Types of Bridge Failure

8/9/2019 Types of Bridge Failure

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COMMON PROBLEMSIN FIXED

PROSTHODONTICS

BY:

Jennifer Bantang

Ramarie Dick!n

"ia De#$an

Ja#ia% La&a'


2/80

Manifetati!n !f

Fai#(re Pain Inability to function

Dissatisfaction with esthetics Broken teeth and/or restoration Inammatory swelling

Bad taste Bad breath

Bleeding gums

Anxiety


3/80

Ca(e !f Fi)e* Pr!t%eiFai#(re

Improper case selectionFaulty diagnosis and

treatment plan Inaccurate clinical or

laboratory proceduresPoor patient care and

maintenance following

insertion


4/80

T'$e !f Bri*ge Fai#(re

! "ementation failure

#! $echanical failure

%!&ingi'al and periodontalbreakdown

(! "aries

)! *ecrosis of pulp+! Biomechanical failure

,!-sthetic failure


5/80

+, CEMENT-TIONF-IL.RE

"ementation failures can bebroadly di'ided into.

! "ement Failure

!# etention Failure

!% 0cclusal Problems

!( Distortion of FPD


6/80

+,+ Cement Fai#(re

Ca(e !f cement fai#(re

1"ement selection#1 0ld cement

%1Prolonged mixing time

(1 2hin mix

)1 "ement setting prior to seating


7/80

+,+ Cement Fai#(re

Ca(e !f cement fai#(re

+1 Inade3uate isolation,1 Incomplete remo'al of

temporary cement

41 2hick cement space

51 Inclusion of cotton 6bers

71 Insu8cient pressure


8/80

"ingi/a# Recei!n *(e t! E)ceCement N!t Rem!/e*


9/80

+,0 RETENTION F-IL.RE

C-.SES FOR RETENTIONF-IL.RE

1 -xcessi'e taper

#1 9hort clinical crowns%1 $is:6t

(1 $isalignment


10/80

Tr!(e %!!ting

In case of excessi'e taper.

a! Incorporation of proximalgroo'es!

b! Additional retenti'e groo'es

;should be along with the path ofinsertion1!

c! Additional pins


11/80

Tr!(e %!!ting

In case of short crowns.

a! "rown lengthening procedure

b! $odi6cation of supra:gingi'almargin to sub:gingi'al margin

c! Additional retenti'e groo'es

and proximal box

d! Incorporation of pins

e! Addition of extra abutments


12/80

Mi1t

De6ned as.

! Internal gap

#! $arginal gap%! ontal marginal discrepancy

)! 0'er:extended margin

+! ?nder:extended margin


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Ca(e f!r mi1t

a! -xpansion of the metalsubstructure

b! Improper water / powder ratio

c! Improper mixing time

d! Improper burnout temperaturee! Distortion of the margins

;towards the tooth surface1


14/80

Ca(e f!r mi1t

f! Distortion of the metalsubstructure

g! $etal bubbles in occlusal ormarginal regions

i! Inade3uate 'acuum duringin'esting

ii! Improper brush techni3ue

iii! *o surfactant


15/80

Ca(e f!r mi1t

i! -xcessi'e oxide layer formationin inner side of the retainer ;due

to contaminated metal orrepeated 6ring of porcelain1

@! 2ight contact points

k! 2hick cement spacel! Insu8cient pressure during

cementation procedure


16/80

.n*er2e)ten*e* Margin


17/80

Mia#ignment

Ca(e f!r mia#ignment

a! Abutment displacement due toimproper tempori>ation!

b! Distortion of wax pattern whilesprueing and in'esting!

c! "asting defects!

d! Distortion of metal frameworks inporcelain 6ring!

e! Porcelain ow inside the retainers!


18/80

Mia#ignment


f! $isalignment of soldering

points!

g! Insu8cient pressure incementation!

h! 2hick cement 6lm!


19/80

Mia#ignment


i! -xcessi'e metal or porcelain in

tissue surface ;ridge lap1 of ponticpre'ents the proper seating of FPDand open margin ;can be detected

by obser'ing the blanching of thetissue or patient may complain ofpressure on the pontic region1!


20/80

+,3 OCCL.S-L PROBLEMS

Ca(e in !cc#(a# $r!em

! Immediate problems

¬ 0cclusal interference¬ $arginal ridges at dierent le'els

¬ 9upra eruption of the opposing

tooth¬ Parafunctional habits


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#! Delayed problems

¬ earing of occlusal surface¬ Coss of occlusal contacts

¬ Perforation of occlusal surface

due to

Porcelain


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¬ Food lodgment due to plunger cusp

¬

Fracture of facing due to defecti'eocclusal contact

¬ Periodontal or gingi'al breakdown

due to improper occlusal contacts¬ 2enderness due to food lodgment


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Occ#(a# Pr!em


24/80

+,4 DISTORTION OF FPD

Ca(e f!r fai#(re in margina#integrit'.

1 Bending of FPD ;wax patterns andmetal substructure1

In waxing stage

emo'al from the die

9pruing stage

In'esting stage ;thick mix ofin'estment distort or displace the wax

pattern1


25/80



#1 Incomplete casting

ax patterns too thin

Incomplete wax elimination "old mold or melt

Inade3uate metal


26/80



%1 ough casting Improper 6nishing of wax pattern

-xcess surfactant

Improper water powder ratio -xcessi'e burnout temperature

Improper de'esting ;direct hit on themetal framework1


27/80



(1 Bending of long span FPDs 2hin crown

9oft metal

=eat treatment not being done

Porosity in the metal

Distortion of the metal substructureduring the porcelain 6ring

"ontaminated metal


28/80

0, MECH-NIC-L F-IL.RES

C#ai1cati!n !f mec%anica#fai#(re

! etainer failure

#! Pontic failure%! "onnector failure


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0,+ RET-INER F-IL.RE

1 Perforation

#1 $arginal discrepancy%1 Facing failure Fractureearing Discoloration


30/80

+5 Perf!rati!n Ca(e

a1 Insu8cient occlusal reduction

b1 Insu8cient occlusal material

c1 =igh points in opposingdentition ;plunger cusp1

d1 Premature contactse1 "ontaminated metal


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+5 Perf!rati!n Ca(e

f1 Porosity in metal work ;subsurfaceEback pressureE suck back1

g1 Due to improper meltingtemperature

h1 Improper pattern position

i1 Improper sprue ;too thin1

@1 Improper location

k1 Parafunctional habits


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05 Margina# *icre$anc'

Ca(e

a1 9election of margin

b1 Improper preparation and failureto establish the margin properly

c1 Failure to do gingi'al retraction

pre'ents de6nite margin locationand subse3uently in impression


33/80


Ca(e

d1 9election of the impressionmaterial

i! 9hrinkage in material ;condensationsilicon1

ii! Distortion of material ;alginate1

e1 Improper impression procedures

f1


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Ca(e

g1


35/80


Ca(e

l1 *odules in margins and inner side ofcoping

i! Due to inade3uate 'acuum duringin'esting

ii! Improper brushing techni3ue

iii! *o surfactantm1 -xcessi'e sand blasting

n1 Distortion due to degassing procedure


36/80


Ca(e

o1 0pen margins due to porcelain

shrinkage ;opa3ue porcelain1p1 2hick cement

31 "ement setting prior to seating

r1 Insu8cient pressure applicationduring cementation


37/80

L!!ene *(e t! Margina#Dicre$anc'


38/80

3, Facing fai#(re T'$e !f /eneerfai#(re

T'$e !f /eneer fai#(re

a1 Fractureb1 earing of facing ;resin

'eneers1c1 Discoloration


39/80

Ca(e f!r /eneer fract(re:

i! 2oo little retention ;mechanical1

ii! Badly designed metal protection

iii! Deformation of the protecting metal

i'! $alocclusion

'! $icro:leakage between metal andfacing

'i! Improper curing or fusing techni3ue

'ii!-xcessi'e oxide layer formation


40/80

Pr!t%ei Fract(re


41/80

Ca(e !f 6earing !f facing:

i! Improper curing or fusingtechni3ue

ii! Deep bite ;decreased o'erbitein lower anteriors1

iii!Acrylic 'eneering opposing

porcelain teethi'! Faulty brushing techni3ues and

ossing

'! Parafunctional habits

Occ#(a# 7ear !n


42/80

Occ#(a# 7ear !nO$$!ing T!!t%


43/80

Ca(e !f *ic!#!rati!n:

i! Absorption of oral uids

ii! Absorption of arti6cial food colouringagents through micro:cracks or

microleakage in metal and facinginterfaces

iii! 2arnish of underlying metal and facing

;greening of porcelain in sil'er alloys1i'! $icro:cracks due to malocclusion


44/80

0,0 PONTIC F-IL.RE

Fact!r a8ecting e#ecti!n an* fai#(re !f$!ntic

1 Pontic space

#1 esidual ridge contour%1 Biological consideration

a! idge relation

b! Dental pla3uec! &ingi'al surface of pontic ;"ontact with

mucosa1

i! $ucosal contact

ii! *on mucosal contact


45/80

0,0 PONTIC F-IL.RE

Fact!r a8ecting e#ecti!n an* fai#(re!f $!ntic

(1 Pontic ridge relationship

)1 Pontic material

+1 Biocompatibility

,1 0cclusal forces

41 $etal substructure support


46/80

0,3 CONNECTOR F-IL.RE

Ca(e f!r c!nnect!r fai#(re

a! Improper selection of connector

b! 2hin metal at the connector

c! Incorrect selection of solder

d! 9older gap narrow or wide

e! Porosity

f! Insu8cient metal aroundg! Defecti'e occlusal contacts o'er thin

connectors

3 "IN"I9-L -ND PERIODONT-L


47/80

3,"IN"I9-L -ND PERIODONT-LPROBLEMS

2here are three locations inwhich to prepare crown

margins.! 9upragingi'al

#! At the crest of the gingi'a

%! 9ubgingi'a

S.PR-"IN"I9-L


48/80

S.PR-"IN"I9-LM-R"INS

AD


49/80

S.PR-"IN"I9-LM-R"INSDI9AD


50/80

S.B"IN"I9-L M-R"INS

AD


51/80

S.B"IN"I9-L M-R"INS

DI9AD


52/80

SOFT TISS.E PROBLEMS

! &-*-ACIG-D ;*ot due to

bridge1

#! C0"ACI9-D ;$ay be due to

bridge1


53/80

Ca(e f!r !ft ti(e $r!em

! 0'er / under contouring

#! *arrow embrasures

%! 0'er / under extended crowns(! Pressure of pontic o'er tissue

)! Coss of contact

+! =ori>ontal food impaction due toplunger cusp in the opposing arch


54/80

Ca(e f!r !ft ti(e $r!em

,! $arginal ridges at dierentle'els

4! ide occlusal table5! 2rauma from occlusion

7! Parafunctional habits

! Acrylic facing in contact withgingi'a


55/80

Peri!*!nta# Break*!6n

RES.LTS OF IMPROPER CONT-CT


56/80

RES.LTS OF IMPROPER CONT-CT-RE-S

! "ause displacement of teethbucallyE linguallyE mesially anddistally!

#! -xert a lifting force on the toothwhen placed too high occlusally!

%! Disturb the axial relation of theteethE resulting in trauma!

(! "ause rotation of the teeth!

RES.LTS OF IMPROPER CONT-CT


57/80

RES.LTS OF IMPROPER CONT-CT-RE-S

)! "ause in@ury to the in'estingstructures by excessi'ely openingor closing the contact and

interproximal embrasures!

+! Disturb the coordination of theinclined planes and cusps causing

deecti'e occlusal contacts!

,! "ause 'ertical or hori>ontal foodimpaction!


58/80

O9ER EXTENDED CRO7N

2he o'er extended crown usually encroachesbeyond the cut of the preparation on the toothand the excess beyond the margin of thepreparation is usually not in contact with the

tooth surface! 2his o'erhang impinges thegingi'al tissueE irritates and often causes edemaand proliferation of the gingi'al tissueE destructionof the marginal al'eolar bone and ultimate loss of

the tooth! 2he o'erextension of the crown isusually due to inaccurate techni3ue and / or thedentists desire to Hplay safe by making it longenough to co'er the preparation or to extendbeneath the gingi'al margin!

Inammati!n !f "ingi/a *(e t! O/er


59/80

Inammati!n !f "ingi/a *(e t! O/erE)ten*e* Margin !f Cr!6n


60/80

SHORT CRO7N

2he short crown fails to co'er the cutsurface of the prepared tooth and oftendoes not extend below the gingi'al

margin! 2his unco'ered ground toothsurface is often sensiti'e to sweets andto temperature changes and in'itesde'elopment of caries and causesgingi'al irritation! AlsoE it is usually dueto inade3uate techni3ue and awillingness of the dentist to accept

impressions that are incomplete!


61/80

CRO7N CONTO.R

2he poorly contoured crown is one whichmay ha'e an excess contour that impingeson the gingi'al tissue and deects food

o'er and away from this tissueE therebydepri'ing it of its normal stimulationJ or itmay be under contoured and permit theimpaction of food into the gingi'al cre'iceE

thereby stripping the gingi'al tissue awayfrom the tooth! -ither will cause irritation ofthe surrounding tissue and may lead to theloss of the tooth!

Ina*e;(ate Inter*enta# an*


62/80

Ina*e;(ate Inter*enta# an*Em&ra(re S$ace

C S


63/80

4, C-RIES

! Iatrogenic ;dentists role1

Failure to identify caries Incomplete remo'al of cariesough abutment 6nishing

margins9ubgingi'al marginal placement

in inaccessible areas or regions

C-.SES

4 C-RIES


64/80

4, C-RIES

! Iatrogenic ;dentists role1Burning of root dentin or cementum

in electro surgical techni3ue ;leadsto damage or rough surface andcauses pla3ue retention1

0'erhanging marginsough margins of crowns or bridges

C-.SES

4 C-RIES


65/80

4, C-RIES


0'er contouring of the cer'icalthirds of crowns or bridgespre'ents the physiologic too

cleaning by tongue or muscles$arginal discrepancy 2hick cement space in margins

leads to cement dissolution!

C-.SES

4 C-RIES


66/80

4, C-RIES


*arrow embrasures;inaccessibility to maintainhygiene1

ide connectorFailure to moti'ate or educate

the patient about oral hygiene

C-.SES

C-.SES


67/80

C-.SES

#! Patient role9ystemic factors

KerostomiaDue to radiation therapyDrug induced-ndocrine disorders-pilepsy ;di8cult to maintain the

oral hygiene1

C-.SES


68/80

C-.SES

#! Patient roleheumatoid arthritis

Cocal factors Improper brushing and ossingDietary habitsFailure to understand importance

of oral hygiene!

C i -& t t


69/80

Cari!( -&(tment

< P.LP DE"ENER-TION


70/80


71/80

P(#$ In=(r'

> BIOMECH-NIC-L F-IL.RE


72/80

>, BIOMECH-NIC-L F-IL.RE

Failure to withstand constantor increasing occlusal load

due to inade3uate in crown:root ratio E pericementalareaE and number of

abutment tooth use

? ESTHETIC F-IL.RES


73/80

?, ESTHETIC F-IL.RES

Failure to identify patientexpectations regarding esthetics

Improper shade selection-xcessi'e metal thickness at

incisal and cer'ical regions

2hick opa3ue layer application9urface blistering ;chalky

appearance1

? ESTHETIC F-IL.RES


74/80


0'er gla>ing or too smooth asurface

$etal exposure in connectorE

cer'ical and incisal regionsDark space in cer'ical third due to

improper pontic selection ;anteriors1Failure to produce incisal and

proximal translucency Improper contouring

? ESTHETIC F-IL.RES


75/80


Failure to harmoni>e contralateral tooth morphology

"ontour"olorPosition

AngulationDiscoloration of facing

Inc!rrect S%a*e


76/80

Inc!rrect S%a*e


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7%en t%e $r!gn!i i


78/80

7%en t%e $r!gn!i i;(eti!nae @@@

2he methods used to facilitatere:treatment are.

?se of temporary cementDesign of prosthesis for

possible future addition 2he placement of a rest seat

for possible future use


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7%en t%e $r!gn!i i


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7%en t%e $r!gn!i i;(eti!nae @@@

2he methods used to facilitatere:treatment are.

ecording of cement usedetention of working casts and

pro'isional restorations

Types of Bridge Failure

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