Long-term follow-up of cross-arch fixed partial dentures in patients with advanced periodontal destruction Evaluation of the supporting tissues

Abstract

The aim of the study was to evaluate the periodontal conditions in patients treated more than 10 years ago for advanced periodontal disease and rehabilitated with cross-arch fixed partial dentures (FPDs). Of 50 randomly selected patients, 34 subjects carrying 43 FPDs agreed to participate in a clinical and radiographic follow-up examination. The FPDs were divided into three groups on the basis of prosthesis design (end abutments, unilateral cantilever, and bilateral cantilevers) and amount of supporting tissues at the time of bridge installation. Seventy per cent of the FPDs were found to be unchanged, whereas the rest had been modified due to various complications leading to extraction of one or more of the abutment teeth. Six FPDs (14%) had been partially replaced by FPDs anchored to osseointegrated dental implants. A total of 21 (8%) of the original 274 abutment teeth had been extracted. Longitudinal changes in the amount of periodontal support were minimal over the average of 15 years of follow-up. FPD design or initial amount of supporting tissues was found not to have significant influence on longitudinal changes in periodontal conditions. It was concluded that combined periodontal and prosthodontic treatment of patients with advanced loss of periodontal support may provide a high rate of long-term successful outcome, provided proper adequate periodontal and prosthetic treatment and maintenance care are given.

Stress distribution among periodontally compromised abutments: A comparative study using three-dimensional finite element analysis

“…This may be attributed to the resistance to the impact of occlusal forces called as “shock absorber effect” as documented by Carranza, Newman. On the contrary, there is evidence that teeth with compromised periodontal support can serve successfully as the fixed bridge abutments[2–7] but clinicians continue to avoid using periodontally compromised abutment teeth.…”

Influence of crown-to-implant ratio on periimplant marginal bone loss in the posterior region: a five-year retrospective study

“…However, these guidelines were based on empiricism rather than scientific data. Several studies have demonstrated that teeth with an unfavorable C/R ratio can function successfully as abutment teeth [4-6]. Grossmann and Sadan [1] concluded that no definitive recommendations for an optimal C/R ratio could be established.…”

Restoration of periodontally compromised dentitions using cross-arch bridges. Principles of perio-prosthetic patient management

“…These consisted of loss of reten tion (3.3%), fracture of abutment teeth (2.4%) and fracture of the bridgework (2.1%). Yi et al 6 evaluated a total of 43 cross-arch bridges in 34 patients, and concluded that 86% of the constructions were still in function after an average time of 15 years. The low rate of com plications in these cases is attributed to the special characteristics of periodontal abutments, ie long clinical crowns that allow for increased retention and robust frameworks, as well as close follow-up of the patients to ensure high standards of plaque control and monitoring of the perio-prosthetic constructions on a reg ular basis.…”

“…This concept has been questioned, since it attaches more importance to the number of teeth to be replaced than to the amount of remaining periodontal tis sues supporting the abutments and thus the bridge constructions. 5,6 Defi ant to Ante's unproven postulation, extensive cross-arch bridges by far not fulfi lling the prerequisites of Ante's law have been successfully provided since the 1970s as a means of rehabilitating periodontally compromised patients. Several long term follow-up studies 1,[6][7][8][9] have shown that fixed bridges can be placed and success fully maintained on a minimal number of abutment teeth with greatly reduced periodontal support, provided the pros thodontic treatment is: 1) preceded by adequate periodontal therapy, and 2) followed by a plaque control programme effective enough to prevent recurrence of periodontal disease.…”

“…If presumptive abutments are well distributed and peri odontal infection is under control, as lit tle as 20-30% of the original periodontal tissue support can be sufficient to carry fixed cross-arch bridges. 6,9,10 PRINCIPLES OF PERIO-PROSTHETIC TREATMENT Patient management and treatment sequence in perio-prosthetic therapy As is true for any advanced restorative procedure, appropriate patient selection is critical. Direct patient involvement throughout the clinical stages of the treatment and during the maintenance phase is a prerequisite for a success ful outcome.…”