CLINICAL REPORT

This report wfrom the JapaAssistant PrbProfessor Em

8

A direct bonded fixed partial dental prosthesis: A clinical report

Naomi Tanoue, DDS, PhDa and Takuo Tanaka, DDS, PhDb

ABSTRACTA direct bonded fixed partial dental prosthesis, with a composite resin denture tooth as a pontic, atri-n-butylborane initiated adhesive resin, and screw posts for reinforcement, was still functioningafter an observation period of 20 years. The prosthesis was found to be reliable for long-termclinical use when chemically and mechanically reinforced. (J Prosthet Dent 2015;113:8-11)

In the extraction of a singletooth, especially an anteriortooth, where adjacent teeth arepresent, the direct bonded par-tial fixed dental prosthesis(DBPFDP) that incorporates a

composite resindenture toothas aponticmaybe selected foresthetic reasons until a definitive prosthesis can be fabri-cated.1 Generally, the DBPFDP technique is used for only alimited time. Themechanical properties of the artificial toothand the adhesive agents and the bond strength between thetooth substance and artificial teeth are considered insuffi-cient for long-term use, although the reliability of theproperties of eachmaterial has been reported.2-10 However,the DBPFDP technique is based on the concept of minimalintervention because it can conserve the enamel of theabutment teeth. The DBPFDP is a useful prosthetic methodwhen it is reinforced with additional materials.1,11,12

An implant-supported fixed dental prosthesis is ef-fective for single tooth replacement but is not suitable forall patients, primarily because of local or general contra-indications or economic circumstances. A conventionalpartial fixed dental prosthesis also is not always suitable.The DBPFDP method is a minimally invasive, 1 visittreatment, at minimal cost, and provides fixed prostho-dontic treatment with minimum intervention. This clinicalreport describes the treatment of a DBPFDP reinforcedwith 2 dental screw posts that connected the pontic to theabutment teeth of a patient with a missing premolar.

CLINICAL REPORT

A 47-year-old woman presented to the Division ofFixed Prosthodontics, Nagasaki University Hospital of

as supported, in part, by two grants-in aid for scientific research, (C) 2359an Society for the Promotion of Science. Presented at the 12th Congress oofessor, Division of Pediatric Prosthodontics, Nagasaki University Hospital,eritus, Kagoshima University Graduate School of Medical and Dental Scie

Dentistry, with difficulty in eating and food impaction as aresult of a missing mandibular right first premolar (Fig. 1).She was using a clasp-retained partial removable dentalprosthesis to replace the missing mandibular right molars.The partial removable prosthesis had a suprabulge claspwith a rest seat on the distal side of the second premolar(Fig. 2). Both the canine and the second premolar wereunrestored. At first, a partial fixed dental prosthesis wasproposed, but the patient declined because she wanted toconserve the intact tooth structure of the existing abut-ment teeth. Implant placement and the fabrication ofimplant-supported prostheses were indicated, but thepatient also declined because she was afraid of implantsurgery. Therefore, a DBPFDP with an artificial denturetooth as a pontic was provided as an interim prosthesisuntil a definitive prosthetic method could be decided.

A composite resin denture tooth (Endura M30; ShofuInc) was shaped as a pontic and adjusted to the missingtooth space. Two grooves for screw posts to increaseretention (Dentatus Classic Post System [gold plated];Dentatus AB) were placed in the mesial and distal ridgesof the artificial tooth. In addition, shallow grooves for thescrew posts were placed in the enamel of the marginalridges of the abutment teeth on the side adjacent to themissing tooth. The bonding surfaces of the compositeresin tooth were airborne-particle abraded with 50 to 70mm alumina (Hi-Aluminas; Shofu Inc) with an airborne-particle abrader (Micro Blaster MB102; Comco Inc),

2858 (2011-2013) and 23592862 (2011-2013),f the Asian Academy of Aesthetic Dentistry, July 2012, Hokkaido, Japan.Nagasaki, Japan.nces School of Dentistry, Kagoshima, Japan.

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Figure 1. Preoperative buccal view of missing mandibular rightfirst premolar.

Figure 3. Buccal view after direct bonded partial fixed dentalprosthesis treatment.

Figure 4. Lingual view after direct bonded partial fixed dentalprosthesis treatment, with clasp-retained partial removabledental prosthesis.

Figure 2. Preoperative occlusal view with clasp-retained partialremovable dental prosthesis.

January 2015 9

lightly air-dried with an air syringe, and primed with a3-liquid ceramic primer (Clearfil Porcelain Bond System;Kuraray Noritake Dental Inc). The bonding surfaces ofthe abutment teeth were polished with fluoride-freepumice, etched with 40% phosphoric acid (K-Etchant;Kuraray Noritake Dental Inc) for 30 seconds, rinsed withwater, and air-dried. The screw posts were airborne-particle abraded with the same method as for thebonding surfaces of the composite resin tooth andtreated with noble metal alloy primer (V-Primer; SunMedical Co Ltd). The composite resin tooth was bondedto the missing tooth space, and 2 screw posts were put onthe grooves to sit astride the abutment tooth and theartificial tooth. The artificial tooth was fixed to theabutment teeth with a tri-n-butylborane (TBB) initiatedadhesive resin (Super-Bond C&B; Sun Medical Co Ltd)by using a brush-dip technique.13

The resin was carefully applied to the mesialand occlusal surfaces of the second premolar abutment

Tanoue and Tanaka

tooth to avoid interference with the clasp of the exist-ing partial removable dental prosthesis. After polymer-ization, complete insertion of the prosthesis wasconfirmed, and the occlusion was adjusted (Figs. 3, 4).The patient was satisfied with the treatment, bothesthetically and functionally. All treatment wascompleted in 1 visit. The patient was followed up at 3-month intervals for oral hygiene and evaluation of theDBPFDP and removable prosthesis. One year after thetreatment, other treatments, including a conventionalpartial fixed dental prosthesis and implant-supportedprostheses, were recommended to the patient, butshe again refused because she was satisfied with theDBPFDP. Ten years after treatment, the partial remov-able dental prosthesis was refabricated because theresin base had fractured. In accordance with the treat-ment plan of the previous dentist, a suprabulge claspwith mesial rest was used for the second premolar. TheDBPFDP had been functioning for more than 20 years

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Figure 5. Buccal view of direct bonded partial fixed dentalprosthesis 20 years after treatment.

Figure 6. Occlusal view of direct bonded partial fixed dentalprosthesis 20 years after treatment.

Figure 7. Occlusal view of direct bonded partial fixed dentalprosthesis 20 years after treatment, with refabricatedclasp-retained partial removable dental prosthesis.

10 Volume 113 Issue 1

without debonding (Figs. 5-7). Although marginalleakage was found, the patient chose to continue withthe DBPFDP.

DISCUSSION

The DBPFDP is a technique that requires a single visitbecause impression and cast making are unnecessary.Nevertheless, the mechanical properties of the DBPFDPas a definitive prosthesis are insufficient when comparedwith a conventional partial fixed dental prosthesis. Toreduce the chance of debonding or fracture, the pros-thesis should be designed so that occlusal forces avoidthe adhesive interface between the resin and artificialtooth. A satisfactory outcome can be achieved by theappropriate selection of materials and bonding systems.Minesaki et al1 reported that both TBB-initiated adhe-sive resin and metal posts with screws were suitable forbonding a DBPFDP. The metal post with screw formechanical retention is one of the materials that canreinforce bonding between the artificial tooth and thetooth structure, although there are other materials forreinforcement, for example, fiber materials.11,12 Becausethe metal post used was gold-plated brass, a thioneprimer (V-Primer) was helpful in the bonding of thenoble metal ingredient to the luting material, whichcontains a carboxylic functional monomer. The metal-treated post was adequately bonded with cement, andthe metal post reinforced the strength of the cementitself.

The pretreatments for bonding between the artificialcomposite resin tooth and cement, and between theenamel and cement also were related to the strength ofthe DBPFDP. Many researchers reported the adequateperformance of adhesive resin for bonding to toothstructure.2-5 For this patient, pretreatment with phos-phoric acid was effective because the bonding area waslimited to the enamel. Airborne-particle abrasion and

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silanization also were appropriate1 because the artificialtooth used for the patient was a microfilled compositeresin that included 47% organic filler.7,8 As a result, theproperties of the materials and bonding systems weresuitable. In addition, the patient’s opposing partialremovable dental prosthesis with the same compositeresin artificial teeth may have increased the longevity ofthe DBPFDP. However, the stained interface betweenthe enamel and the resin cement was an esthetic prob-lem (Figs. 5, 6). The position of the rest of the refabricateddenture might make the color change of the cementor the stains caused by microleakage of the cementless noticeable (Fig. 7). Piemjai et al5 reported thatthe TBB-initiated adhesive resin used exhibited lessmicroleakage than other acid-base cements at thecementum margins. Yet, the microleakage could not beavoided, regardless of the performance of the resinbecause this DBPFDP had unexpectedly been in place for20 years. In addition, the resin itself had changed color.Even if the bond strength between the artificial tooth

Tanoue and Tanaka

January 2015 11

and the abutment teeth is clinically satisfactory, theDBPFDP should be removed at the patient’s request inthe future.

SUMMARY

This clinical report describes a DBPFDP technique with acomposite resin tooth as a pontic, a TBB initiated adhe-sive resin, and 2 screw posts. The DBPFDP that in-corporates a composite resin denture tooth as a pontic isreliable for long-term clinical use when chemically andmechanically reinforced.

REFERENCES1. Minesaki Y, Suzuki S, Kajihara H, Tanaka T. Effect of reinforcement methods

on the retention of resin-bonded fixed partial dentures using a compositedenture tooth as a pontic: in vitro evaluation. J Adhes Dent 2003;5:225-34.

2. Burke FJ, Wilson NH, Watts DC. Fracture resistance of teeth restored withindirect composite resins: the effect of alternative luting procedures. Quin-tessence Int 1994;25:269-75.

3. McSherry PF. An in vitro evaluation of the tensile and shear strengths of fouradhesives used in orthodontics. Eur J Orthod 1996;18:319-27.

4. Walmann JO, Donnelly JC. Effect of dowel lubrication on resistance todislodgment of dowels cemented with a 4-META resinous cement. J ProsthetDent 1996;76:15-8.

5. Piemjai M, Miyasaka K, Iwasaki Y, Nakabayashi N. Comparison ofmicroleakage of three acid-base luting cements versus one resin-bonded

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cement for Class V direct composite inlays. J Prosthet Dent 2002;88:598-603.

6. Yang B, Adelung R, Ludwig K, Bössmann K, Pashley DH, Kern M. Effect ofstructural change of collagen fibrils on the durability of dentin bonding.Biomaterials 2005;26:5021-31.

7. Suzuki S. In vitro wear of nano-composite denture teeth. J Prosthodont2004;13:238-43.

8. Zeng J, Sato Y, Ohkubo C, Hosoi T. In vitro wear resistance of three types ofcomposite resin denture teeth. J Prosthet Dent 2005;94:453-7.

9. Nagle S, Ray NJ, Burke FM, Gorman CM. Bonding auto-polymerisingacrylic resin to acrylic denture teeth. Eur J Prosthodont Restor Dent2009;17:134-6.

10. Meng GK, Chung KH, Fletcher-Stark ML, Zhang H. Effect of surfacetreatments and cyclic loading on the bond strength of acrylic resin dentureteeth with autopolymerized repair acrylic resin. J Prosthet Dent 2010;103:245-52.

11. Belli S, Ozer F. A simple method for single anterior tooth replacement.J Adhes Dent 2000;2:67-70.

12. Meriç G, Ruyter IE. Bond strength between a silica glass-fiber-reinforcedcomposite and artificial polymer teeth. Acta Odontol Scand 2007;65:306-12.

13. Tanoue N, Yanagida H, Sawase T. Evaluation of a newly developed poly-methyl methacrylate powder for brush-dip technique. J Prosthodont Res2011;55:193-8.

Corresponding author:Dr Naomi TanoueNagasaki University Hospital1-7-1 SakamotoNagasaki 852-8501, JAPANE-mail: t-naomi@nagasaki-u.ac.jp

Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.

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