Design of a Fixed Partial Denture

with Abutment Tooth Preparation

Dr. Taseef Hasan Farook (BDS)(DU)

Bangladesh Dental College
Crown- Extracoronal restoration that covers the
outer surface of the remaining clinical crown
and restore structure and function

Bridge/ Fixed Partial Denture- A restoration or

replacement which is attached by a cementing
medium to natural teeth, roots or implants-
GPT
Indications of Fixed partial Denture:
1. Short span edentulous arch
2. Periodontally strong supporting teeth (abutment)
3. Inadequate tissue support ex. Excessive ridge resorption
4. Aesthetic Consideration

Contraindications of fixed partial denture

5. Young patients with large pulp chamber
6. Patient attitude (uncooperative patients)
7. Recurrent/ grossly carious dentition
8. Athletes participating in contact sports
9. Congenitally malformed teeth
10. Bilaterally missing teeth which require cross arch stabilization
11. Weak periodontal condition of abutment teeth
Congenital malformation of tooth Poor periodontal condition

Pulp chamber thickness change with age (young to old)

 Step 1a: Diagnosis
• History of physical and medical conditions
• Patient attitude According to House’s Classification
• Extraoral examination of TMJ and muscles of
mastication
• Intraoral examination of oral hygiene, periodontium
and any intraoral pathologies
• Radiograph to determine caries, alveolar bone
support, morphology of abutment and presence of any
underlying pathologies along with examination of any
existing prostheses.
 Radiograph of missing space Radiograph of an implant abutment

Radiograph of 3 unit FPD with rigid Radiograph of a 3 unit FPD with non rigid
connectors connector
 Step 1b: Treatment planning
• Construction of diagnostic casts of both arches
• Occlusal rehabilitation- Intentional alteration of the
occlusal surfaces of teeth to change their form- GPT
• Mount the cast on the articulator and assess the
height, rotation and inclination of abutment teeth
along with a general idea about the present
occlusion.
• Determine the need for preprosthetic mouth
preparation ex. For unfavorable residual ridge
 Treatment Planning
• Selection of type of material according to the
condition of abutment teeth and surrounding
periodontium (ex. Conventional FPD for sound
abutment teeth and implant supported FPD for
inadequate abutment support)
• Provide the patient with a few treatment
options according to your diagnosis and let the
patient choose according to their needs and
ability.
Preparation of a diagnostic cast.
Mounting a cast and surveying to
check for tooth borne undercuts,
path of insertion of retainer,
occlusal contact etc.
 Step 2: Abutment Selection
Abutment
A tooth, a portion of tooth or that portion of an
implant used for the support of a fixed or
removable prosthesis- GPT
 Selection Criteria of Abutment
1. Location and condition of abutment: grossly
decayed or pulp capped tooth avoided
2. Root configuration: Irregularly curved long
roots preferred with greater labiolingual
width
3. Crown:root ratio should be <1 (ideally 2:3)
4. Must Satisfy Ante’s Law
5. Vital Tooth preferred
 Ante’s Law
The Combined pericemental area of all
abutment teeth supporting a fixed dental
prosthesis should be equal to or greater in
pericemental area than the tooth or teeth to be
replaced- GPT

Satisfies Ante’s Law Does not Satisfy Ante’s Law

 Types of abutment
• Ideal Abutment: matches all selection criteria
• Cantilever: abutment present on only one side of
the fixed prosthesis
• Pier abutment: a natural tooth located between
terminal abutments to support the prosthesis
• Tilted abutment
• Others: Endodontically treated, Post core,
periodontally weakened abutment
 Types of Abutment

Tilted abutment Cantilever abutment

Pier abutment Post core abutment

 Special Considerations for Abutment
• Single missing Canine: Since the canine lies outside
the inter-abutment axis, support should be taken
from either both central and lateral incisors or the
premolars & molar
• Tilted posterior teeth: fabricate a partial veneer
crown or a telescopic crown if pre-prosthetic
management is not carried out
• Pier abutment: the central abutment is subjected to
torsion and leverage, hence non rigid stress breakers
should be used at pier connector
Canine lies outside the inter-abutment line

Stress breaker for pier abutment

 Special Considerations for Abutment

• For extensively damaged/Decayed tooth:

Carry out endodontic obturation, then remove
2/3rd of the Gutta percha to create a vacuum.
• The vacuum is then filled by preformed or
custom made posts. The posts should have an
apical lock to maintain appropriate canal
length. The core is then built on the post. This
procedure is known as Dowel Core Crown/
Post Core Crown
Procedure for Dowel Core Crown (Textbook of Endodontology, Preben Horsted-Bindslev)
 Special Considerations for Abutment
• Implant Abutment: used for long span edentulous arches
with minimal abutment support.
Implant: a substance placed into the jaw to support a crown or a
fixed/removable appliance.
Factors affecting implant success:
• osseo/fibrointegration,
• bone turnover,
• healing rates,
• appropriate occlusal stress,
• infection free surrounding soft tissue.
 Step 3: Preparation of abutment tooth aka
Tooth preparation
Tooth Preparation:
The mechanical alteration of a defective,
diseased or injured tooth to receive a restorative
material that reestablishes a healthy state for
the tooth, including aesthetic corrections where
indicated and normal form and function
Principles of Tooth Preparation
 Principles of tooth preparation
Biological consideration Mechanical Consideration Aesthetic Consideration
Condition of adjacent teeth Retention form Color selection
Soft tissue condition Resistance form Material selection
Status of the pulp Conservative margin Type of design
Biological width integrity Miniature form
Occlusal harmony Path of insertion and tilt
Conservative tooth structure Appropriate finish lines
 Tooth Preparation: Importance of
Biological Width
The prepared tooth finish line must not
extend or violate the junctional epithelium
as it will damage the periodontium.

According to the biological width, 3 types of

marginal finish lines can be obtained:

1. Supragingival: above the histological

sulcus
2. Equigingival: at the histological sulcus
3. Subgingival: below the histological sulcus

(a) Histological sulcus (0.69 mm), (b) Junctional Epithelial attachment (0.97
mm), (c) Connective tissue attachment (1.07 mm), (d) Biologic width (b+c)
 Gingival Margin Finish
• Supragingival Finish: easier to prepare with easy finish.
Restorations and impressions are made easily without soft
tissue injury

• Subgingival Finish: additional retention is needed with margin

of the crown hidden behind the labiogingival crest. Root
sensitivity can not be controlled by conservative dentin
bonding agents
 Gingival retraction for Exposure of operating
site and construction of Finish line
For maximal exposure of operating site
• Can be done by Copper bands, retraction cords and
rubber dam.
• Retraction can be done chemically via astringents
(like Aluminium Chloride) or surgically

Gingival retraction cord

 Gingival retraction for finish line exposure
(A commercial brand of retraction astringent)
 The Different Finish line Designs
Feather edge/Knife Edge/Shoulderless-
Advantage:
1. conservative tooth structure
2. Margins used for full veneer crowns, small crowns and already designed
margins
Disadvantage:
1.Fail to provide adequate bulk at margins for strength
2. Over contoured restorations
 The Different Finish line Designs
Chamfer: An obtuse angle at the axial wall of the tooth surface
and the prepared margin
Disadvantage
Tilting it away leaves an undercut, tilting it towards the tooth
leads to over reduction
 The Different Finish line Designs
Shoulder/ butt joint (90 degree joint)
Advantage: allows substantial room for veneer and facial parts
of metal ceramic crowns
Disadvantage: Less conservative tooth structure
Modifications: 1. Shoulder with bevel 2. Sloped shoulder

Shoulder by flat end fissure bur

Chamfer by torpedo bur
 The Different Finish line Designs
Shoulder with Bevel
Allow improved aesthetic as metal margins can be trimmed down to a knife
edge and hidden in the sulcus without moving epithelial attachment

Sloped shoulder/ angulated shoulder

A 120 degree slope on the facial aspect leaves sufficient bulk as well as
improving aesthetics
 Preparation of Tooth Miniature
Anterior Teeth Posterior Teeth
1. Create incisal Guiding grooves 1. Create occlusal Guiding grooves
2. Incisal reduction by fissure bur 2. Occlusal reduction , reduce functional
3. Create facial guiding grooves cusp more than non functional cusp
4. Facial reduction by tapered fissure bur by fissure bur
5. Interproximal reduction by fine needle 3. Buccal and Lingual reduction
fissure bur 4. Interproximal reduction
6. Lingual reduction by teardrop/football 5. Bevel functional cusp and apply
bur appropriate finish lines: Shoulder/
7. Finish lines: either Shoulder or Chamfer/knife edge
Chamfer with appropriate functional
bevels

Different burs used in

tooth preparation
 Fig: Tooth
preparation of
posterior teeth

A) Natural tooth B) Functional groove C) Occlusal reduction D) Interproximal reduction

E) Bucco-lingual Reduction F) Finish Line - Shoulder
Fig: Posterior tooth reduction
Fig: Anterior tooth reduction (with pin ledge)
• Amount of reduction depends on the material to be used for
the fabrication of the fixed prosthesis:
Example: Full Veneer crowns require greater thickness hence
more tooth structure needs to be cut as opposed to full metal
crowns which require thin sections and hence less tooth
structure needs to be sacrificed.

Anterior tooth preparation

Posterior tooth preparation
• Finish Line depends on aesthetics as well as the
thickness of the prosthesis.
Example: shoulder finishes provide greater surface area
and hence are preferred for Full veneer crowns
whereas Chamfers are preferred for metal crowns.
 Step 4: Impression of prepared abutment and
operating site for fixed partial denture design
Isolation of the Impression field by:
• rubber dam
• suction devices
• Antisialogogue- (example: Proantheline
bromide, Methantheline bromide)
• Local anesthetic solution
• Gingival finish line isolation by retraction cords
and astringents
 Impression Technique for fixed partial
denture
When using elastomer (available in various consistencies like
light, medium, heavy and putty), the impression can be
recorded as:
• Single mix technique with stock/custom tray- medium
body elastomer loaded onto tray, light body syringed into
operating site
• Double mix technique with stock/custom tray- primary
loadout with medium body followed by light body wash on
the tray along with light body syringed into operating site.
• Others: triple mix technique, closed bite technique
 Impression Technique for fixed partial
denture
• Single Mix putty wash impression technique
 Impression Technique for fixed partial
denture
• Double mix putty wash technique
Parts of a Fixed Partial Denture

Retainer

Pontic

Connector
 Step5a: Retainer design
Retainer
The part of a fixed partial Denture which unites
the abutments to the remainder of the
restoration- GPT
 Selection of type of retainer
• Full Veneer- For extensively damaged teeth
• Partial Veneer- For teeth with insufficient natural tooth material present
for full veneer
• Conservative/ Acid etched retainer- For minimum tooth reduction, ideal
for anterior teeth. They have poor strength but good aesthetic
• Telescopic retainer- for abutment teeth which are not in long axis with
the path of insertion of the prosthesis. (Requires Coping)
• Pin retained crown- if two abutment teeth are not aligned parallel to
each other
• Full metal crown- when minimum tooth reduction is indicated with
strength being a necessity
• Metal Ceramic Jacket crown- Veneer over the buccal or labial aspect for
aesthetic consideration.
Full Veneer Crown

Metal Ceramic Jacket Crown

Pin retained Crown

Telescopic Crown
 Step 5b: Pontic Design
Pontic
An artificial tooth on a fixed partial denture
that replaces a missing tooth, restores its
functions and usually fills the space previously
filled by a natural crown- GPT
 Design Criteria for a Pontic
1. Edentulous space available- will determine pontic size
2. Residual Alveolar ridge contour- determines the need for coping
3. Occlusal load on the pontic- if high, the pontic should have wider
dimensions to support the stress. Reduce occlusal table to
decrease occlusal load
4. Cusps: preserve functional cusps, preserve maxillary buccal cusp
for aesthetic, preserve lingual cusp for tongue protection
5. Proximal Embrasure- sufficient space for hygiene practice
6. Anterior teeth pontic- Should have aesthetic contact with the
residual alveolar ridge
7. Posterior teeth pontic- Smooth minimal contact for hygiene
practices. Sanitary pontic often preferred
 Selection of Pontic (according to Rosenstiel et al)
With Mucosal Contact Without Mucosal Contact
Contact with ridge Mucosa No contact with the ridge mucosa
Full facial contact Approx. 3mm above cervical contact
More Aesthetic More hygienic
Usually for anterior teeth Usually suitable for posterior teeth
Examples: Stein pontic, ridge lap pontic, Example: Bullet Pontic, Hygienic / Sanitary
Modified ridge lap pontic, Ovate pontic pontic
 fixed removable partial denture: In
case of resorbed alveolar ridge
• Fabrication of
Andrew’s Bridge
System:  
a removable
prosthesis is
retained by a bar
and sleeve
attachment to fixed
retainers on the
either side of the
edentulous space.
 Step 5c: Connector Design
Connector
The portion of a fixed partial denture that
unites the retainer and pontic- GPT
 Selection of Connector
• Rigid Connectors: transfer entire load directly to the
abutment. (Can be cast or soldered)
• Non Rigid Connector: When abutments are not
parallel to each other producing multiple paths of
insertion. Usually done by Tenon Mortise connectors
• Loop Connector: In order to maintain an existing
diastema
• Cross pin, Wings and Split connector: For tilted
abutment teeth
 Tenon Mortise Non-Rigid Connector

Wing Connector Split Connector

Design for Replacement of Maxillary Incisor

• Support obtained from a single/ group of posterior teeth

(usually molars) in the form of Spring Cantilever
Disadvantage: The bar may interfere with speech and
mastication with food entrapment and subsequent tissue
hyperplasia
 After design of the denture
The cast with design plans are carried over to
the Laboratory for appropriate fabrication (wax
pattern with subsequent metal casting,
porcelain furnace treatment or resin processing)
References:
• Herbert T. Shillingburg, Fundamentals of Fixed Prosthodontics, 3rd edition, 1996
• Deepak Nallaswamy, Textbook of prosthodontics, 2003
• Nugala B, Santosh Kumar B B, Sahitya S, Krishna P M. Biologic width and its importance in
periodontal and restorative dentistry. J Conserv Dent 2012;15:12-7
• Yaqoob A, Rasheed N, Ashraf J, Yaqub G. Nonrigid semi-precision connectors for FPD. Dent Med Res
2014;2:17-21
• Yogesh Rao, Pankaj Yadav, Mariette D’Souza, Jagjeet Singh, Anurag Jain, .BAR AND SLEEVE
ATTACHMENT: A REPORT OF TWO CASES.Journal of Clinical and Diagnostic Research [serial
online]2013 Dec[cited:2018 Jan 14] 12 3096 – 3098
• Ashu Sharma, G. R. Rahul, Soorya T. Poduval, Assessment of Various Factors for Feasibility of Fixed
Cantilever Bridge: A Review Study:ISRN Dentistry volume 2012 (2012), Article ID 259891, 7 pages
• Various slideshare online presentations by various authors
• Presentations by Indian Dental Academy
• Pictures from the internet
Thank You