Fracture of a xed partial denture abutment: A clinical report

Ronald G. Verrett, DDS, MS,

a
and David A. Kaiser, DDS, MSD
b
Department of Prosthodontics, University of Texas Health Science Center at San Antonio
Dental School, San Antonio, Texas
Commonly observed complications associated with a conventional xed partial denture (FPD) include
loss of retention and tooth fracture. This report describes the occurrence of an unusual FPD abutment
fracture and subsequent treatment. The distal abutment of an FPD developed severe periodontal disease
with mobility. The anterior abutment fractured in the middle of the clinical crown and experienced
cement failure. (J Prosthet Dent 2005;93:21-3.)
Fixed partial dentures (FPDs) have been shown to
exhibit clinical complications due to a wide variety of
factors. In a review of the literature, Goodacre et al
1
identied the most common FPD complications as car-
ies, need for endodontic treatment, loss of retention, es-
thetics, periodontal disease, tooth fracture, and
prosthesis fracture. In that review, fracture of an abut-
ment tooth occurred in 3% of prostheses.
The technical and biomechanical complications for
FPDs may result in loss of retention, abutment tooth
fracture, and prosthesis fracture. Technical failures occur
more frequently in FPDs with at least 1 cantilever exten-
sion pontic, with the rate of failure increasing as the
length of the cantilever span increases.
2,3
Fracture of
an FPD abutment adjacent to a cantilever has been re-
ported to occur twice as frequently as fracture of an
abutment not adjacent to a cantilever.
4
Abutment frac-
tures in conventional FPDs have also been documented
in longitudinal clinical studies
5
; however, abutment
fracture of the type reported here is infrequent.
6,7
This
clinical report describes an unusual fracture of an FPD
abutment that occurred within the retainer of a conven-
tional FPD and the subsequent treatment.
CLINICAL REPORT
A 69-year-old woman reported to the University of
Texas Health Science Center at San Antonio Dental
School clinic with a chief complaint that the bridge
on the upper right side was loose. The patient reported
that the FPD had been inserted 12 years ago (Fig. 1).
The FPDwas found to be loose at the anterior abutment
(maxillary right second premolar) but remained ce-
mented on the distal abutment (maxillary right second
molar). Clinical and radiographic examination revealed
that the distal abutment had periodontal probing depths
of 8 to 9 mm and exhibited Class III mobility (Fig. 2).
The FPD was successfully removed and the maxillary
right second premolar abutment was found to be frac-
tured in the middle of the clinical crown, between the
occlusal surface and the nish line of the preparation
(Fig. 3). This abutment had remained asymptomatic de-
spite the fracture of the coronal tooth structure. The
margin remained intact around the circumference of
the preparation. The patient was informed of the clinical
ndings and was advised that the maxillary right second
molar was not restorable due to severe periodontal pa-
thology. The maxillary right second premolar had a wid-
ened periodontal ligament space (Fig. 3), which is often
indicative of occlusal trauma. This nding was related to
the tipping forces transmitted to this abutment during
occlusal loading of the mobile distal abutment of the
FPD. It was noted that the mandibular right rst molar
contacted the distal marginal ridge area of the retainer
on the maxillary right second premolar. The possibility
of supraeruption of an unopposed mandibular second
molar and diminished masticatory ability on the right
side of the arch following extraction of the maxillary sec-
ond molar was discussed. Treatment options were pre-
sented that included replacement of the maxillary right
molars with a removable partial denture (RPD) or with
implant-supported crowns that would likely require ad-
junctive osseous augmentation. The patient declined the
implant option owing to nancial considerations as well
as the RPDoption because she did not want to wear a re-
movable prosthesis. The patient stated that her desire
Fig. 1. Maxillary right posterior FPD at time of insertion (12
years previous).
a
Assistant Professor.
b
Professor.
JANUARY 2005 THE JOURNAL OF PROSTHETIC DENTISTRY 21
was to retain the maxillary second premolar and to have
the second molar extracted.
Endodontic treatment of the maxillary right second
premolar was accomplished to place a dowel-retained
foundation restoration. The most common dowel and
core complication has been reported to be loosening of
the dowel and root fractures.
8
Root fractures have been
reported to account for 3% to 10% of dowel and core
complications, and cemented dowels have been found
to cause the least intraradicular stress.
8
A prefabricated
passive parallel dowel (ParaPost Plus; Coltene/
Whaledent, Cuyahoga Falls, Ohio) was adaptedtothe ca-
nal space and cemented with glass ionomer cement
(Ketac-Cem; 3MESPE, St. Paul, Minn). Aprefabricated
post was selectedbecause it was less expensive anddidnot
require the additional appointment needed to restore the
second premolar with a custom-cast dowel. According to
Summitt et al,
9
prefabricated dowels have been shown to
exhibit greater fracture resistance than custom-cast dow-
els in laboratory studies and to provide a more favorable
prognosis in retrospective clinical studies.
The FPDwas then sectioned at the interproximal em-
brasure between the maxillary second premolar and the
rst molar, and the resultant second premolar crown was
repolished. The crown was placed on the tooth and mar-
ginal integrity was clinically conrmed. A core founda-
tion of the coronal portion of the maxillary right
second premolar was accomplished using an autopoly-
merizing hybrid, lled resin composite, reinforced
with titanium (Ti-Core; Essential Dental Systems,
Hackensack, NJ). The resin composite was placed on
the tooth and the crown was fully seated, shaping the
core foundation and simultaneously cementing the
crown (Fig. 4). The nonrestorable maxillary second mo-
lar was extracted.
Fig. 2. FPD at time of patient presentation with distal
abutment exhibiting 8 to 9 mm periodontal probing depths
and Class III mobility.
Fig. 3. Removal of FPD revealed horizontal fracture through
anterior abutment.
Fig. 4. Maxillary right second premolar received endodontic
treatment and prefabricated dowel with core foundation. FPD
was sectioned and premolar crown was recemented.
Fig. 5. Increased mobility of distal abutment (A), combined
with occlusal forces (B), created shear forces between
abutment anterior abutment and axial walls of retainer. These
forces may result in fracture of abutment (C).
THE JOURNAL OF PROSTHETIC DENTISTRY VERRETT AND KAISER
22 VOLUME 93 NUMBER 1
DISCUSSION
This clinical report describes the catastrophic failure
of an FPD. The etiology was severe periodontal disease
localized to the maxillary second molar that permitted
excessive forces on the second premolar abutment. A
biomechanical challenge was created when the exces-
sively mobile distal abutment was rigidly connected to
an abutment with only limited physiologic mobility.
When an excessively mobile FPD abutment is subjected
to an occlusal force, a torquing force is created on the
other abutment that may result in cement failure or frac-
ture of the abutment (Fig. 5). The forces transmitted to
the anterior abutment in this instance are similar to the
forces that occur on a cantilever FPDabutment adjacent
to the cantilever section when the cantilever is subjected
to occlusal loading.
SUMMARY
An FPDabutment may fracture or the cement within
a retainer can fail when subjected to excessive forces.
Fortunately, retrospective clinical studies of conven-
tional FPD complications have concluded that abut-
ment fracture of the type reported is infrequent.
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Reprint requests to:
DR RONALD G. VERRETT
DEPARTMENT OF PROSTHODONTICS
UTHSCSA DENTAL SCHOOL
7703 FLOYD CURL DRIVE, MSC 7912
SAN ANTONIO, TX 78229-3900
FAX: 210-567-6376
E-MAIL: verrett@uthscsa.edu
0022-3913/$30.00
Copyright 2005 by The Editorial Council of The Journal of Prosthetic
Dentistry.
doi:10.1016/j.prosdent.2004.10.009
THE JOURNAL OF PROSTHETIC DENTISTRY VERRETT AND KAISER
JANUARY 2005 23