Singh S et al.

: Treatment Planning for Fixed Partial Dentures REVIEW ARTICLE

Treatment Planning for Fixed Partial

Dentures
Snigdha Singh1, Niyati Singh2
Correspondence to:
1- Lecturer, Rama Dental College Hospital & Reseach Centre,Lakhanpur, Kanpur. 2- Dr. Snigdha Singh, Lecturer, Rama Dental College Hospital
Senior Lecturer, Department of Prosthodontics,Rama Dental College Hospital & Research & Reseach Centre,Lakhanpur, Kanpur.
Centre, Lakhanpur,Kanpur. Contact Us: www.ijohmr.com

ABSTRACT
The treatment planning is based on the identification of the need of a patient, ascertaining expectations and comparing
these with the available techniques. Thereafter a sequence of treatment may be initiated for therapy, symptomatic relief,
stabilization, and follow up. This paper focuses on the importance of properly sequenced treatment planning for fixed
partial denture cases.
KEYWORDS: Treatment Planning, Abutment Teeth, FPD, Preservation, Periodontal Diseases
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INTRODUCTION
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Treatment planning consists of determining a sequence of multiple missing teeth can be replaced with an implant
treatment logically designed to restore the patients’ supported prosthesis which involve successful
dentition to good health, with optimal function and osseointegrated technique where the bone is drilled
esthetics. An appropriate plan informs the patient about atraumatically to receive precisely fitting titanium
the present conditions, the proposed dental treatment, cylinders.1
personal and professional follow up required for success.
These are left without loading for few months until they
For the long term success of FPD, the abutment teeth
are invested with bone, then function and esthetics are
assessment must be done carefully. The treatment plan
restored with prosthesis.
should be properly sequenced as part of an on-going
comprehensive dental treatment program.
SELECTION OF ABUTMENT
DETERMINATION OF PATIENT TEETH
NEEDS REPLACEMENT OF SINGLE MISSING TEETH: A
Successful treatment planning is based on the proper single missing teeth can be replaced by a three unit FPD
determination of patient needs. Treatment is required to having one mesial and one distal abutment tooth. A three
achieve one or more of the following objectives: unit FPD consists of a pontic, two retainers on each side
 Correction of existing disease of pontic and connectors which connect pontic to
 Prevention of future disease retainers. The pontic replaces the missing tooth. The
retainers are cemented to the prepared abutment teeth.
 Restoration of function
FPDs in which only one side of pontic is attached to a
 Improvement of appearance
retainer are referred to as cantilevered.
AVAILABLE TECHNIQUES The long term prognosis of a single abutment cantilever
is poor2. Forces are best tolerated by periodontal
FIXED PARTIAL DENTURES: FPD is indicated
supporting structures when directed in the long axis of the
where one or more teeth are missing or require removal.
teeth3. In such cases, a three unit FPD is used. A
In this condition, these teeth are replaced by pontics that
cantilever will induce lateral forces on the supporting
are designed to fulfill the functional and esthetic
tissues, which may harm & lead to tipping, rotation of the
requirements of missing teeth. Pontics are connected to
abutment. The potential harmful nature of such FPDs
retainers, which are restorations on prepared abutment
have been confirmed by laboratory analysis4,5. Clinical
teeth.
experience with resin retained FPDs have suggested that
If FPD is designed in such a way that the forces are cantilever designs may be preferred, especially since
directed along the long axis of the teeth, the success rate readhesion after failure is greatly facilitated & often leads
of FPD is higher. The success of such FPD is further to predictable long term success6.
enhanced in patients maintaining oral hygiene.
Cantilevers with implant supported prosthesis may be
IMPLANT SUPPORTED PROSTHESIS: Single or used successfully.
How to cite this article:
Singh S, Singh N. Treatment Planning for Fixed Partial Dentures. Int J Oral Health Med Res 2015;2(2):99-101.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY- AUGUST 2015 | VOL 2 | ISSUE 2 99
 Singh S et al.: Treatment Planning for Fixed Partial Dentures REVIEW ARTICLE

ASSESSMENT OF ABUTMENT TEETH: Pulpal where a significant bone loss is noted. A successful fixed
health assessment is done by evaluating the response to prosthesis can be fabricated for teeth with severely
thermal & electrical stimulation and with the help of reduced periodontal support provided periodontal tissues
radiographs. Existing restorations, cavity liners & have been returned to excellent health & long term
residual caries are removed7 & teeth are carefully maintenance has been ensured9,10. Healthy periodontal
checked for possible pulpal exposure if any. Teeth in tissues are a necessary requirement for fixed restorations.
which pulpal health is doubtful must be endodontically
SPAN LENGTH: Failure of a long span FPD may occur
treated before fixed prosthodontic treatment is initiated.
due to excessive flexing under occlusal load. The
ABUTMENTS TREATED BY ENDODONTIC relationship between deflection & length varies with the
PROCEDURES: Teeth with appropriate endodontic cube of the length of the span. Pontics & connectors
treatment with post and core are suitable abutments. should be made as bulky as possible to ensure optimum
Failures may occur on teeth with short roots or teeth with rigidity when fabricating long span FPD without
little remaining coronal tooth structures. To obtain jeopardising gingival health . High strength & high
maximum retention for the post & core, a careful rigidity materials are preferred for prosthesis fabrication.
attention is necessary.
ABUTMENTS WITHOUT RESTORATIONS: A REPLACING MULTIPLE
tooth without any restoration or any dental pathology will ANTERIOR TEETH
serve as an ideal abutment. It can be conservatively
prepared for a strong retentive restoration with optimum Special considerations in this situation include problems
esthetics. associated with esthetics & requirement to resist tipping
forces directed laterally.
MESIALLY TILTED SECOND MOLAR: FPD is
made preferably after uprighting the tilted abutment When maxillary incisors are being replaced forces
orthodontically by using simple fixed appliances or with directed against a maxillary incisor pontic will tend to tip
modified preparation designs or with a non rigid the abutment teeth due to curvature of the arch..
connector . Tipping forces must be resisted by means of two
abutment teeth at each end of long span anterior FPD.
REPLACEMENT OF SEVERAL Thus, when replacing four maxillary incisors, the
MISSING TEETH clinician should generally use canines & first premolars
as abutment teeth11.
To ensure a successful result, the prosthesis is planned by
waxing the intended restorations on articulated diagnostic The four mandibular incisors can usually be replaced by
casts. This step is required for complex fixed FPD with retainers on each canine. It is not usually
prosthodontic treatments involving corrections of an necessary to include first premolars.
irregular occlusal plane, alteration of the vertical
dimension of occlusion, therefore implant supported REPLACING MULTIPLE
prostheses is suggested in such cases. POSTERIOR TEETH
OVERLOADING OF ABUTMENT TEETH: The When replacing multiple posterior teeth, it is
ability of abutment teeth to withstand the applied forces advantageous to restore the posterior segments at the
without becoming mobile or drifting should be estimated same time as this leads to the development of an efficient
as it influences the success of the prosthodontic treatment occlusal scheme.
plan.
Treatment of all four posterior segments together might
DIRECTION OF FORCES: The most favourable lead to complications and difficulties for the patient as
direction of forces is along the long axis of teeth. An FPD well as the dentist.
is designed keeping this under consideration. An FPD
design should confine the potentially damaging lateral It is preferable to complete treatment of one side before
forces to anterior teeth & also include a longer lever arm starting treatment on the other side.
to reduce these forces.
ROOT SURFACE AREA: It should be assessed by DISCUSSION
Ante’s law. Ante8 suggested in 1926 that the combined The success of a treatment depends on careful planning
root surface area of the abutment teeth should exceed the which involves assessment of the dentition and choosing
combined root surface area of the teeth being replaced. the best suitable option from available techniques as
ROOT SHAPE & ANGULATION: A better support is discussed above. Fixed partial dentures are indicated
provided by a molar with divergent root, a single rooted where one or more teeth are missing. Such missing teeth
tooth with elliptic cross section & a well aligned tooth. are replaced by pontics which perform the functional and
esthetic requirements. In certain cases where invasive
PERIODONTAL DISEASE: A careful assessment of procedures are not feasible fixed partial dentures are an
periodontal health is needed for potential abutment teeth option of preference over implants.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY- AUGUST 2015 | VOL 2 | ISSUE 2 100
 Singh S et al.: Treatment Planning for Fixed Partial Dentures REVIEW ARTICLE

CONCLUSION denture abutments, J Prosthet Dent 42:411, 1979.

5. Yang Hset al : Stress analysis of a cantilevered fixed
Treatment planning is very important for successful partial denture with normal and reduced bone support, J
treatment and patient satisfaction. It should be decided Prosthet Dent 76:424, 1996.
after consideration of patient needs. Successful treatment 6. Briggs P et al: The single unit, single retainer, cantilever
of fixed partial dentures depends on the appropriate resin bonded bridge, Br Dent J 181:373, 1996.
selection of the abutment teeth and the number of missing 7. Christensen GJ: When to use fillers, build- ups or posts and
teeth which are to be replaced. cores, J Am Dent Assoc 127:1397,1996.S
8. Ante IH: The fundamental princiles of abutments, Mich
State Dent Soc Bull8:14, July 1926.
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4. Wright KWJ, Yettram AL : Reactive force distributions for Source of Support: Nil
Conflict of Interest: Nil
teeth when loaded singly and when used as fixed partial

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY- AUGUST 2015 | VOL 2 | ISSUE 2 101