Retainers in FPD

Restraining what is left

By: Ghida Lawand

Hind Tabbal
 What is a Retainer?
It’s that component of an FPD which takes
support from the abutment tooth and provides
retention to the prosthesis.
 Ideal Requirements:

1) Should cause least amount of

destruction to the abutment
2) Least destroys the outline form of
the tooth
3) Marginal line should be finished
with great accuracy
4) Rigidity  withstand requisite load
 Functional adaptation and protect the tooth
against its fracture
 Least destroys the cervical marginal ridge
 Positioned margins at less susceptible to caries
or recurrence of caries
 Preparation should be made without trauma to
the pulp or surrounding tissue
 Accurate complement to the lost tooth
structure
 Cleansable
 Esthetic
 Retainers

Extracoronal Intracoronal Radicular

Complete Partial Veneer -Inlay -Cast Post

Crowns Crowns -onlay -Prefabricated post

-All Metal -3/4th crown

-All Ceramic -Mesial half Crown
-Metal Ceramic -7/8th crown
 Criteria of selecting type of retainer
Abutment teeth are aligned
Full Veneer crown
parallel to one another

Non carious abutments

/abutments with large
Partial Veneer crown
restorations but intact buccal
and lingual surfaces

All Ceramic
 Classification of retainers

Based on
Based on the Based on the Based on mode
material being
tooth coverage location of retention
used
 Based on the tooth coverage

Full coverage Partial coverage Conservative Telescopic retainer

retainer retainer retainer
 A- Full coverage
retainer
These retainers cover all the five surfaces of the abutment
tooth.
Advantages
 Contact area can be properly developed
 Embrasure area can be enhanced
 Buccal contours can be correctly developed
 Facilitate occlusal plane modifications
 Indicated for endodontically treated abutments
 Ideal for restoring edentulous area in patients with
craniofacial anomalies
Disadvantages

Extensive tooth preparation

Poor supportive tissue response
(subgingival finish line)
Gingival decay is prevalent
Poor esthetics (metal crowns), restricted to
posterior teeth
Indications

1. Short clinical crown

2. For a patient with a history of active caries and

poor hygiene

3. In both vital and pulpless teeth

4. Metal ceramic crowns and all ceramic crowns are used in
situations that require good cosmetic results with maximum
resistance and retention requirements.
 1. Full metal crown:

It is an artificial metallic restoration used to cover the all surfaces of the clinical crown.
It is made only from metal, e.g. gold.
Can be either partial or full veneer crown.
Require minimal tooth reduction.
Strong even in thin sections.
Preperation:
Occlusal reduction:
 non centric cusp – 1mm
 centric cusp – 1.5mm
Margin:
chamfer – allows 0.5mm thickness
 Indications

1.As single crown or as a bridge.

2.Only for posterior teeth.
3.In patients with high caries index.
4.For an endodontically treated tooth/or teeth.
5.For malalignment tooth/or teeth.
6.For teeth with a short occluso-gingival height.
7.For a badly broken clinical crown.
8. In a long span bridge.
 Contraindications
1. In case of anterior teeth, for esthetic reasons.
2. In a situation where anther conservative preparation can be
used.
3. When less than maximum resistance and retention is needed.
4. When caries extend gingivally, as that the finish line cannot
be made.
5. In case of uncontrolled caries.
 ADVANTAGES DISADVANTAGES
1. Great resistance form. 1. Bad esthetics (especially for
anterior teeth).
2. Great retention.
2. Pulp vitality can-not be
3. High strength. detected.

4. Good protection for a tooth to 3. Incipient caries can-not be

be restored. detected.

5. Can modify occlusion in case of 4. Extensive amount of tooth

overeruption. reduction

6. Can modify tooth contour in

case of open contact or in buccal
or lingual contour in a tooth used
as a retainer for FPD.

7. Ideal restorations for teeth with

developmental defects.
2. Metal ceramic crown:

Tare full cast crowns having porcelain or acrylic facing on facial or

lingual surface. They require more tooth reduction
• Can be fabricated over full veneer crown or partial veneer crown
• Indicated on teeth that require complete coverage & esthetic demand
• Can accommodate cast or soldered connectors
• Can afford high force—metal
Preparation:
Incisal reduction
- 2mm Occlusal reduction
- 1.5mm – for metal coverage
- 2mm – for metal with ceramic veneer
Margins
- facial surface- shoulder
- lingual surface- chamfer
- Shoulder must extend at least 1mm lingual
to proximal contact area.
 ADVANTAGES DISADVANTAGES
 Have the strength of cast metal crowns X Their preparation requires more tooth
with the esthetic of the all ceramic reduction to provide sufficient space
crowns for the restorative materials.

 Have good retention. X Their facial margins for anterior teeth,

is often placed sub-gingivally which
 Permit easy correction of the axial increase the risk for periodontal
walls. disease.

X The laboratory casts are expensive.

X A frequent problem is the difficulty of

accurate shade selection.
3. Non- metal crown (ALL Ceramic)
It is also called the jacket crown is an artificial non-metallic
restoration made of porcelain.
It is used to cover the all surfaces of the clinical crown. May be
fabricated as full or partial coverage crown.
Primary purpose: to achieve best possible esthetic results.
Risk of reduced restoration longevity—potential for fracture
Preparation:
Incisal
Incisal
reduction:
reduction:
2mm2mm
clearance
clearance
( this
( this
enables
enables
cosmetically
cosmetically
pleasing restoration & provides adequate strength )
Facial
Facial
reduction:
reduction:
1mm1mm
clearance
clearance
Lingual
Lingual
reduction:
reduction:
1mm1mm
clearance
clearance
Margin:
Margin:
shoulder
shoulder
preparation – 90– degree
preparation 90 degree
angle
angle
 INDICATIONS CONTRAINDICATIONS
1. For anterior teeth (especially 1. In Posterior teeth.
incisors).
2. In case of tooth with short clinical
2. For severely discolored anterior crown
teeth.
3. In case of edge to edge or overbite
3. over an existing post and core
substructure. 4. As a retainer for FPD.
 ADVANTAGES DISADVANTAGES
1. Have the best cosmetic effect of 1. Have high risk of fracture
dental restorations. because they’re brittle.

2. Are very strong.

3. Are the best to use on the

incisors.
All acrylic retainers
Used as temporary fixed partial dentures Not
indicated for permanent restorations
B- Partial coverage retainer
Advantages
Conservative tooth preparation
Guides for coronal contours
Embrasure forms are pre-established
Improved periodontal health as limited contact between margin
of restoration and gingiva.
Marginal fit and Complete seating of casting can be easily
verified before and during cementation
Margin accessibility for finishing and cleaning
Uncovered portion of tooth can be used for electric pulp testing
Acceptable esthetics.
Disadvantages
 Are not as retentive as complete coverage
retainers.
 There is a limited display of metal.
 Tooth preparation is difficult because only
limited adjustments can be made in the path
of placement.
Indications
• Intact or minimal restored teeth
• Normal anatomic clinical crown
• Teeth with adequate labiolingual thickness
Contraindications
1. Teeth with short clinical crowns
2. Thin teeth bucco-lingually
3. Teeth that are proximally bulbous
4. Poorly aligned tooth
5. Bad oral hygiene and high caries index
6. Retainers for long span bridges
7. Endodontically treated teeth
8. Malformed teeth
Types of partial coverage retainers

1 2 3
Posterior three quarter Anterior three quarter Pin modified three
crowns crown quarter crown
II. Partial coverage

1. ¾ crown:
Indications Contraindications
1. Carious or damaged tooth with 1. Short clinical crown
intact facial surface
2. Damaged facial surface of teeth
2. As bridge retainer in short span
bridge 3. Long span bridge

3. Long clinical crown 4. Anterior teeth with thin labio-

lingual dimension
4. Splinting
5. Malformed tooth
Ex: Pig shaped tooth, tilted tooth,
etc
 Advantages Disadvantages
1. More conservative than full metal 1. Less retentive than full coverage
crown
2. Needs skill from operator
2. More esthetics as facial surface
remains intact 3. Metal display may occurs

3. Pulp vitality test can b done as one

surface is un covered

4. Less gingival irritation

2. ½ crown:
• It is a partial coverage restoration that restores the
occlusal surface (or incisal edge), the mesial surface
and a portion of the facial or lingual surfaces.
• This type is indicated for mesially tilted tooth.

3. Pin ledge:
• It is a technique that employs parallel long pins
prepared in the lingual or palatal surface of the clinical
crown, in order to increase retention of the restoration.
• These restorations used the both grooves and pins to
improve retention.
4. ¾ reversed crown:
• It is a partial coverage restoration that restores the occlusal
surface (or incisal edge), and three axial surface of the clinical
crown (the lingual surface is not included).
• This type is indicated for lower posterior teeth. And it is
useful for server lingual indications.
5. 7/8 crown:
• It is a partial coverage restoration that restores all surfaces of
the crown except the mesio-buccal cusp.
• This type is only used for the upper 1st molar.
6. Modified type:
Indications Contraindications
1. For both anterior and posterior 1. When maximum retention is
teeth. required.

2. When the coronal portion is intact. 2. in case of a thin or short clinical

crown.
3. When there is a good crown length.
3. for patient with high caries index.
4. as a retainer for FPD (short
edentulous span). 4. When there is active periodontal
disease.
5. When there is a minimum occlusal
stress. 5. In case of mal formed tooth, e.g.
Bellshaped canine.
 Advantages Disadvantages

1. Preservation of tooth structure. 1. Less retentive than the full

coverage.
2. More esthetic than full coverage
restorations. 2. Difficultly of placing the grooves
and pins properly.
3. The finish line is easy to place.
3. In some restorations, the metal is
4. Less periodontal irritation due to displayed and this is not acceptable
the less contact with the tissues. by the patient.

5. Pulp damaged is reduced.

 Complete or Partial coverage?
(Periodontal point of view)
• The complete retainers accumulate more plaque,
which leads to gingivitis and increases pocket depth
than abutment with partial retainers.
• The difference may not be evident if the patient
practices meticulous oral hygiene.
• Complete retainers are performable in patients with
long span FPDs or splints with few abutment teeth.
• Partial veneer retainers have less resistance to
deformation than complete retainers.
C- Conservative retainers
• Require minimal tooth reduction
• Do not accept heavy loads, therefore indicated for
anterior teeth.
• Have a small metallic extension which are designed
to be luted directly onto the lingual surface of the
abutment tooth using resin cement.
Resin bonded FPD

Missing anterior teeth

Retainer with wings

Wings bonded to the

lingual surface of the
abutment teeth
Why resin-bonded FPD ?
• Conventional FPD’s requires abutment
preparation which leads to destruction of
adjacent teeth.
• Various solution tried for this problem but
not of much result oriented
1.Inlay retainer
2.Cantilever FPD
loss of PDL support of abutment teeth
3.Unilateral RPD
lack of retention stability and risk of
aspirated if dislodged
Classification of RBFPD
• Classified on the basis progression of
development:
–Rochettebridge
–Maryland bridge
–Cast Mesh
–Virginia bridges
Rochette bridge

 wing-like retainers,
 with funnel-shaped perforations through them to enhance
resin retention
 combined mechanical retention with a silanecoupling agent
to produce adhesion to the metal
Disadvantage
• Weakening of the metal retainer by the perforations
• Limited adhesion of the metal provided by the perforations
• Wear of composite resin
• Thick lingual retainers
• Plaque accumlation
• 50% fail in about 110 months
Maryland Bridge:
 Etched-metal prosthesis
 Done in either two step process or one step process –equally
retentive.
 Advantages over the caste perforated restorations:
 resin-to-etched metal bond can be substantially stronger than the resin-to-
etched enamel
 The retainers can be thinner and still resist flexing
 oral surface of the cast retainers is highly polished and resists plaque
accumulation
Two-step process
• Livaditisand Thompson
• Electrochemical pit corroding technique
• 1ststep
o 3.5 % Nitric acid at 250 mA/sq cm (current) for 5
min –non-beryllium-containing nickel-chromium
alloy
o 10% sulfuricacid at 300 mA/cm2 (current) for 5 min
-beryllium nickel-chromium alloy
• 2nd step :
18% HClfor 10 minutes in an ultrasonic cleaner bath
1-step
• McLaughlin
• Faster technique
• Combined solution of sulfuricand
hydrochloric acids placed in an
activated ultrasonic cleaner for 99
seconds passing electrical current.
Cast Mesh FPD
• Non etching method after casting
• Produce roughness before the alloy is
cast.
• Net-like nylon mesh –lingual surfaces
of the abutment teeth on the working
cast
• Covered by and incorporated into the
retainer wax pattern
• Mesh-like surface when the retainer
is cast
• Eliminates the need for etching
Advantage:
Use of noble-metal alloys
Disadvantage:
 stiff, making it somewhat difficult to adapt to detail of the
abutment tooth
 Wax runs too freely into mesh –blocks undercut compromising
retentivity
Virginia bridge
 Lost salt technique
 Particle roughened retainers by incorporating salt
crystals into the retainer patterns to produce
roughness on the inner surfaces
Steps
1. Sieved cubic salt crystals (NaCl) -
sprinkled over the outlined area sparing
0.5-1.0 mm wide crystal free margin
2. Retainer patterns were fabricated from
resin
3. Removed from the cast-resin was
polymerized
4. Cleaned with a solvent
5. Placed in water in an ultrasonic cleaner
to dissolve the salt crystals
6. Left cubic voids in the surface
 ADVANTAGES DISADVANTAGES

 Non invasive to dentin with lingual - Demanding technique and tooth

and proximal tooth preparation prep.
including occlusal rest. - plaque accumulation
 Conservative preparation. - bulky contours may be intolerable
 Good esthetics. to some patients
 Tissue tolerant because of - not ideal for replacing more than
Supragingival margin, and no one tooth
pulpal irritation. - Graying out of teeth that are thin
 Reduced cost and less chair side labiolingually.
time
 INDICATIONS CONTRAINDICTIONS

- In patients with sensitivity to base metal

• As retainers of FPD, on abutment with alloys.
sufficient enamel to etch. - When facial esthetic of abutment require
• Splinting of periodontally compromised improvement.
teeth. - Inadequate enamel surface to bond eg;
• Stabilizing dentition after orthodontic caries, existing restoration.
treatment. - Incisor with extremely thin faciolingual
dimension.
D-Telescopic retainers
• These are used when path of insertion of the fixed
partial denture does not coincide with the long axis
of the abutment tooth.
• Indicated in tilted abutment.
• The design involves the fabrication of two copings
one over the other:
- Primary coping:
Functions to modify the morphology of the tooth and
helps to change the path of insertion.
- Secondary coping:
Designed to fit over the primary coping along the new
path of insertion.
• Thus accurate parallelism of the copings is necessary.
 2. Based on location
• Extra-coronal (complete coverage or partial
coverage)
• Intra-coronal (Inlay / onlay)
• Intra-radicular (Post and core)
 Intra-coronal Retainers

Intra-coronal retainers can either be

I. Inlay
II. Onlay
I. Inlay
• Inlay is defined as a restoration which has been
constructed out of the mouth from gold, porcelain or
other metal and then cemented into the prepared cavity
of the tooth.
• It is mostly used.

II. Onlay
• It is essentially an inlay that covers one or more cusp and
adjoining occlusal surface of the tooth.
• It is retained by mechanical or adhesive mean.
 INDICATIONS CONTRAINDICATIONS
1. Onlay is used in large restorations 1. High caries rate

2. Endodontic ally treated teeth 2. Young patients

3. Teeth at risk for fracture 3. Esthetics

4. Dental Rehabilitation with cast Metal Alloys 4. Small restorations

5. Diastema closure and occlusal plane

correction

6. Removable prosthodontic abutment

 ADVANTAGES DISADVANTAGES
1. Strength 1. Number of appointment

2. Bio-compatibility 2. Higher chair time

3. Low wear 3. Temporary Restoration

4. Control of contours 4. Cost

5. Technique sensitive

6. Splitting forces
 Intra-radicular Retainers

• Radicular retained prosthesis consists of a post or dowel with an

attached core that obtains its retention and resistance to
displacement from the prepared root portion of an endodontically
treated teeth.
• While the root preparation retains the post, the core establishes
retention and resistance for a complete veneer crown that restores
the pulp less tooth to normal form and function.
• The post or dowel and core may be custom cast, where the
radicular retainer is fabricated to fit the root preparation or
prefabricated where the root preparation is designed to fit a stock
post and core is build up with silver amalgam or composite resin.
Post
1. Custom made
2. Prefabricated
Tapered smooth sided posts
Tapered serrated posts
Tapered threaded posts
Parallel threaded posts
Parallel serrated posts
Parallel smooth side posts
1. Detached dowel crown
(Davis):

All porcelain crown with a post that is

detached and can be placed on a
prepared root end by cementation of
both the post in the root and the
cementation of crown on the post.
 INDICATIONS CONTRAINDICATIONS

1. When impossible to restore crown by 1. Heavy and close bite cases.

other means so that vitality can be
maintained. 2. Poor oral hygiene.

2. Mostly on anterior teeth, occasionally on 3. Patients with para-functional habits.

posterior teeth.
4. Thin narrow roots.
3. When there is normal occlusal relationship.

4. Sufficiently long and thick root structure.

5. Only when peri-apical and periodontal

conditions are favorable.
 ADVANTAGES DISADVANTAGES
1. Esthetics. 1. Tooth must be non vital.

2. Adequetely strong. 2. Weakening of root face and canal by

enlarging.
3. Permits alignment with other teeth.

4. Good tissue adaptability.

5. Easily removed for treatment of required.

2. Richmond crown:
A dowel retained crown made for an endodontically
treated tooth using porcelain facing.

3. Detached post crown with a cast base:

When the coronal portion of the remaining tooth is
missing to a point below gingiva and it is impossible
to adapt the crown and root face, a cast metal base is
interposed between the base of the crown and root
face.
This cast base is rigidly attached to the dowel.
 INDICATIONS CONTRAINDICATIONS

1. Tooth broken or destroyed by caries to a 1. Poor oral hygiene.

point sub-gingivally.
2. Thin and narrow roots.
2. Mostly anterior teeth, occasionally
bicuspids. 3. If possible to design other variety, such as
core and jacket restoration.
3. In cases with heavy bite.

4. Sufficiently long or thick roots.

5. All periodontal factors favorable.

 ADVANTAGES DISADVANTAGES
1. Quite strong and lasting. 1. Tooth must be non vital.

2. Strengthens remaining tooth structures. 2. Difficult to construct in comparison to the

restoration without a cast base.
3. Esthetics.
3. Based on mode of retention

• Encircling the tooth (Full coverage )

• Mainly by grooves (Partial coverage)
• Mainly by Dowel pins (Pin ledge)
• Post in root canal
• Conservative restorations (Resin bonded)
4. Based on material being used
• All metal retainers
• Non-metallic retainers (Ceramic / Acrylic)
• Combined retainers (Veneered / full veneered)
• Resin bonded bridge retainers
 FACTORS AFFECTING SELECTION
OF RETAINERS
1-RETENTION
A- amount of remaining tooth structure influence retentive
properties of retainers

B- teeth with extensive defective restorations or fractures may

need intentional endodontic treatment and post & core.

C- crown lengthening when caries, restoration, or fracture are

present.
D- crown morphology and quantity of sound enamel & dentin.
Resin bonded bridge needs intact enamel to be etched for
microretention.
2-ESTHETICS :
A- Drifting of teeth into edentulous area may lead to
reduce pontic space.
This affects selection of retainer.
B- Diastema may lead to exccessive mesiodistal width.
C-long clinical crown due to recession or bone loss
may need full coveraage retainer & gingival porcelain
D- precision attachment to replace unesthetic clasp
arm.
E – Porcelain on occlusal surfaces of post teeth is not
recommended unless opposing occluding teeth are with
porcelain occlusal surfaces.
3- AGE OF PATIENT
Below 18—20 years
A- large pulp size & high pulp horns lead to pulp
exposure
B- If a crown is made when the gingival attachment
level is high (at young age), the margin of restoration
will become exposed with nomal gingival recession
leading to poor esthetics .
4- EXISTING CARIES
A- Simple proximal caries (partial coverage crowns)
B - MO or MOD caries ( inlay retained restoration or full
coverage crowns)
5- Amount & direction of stress Deep overbite:
complete coverage
6- Type of opposing restoration
RPD + complete dentures create less force than
natural dentition, so use either partial or complete
coverage.
7- Size & position of abutment
8- Condition of abutment
Crown, roots, bone level, gingiva, mobility, tilting , pulp
vitality, post & core all affect retainer selection.
9- Caries Index poor oral hygiene +high caries index
necessitate full coverage retainers
10- length of edentulous span Increased span length needs
retentive & strong retainers (complete coverage
restoration)
11- Patient musculature males have heavy muscules
(complete coverage restoration)
References:
• A.E. Kahn, Partial Versus Full Coverage. J. Prosthet.
Dent. 10:167-178, 1960.
• Johnstons, Modern Practice in Fixed Prosthodontics
4th edition 1986.
• T.Shillinburg.Fundamentals of Fixed
Prosthodontics, III edition
• •T.Shillinburg.Fundamentals of Fixed
Prosthodontics, IV edition
• •Rosenstiel, Land, Fujimoto. ContemperoryFixed
Prosthodontics, III edition
Thank You