Five-year survival of 3-unit fiber-reinforced composite fixed partial dentures in the posterior area
Introduction
The fixed partial denture (FPD) is a treatment modality offering tooth tissue conservation together with lower treatment costs. In a recent meta-analysis, the resin bonded FPD fabricated with a metal framework showed an estimated survival rate of 87.7% after 5 years [1]. Complications like debonding of the framework from the luting cement were frequent and have been related to the unsatisfactory surface treatment of the metal alloy, due to difference in thermal expansion with regard to resin composite luting cements and the rigidity of the metal framework [2]. Moreover, esthetic considerations may be a drawback. It is expected that fiber-reinforced composite (FRC) FPDs may provide an improved adhesive performance, because the material of the construction is similar to the luting material and FRC constructions are less rigid.
FRCs have recently been developed for dental applications and various types of fibers and fiber-products have been tested as reinforcing materials. Glass fibers are most often used because of their ability to withstand tensile stress and to prevent crack propagation in resin composite materials, and their esthetic character [3], [4]. Substantial improvements in flexural strength, fracture toughness and elastic modulus have been achieved in dental resin composites reinforced with fibers [5]. The development of fiber products available for dental use has led from plain fibers to pre-impregnated fibers and finally fully resin impregnated fibers.
The retainer designs of an FRC prosthesis can be either full-coverage or partial coverage types, depending on the condition and amount of remaining sound tissue of the abutment teeth. The freedom in design of the FPD allows a tooth-conserving preparation when the abutment teeth are unrestored or have modest restorations. Fibers in the bridge construction run from the retainer at one end to the other, are preferably located in the tension side of the bridge and are completely covered by resin composite material. In addition, an FRC FPD can be fabricated either directly in the mouth or indirectly by a dental technician.
Two systematic reviews of all commercially available FRC products without discrimination between type of retainers or fabrication technique have been published [6], [7]. In both studies a limited number of published clinical studies was found, all of relatively limited duration, and few of the reported commercial products demonstrated robust clinical documentation to support their use. Problems specifically associated with a commonly used system include fractures of the veneering composite [8], [9], [10], but also wear [8] and discoloration [10] have been observed. Consequently, there is a need for data on other systems, preferably based on trials of longer duration.
In a recent study we reported 5-year follow-up data of three-unit anterior FRC FPDs, made of manually resin impregnated glass-FRC, which were placed in three academic centers in Finland, the Netherlands and Sweden [11]. The purpose of the present study was to evaluate the long-term clinical outcome of three-unit FRC FPDs, but now applied in the posterior area. The FRC material was identical and all FPDs were indirectly made. Minimum service time was 4.5 years and design factors influencing survival were identified. Studies on metal resin-bonded FPDs showed lower survival rates in the posterior than in the anterior region, thus we expect that the survival rate of FRC FPDs shows the same difference.
Section snippets
Materials and methods
Between April 1998 and September 2002, 77 patients (52 females, 25 males) of the departments of Oral Function and the Centre of Special Dental Care of the Radboud University of Nijmegen (the Netherlands), the Institute of Dentistry University of Turku (Finland) and the Dental School Umeå (Sweden) were treated with 96 three-unit posterior indirect FRC FPDs. Approval of the University Medical Ethical Committee was obtained (the joint commission on the ethics of the Turku University and the Turku
Results
Mean follow-up time was 5.5 years, with a minimum of 4.5 years and 8.9 years as the maximum. During the follow-up period 11 patients with 12 FPDs were lost to follow-up (12.5%). These drop-out patients could not be contacted or were not able to participate in follow-up examination mostly because of travel distance. The lifecycle of the FRC FPDs included in this study is shown in Fig. 2. Twenty-eight FPDs failed because of fracture, delamination or debonding. The operators regarded 20 of them as
Discussion
This study reports clinical follow-up data on three-unit posterior indirect FRC FPDs after a mean service time of 5.5 years. This study forms part of a trial including the previously referred anterior FPDs. A survival rate of 78% was observed for posterior FPDs, which is higher than the 63% survival rate we found for anterior FRC FPDs after 5 years [11]. Thus, our hypothesis is rejected. Other published clinical studies on FRC FPDs do not discriminate between anterior or posterior bridges and
Conclusion
In the present study, three unit posterior FRC FDPs demonstrated a success rate of 71% during an observation period of 4.5–8.9 years. If repaired FPDs were included as successful performing constructions, the survival rate was 78%. Survival rates of inlay, hybrid and surface retained FPDs did not significantly differ. Delamination, debonding and fracture of the framework were most prevalent failure modes and debonding was seen only for surface retained FPDs.
Acknowledgements
This study was supported in part by the County Council of Västerbotten and The Swedish National Board of Health and Welfare.
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