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Title Single-Retainer Cantilever Resin Bonded FDPs Show Clinical Success
Clinical Question For a single missing anterior tooth, does a single-retainer cantilever resin bonded FDP, compared to a two-retainer resin bonded FDP, affect clinical success?
Clinical Bottom Line For patients missing a single anterior tooth, a single retainer resin bonded cantilever FDP demonstrates lower clinical failure rates when compared to a two-retainer FDP. A systematic review supports this conclusion with the analysis of 5 studies (1 RCT, 2 prospective cohort studies, 2 retrospective cohort studies). In that review, treatment with single-retainer resin bonded cantilever FDPs showed a statistically significant decrease in failure rates compared to two-retainer FDPs. In the interest of minimally invasive dentistry, clinicians should consider the use of a resin bonded cantilever FDP.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26875611Wei/2016193 prostheses (131 cantilever, 72 two-retainer in 5 studies)Systematic review of non-randomized trials
Key resultsResults were reported on analysis of five studies (one RCT, two prospective cohort, and two retrospective cohort) published before Dec 2014 on the failure rate (debonding and prosthesis fracture) for different resin bonded FDP framework designs. Data was analyzed for two outcomes (failure and debonding) for all one- vs. two-retainer FDPs, metal-ceramic one- vs. two-retainer FDPs, and all-ceramic one- vs. two-retainer FDPs. The odds of failure for one-retainer cantilever FDPs was significantly lower than for two-retainer FDPs (OR 0.42, 95% CI 0.19-0.94, P=0.04). There was no significant difference between the debonding rates of one- and two-retainer RBFDPs, nor between the failure rates of one- vs. two-retainer metal-ceramic RBFDPs, nor between the failure rates of one- vs. two-retainer all-ceramic RBFDPs . The authors note that more RCTs are needed to better evaluate the differences in therapeutic options.
#2) 26756882Botelho/201623 prostheses (13 cantilever, 10 two retainer)Randomized Controlled Trial
Key resultsThis RCT evaluated clinical success and subject satisfaction differences between two patient groups receiving single-pontic metal-ceramic anterior resin bonded fixed dental prostheses: 13 of a cantilevered design, and 10 of a two-retainer design. All cantilevered prostheses survived without complications, while only 10% of the two-retainer prostheses were complication free and 50% survived. The oral health-related quality of life (OHRQoL) survey of participants demonstrated similar patient satisfaction levels for all areas evaluated except for satisfaction in cleaning of the prostheses. In that category, the cantilever prosthesis was rated significantly higher in satisfaction than the two-retainer design.
Evidence Search (("resins, plant"[MeSH Terms] OR ("resins"[All Fields] AND "plant"[All Fields]) OR "plant resins"[All Fields] OR "resin"[All Fields]) AND bonded[All Fields] AND ("dentures"[MeSH Terms] OR "dentures"[All Fields] OR "denture"[All Fields])) AND (retainer[All Fields] AND design[All Fields]) AND ("mortality"[Subheading] OR "mortality"[All Fields] OR "survival"[All Fields] OR "survival"[MeSH Terms])
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The Evidence
The Wei systematic review included a thorough search of the literature up to December 2014 with inclusion/exclusion criteria that allowed for a clear and concise grouping of evidence related to the question in study. However, there were only five articles with a high risk of bias that fit the criteria and only one was an RCT. After Dec. 2014, conclusions from an additional RCT of relatively small sample size by Botelho in 2016 adds confidence to the validity of the Wei findings. While the results of these studies may seem counterintuitive, it has been suggested that two-retainer FDPs tend to fail more frequently due to differential movement between the abutment teeth under functional stresses.
Applicability A resin-bonded FDP may be the treatment of choice as a fixed alternative to implant therapy in situations where there are anatomical, medical, or economic limitations. It may also function as an interim restoration instead of a removable prosthesis while awaiting growth completion or implant healing. When a minimally invasive prosthesis of intermediate longevity is planned, a single retainer resin bonded cantilever FDP can be a viable treatment option.
Specialty/Discipline (General Dentistry) (Prosthodontics)
Keywords Maryland bridge, resin bonded bridge, cantilever FDP
ID# 3114
Date of submission: 11/15/2016spacer
E-mail gordner@livemail.uthscsa.edu
Author Harrison D. Gordner, DMD
Co-author(s) e-mail
Faculty mentor/Co-author Stephan Haney, DDS
Faculty mentor/Co-author e-mail haneys2@uthscsa.edu
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