Anterior Cantilever Resin-bonded Fixed Dental Prostheses a Review of the Literature

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All-Ceramic Resin-Bonded Fixed Denture Prostheses Survival and Complexity Rates: A Review

Bandar Awadh Alresheedi

International Periodical of Dental Sciences and Enquiry. 2020 , viii(6), 143-149. DOI: 10.12691/ijdsr-viii-6-ane

Received October 14, 2020; Revised November fifteen, 2020; Accustomed November 24, 2020

Abstract

This review identified research related to the survival and complication rates of all-ceramic resin-bonded stock-still dental prostheses (RBFDPs) and ranked them according to their quality of enquiry. An electronic search in PubMed, MEDLINE, Science Direct, complemented past a manual search was done. Just clinical (in vivo) studies on all-ceramic RBFDPs with a mean follow-up menses of at least two years or more were included. The critical appraisal skills program (CASP) was used to evaluate the papers and to put accent on their results. Among 140 screened articles, ane randomized controlled trial (RCT), 4 prospective and iii retrospective cohort studies were included in this review. The CASP evaluation showed high-quality for four studies with calculated quality scores, ranging from 90-102.5. The other four studies showed a low-level of calculated scores, ranging from 57.five-seventy. The overall survival rate for all-ceramic RBFDPs was calculated as 94.2%. The calculated annual failure charge per unit was estimated at 1.12%. De-bonding and framework fracture were the virtually common complications. Additionally, all included studies reported all-ceramic RBFDPs in the anterior expanse and were more frequently designed with a cantilever design bonded to ane abutment molar and the polycrystalline ceramic (zirconia) framework material shows good clinical outcomes. To conclude, all-ceramic RBFDPs seem to work best and last longest in the anterior surface area, the framework cloth of choice is zirconia which works better with a cantilever design.

one. Introduction

Missing inductive teeth are a disquisitional upshot from both aesthetic and functional aspects. Missing teeth could occur equally a outcome of some syndromes or every bit a result of traumatic injuries. Teeth could be extracted every bit a effect of deep caries and periodontal diseases. ^{i, 2} The replacement of a single missing tooth has a significant affect on patients to restore both their aesthetic and part. Several treatment options are bachelor to supersede missing teeth such as orthodontic intervention; resin-bonded fixed denture prostheses (RBFDPs), conventional fixed dental prostheses (FDPs) and implants. Still, all the treatment options have advantages and limitations. ^{1, two} The RBFDPs is characterized past several advantages over other treatment options for the replacement of missing teeth. The main advantage is the depression invasiveness compared with FDPs and implants, as no or minimal tooth preparation is needed for RBFDPs. ^three In a laboratory written report, it was stated that 25% to 50% less tooth substance is removed for an RBFDP preparation compared with a conventional full-coverage metallic-ceramic stock-still prosthesis. ⁴ Specifically, RBFDPs preserve tooth structure; and hence, preserve the pulp vitality. ^{5, 6} Finally, the treatment price-effectiveness related to RBFDPs is considerably lower than for conventional FDPs or single-tooth implants. ^vii

Resin-bonded fixed denture prostheses (RBFDPs) are fixed partial dentures that are luted to tooth substance, primarily enamel, which has been etched to provide micromechanical retention for the resin luting cement. ⁸ The plumbing fixtures surface is altered to facilitate a chemo-mechanical bond which is the primary mode of retention for this type of span-work. This surface area of the retainer should exist maximized without compromising the artful appearance of the bridge. In club to achieve this, the retainer tends to be placed on the lingual or palatal aspect of the abutment tooth.

Survival is defined as the RBFDP remaining insitu without de-bonding more than once, for the entire ascertainment period. ^{nine, 10} Failure is defined as the RBFDPs that were lost or required re-fabrication. ^{ix, 10} The survival of RBFDPs is determined by the mechanical properties of the prosthetic materials, the tooth preparation pattern and the quality of the adhesive bond. ^eleven The survival rates of RBFDPs vary widely from 59% to 100%. ^{11, 12} The metal RBFDPs accept shown acceptable survival rates of 87.7%, which was reported in a systematic review over a v-year period. ⁹ The near common cause of failure for RBFDPs was de-bonding. The de-bonding by and large occurred at metal-ceramic RBFDPs made with perforated cast metal framework. The use of a non-perforated cast metal framework improved the poor performance of the RBFDP. Nevertheless, the agglutinative cementation of the metal-ceramic RBFDPs remains a challenge. Overall, the resin bonded treatment pick has considerably increased in recent years. However, long-term survival and complications are withal under investigations. Currently, there is no clear and well-established clinical show regarding the survival and complication rates of all-ceramic RBFDPs in relation to the materials used, the location of the bridge and the pattern of the prosthesis. The aim of this review was to identify the papers related to the survival and complication rates of all-ceramic RBFDPs and rank them co-ordinate to the quality of the research and to draw a clear conclusion for the survival and complexity rates of all-ceramic RBFDPs after a mean observation written report period of at least 2 years or more.

2. Materials and Methods

ii.1. Report Selection

An initial electronic search on Pub-Med, MEDLINE and Science Directly. The review of research was conducted from January 2000 to June 2020 for English language language articles published in the dental literature, using the keywords "resin-bonded bridge'', or "Maryland bridge'', or "adhesive'', or "metal-free bridge'', or "all-ceramic resin-bonded bridge", or "zirconia resin-bonded span" and "survival" and "survival rate" and "complication charge per unit". Thereafter, the articles were obtained and screened for possible inclusion and exclusion criteria.

Longitudinal prospective and retrospective clinical studies (in vivo) (randomized controlled trials, controlled clinical trials and cohort studies) reporting data with regards to the outcome of treatment with different all-ceramic RBFDPs were accepted for inclusion. In contrast, case studies and clinical reports were excluded. Studies with a mean follow up of two years or more than were included while studies with a mean follow up of less than 2 years were excluded. In improver, studies which included at least ten patients at review were included. Furthermore, this review was augmented past a manus search of the bibliographies of the selected papers for additional papers on the subject. Only articles published within the last 20 years (1997-2017) were included in gild to obtain a review of the current materials of all-ceramic RBFDPs. The studies which were chosen for the review had to include information on survival and complication rates Table i.

• Table 1. Table to show the inclusion and exclusion criteria of the literature research

  

An initial literature search was conducted and afterwards refined to yield disquisitional articles for further evaluation. The articles were then rated in terms of study type and risk of bias to determine what accent might exist placed on particular elements of the bachelor literature, thus identifying the strongest evidence for whatsoever outcomes reported.

2.2. Focused Questions

1. How can the identified papers be ranked according to the quality of the research undertaken and therefore, the emphasis placed on the results?

2. What are the survival and complication rates of all-ceramic RBFDPs later a hateful observation study catamenia of at to the lowest degree ii years or more? More precisely, what are the influences of differing all-ceramic materials, location of the span-work (maxilla, mandible, anterior, posterior) and, the number and organisation of retainers (one, ii or multiple / cantilever or fixed) on the survival and complexity rates of all-ceramic RBFDPs after a mean observation report period of at least two years or more?

2.iii. Search Strategy

The MeSH terms were used as follows:

one. Search ((((zirconia) OR "All ceramic")) AND (("resin bonded bridge") OR "RBFDP")) AND ((("Success charge per unit") OR "Failure rate") OR "Complication rate").

2. Search ((((("resin bonded bridges") OR "acid etched bridge") OR "Maryland bridge")) AND ((("ceramics") OR Zirconium) OR Zirconia)) AND (("failure rate") OR "survival Rate").

2.4. Critical Evaluation

Even though a written report has been published in a well-known periodical or was written by a well-reputed person, this is non in itself an indication of its reliability and relevance. The Critical Appraisal Skills Programme (CASP) was used to evaluate the papers and to put accent on their results. ^thirteen CASP approaches to inquiry in three steps. First, the study'south validity is assessed to make up one's mind whether the study was unbiased by evaluating its methodological quality. Second, in looking at the results, we consider whether the study's results are clinically relevant. In the final step, we recall near how to apply these results to a patient or population.

The eight studies were evaluated past 11 questions. Some questions were modified to exist appropriate to the report, and some questions needed further sub-questions to make them more precise for the evaluator. For example, the starting time question of CASP was, "Did the study address a clearly focused outcome?" In social club to be more advisable, the question was modified to, "Were the outcomes of the study articulate? what did the study evaluate?" This question then needed some sub-questions in relation to the report issue to help in evaluation, such as success charge per unit, survival rate and failure rate. A scoring system was created to find the highest level of evidence to rely on in this study, and it was ranged between 0-110. Every question was worth 10 grades for "Yes", five grades for "Not articulate" and a zilch form for "No". Then, the traffic calorie-free coloured system was used to make information technology simple and clear for the reader, greenish for "Yes", yellowish for "Non articulate" and crimson for "No".

3. Results

140 publications were identified through database research equally potentially relevant to the review (Figure 1). Later on reviewing the titles and the abstracts, ninety manufactures were discarded as not related to the nowadays review and 50 full-text articles were obtained. Afterwards the inclusion and exclusion criteria were practical, 43 articles were eliminated, leaving 7 articles for concluding cess. Ane commodity was eliminated as at that place was no total-text available in the English language language. Finally, hand inquiry in bibliographies was applied, and two farther manufactures were obtained.

iii.1. Included Studies

Eight studies were selected, the oldest report was published in 2011, the nigh recent study was published in 2017, and the median twelvemonth of publication was 2014. I study was a randomized control trial, while four of the studies were prospective, and three were retrospective-cohort studies Table ii. ^{14, fifteen, 16, 17, 18, 19, 20, 21} The bias and quality of the RCT and cohort studies were evaluated by the Disquisitional Appraisal Skills Program. The CASP evaluation showed high-quality for 4 studies with a calculated quality score ranging from 90-102.5. The other four studies showed a low-level of calculated score ranging from 57.5-70.

• 

• Figure 1. Flowchart to demonstrate the progress of the study and the numbers of papers identified

• Table 2. Table to show the included studies with twelvemonth of publication and the type of report

  

The included studies had a total of more than 283 patients, with 344 all-ceramic RBFDPs. The proportion of patients with all-ceramic RBFDPs who were lost to follow-up during the study period was bachelor for simply 2 of the eight studies. The shortest study mean observation catamenia was 4.44 years, while the most extended mean observation catamenia study was 15.seven years. Seven studies were reported on anterior all-ceramic RBFPDs while merely one study reported on posterior all-ceramic RBFDPs. In improver, the blueprint of the all-ceramic RBFDPs was more often than not a cantilever blueprint (reported in 6 studies), while a stock-still-fixed blueprint was used in 1 written report and i study used both designs (cantilever & stock-still-stock-still). Furthermore, 4 studies used glass-ceramic material, and four other studies used polycrystalline (zirconia) ceramic CAD/CAM material. Most of the studies made conservative preparations on abutments, although, ane report applied the all-ceramic RBFDPs direct without any preparation for anterior abutments and minimal inlay tooth preparation for posterior abutment teeth. The most prevalent bonding system used in the eight studies was Panagia 21 TC.

3.two. Survival Rate

All viii studies reported the survival and complexity rates of the all-ceramic RBFDPs. The results showed 5 studies reported between 98% and 100% survival rates while three studies reported between 92.half dozen% and 95.4%. The one study which reported a fixed-fixed design demonstrated a 67% survival rate. An overall survival rate for all-ceramic RBFDPs was calculated as 94.2% (95% CI: 67.three-100%) (Tabular array 3).

3.3. Failure

In total, 21 out of 344 all-ceramic RBFDPs were known to be lost or had de-bonded more than once. The calculated almanac failure rate was estimated at i.12% (95% CI: 0.half-dozen-2.20%) (Tabular array 4).

• Tabular array 3. The number of patients, the mean follow-up, the cloth used in the written report, the design of the retainer, the location of the missing teeth and the survival charge per unit of the all-ceramic RBFDPs

  

• Table 4. The total number of RBFDPS (A), number of failure (B), the mean follow-up (C), the exposure time (D), the estimated almanac failure charge per unit (F) and the mode of failure. The failure rate was calculated by dividing the number of failures in the numerator by the total exposure fourth dimension (RBFDP fourth dimension or abutment time) in the denominator

  

3.4. Biological Complications
three.4.1. Dental Caries & Periodontitis

Simply i study with a full of 42 abutment teeth, reported the incidence of caries. ¹⁴ This occurred in but one abutment, which was restored with a composite restorative material. Periodontitis was reported as a possible complication in two studies, simply no actual cases were reported Table four.

3.4.two. Loss of Vitality of Abutment Teeth

In all the eight studies, there was no reported loss of vitality of abutment teeth; hence statistical analysis was not possible Table iv.

iii.iv.3. Abutment molar Fracture

Abutment fracture was non reported in whatsoever written report. One study reported rotation in one abutment, which was de-rotated using a thermoformed splint Table 4. ^xix

iii.5. Technical Complications
iii.5.i. De-bonding (Loss of Retention)

De-bonding was the almost frequent technical complication of all-ceramic RBFDPs. It was addressed in five of the eight studies. It was not reported in 3 studies. De-bonding was generally reported in studies which used polycrystalline (zirconia) material. But one study that used glass-ceramic cloth reported two de-bonded RBFDPs out of 54 all-ceramic RBFDPs Table 4.

iii.6. Material Complications
three.6.1. Framework Fracture and Veneer Chipping

Framework fracture was the second nigh frequent complication of all-ceramic RBFDPs. Information technology was reported in iii studies and was related to the all-ceramic framework material. There were no fractures reported when polycrystalline (zirconia) framework fabric was used. Veneer chipping was also some other complication which was reported in two studies. Veneer chipping was establish in both glass-ceramic (east. max) and polycrystalline (zirconia) fabric Table iv.

3.vi.2. Patient Satisfaction

Patient satisfaction with aesthetics and function was reported but in one study. ^xviii In that location was just one patient out of 49 who was unsatisfied. This was due to a large edentulous infinite in the upper anterior area, which could not be replaced by but one pontic to produce a symmetrical appearance.

4. Discussion

The subject of all-ceramic RBFDPs has been selected equally a sub-set of RBFDPs in general. This is a relatively new area of RBFDP treatment, and the volume of literature is therefore smaller. A brief literature search for all-ceramic RBFDPs identified 140 articles published in this area over the past 20 years. However, post-obit the application of inclusion and exclusion criteria, only 8 articles were identified for this review. The evaluation of quality was developed and applied in an attempt to rank the papers in terms of their bias and the emphasis that might be placed on their results. At that place are three systematic reviews ^{half dozen, ix, 10} for RBFDPs, but only one for all-ceramic RBFDPs. ²²

The results of this review demonstrated a lack of clinically-useful prove studies to indicate the superiority of one material of all-ceramic over another, and a lack of evidence to demonstrate the effect of the position within the mouth on the success of such bridge-work of all-ceramic RBFDPs. In improver, at that place is a lack of evidence to suggest which design of all-ceramic bridge-work was the most successful, although lower success rates for fixed-fixed were reported compared with a cantilever pattern. Finally, there is a lack of evidence to suggest that the cementation agent makes a meaning difference in all-ceramic RBFDPs survival. There appeared to be no prove in relation to occlusal factors on the survival rate of all-ceramic RBFDPs. Overall, from the express numbers of studies available, all-ceramic RBFDPs would appear to testify a reasonable survival rate in the medium term (two years or more). Therefore, clinicians might be advised to ensure their placement using cantilever design, in a low occlusal stress situation and with composite luting cement. These results are consequent with the systematic review published. ²²

The CASP evaluation showed a high-quality for 4 studies with calculated quality scores ranging from 90-102.5. The other four studies showed a low-level of calculated scores ranging from 57.5-70. Fifty-fifty though there were loftier-quality studies, at that place were no meaning differences in all-ceramic RBFDPs survival rate between the two groups.

The overall survival rate of all-ceramic RBFDPs in the papers reviewed in this review was 94.2% (95% CI: 67.3-100%) based on the eight included studies reporting on 344 all-ceramic RBFDPs. This is higher than compared with a 5- yr survival rate in a previous systematic review ²³ of 91.4 (95% CI: 86.7- 94.4%) based on xviii studies with 1755 RBFDPs. Even so, the systematic review by Thoma et al. included other framework materials such equally all-ceramic and fibre reinforced composite. ¹⁰

This review showed unlike material combinations experience different complications. The main problem with glassy ceramic RBFDPs is framework fracture. Just relatively few glass-ceramic RBFDPs are lost due to de-bonding. 2 studies reported this, one written report using a glass-ceramic material framework reported no de-bonding but a high incidence of RBFDPs failure due to material framework fracture. ¹⁴ Another study using the drinking glass-ceramic cloth framework besides reported no de-bonding but a relatively high rate of covering aesthetic feldspathic porcelain veneer fractures. ^sixteen On the other paw, polycrystalline ceramic (zirconia) fabric shows less frequency of framework fracture but a moderately higher incidence of de-bonding. Hence, even though polycrystalline ceramic RBFDPs showed a significantly college survival rate than the drinking glass-ceramic, there is still the issue of de-bonding.

The result with all-ceramic RBFDPs was likewise investigated regarding the position in the oral cavity. From the limited studies available, seven studies reported on all-ceramic RBFDPs in the anterior area of the rima oris, whereas only 1 written report reported on all-ceramic RBFDPs to supercede both the inductive and the posterior teeth. The survival rate was similar in both areas, but a minor complication was reported for the posterior area, which was chipping the framework of the veneering porcelain. In a previous systematic review, the incidence of de-bonding charge per unit was reported to be higher in the posterior expanse compared with the anterior area, although, information technology was at the margin of statistical significance (p = 0.056). ²³

Recently, all-ceramic RBFDPs are more frequently designed with cantilever blueprint bonded to one abutment tooth, instead of using stock-still-fixed design. In the eight papers identified for this review, the cantilever design was used in six studies, whereas the fixed-fixed blueprint was only used in one study, and one study used both designs. The thought backside the cantilever design is to minimize the number of prostheses de-bonding, which is induced by the differential movement of the abutment teeth in different directions under functional loading. The cantilever blueprint showed a amend clinical outcome compared with fixed-fixed design; the survival rate was approximately 95-100% using the cantilever blueprint compared with the fixed-fixed design which showed a survival rate of between 67.3% and 92.6%. Two published systematic reviews have likewise reported that the cantilever design showed significantly college survival rates and significantly lower de-bonding rates than the fixed-fixed design. ^{9, 23}

Overall, despite limitations of information and knowledge in the present review, all-ceramic RBFDPs seem to work best and last longest in the anterior surface area, and the framework fabric of choice appears to be zirconia which works improve with a cantilever design.

5. Determination

The all-ceramic RBFDPs appeared to provide an effective-curt to medium term (ii years or more than). The factors influencing the outcomes of the all-ceramic RBFDPs were the location in the mouth, the design of the all-ceramic RBFDPs, and the selection of framework textile. The present review has illustrated that the all-ceramic RBFDP exhibited the best outcomes in the anterior regions, with a cantilever design and when fabricated of zirconia-ceramic. However, the level of testify was low, and there is a strong need for boosted studies in the surface area of all-ceramic RBFDPs with well-established randomized control trials and cohort studies.

Financial Back up and Sponsorship

Nil.

Conflicts of Interest

At that place are no conflicts of interest.

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Published with license past Science and Educational activity Publishing, Copyright © 2020 Bandar Awadh Alresheedi

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Bandar Awadh Alresheedi. All-Ceramic Resin-Bonded Fixed Denture Prostheses Survival and Complication Rates: A Review. International Periodical of Dental Sciences and Research. Vol. 8, No. 6, 2020, pp 143-149. http://pubs.sciepub.com/ijdsr/eight/6/1

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Alresheedi, Bandar Awadh. "All-Ceramic Resin-Bonded Fixed Denture Prostheses Survival and Complication Rates: A Review." International Journal of Dental Sciences and Research eight.6 (2020): 143-149.

APA Style

Alresheedi, B. A. (2020). All-Ceramic Resin-Bonded Fixed Denture Prostheses Survival and Complication Rates: A Review. International Journal of Dental Sciences and Enquiry, viii(6), 143-149.

Chicago Style

Alresheedi, Bandar Awadh. "All-Ceramic Resin-Bonded Fixed Denture Prostheses Survival and Complication Rates: A Review." International Journal of Dental Sciences and Research 8, no. 6 (2020): 143-149.

• Sections
• Figures
• Tables
• References

• Abstract
• i. Introduction
• ii. Materials and Methods
• 3. Results
• iv. Discussion
• 5. Decision
• Financial Support and Sponsorship
• Conflicts of Interest
• References

• Effigy ane. Flowchart to demonstrate the progress of the study and the numbers of papers identified

  

• Table 1. Table to testify the inclusion and exclusion criteria of the literature research

  

• Table 2. Table to show the included studies with year of publication and the type of study

  

• Table iii. The number of patients, the hateful follow-upwards, the material used in the report, the design of the retainer, the location of the missing teeth and the survival rate of the all-ceramic RBFDPs

  

• Table 4. The total number of RBFDPS (A), number of failure (B), the hateful follow-upwards (C), the exposure fourth dimension (D), the estimated annual failure rate (F) and the mode of failure. The failure rate was calculated by dividing the number of failures in the numerator by the total exposure time (RBFDP time or abutment time) in the denominator

  

[1]	Zitzmann NU, Ozcan 1000, Scherrer SS, Buhler JM, Weiger R, Krastl G. Resin-bonded restorations: a strategy for managing anterior tooth loss in adolescence. J Prosthet Dent 2015; 113: 270-276.
	In article		View Article  PubMed
[two]	Terheyden H, Wusthoff F. Occlusal rehabilitation in patients with congenitally missing teeth-dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth-a systematic review. Int J Implant Dent 2015; 1: thirty-39.
	In article		View Commodity  PubMed
[3]	Cheung GS, Lai SC, Ng RP. Fate of vital pulps beneath a metal-ceramic crown or a bridge retainer. IntEndod J 2005; 38: 521-530.
	In commodity		View Article  PubMed
[4]	Edelhoff D, Sorensen JA. Tooth structure removal associated with diverse training designs for posterior teeth. Int J Periodontics Restorative Dent 2002; 22: 241-249.
	In article
[5]	Howard-Bowles E, McKenna Chiliad, Allen F. An evidence based approach for the provision of resin-bonded bridgework. Eur J ProsthodontRestor Dent 2011; 19: 99-104.
	In article
[six]	Miettinen G, Millar BJ. A review of the success and failure characteristics of resin-bonded bridges. Br Dent J 2013; 215: E3.
	In article		View Article  PubMed
[seven]	Bragger U, Krenander P, Lang NP. Economic aspects of single-tooth replacement. In: Clin Oral Implants Res. Kingdom of denmark; 2005. p. 335-341.
	In article		View Article  PubMed
[eight]	The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent 2017; 117: e1-e105.
	In commodity		View Article
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