonding 7029/1481 21%21%
Tooth discoloration 343/62Tooth discoloration 343/62 18%18%
Caries 3426/242Caries 3426/242 7%7%
Porcelain fracture 1126/38Porcelain fracture 1126/38 3%3%
Periodontal disease 748/0Periodontal disease 748/0 0%0%

SummarySummary
 Patient selectionPatient selection
 Tooth preparationTooth preparation
 Accurate impressionAccurate impression
 Careful laboratory techniqueCareful laboratory technique
 Use of a good adhesive agentUse of a good adhesive agent

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

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

 Goodacre CGoodacre C..J, Bernad G, et alJ, Bernad G, et al. Clinical. Clinical
complications in Fixed Prosthodontics. J.complications in Fixed Prosthodontics. J.
Prosthet Dent. 2003; 90, 31-41.Prosthet Dent. 2003; 90, 31-41.
 Livaditis G.A.Livaditis G.A. Chemical etching system forChemical etching system for
creating micromechanical retention in resin-creating micromechanical retention in resin-
bonded retainers. J Prosthet Dent 1987; 56,bonded retainers. J Prosthet Dent 1987; 56,
181181
 Salam Sakal M.A et alSalam Sakal M.A et al. Effect of tooth. Effect of tooth
preparation design on bond strengths of RBP.Jpreparation design on bond strengths of RBP.J
Prosthet Dent 1997; 77, 243.Prosthet Dent 1997; 77, 243.

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

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