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 , 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

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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 , onlays, and cumstances in which they would not provide a veneers) is the minimal tooth preparation required. conventionally cemented prosthesis. The reported Standard 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.

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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 clinical tecbniques sbotild be although the appearance may be compromised. The executed carefttlly. Resin-bonded prostheses should be problem of graying ofthe abutments can be reduced by avoided when enamel is inadequate for bonding; cementation with an opaque luting agent. When esthetic problems are associated with abutment teetb flanges are not extended to the ineisal edges, the in tenns of position, color, and alignment; paraflinc- cement will be loaded in shear during retrusion from a tional acti\'ities are present; undesirable occlusal protruded mandibular position. It is imported to relaîionsbips are present; or the patient indulges in ensure that the minimum permissible thickness (0,3 mm for base metal alloys) of the metal flange is contact sport. Resin-bonded prostheses sbould be achieved, to decrease the amount of adjustment designed to etisure a maximal area of bonding of required on the opposing teeth. In patients with large retainers to enamel. Framework designs should aiso anterior guidance such as those with Class II, division mechanically engage each abutment and have a distinct 2. malocclusion, acid-etched prostheses are best path of insertion to iimit the stresses placed on the avoided because the metal flanges usually cannot be luting agent and the bond. This is achieved by creating accommodated without excessive adjustment of both proximal resistance form (proximal wrap-around) and metal and the opposing teeth. may be supplemented by the use of auxiliary retention. It is essential that the framework be rigid, particularly For posterior resin-bonded prostheses, catiine- with increasing span and when it is not possible to guided is most favorable. For patients with group function, occlusal contacts in excursive move- control occlusal loads on the framework. All-porcelain ment should ideally be removed to decrease stresses on resin-bonded prostheses have been introduced to the cement lute. improve esthetics," but long-term clinical studies of such prostheses are not available. Decision making and occlusal planning are simpli- Esthetic therapy fied by the use of diagnostic casts mounted on a semi- The concept of using porcelain veneers to mask adjustable articulator. Trial preparations often help as unsightly teeth is not new, Pincus'^ in 1928 first well. The use of resin-bonded prostbeses can be described the use of porcelain veneers, which were considered under the following situations. baked on platinum foil and cemented with denture adhesives, to alter an actor's teeth. Veneers can be No anterior guidance (open bite) fabricated tbrough direct techniques with resin compo- Flatiges on abutments in such cases generally do not sites and indirect techniques with acrylic resin, resin pose any problems. It is not essential that tbe flanges composite, or porcelain. The veneers fabricated with be extended to cover the ineisal edges; tbus, graying of indirect techniques are generally more accurate in fit these teeth is avoided. Occlusion should, however, be and form. Direct techniques are, however, more carefully examined to ensure that the flanges do not practical when defects or discrepancies are localized, interfere with excursive movements. Phonetics should as with small diastemas or fractures and litnited areas also be checked. of discoloration. Acrylic resin and resin composite veneers offer smooth surfaces, good masking, and easy Shallow anterior guidance chairside finishing, but porcelain veneers (Figs 2a If the path is less than a quarter ofthe clinical crown and 2b) are superior in appearance, color stability, resistance to abrasion, and longevity. height, it is best not to alter the occlusal relationship. Rather, the margin ofthe flange should circumvent the Essential to the bonding of porcelain to tooth is contact areas, provided that this does not compromise etching ofthe porcelain fitting surface, enhanced by the retention ofthe flange. silane coupling,^" Porcelain veneers seem to be pro- viding better chnical results'*-'^ than initial impres- Moderate and large anterior guidance sions would have indicated. Calamia," who conducted If the path is greater than a quarter ofthe clinical crown a very thorough clinical trial, had an extremely low height, space must be created to accommodate the fracture rate of 0,4% over 2 to 3 years. He also found a flange either by removing enamel on the abutment slight deterioration of the marginal adaption and an

524 Quintessence international Volume 26, Number 8/1995 Prosthodontics

Fig 2a Peg-shaped maxillary left iateral incisor. Fig 2b Porcelain placed to restore esthetics.

increase in mat^inal discoloration, neither of which some authors have advocated placement of veneers was of any chnical significance. Marginal discoloration without tooth preparations, Highton et aP* have shown was freqnently located at the proximal and gingival that, with normal incisai loading patterns, gingival and t:iai^ins in dentin. Changes in marginal adaption were incisai tooth preparations reduce stresses within the commonly in the incisai region and were caused by vencer. An impact fracture study on intact and crowned dissolution, or wash out. ofthe luting medium. Just as teeth performed by Stokes and Hood^^ has indicated with resin-bonded prostheses, porcelain veneers are that porcelain veneers may actually stiffen teeth. contraindicated in patients with active caries, peri- Several problems are associated with the use of odontal disease, inadequate enamel for bonding, or porcelain veneers. To begin, the fit of such restorations paratlinctional activities. needs to be improved. GapsofS0to400 |im have been Preparation for veneers should be kept within reported between veneers and tooth preparation.''"'" enamel where possible to rednee microleakage and The different finishing techniques have their disadvan- allow for assessment of margins. Wat et al," however, tages as well.^^ The use of a cotton pellet to remove have shown that 80% to 100% of anterior teeth have excess resin tends to drag out the resin, resulting in a exposed dentin cervically when prepared for veneers. gap between the veneer and the preparation. The Their study indicated that dentinal bonding agents may paintbrush and resin technique usually leaves excess be ineffective in preventing marginal leakage at the resin over the outer surface ofthe veneer. The use of cervical aspect ofthe veneers where exposed dentin is white stone or diamonds causes a loss of glaze and present. They found that the addition of a short beyel roughness ofthe porcelain. The color ofthe veneers in to the preparation prior to cementation improved general is good, but it is influenced by the shade ofthe marginal adaption and suggested that this occurred as underlying resin composite, which may shift following a result of a better orientation of the enamel rods as cementation if dual-curing cements with a chemical well as an increase in the surface area of enamel for acid catalyst are used. Although characterization can be done and instant investments that allow conventional etching. glazing are marketed, glazing may be difficult because Several veneer designs have been proposed. These ofthe volume of investment material, which absorbs have been termed window, feather edge, and inct.ml heat and precludes the porcelain from reaching a high .coverage in relation to maiBinal position. Choice of enough temperature to fuse in the surface 100 ^im. design is dictated by the position and shape ofthe final Luting agents used arc either light cured or chemically restoration, the extent of discoloration of the tooth cured. Linden et al,''- however, indicated that there is concerned, the anticipated tooth-loading pattern, and very little postcure and that light curing alone is the existing occlusion. With regard to occlusal con- inadequate because of attenuation by the porcelain tacts, the aims are to minimize shear stresses in the yeneer itself. Some chemical curing is therefore luting agent while in ftmction and to avoid intercuspal desirable. The problem with dual-curing cements is contacts on the porcelain-tooth junction. Although

=¡.iiM¡i¡Mi!Mr|ij!"'.f;|inrvi?-g*\ Number 8/1995 525 Prosthodontics

Fig 3a Bonded gold veneers on all maxillary anienor teeth Fig 3b Completed rehabilitaliori of the maxillary arch. The except the crowned central incisor. A removable prosthesis restorations provide a permanent increase in the vertical provides a provisional increase in the vertical dimension of dimension of occlusion. occlusion

Fig 4a Mandibular molar eliciting symptoms of cracked- Fig 4b Adhesive onlay cemented with Panavia Ex (J tooth syndrome. An orthodontic band has been provision- Monta) over the tooth and resin composite {which was ally cemented placed over a glass-ionomer cement base to replace the original amalgam restoration).

their unknown long-term color stability, which may dimension of occiusion if esthetics is not compromised lead to disappointment after some years' use, and if the tooth is not heavily restored. Margins of resin-bonded retainers placed on amalgam restora- Occlusal therapy tions have been shown to leak more than those placed The same principle of bonding a metal retainer to tooth on resin composite restorations or tooth/*"'^^ Minimal substance that is used for resin-bonded prostheses may tooth preparations arc required for this purpose, and be applied to the provision of occlusal veneers to thus conservation of the already-compromised tooth restore and protect worn teeth/^ In patients with tissue is achieved (Figs 4a and 4b), extensive tooth wear, it is sometimes necessary to Traditionally such castings have been fabricated in crown individual teeth or groups of anterior or nickel-chromium or cobalt-chromium alloys. Type IV posterior teeth to improve esthetics and function. gold alloys can also be used if they are heated to more Alteration of the vertical dimension of occlusion may than 65O°C, This heating process results in the be necessary to create space for restorations (Figs 3a formation of an oxide layer that increases chemical and 3b) and enhance the patient's extraoral appearace. adhesion to the resin cements,''^ In prosthodontic Adhesive onlays can be used to increase the vertical terms, gold alloys remain popular, owing to their

526 Quintessence International Volume 26, Number 8/199F; Prosthodoníics

Fig 5a Patient with a repaired ciell palate and congenitaiiy Fig 5b Resin-bonded prosthesis providing function and missing maxJilary right lateral ¡ncisor. Finai alignment has esthetics, as weii as orthodontic retention imirrow view). been achieved orthodonticaily stability under oral conditions, easy handling, and good adaptability. Several other methods to achieve adhesion to gold alloy surfaces have been attempted. They include electro-oxidation, chemical oxidation, and electro- etching. Wada'" concluded that a combination of sandbiasting and tin electroplating is the best way to maximize resin adhesion to gold alioys. Tin plating produces a roughened surface; both micromechanical retention and chemical attraction through hydrogen bonding to the tin oxide that is formed appear to be responsible for the increased bond strength."'^*'' It is essential to sandblast the bonding surface of the restoration before tin plating to clean it and to allow Fig 5c Faciai view ot the compieted prosthesis. good wetting by the plating solution. There are no long-term data on the longevity of such prostheses. McLundie^" has reported, the use of porcelain laminates for the restoration of localized palatal tooth provision of removable retainers, which depend on surface loss after initial treatment with an anterior bite patient compliance. Resin-bonded splints are also more plane. esthetic than removable retainers and are particularly useful in patients with cleft palate in whom both orthodontic and prosthodontic treatment is required Orthodontic/periodonfic therapy (Figs 5a to 5c). Resin-bonded prostheses evolved from periodontal Orthodontic tooth movement can also be achieved splints that were fabricated to increase the comfort of with the use of Dahl's appliance, which is basically a patients with disturbing tooth mobility. Practical resin-bonded, cobait-chromium anterior bite plate or problems with such splints include the immobilization splint covering the palatal surfaces ofthe six anterior of the teeth during impression procedures, the de- teeth. Dahl and Krogstad^' used such prostheses as a creased access for oral hygiene maintenance, and the temporary measure to treat 20 patients with pathologic large differential mobility of teeth, which may lead to attrition of maxillary and/or mandibular anterior teeth. debonds. Such prostheses are no longer in vogue. They found that the continuous use of these splints Resin-bonded splints are, however, currently used for under functional load caused intrusion of the front retention of tooth position after active orthodontic teeth and eruption ofthe other teeth in all patients. The treatment. They are often preferred to the long-term mean intrusion was 1.05 mm and the mean eruption

^, Number 8/1995 527 Prosthodontics

Fig 6a f/effj Mandibular ngtit seoond premolai with a failing and unesthetic mesio-occlusodis1al res- toration.

Fig 6b Ibelowj Porceiain inlay/oniay cemented wilh duai- curing resin. The restoration improves esthetics without ioss of funclion.

was 1.47 mm after 6 to 14 months, which indicated These ceramic restorations can be distinguished, that there is a potential for tooth eruption in human according to their material composition and their adults. More eruption than intrusion appeared to take fabrication, into three groups; castable materials (eg, place in the youngest age group. The use of such splints Dicor, Dentspiy International), materials fired on caused only transient discomfort for the wearers. Such investment material (eg. Optec HSR Jeneric/ resin-bonded appliances can be used to create space Penetron), and computer-aided, milled materials (eg, for restorations, increase the vertical dimension of Cerec system, Siemens Dental), Compared with occlusion, and reduce the need for elective endodontic directly placed resin composites in posterior teeth, and extensive prosthodontic therapy in the treatment ceramic inlays have been shown to provide a better of worn-down dentitions. marginal seal at the cervical restoration-dentin inter- face.'- There is, however, a possibilitj' of mat^inal quality deterioration at the enamel-resin composite Other forms of resin-bonded prostheses and inlay-resin composite interfaces of ceramic inlay Ceramic restorations after thermocycHng," A clinical study by Improved strength and the ability to bond to tooth O'Neal et al^'' showed that the width ofthe interfacial structure through the use of adhesive resins make gap between the inlay restoration and tooth, which porcelain inlays and onlays an option for esthetic determines the vertical loss of wear of luting agents, restoration of posterior teeth (Eigs 6a and 6b), Such varies among the different inlay systems. The vertical wear of luting agents tends to occur lineariy in the ftrst restorations must, however, be used with caution, year and then generally levels oif. They also concluded because all ceramics, whether glazed or unglazed, will that microfilled luting agents or those containing cause wear on the opposing natural dentition. Such subtiiicron-sized fillers are considerably more resistant prostheses are contraindicated in patients who clench, to wear than hybrid ones.^"* brux, have poor orai hygiene, or inadequate motivation and in situations in which adequate moisture isolation Jensen et al" have demonstrated that resin-bonded cannot be achieved. They are also contraindicated in ceramic inlays can restore the cuspal stifihess of preparations in which there arc excessive undercuts prepared teeth to a level equal to that of unprepared and when proximal boxes have cavosurface margins teeth. Long-term clitiical assessments of such restora- primarily in dentin. tions are not currently available.

528 Quintessence International Volume 26, Number 8/1995 Prosthodontics

Resin inlays and onlays References

Resin-bonded resin composite inlays were introduced 1. Rochelle AL, Atlachmcnt ora spUiiL lo enamel of lower anieriur to avoid or reduce in situ polymerization shrinkage tmh. J Prosthet Dem 1973;30;4l8-423. associated with direct placement of posterior resin 2. Ibsen RL. Fixed proslhelks with a naturai crown ponlie using an composite restorations and to optimize restoration adiiesive composilc. J Soulti CaiifDent Assoc I973;4I:100-I02. 3. Stolpa JB. All adhesive technique for small anterior fiíLed panial contour and adaption. Such inlay systems may be denliires. J Proslliel Dent Í975;34:5I3-SI9. classified according to the method of construction 4 Ponnoy LL. Coiistrucling a composite ponlie in a single visil. Dent (direct or indirect), method of curing (post-cured, Surv 1973;AuE:20-33. secondarily cured, or conventionally cured), and the 5 Howe DF, Dcnetiy CE, Anterior fixed partial dentures using the type of resin composite (microfilled, fine, or coarse acjd elch technique and a cast metal framework. J Proslhet Denl hybrid).^" Although it has been shown that the 6. Wiltshire WA. Tensile bond strengths of various alloy surface physical properties of some resin composite materials, treatments for resin bonded bridges. Quinlessence Dent Teehnol such as hardness, in vitro wear, diametral tensile l986ilO:227-232. strength, and color stability, can be improved by 7. Doukotidakis A, Cohen B, Tsoulsos A. A new chemical method for etching metal frameworks for acid-elched prosthesis. J Prosthet supercuring of the material,-'-^* overcuring of such Dent l987;5g;421-423. materials will deplete the pendant groups available for S. McLaughlinG. Composite bonding of etched metal anterior splints. chemical bonding with the resin luting cement.^* Compend Comin Educ Dent 19i!l;::279-2B3. Such resin-bonded inlays have been reported to 9. Lividitjs GJ, Thompson VP. Etched castings: An improved retentive mechanism for resin-bonded retainers, J Prosthet Denl 19E2i47; provide a better marginal seal than directly placed 52-SS. resin composite restorations in both Class I and II 10. Stokes AN, Tidniarsh BG. Porous metal coating for resin-bonding situations,"'^"''' In a 1-year clinical study, Bessing and systems. J Hrosthet Dent l9S6;18:675-678. 11. Boggia R. Harris T An alternative retention system for Rochette Lundqvist^- reported that 21 of 30 resin-bonded inlays bridges. Dent Pract 19S3;July; 10-13. had excellent ratings and eight of the remaining nine 12. LaBarre EE. Ward HE. An alternative resin bonded restoration. had acceptable ratings. Wendt and Leinfelder^^ con- J Prosthet Dent l984;52:247-249, ducted a 3-year clinical trial of 60 inlays and observed 13. Moon PC, Knap FJ. Acid-etched bridge bond strength utilising a new retention method [abstract 2961, J Dent Res Í983;6:|spccial no failures. They also stated that the marginal charac- issue A¡:6S2. teristics of the inlays are superior to those of directly Í4. Tanaka T, Nagata K, Takeyama M, et al 4 META opaque resin. A placed restorations. new resin strongiy adhesive to nickel-chromium alloy J Dent Res Í982;6O:1697-Í7O6, Í5, Omura S, Yamuciii J, Horada L et al. Adhesive and mechanical Conclusions properties of a new dental adhesive |abstract 56i|. J Dent Res 1984.63:233. Resin bonding of prostheses has become an important Ih. vanderVeenJH,Kranji inkT, Bronsdijk AE, elal. Resin bonding technique in the provision of dental health care, of tin electroplated pre JS metal fixed partial dentures: One-year Ahhough the provision of such resin-bonded pros- chnical results. Quinte ce Int 1986;I7:229-3OL 17 Musil R, Tiller HJ. The adhesion of dental resins to metal surfaces. theses does not require any special training, and they The Kulier Silicoater Technique. Germany: Kulzer, 1984, are fairly easy to execute, cases must be selected with 18. Simonsen RJ, CalamiaJR. Tensile bond strength of etched porcelain caution and patients must be warned of possible (absiract 1154] J Dent Res 1985:52:297. deterioration in the ftiture. The need for life-long 19. Horn HR. Porcelain laminate veneers bonded to etched enamel. recalls and maintenance cannot be overemphasized, Dent Chn North Am 1983:27:671-684. 20. Calamia JR, Simonsen RJ Effect of coupling agents on bond particularly for resin-bonded fixed partial dentures, strength of etched porceiain (abstract 791, J Dent Res 1984; because partial debonds can lead to extensive caries. 63 179 The frequency of such debonds increases with the 21. Calamia JR, Vaidynathan J. Vaidynathan TK, Hirsch SM, Shear bond usage of multiple abutments. Designs should therefore strength of etched porcelains ¡abstract 10961. J Dent Res I9S5: 64:296, be kept simple and practical. If used wisely, such 22 Tay WM. Resin Bonded Bridges. A Practioner's Guide. London: resin-bonded prostheses can be a feasible component Martin Dunitz, Í992:li6. ofthe daily practice of dentistry. 23, Creugers NH, Snoek PA, Van'T Hof MA, Kayser AF. Clinical performance of resin-bonded bridges: A 5 year prospective study. Part I, Design ofthe sttidy and influence of experimental variables, JOralRehabil 1989:16:427-436. 24. Ferrari M, Mason PN, Cagidiaco D, Cagidiaeo MC. Clinical evaluation of resin bonded bridges, Int J Periodont Rest Denl Í989;3:2O7-2I9.

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