MANAGEMENT OF ANTERIOR RESIN BONDED CANTILEVER: A REVIEW OF RECENT LITERATURE
Abdullah Binassfour1*, Alhanouf Alamri2, Yara bushnaq2, Razan Almutairi2, Badreah Alyaqoub3, Nouf Alamri4
1Department of Prosthodontics, College of Dentistry, Riyadh Elm University, Riyadh, KSA. [email protected]
2Department of Internship training program, College of Dentistry, Riyadh Elm University, Riyadh, KSA.
3Department of general dentistry, College of Dentistry, Riyadh Elm University, Riyadh, KSA.
4Department of general dentistry, Private Clinic, Riyadh, KSA.
https://doi.org/10.51847/7chQHKcYSH
ABSTRACT
There are many options to replace anterior missing teeth, including implant-supported prosthesis, fixed dental prosthesis, and resin-bonded fixed dental prosthesis. However, implant replacement has some limitations to placing it directly in an edentulous area. In such cases who have hard and soft tissue deficiency might need bone augmentation and connective tissue grafting. The Study aims to systematically review anterior resin bonded cantilever management and Educate practitioners about managing the failures of (RBCFPS). A systematic review was conducted after searching electronic databases Cochrane, Pubmed, google scholar, and SDL Research Databases for articles published in English between 2000 to 2022. Overall, 3225 articles were discovered from the initial electronic search, 110 studies were left after the manual search by titles, duplicate removal, and exclusion of the unwanted studies .40 articles were assessed as a full text, and only 14 were included in this review. It appears that RBFDPs have promising outcomes and high survival rates. It’s also comparable to other treatment modalities, Debonding is a main issue, but it decreases when using a luting agent containing resin cement and the zirconia ceramic framework.
Key words: Resin bonded cantilever, Prosthodontics, Literature review, Dental rehabilitation.
Introduction
There are many options to replace anterior missing teeth, including implant-supported prosthesis, fixed dental prosthesis, and resin-bonded fixed dental prosthesis. However, implant replacement has some limitations to placing it directly in an edentulous area [1]. In such cases who have hard and soft tissue deficiency might need bone augmentation and connective tissue grafting [2]. In such situations, due to the aggressiveness of the treatment options and the patient fear of surgery, they will prefer alternative simple treatment [3]. other limitations, like the patient's age, who cannot receive implant-supported prosthesis until adulthood, to avoid potential complications with implant infra-position [4].
The conventional fixed dental prosthesis is securely retained in natural teeth. The crown preparation removes 63% to 72% of the total sound tooth structures. However, endodontic treatment might be needed due to the crown preparation or the size of the pulp chamber and morphology of the tooth, which will increase the cost of the treatment [5].
A resin-bonded fixed dental prosthesis is a conservative alternative treatment that will meet the patient's wishes for Esthetics and function needs [6]. In 1973, Rochette came up with the idea of bonding a metal retainer to enamel using adhesive cement. in the early 1990s, a modification was made to use oxide ceramics instead of metals as the framework material. The significant improvements in materials and clinical techniques have solved the failure rate of depending and ceramic chipping of RBFDPs [7].
The main advantages of a single retainer are the simplicity of the minimally invasive preparation design, reduced endodontic complications, and reduced financial costs [8]. The design of the resin-bonded cantilever is made of a wing-like extension, which is bonded to the abutment tooth or teeth, using strong dental adhesive so that it stays over the long term [9].
Retention of (RBFPD) is achieved by utilizing adhesive resin cement to adhere the restoration to the enamel [10]. Appropriate case selection and bridge design are important variables in the success of the project (RBFPD). Patient-related parameters (patient's age, expectations, pontic position, abutment tooth assessment, and occlusion) are all taken into account while choosing a case [11]. Periodontal health, a slightly repaired tooth, and acceptable clinical crown height are among the abutment tooth selection factors [12].
The aim of the Study is Review systematically Anterior resin bonded cantilever management and Educate practitioners about managing the failures of (RBCFPS).
Materials and Methods
A systematic review was conducted after searching electronic databases Cochrane, Pubmed, google scholar, and SDL Research Databases for articles published in English between 2000 to 2022. The search text words included (Anterior resin bonded cantilever and Management of cantilever). After the application of exclusion criteria, All the titles and abstracts were screened in detail, and the results were analyzed.
Inclusion criteria
Exclusion criteria
PICO
P- Patient with Anterior resin-bonded cantilever.
I- Identify the changes in the Anterior resin-bonded cantilever
C- Compare between the old and new cantilever management.
O- Educate practitioners about the improvement and management
|
|
|
Figure 1. PRISMA flow chart showing the screening process of included studies |
Results and Discussion
Overall, 3225 articles were discovered from the initial electronic search, 110 studies were left after the manual search by titles, duplicate removal, and exclusion of the unwanted studies .40 articles were assessed as a full text, and only 14 were included in this review.
This systematic review includes 5 retrospective studies, 6 prospective, and 3 randomized controlled trials that meet the inclusion criteria. the following was found :
List of the included literature (Table 1)
Table 1. Summary of results from included studies.
|
Auther /Year |
Study Design |
Sample Size |
Follow Up Period |
Material |
Cement |
Type of Failure |
Success Rate/ Survival Rate |
Complication |
|
A. W. K. Chan et al. 2000 |
A prospective study patient divided into 2 groups: group A FF group B CL |
24SUBJECT 25RBFPD 12FF 13CL |
14 TO 45 months |
METAL FRAMEWORK |
Panavia (resin cement) + RUBBERDAM |
Debonding ONE FF deboned, than it was turned into a CL and recemented |
Retention was the only criteria for success no survival rete mentioned |
the metal framework showing through thin or translucent anterior teeth |
|
Matthias Kern et al. 2005 |
A prospective study |
30P 37RBFPD 16FF 21CL |
75.8 months in FF 51.7 months in CL |
glass-infiltrated alumina ceramic in cream |
Panavia or panavia 21 |
Fracture 1 CL 6FF: 1frctured in both connectors, 1removed accidentally, 4fractured at 1 connector and remained in situ as CL |
-5YEAR 92.3% CL 73.9%FF survival rate |
No complications mentioned |
|
Martin Sasse 2012 |
Randomized clinical trial |
30CL |
5 years |
zirconia ceramic (IPS e.max ZirCAD veneered with IPS e.max Ceram; both Ivoclar Vivadent) |
Either a phosphate monomer containing resin (Panavia ) without any primer or using an adhesive bonding system with a phosphoric acid acrylate primer for the zirconia ceramic (Multilink–Automix bonding system with Metal/ Zirconia primer. |
2 debonding by tramatic event. |
Both RBFPDs could be rebonded successfully, resulting in a three-year survival rate of 100%. |
- |
|
Martin Sasse et al. 2014 |
A prospective study |
37p 42cl |
-61.8 months |
yttrium oxide-stabilized zirconium oxide ceramic |
Panavia 21 TC |
Debonding
only 2 debonding happened |
the success rate was 95.2% after 6 years |
No complications mentioned |
|
Aristidis A. Galiatsatos 2014 |
Clinical evaluation |
54 |
1, 2, 4, 6, and 8 years after placement |
glass-infiltrated alumina ceramic In-Ceram |
Dual polymerizing composite resin cement (Variolink II, Ivoclar Vivadent) |
2 Deboned,1 patient unsatisfied,6 Fractures |
At 8 years, the success rate was 85.18%. |
- |
|
Samah Saker 2014 |
retrospective cohort study |
(22 women, 18 men |
60 Months |
cobalt-chromium-ceramic or glass-infiltrated alumina |
resin cement |
Two fractures were observed with AC. No debonding was observed with MC (n = 0) but was observed with AC. |
MC: 100%; AC: 90%; |
- |
|
Irena Sailer 2014 |
Retrospective study |
15 |
8 years |
Zirconia ceramic |
Resin cement (Panavia 21 TC). |
2 debonding |
No catastrophic failure due to fracture of an RBFDP occurred. Furthermore,noneoftheRBFDPs had to be removed due to technical or biological complications. Hence, the zirconia ceramic RBFDPs had a survival rate of 100%. |
- |
|
Michael G. Botelho et al. 2016 |
A prospective study |
22p 13CL FF10 |
216.5 ±20.8 months |
METAL FRAMEWORK |
Panavia (resin cement) + RUBBERDAM |
|
retention |
absence of complications requiring intervention |
|
Andrea Klink et al. 2016 |
A prospective study |
18p 9m 9f 24CL |
35 months |
different zirconia materials |
(all luting materials, Ivoclar Vivadent]. |
Debonding |
95.5% success between 82.4% and 76% survival |
- |
|
Matthias Kern et al. 2017 |
A retrospective study |
92.2±33 months. |
108CL Restorations were designed using CAD/CAM technology and milled out of pre-sintered zirconia ceramic blocks. |
Restorations were designed using CAD/CAM technology and milled out of pre-sintered zirconia ceramic blocks. |
Panavia 21 TC, Kuraray, or Multilink Automix + RUBBERDAM |
Debonding luted with Panavia 21 TC debonded (4.2%), luted with Multilink Automix debonded (14.2%). Loss of restoration |
10-year survival rate of 98.2 |
|
|
Menaka Abuzar 2018 |
A retrospective study |
|
206Arrbs |
- |
adhesive resin cement |
Debonding |
95.1% at 12 years and beyond |
- |
|
Nadja Naenni 2020 |
Retrospective study |
10 years |
10 |
zirconia (IPS e.max ZirCAD, Ivoclar Vivadent; Cerion, Straumann |
(Panavia 21 TC, Kuraray) |
2 Loss of retention, |
The survival rate after a mean follow-up time of at least 10.0 years was 100% |
- |
|
Hai-Yan Qiu et al. 2020 |
prospective |
12 to 40 months. |
186 CRBFPDs |
Cobalt-chrome alloy |
Panavia F 2.0 |
(1.1%) were regarded as failed |
(88%) survived |
- Complications were recorded when bridges were debonded on ! 2 occasions |
|
Tine Malgaj 2021 |
Randomized clinical trial |
3 year |
|
zirconia frameworkS |
Panavia (resin cement) + RUBBERDAM divided into 2 groups for different pretreatment the first group (n=15) (APA), where the bonding surface was airborne-particle abraded, served as the control. In the second group (n=16), the restorations were pretreated with NAC. |
Debonding |
The 2year survival rate of 93.8% for the NAC RBFDPs was higher than 86.7% for the APA RBFDPs |
|
The goal of this review is to assess the management of cantilever RBFDPs in the anterior region; cantilever RBFDPs can be considered as an alternative option to more invasive treatments like implant surgery or FDPs, especially since there are more contraindications for those treatment options like young or medically compromised patients, also Mourshed et al. (2018) reported RBFDPs longevity can be comparable with FDP. Furthermore, the enhancement of the traditional two-retainer RBFDPs design to a cantilever design raised its survival rate and longevity [13, 14]. The cantilever has a higher success rate, as explained by Sasse et al. (2012), due to the differential movements of the abutment teeth that stress the bonding interface of the two-retainer design prosthesis. Such inter abutment stress is not possible with cantilever designs. The stress of the movement over time will fatigue the bonding interface, which leads to debonding [15]. In the literature extracted for this review, the main failure type is deboning, which a multi-faceted issue is caused by many factors such as the Design of the RBFDP, as discussed earlier, the choice of luting cement, and the RBFDP framework material [16].
Most of the studies included used phosphate monomer-containing composite resin like the (Panavia21) as a luting cement, and it showed positive results as it has a higher bonding strength than the other cement-like (Multilink-Automix). Despite that, there was no significant difference discovered between them. As well, debonding could occur due to other events, including trauma, habits, and food culture.
Naenni et al. (2020) reported the loss of retention is mainly dependent on the framework material, which in metal and zirconia frameworks is higher and less in alumina glass infiltrated ceramics, but conversely, fracture rates are higher in alumina glass infiltrated ceramics. Fracture of the RBFDP was only a failure that is observed in alumina-infiltrated ceramics [17]. Saker et al. explained the fracture might be attributed to the protrusive and lateral movement that leads to torque force in the abutment teeth. In the included literature, no fractures occurred using a zirconia ceramic (IPS E.maxZircad veneered with IPS e.max ceramic). Overall, zirconia has the highest fracture strength among dental ceramics, and it gives promising outcomes [18, 19].
Also, a rubber dam was used in the cementation process in some of the studies, but no advantage was observed in the survival of the prostheses. All the prostheses were pretreated with air-borne particles, but some authors reported RBFPDs made with zirconia and pretreated with nano-structured alumina particles are viable alternatives to conventional airborne-particle abrasion pretreatment [20, 21].
Conclusion
It appears that RBFDPs have promising outcomes and high survival rates. It’s also comparable to other treatment modalities, Debonding is a main issue, but it’s desirable when using a luting agent containing resin cement and the zirconia ceramic framework.
Acknowledgments: We would like to acknowledge the support of REU research center.
Conflict of interest: None
Financial support: None
Ethics statement: None
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