A SYSTEMATIC REVIEW OF THE SURVIVAL AND COMPLICATION

RATES OF RESIN-BONDED FIXED DENTAL PROSTHESES AFTER A

MEAN OBSERVATION PERIOD OF AT LEAST 5 YEARS
Thoma DS, Sailer I, Ioannidis A, Zwahlen M, Makarov N, Pjetursson BE. A Systematic Review Of The Survival And Complication Rates Of Resin-bonded
fixed Dental Prostheses After A Mean Observation Period Of At Least 5 Years. Clin. Oral Impl. Res. 00, 2017, 1–10
INTRODUCTION
 Single missing
tooth

Pjetursson BE, Tan WC, Tan K, Brägger U, Zwahlen M,

Removable Fixed Lang NP. A systematic review of the survival and
prosthesis prosthesis complication rates of resin-bonded bridges after an
observation period of at least 5 years. Clin Oral Implants
Res. 2008;19(2):131–141.

Implant
Resin Bonded Fixed dental
Removable supported
Bridges (RBBs) Prosthesis
partial denture single crowns
(FDPs)
(SCI)

87.7% 94.4% 96.3%

 “What are the survival and complication rates of RBBs
after a mean observation period of 5 years?”

FOCUSED QUESTIONS

“What is the influence of the framework material, the

location (maxilla, mandible, anterior, posterior), and
the number of retainers on the survival and
complications rates of RBBs after a mean observation
period of 5 years?”
Population
PICOTS
• Patients with single missing tooth replaced with resin bonded bridges

Intervention and Comparison

• Resin bonded bridges made of Metal Ceramic, Metal resin, Glass infiltrated ceramic, Glass
reinforced ceramics, densely sintered Zirconia and composite
• Resin bonded bridges in the anterior jaw Vs in the Posterior jaw
• Resin bonded bridges in the maxilla Vs in the mandible
• Resin bonded bridges with one wing ( cantilever) Vs with two winged or fixed – fixed prosthesis

Outcome
• Survival and complication rates

Time
• Time interval of at least 5 years

Study design
• Randomized controlled trials, prospective studies, retrospective studies
OBJECTIVES

• To obtain the long-term survival rate of RBBs and

• To evaluate the incidence of technical, biological, and esthetic
complication over a mean observation period of at least 5 years
INCLUSION CRITERIA EXCLUSIO
N
CRITERIA
Human trials
S
Mean follow-up of 5 years or more
Studies based on
Prospective and retrospective cohort studies and case patient records (i.e.,
series
Published in dental journals
questionnaires,
interviews)
Patient needed to be examined clinically at the follow-up
visit
Reported details of suprastructure Studies involving
extensive tooth
preparations (e.g.,
Included at least 10 patients inlay-retained
FDPs).
Language: English; German
 A MEDLINE (PubMed) search was performed for
clinical studies, including articles published from
February 1, 2007 up to October 28, 2015 in the
MESH TERMS USED Dental literature

FPD OR FPDs Or fixed

dental prosthesis OR FDPs
(Denture, Partial, Fixed, Fixed Resin-Bonded OR
OR FDP OR FDPs OR
Resin-Bonded [Mesh] RBB OR RBBs
bridge OR fixed partial
denture

Survival OR survival rate

OR survival analysis OR
Adhesive bridge OR
dental restoration failure
Maryland bridge
OR prosthesis failure OR
treatment failure
 15
15 Prospective
Prospective
studies
studies

29 studies
13
included in
13
Retrospective
Retrospective
studies
studies
the
systematic
review

11 multi-
multi- center
center
study
study

The studies included 2366 patients aging between 13 and 87 years

 OPERATIONAL DEFINITIO
RBB survival RBB remaining in situ with or without modification for the
entire observation period.

Failure of RBBs that were lost and required re-fabrication, or multiple

re-cementations representing reconstructions that had been re-
RBBs cemented more than once

Biological Caries on abutment teeth

complications Periodontal disease progression.
Loss of retention with or without loss of the reconstruction
Technical
Fractures of the veneering ceramic, with or without loss of the
complications reconstruction.
RESULTS
SURVIVAL Exposure
Exposure time
time of
of
RBBs
RBBs that could be
that could be
followed for the
followed for the
whole
whole observation
observation
time.
time.

Exposure
Exposure time
time up
up to
to aa
failure
failure of
of the
the RBBs
RBBs TOTAL
that
that were
were lost
lost due
due to
to EXPOSUR
EXPOSUR
failure during the
failure during the E
E TIME
TIME
observation
observation time.
time.

Exposure
Exposure time
time upup to
to
the end of
the end of
observation
observation time
time for
for
RBBs that did
RBBs that did notnot
complete
complete the
the
observation period
observation period
SURVIVA
L
ANNUAL SURVIVAL AND
FAILURE RATES
ACCORDING TO
DIFFERENT MATERIALS
UTILISED
SURVIVAL RATES ACCORDING TO NUMBER OF RETAINERS

The one retainer group had significantly (P < 0.0001) lower annual failure rate of 0.87 (95% CI: 0.59–1.28%)
compared with an annual failure rate of 2.17 (95% CI: 1.44–3.27%) for the two-retainer group.
SURVIVAL RATES ACCORDING TO LOCATION IN THE ORAL
CAVITY

MAXILLA
MAXILLA>>
MANDIBLE
MANDIBLE
ANTERIOR >
 Dental
Dental caries
caries
Loss
Loss of
of
vitality
vitality of
of
abutment
abutment
teeth
teeth

Abutment
Abutment
Recurrent
Recurrent tooth
tooth
periodontitis
periodontitis fracture
fracture

BIOLOGICAL
COMPLICATIONS
 TECHNICAL
COMPLICATIONS
• DEBONDIN
G
Framework Annual
material debonding rate
Metal Acrylic 4.17%
Metal Ceramic 2.89 %
Fibre reinforced 1.72%
composite
Zirconia 1.42%
framework
Glass infiltrated No debonding
and glass occurred
reinforced
ceramics
ANNUAL DEBONDING RATES ACCORDING TO LOCATION IN THE
ORAL CAVITY

MAXILLA
MAXILLA>>
MANDIBLE
MANDIBLE
ANTERIOR >
 TECHNICAL
COMPLICATIONS
• FRAMEWOR
K AND
VENEER
FRACTURE
No failures Statistically
• RBBs made of significant
metal–ceramic failures
• zirconia • RBBs made of
• Reinforced glass metal–resin
ceramic • Glass-infiltrated
ceramic,
• Fber-reinforced
composite
 TECHNICAL
COMPLICATIONS
• MINOR
VENEER
FRACTUES /
Framework Annual
CHIPPING
material chipping
rates
Metal Acrylic 2.89
Fibre reinforced 1.42
composite
Glass infiltrated 1.04
Ceramics
Glass reinforced 0.95
ceramics
Metal Ceramic 0.29
Zirconia framework 0
 TECHNICAL
COMPLICATIONS
• ESTHETIC
FAILURES
DISCUSSION
CHANGE IN TRENDS
The factors influencing the
outcomes of the RBBs were Pjetursson BE, Tan WC, Tan K, Brägger U,
Zwahlen M, Lang NP. A systematic review
of the survival and complication rates of
resin-bonded bridges after an observation
The selection of period of at least 5 years. Clin Oral
Implants Res. 2008;19(2):131–141.
framework material

The design of the

RBB Thoma DS, Sailer I, Ioannidis A, Zwahlen
M, Makarov N, Pjetursson BE. A
Systematic Review Of The Survival And
The location in the Complication Rates Of Resin-bonded fixed
Dental Prostheses After A Mean
jaws Observation Period Of At Least 5 Years.
Clin. Oral Impl. Res. 00, 2017, 1–10
DISCUSSION

The 5-year survival rate of

RBBs is only 4.9% lower and
the 10-year survival rate
6.5% lower than the survival
rate reported for implant-
supported SCs
Jung RE, Zembic A, Pjetursson BE, Zwahlen M,
Thoma DS. Systematic review of the survival rate
and the incidence of biological, technical, and
aesthetic complications of single crowns on
implants reported in longitudinal studies with a
mean follow-up of 5 years

• Caries at abutment level was 1.7%, and incidence of RBBs lost due to periodontal diseases was 0.8% over and 5-year
observation period. For traditional tooth-supported end abutment FDPs, the respective figures are 4.8% and 0.4%.
• The incidence of RBBs lost due to esthetic failures was only 0.3%. For implant-supported SCs, 7.1% of the cases were
reported to have unacceptable esthetic outcome
COMPARISON BETWEEN DIFFERENT MATERIALS
CHIPPING
DEBONDING
FRAMEWORK FRACTURE Framework Annual
Framework Annual material chipping
material debonding rate rates
Metal Acrylic 4.17% Metal Acrylic 2.89
Metal Ceramic 2.89 % No failures Statistically Fibre reinforced 1.42
Fibre reinforced 1.72% • RBBs made of significant composite
composite metal–ceramic failures
• zirconia Glass infiltrated 1.04
Zirconia 1.42% • Reinforced glass
• RBBs made of Ceramics
framework metal–resin
ceramic • Glass-infiltrated Glass reinforced 0.95
Glass infiltrated No debonding ceramic, ceramics
and glass occurred • Fiber-reinforced
Metal Ceramic 0.29
reinforced composite
ceramics Zirconia framework 0
COMPARISON BETWEEN DIFFERENT MATERIALS
CHIPPING
DEBONDING
FRAMEWORK FRACTURE Framework Annual
Framework Annual material chipping
material debonding rate rates
Metal Acrylic 4.17% Metal Acrylic 2.89
Metal Ceramic 2.89 % No failures Statistically Fibre reinforced 1.42
Fibre reinforced 1.72% • RBBs made of significant composite
composite metal–ceramic failures
• zirconia Glass infiltrated 1.04
Zirconia 1.42% • Reinforced glass
• RBBs made of Ceramics
framework metal–resin
ceramic • Glass-infiltrated Glass reinforced 0.95
Glass infiltrated No debonding ceramic, ceramics
and glass occurred • Fiber-reinforced
Metal Ceramic 0.29
reinforced composite
ceramics Zirconia framework 0
COMPARISON BETWEEN DIFFERENT MATERIALS
CHIPPING
DEBONDING
FRAMEWORK FRACTURE Framework Annual
Framework Annual material chipping
material debonding rate rates
Metal Acrylic 4.17% Metal Acrylic 2.89
Metal Ceramic 2.89 % No failures Statistically Fibre reinforced 1.42
Fibre reinforced 1.72% • RBBs made of significant composite
composite metal–ceramic failures
• zirconia Glass infiltrated 1.04
Zirconia 1.42% • Reinforced glass
• RBBs made of Ceramics
framework metal–resin
ceramic • Glass-infiltrated Glass reinforced 0.95
Glass infiltrated No debonding ceramic, ceramics
and glass occurred • Fiber-reinforced
Metal Ceramic 0.29
reinforced composite
ceramics Zirconia framework 0
COMPARISON BETWEEN DIFFERENT MATERIALS
CHIPPING
DEBONDING
FRAMEWORK FRACTURE Framework Annual
Framework Annual material chipping
material debonding rate rates
Metal Acrylic 4.17% Metal Acrylic 2.89
Metal Ceramic 2.89 % No failures Statistically Fibre reinforced 1.42
Fibre reinforced 1.72% • RBBs made of significant composite
composite metal–ceramic failures
• zirconia Glass infiltrated 1.04
Zirconia 1.42% • Reinforced glass
• RBBs made of Ceramics
framework metal–resin
ceramic • Glass-infiltrated Glass reinforced 0.95
Glass infiltrated No debonding ceramic, ceramics
and glass occurred • Fiber-reinforced
Metal Ceramic 0.29
reinforced composite
ceramics Zirconia framework 0
COMPARISON BETWEEN DIFFERENT MATERIALS
CHIPPING
DEBONDING
FRAMEWORK FRACTURE Framework Annual
Framework Annual material chipping
material debonding rate rates
Metal Acrylic 4.17% Metal Acrylic 2.89
Metal Ceramic 2.89 % No failures Statistically Fibre reinforced 1.42
Fibre reinforced 1.72% • RBBs made of significant composite
composite metal–ceramic failures
• zirconia Glass infiltrated 1.04
Zirconia 1.42% • Reinforced glass
• RBBs made of Ceramics
framework metal–resin
ceramic • Glass-infiltrated Glass reinforced 0.95
Glass infiltrated No debonding ceramic, ceramics
and glass occurred • Fiber-reinforced
Metal Ceramic 0.29
reinforced composite
ceramics Zirconia framework 0
 In specific and clearly defined patient
situations, RBBs may be considered as
valid minimally invasive treatment
CONCLUSIO alternative to conventional FDPs or
single implant crowns

N
Combining the information and
knowledge from the present systematic
review, The RBBs exhibited the best
outcomes in anterior regions, with a
single-retainer design and when made of
zirconia-ceramic

The need for improvement today is to

decrease the de-bonding rate with
surface treatment of the ceramic, new
cementation protocols, or new abutment
tooth preparation designs
 The exclusion criteria was not stringent

CRITICAL APPRAISAL Quality assessment of the included studies not

performed

Risk of bias not evaluated.

Preparation details not considered

Surface treatments of the retainers

Bonding agents / cements used

Occlusion and Incisal guidance not considered

Assumption of annual failure rates to be constant

CROSS REFERENCES
 CONCLUSION :
>15-year
>15-year prognostic
prognostic investigation
investigation regarding
regarding 3-
3-
unit
unit RBFDPs
RBFDPs and and full-coverage
full-coverage FDPs.
FDPs.
1.
1. The
The 15-year
15-year cumulative
cumulative survival
survival and
and event-
event-
free
free rates
rates of
of RBFDP
RBFDP and and FDP
FDP groups
groups were
were
not
not significantly
significantly different.
different.
2.
2. Non-survival
Non-survival duedue to
to abutment
abutment tooth
tooth
extraction
extraction were
were significantly
significantly less
less frequent
frequent
in
in the
the RBFDP
RBFDP group.
group.

RESULT:
1. The 15 year cumulative survival rates of RBFDPs was 66.5 % and that of FDPs
was 61.6%
2. The 15-year cumulative event-free rates were 53.4% for the RBFDP group and
59.2% for the FDP group

Yoshida T, Kurosaki Y, Mine A, et al. Fifteen-year survival of resin-bonded vs full-coverage fixed dental prostheses. J Prosthodont Res. 2019;63(3):374‐
 OBJECTIVE :
To evaluate the survival rate of resin bonded
bridges (RBBs) and understand the
relationship between various prognostic
factors and survival rate

ASSOCIATION BETWEEN
The predicted survival rate:
PROGNOSTIC FACTORS AND
SURVIVAL OF RBB:
5 Years 83.6% 1. Tooth preparation design
2. Tooth preparation depth
3. Occlusion
10 Years 64.9% 4. Surface treatment of retainer
5. Retainer type
6. Gingival finish line location
7. Retainer alloy
COMPLICATIONS: 8. Luting cements
9. Location of bridge
77% are due to 13% are due to
debonding of RBBs porcelain fracture
Balasubramaniam GR. Predictability of resin bonded bridges - a
systematic review. Br Dent J. 2017;222(11):849‐858.
 PROGNOSTIC CONCLUSIONS
FACTOR
Tooth preparation design A minimal preparation or no preparation design had more chances of failure than a
retentive preparation
Tooth preparation depth All preparation should lie only in enamel whatever may be the design chosen as bond
strength to dentine is lower than in enamel
Occlusion Occlusion on retention wings, occlusion on pontics, a pontic directly involved in protrusive
and laterotrusive contacts had no significant effect on longevity of rbbs
Surface treatment of retainer Silicoating the retainers showed better survival than other surface treatments.
Retainer type Chemically etched retainers performed better and the MOD design or extracoronal retainer
performed better than the inlay design
Gingival finish line location Bridges with both retainers having supra gingival finish lines showed a better retention rate

Retainer alloy It was concluded that ni-cr and co-cr alloys are preferred over gold or titanium alloys as
they double the modulus of elasticity.
Luting cements Multi link (93%) and panavia (82%)

Location of bridge Maxilla> mandible

Anterior > posterior
“The preservation of that which remains is of utmost
importance and not the meticulous replacement of that
which has been lost”. - Muller DeVan, 1952.
CONCLUSION
 REFERENCES
 Yoshida T, Kurosaki Y, Mine A, et al. Fifteen-year survival of resin-bonded vs full-coverage fixed dental
prostheses. J Prosthodont Res. 2019;63(3):374‐382.
 Behr M, Leibrock A, Stich W, Rammelsberg P, Rosentritt M, Handel G. Adhesive-fixed partial dentures in
anterior and posterior areas Results of an on-going prospective study begun in 1985. Clin Oral
Investig 1998; 2: 31–35.
 De kanter R J, Creugers N H, Verzijden C W, Vant hof M A. Five-year multi-practice clinical study on
posterior resin-bonded bridges. J Dent Res 1998; 77: 609–614.
 Rammelsberg P, Pospiech P, Gernet W. Clinical factors affecting adhesive fixed partial dentures: a 6year
study. J Prosthet Dent 1993; 70: 300–307
 Balasubramaniam GR. Predictability of resin bonded bridges - a systematic review. Br Dent J.
2017;222(11):849‐858.
 Thoma DS, Sailer I, Ioannidis A, Zwahlen M, Makarov N, Pjetursson BE. A Systematic Review Of The
Survival And Complication Rates Of Resin-bonded fixed Dental Prostheses After A Mean Observation
Period Of At Least 5 Years. Clin. Oral Impl. Res. 00, 2017, 1–10
 Pjetursson BE, Tan WC, Tan K, Brägger U, Zwahlen M, Lang NP. A systematic review of the survival and
complication rates of resin-bonded bridges after an observation period of at least 5 years. Clin Oral
THANK YOU!