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Resin-Bonded Prostheses Adrian U Prosthodontics Resin-bonded prostheses Adrian U. J. Yap*/Alastair N. S. Stokes""* This article reviews the uses, advantages, and disadvantages of the different types of resin-bonded prostheses. Resin-bonded prostheses can be used for tooth replacement as well as for occlusal, cosmetic, and orthodontic/periodontic therapy Proper case selection is essential to their stieeess. Although long-term clinical studies are not available for some of these types of prosthesis, they are generally promising and have become important elements in the provision of dental health care. (Quintessence Int 1995:26:521-530.) Introduction Table 1 Techniques used to enhance the resin to- metal bond With the evolution of adhesive techniques, the interest in and usage of resin-bonded prostheses has grown substantially. Application of resin-bonded prostheses Mechanical Chemical is no longer confined to tooth replacement and Micromechanical Chemically active cements periodomal splints; they are now used as cosmetic Sandblasting* 4-META resins'* veneers, and occlusal and orthodontic appliances are Chemical etching Phosponated resins'^ among the many recent innovative applications of the Electrochemical etching' resin-bonding technique. Porous metal coating'" Resin-metal bond Macromechanical Adhesive layer Network (mesh) retention" Tin piating'* Rochette' pioneered the use of the acid-etching system Retention beads'^ Silicoaîing' ' to bond perforated gold frameworks to loose teeth. At Particle roughened surface'^ about the same time, case reports described the bonding of natural teeth- and resin pontics^ •* to make small resin-bonded prostheses. The Rochette bridge, first described by Howe and Denehy,' combined the principle of bonding a perforated metal plate to etched which was small compared to the resin-enamel inter- natural teeth with the provision of one or more face, favored failure at the resin-metal region. In an integrated pontics. They used a chemicaily cured attempt to eliminate the disadvantages of the perfo- di methacrylate resin composite to bond a perforated rated framework, several indirect tecliniques have been nonprecious metal framework to acid-etched enamel. developed to increase the retentive area. These tech- Retention of the framework was. however, limited to niques, aimed at improving the resin-to-metal bond, areas around the perforations; this retentive area. can be divided into mechanical and chemical methods (Table 1), Such techniques have been adapted for use with single restorations, splints, and bite planes. * Lecturer, National University of Singapore, Faculty of Dentislry, Singapore, '- Senior Teaching Fellow, Nationai Universily of Singapore, Faculty of Resin-porcelain bond Dentistry, Singapore. Porcelain veneers, inlays, and onlays, like resin- Repdnt requests: Dr Adrian U, J, Yap, National University of Singapore. Faculty of Dentistry, S Lower Kent Ridge Road, Singapore 0511, bonded metal prostheses, require specific treatment of .2Q, Number 8/1995 521 Prosthodoníics Table 2 Luting techniques for resin-bonded prostheses Base metal Procedure Treatment Gold alloys Resin Porcelain Preparation of Heat treatment •/ y X X prostheses Sandblasting X y y X Etching X •/' X y Steam cleaning y y y y Priming (silane treatment) X X y y Preparation of Isolation V / y y adherent Etching enamel and dentin' y y y y Washing and drying y y y y Applying unfilled resin X X y y Cementation Dual-cured resin X X y y Chemically cured resin y y y y -/ = yes; X = no. * If total-etch system is followed. + Electrolytic/chemical etching. their internal surfaces to achieve the best bond to resin environment conducive to gingival health. Chairs ide adhesives. This treatment has been achieved through a time is therefore reduced. The various luting tech- combination of mechanical and chemical means. The niques for the different resin-bonded prostheses are former is provided by etching the porcelain fitting indicated in Table 2. surface'^" and the latter by covering the surface with a silane coupling agent.-" For different porcelain sys- Disadvantages of resin-bonded prostheses tems, different etching concentrations and etching The worst reported disadvantage of resin-bonded times might be required to ensure optimai bonding to prostheses is that their failure rate is higher than that of resin-based adhesives.-' conventional prostheses.-- It is not certain whether this reported difference is absolute or whether it Advantages of resin-bonded prostheses represents (at least in part) the willingness of prac- One ofthe most important advantages of resin-bonded titioners to provide resin-bonded prosthesis in cir- prostheses (fixed partial dentures, onlays, and cumstances in which they would not provide a veneers) is the minimal tooth preparation required. conventionally cemented prosthesis. The reported Standard crown preparations demand the removal of survival rates of resin-bonded prostheses, however, at least 1,5 to 2.0 mm of tooth tissue. In teeth with large yary widely; rates range from 74% to 95?^.-^-" More pulp chambers or small dimensions (eg, mandibular long-term studies with larger sample sizes are required incisors), this preparation may result in short- or before comparisons between their longevity and that of long-term pulpal damage. Because of the minimal conventional prostheses can be drawn. preparation required with resin-bonded prostheses, Occlusal interferences are of'ten introduced with there is often no need for analgesia. Margins of such resin-bonded fixed partial dentures, especially when prostheses can often be kept supragingivaliy. This the maxillary anterior teeth are involved, because it is simplifies impression procedures and maintains an often not possible to reduce the abutment teeth 522 Ouinlessence Internationai Volume 26, Number 8/1995 Prosthodontics Fig 1 a Gross caries associated with debonded retainer on Fig 1b RGSin-bonded tixed partial denture after removai. maxillary right central incisor (mirror view). Resin cement remains on the debonded retainer, indicating failure ol the cement-enamei bond. sufficiently to allow for the thickness ofthe metal and Tooth replacement yet preserve enamel for bonding. Occlusal adjustments usually can be done only after cementation of the It must not be misconstrued that resin-bonded pros- prosthesis. However, the tensile bond strength of these theses are a cheaper, faster, and simpler route to tooth bonded prostheses can be adversely affected by the replacements than conventional fixed pariial dentures. heat or vibration produced during finishing and Eailures do occur, and. if the design is complex, tooth pohshitig.-* Unlike standard crown-and-bridge pros- destruction can be as severe and subsequent treatment theses, no trial periods for esthetic, fLtnctional, or as costly as that caused by the loss of cementation of periodontal reasons are possible with resin-bonded conventional units (Eigs la and lb), Creugers and prostheses. These problems may be overcome with the Van'T Hof^' conducted an analysis of about 60 clinical use of retentive framework designs that can be studies on resin-bonded prostheses and concluded provisionally cemented to allow trial periods and that the overall survival rates were 89% + l/iat I year; occlusal adjustment. 84% ± U at 2 years; 80% ± 1% at 3 years; and 74% ± Appearance can be a problem with resin-bonded 2% at 4 years, Creugers et al'* reported survival rates of prostheses because discrepancies in tooth size, posi- 75% for anterior prostheses and 44% for posterior tion, color, or pontic space are not as easily compen- prostheses. in a 7.5-year follow-up of 203 resin- sated as with standard crowns and fixed partial bonded prostheses. Maxillary anterior resin-bonded dentures. There is also the possibility of graying ofthe prostheses were more susceptible to failure than were abutment teeth, especially in the anterior region, when mandibular resin-bonded prostheses. Electrolytically palatal metal frameworks of resin-bonded prostheses etched prostheses were found to be more retentive approach the incisai edge. Porcelain veneers, as than perforated ones; the survival rates were 78% and currently fabricated, appear to suffer relatively few 63%, respectively. Dunne and Millar^" reported that debonds. Their immediate difficulties lie in achieving perforated retainers had a higher debond rate than did correct shape and color within a very limited bulk; other retainer designs. In this study, splints were found long-term, the quality of the resin bonding agents to have a higher debond rate than simple ftxed partial stands as an unknown factor. denttires, as did restorations placed in patients in the age group 11 to 20 years, restorations involving more Resin-bonded prostheses can be used for tooth than two abutment teeth, and restorations containitig replacement, cosmetic therapy, occlusal therapy, and more than one tooth pontic, Williams et al,^' however, orthodontic/periodontic therapy. found little difference between electrolytically etched and perforated retainers and reported a general debond rate of 31% over a period of 10 years. l—\¿jlume.^6, Number 8/1995 523 Prosthodofitics Dislodged and rebondcd resin-bonded prostbeses bave teeth or trimming the opposing teeth. Point contacts a lower retention rate tban do original bonded pros- should be achieved rather than broad contacts when the mandibular teeth are trimmed. It is preferable in To reduce failures, case selection, prostbesis design, such cases to extend the flange to the ineisal edges and laboratory and
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