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Crowns, Bridges, Dentures, Implants

Removable Versus Fixed Bridge

04/18/2005

Question:

How do they compare for 2 missing teeth.

The last upper molar is a solid capped tooth, then 2 missing teeth and then another capped tooth. I previously had a removable 1 tooth bridge in this spot, and liked it better than the fixed bridge on the other side. It was easier to clean and felt better chewing.

Answer:

The handout below compares the two. 

Treatment Planning for Single Missing Teeth

Single Tooth Replacement Options

                            

Fixed Partial Denture (FPD)

Removable Partial Denture (RPD)

Interim or Transitional Partial Denture (Flipper)

Implant Supported Restoration

Resin Retained Bridge (Maryland bridge)

Cantilever Bridge

Indications for  Single Tooth Replacement

Traumatically avulsed tooth

Congenitally missing tooth

Extraction of non-restorable tooth

External resorption

Removable Partial Denture

Advantages                                                     Disadvantages

·Indicated when acrylic will improve                 ·Requires an essential amount of metal

 appearance (excessive bone loss)                     framework and tooth support to replace

· Least expensive                                             one or two teeth

· Treatment of choice for patients who

have difficulty with hygiene

Fixed Partial Denture

Advantages                                                     Disadvantages

 

·Esthetics                                                         ·May involve irreversible preparation

·Covered at least partially by                            of minimally restored or virgin teeth

 insurance                                                         ·Abutments susceptible to recurrent decay

·FPD feels more permanent than RPD  ·Cost for remake if needs replaced

·Capable of directing forces                             ·Pontic emergence profile

along long axes of teeth                         ·Labial bone inadequacy

                                                                        ·Need floss threader

                                                                        ·Retention of diastema difficult

Transitional Partial Denture (Flipper)

Advantages                                                     Disadvantages

·provides esthetics, function and space ·no rest seats to prevent overseating,

 maintenance for a limited period of                   can cause tissue erythema

 time (may be used while implant sites    ·resin subject to fracture and to imbibing

 heal or as a space maintainer waiting for           oral fluids

completion of growth)

·inexpensive

·may be treatment of choice for an

patient who can not sit through the

lengthy or physically trying appointments

needed to make fixed prostheses

Resin-Retained Fixed Partial Denture  (Maryland Bridge)

Advantages                                                     Disadvantages

·conservation of tooth structure as               ·debonding of the bridge

compared to FPD                                             ·metal retainers may cause noticeable

·alternative to FPD for young patients   darkening of abutment teeth

with large pulps                                     ·emergence profile not as esthetic as

·alternative to implant crown for                        implant-supported crown

young patients who have not completed ·retention of diastema not an esthetic option

growth                                                              ·abutments can not have large carious

                                                                        or large restorations

                                                                        ·patient can not have parafunctional habits

                                                                        or poor posterior occlusion

                                                                        ·5-year survival rate (loss of retention)

                                                                        approx 70% (Creugers, NHJ, et al : Clinical

Performance of  resin-bonded bridges:

A 5-year prospective study. J Oral Rehabil 16:427,1989)

Cantilever Fixed Partial Denture

Advantages                                                     Disadvantages

·may prepare only one abutment tooth  ·a cantilever will introduce lateral

(for example, leave a maxillary incisor    forces which may lead to tipping, rotation,

intact when replacing a lateral using the  or drifting of abutment

canine as the retainer

·may replace one tooth using two                     ·tooth preparation required (as opposed

abutments for a distal extension             to implant)

situation when occlusion is favorable

Implant Supported Restoration

Advantages                                                     Disadvantages

· approximately same cost as FPD       

·esthetic emergence profile                               ·requires two surgeries

·does not  remove tooth structure                     ·requires additional planning

  from adjacent teeth                                         ·healing time

·may be retrievable                                          ·need for interim prosthesis

·preservation of existing bone               ·potential color shift with age still present

                                                                        but only one tooth is involved

                                                                        ·gingival esthetics can be difficult,

especially in areas where regenerative techniques have been used to restore hard tissue

                                                                        ·patient must meet selection criteria as far as

                                                                        current health status (absolute

                                                                        contraindications include persons who are

                                                                        acutely ill, persons who have uncontrolled

                                                                        metabolic disease and pregnant women) and

                                                                        available bone  or candidate for grafting

                                                                        (need 10 mm vertical bone

                                                                        and 6 mm horizontal bone; 1 mm bone

                                                                        lingual  and .5 mm bone facial to inferior

                                                                        dental canal; 1 mm from PDL of adjacent

                                                                        teeth; 3 mm from mental foramen)

Indications for Implant Placement in the Partially Edentulous Patient

1.                  Inability to wear a removable partial denture

2.                  Long edentulous span (unfavorable for fixed)

3.                  Unfavorable number and location of potential natural tooth abutments

4.                  Single tooth loss that would necessitate preparation of undamaged teeth for a

            fixed prosthesis

Related Resources:

removable vs fixed bridge - Part 2

For more information:

Go to the Crowns, Bridges, Dentures, Implants health topic, where you can:

Response by:

Nancy L Clelland, DMD, MSD Nancy L Clelland, DMD, MSD
Professor of Restorative & Prosthetic Dentistry
College of Dentistry
The Ohio State University