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A Contemporary Approach to the Provision of Tooth-Supported Fixed Prostheses Part 1: Indications for Tooth Replacement and the Use of Fixed Bridges Retained by Crowns

From Volume 45, Issue 1, January 2018 | Pages 10-20


Richard Ibbetson


Director, Edinburgh Postgraduate Dental Institute, The University of Edinburgh

Articles by Richard Ibbetson


Fixed tooth replacement is a central part of prosthodontic care for patients. The approach and options for treatment have changed due to the decrease in dental disease in the population and the impact of the osseo-integrated implant. Despite the impact of the dental implant, there remain indications for the use of tooth-supported fixed prostheses. Improving oral health, the continued developments in resin-retained bridgework and the dental implant have reduced the indications for fixed prostheses retained by crowns. The last 30 years have seen a simplification in the design of fixed bridgework and this article describes the contemporary approach to this treatment modality. The first of this two part series discusses appropriate designs and the use of fixed bridges retained by crowns and the second part discusses fixed bridges where the abutment teeth require minimal or no preparation.

CPD/Clinical Relevance: To assist in the appreciation of the principles of design for fixed bridgework, whether supported by crowns or resin retainers.


Changes in the pattern of dental disease with the reduction in tooth loss and an improved understanding of what constitutes a stable functioning dentition have altered the indications for tooth replacement.

When fixed tooth replacement is required, the need for tooth-supported fixed prostheses has decreased as a consequence of the impact of implants. Their increasing and generally beneficial use necessitates a re-evaluation of the advice that patients are given. In a recent informal survey, young dentists were asked how they would choose to have their own missing maxillary central incisor replaced, and well over 90% of respondents opted for an implant-supported prosthesis. This was not surprising, nor was their second choice, which was overwhelmingly a resin-retained bridge rather than a tooth-supported fixed bridge where the retainers were crowns.

There are four indications:

The aesthetic requirements of patients are a clear indication for some form of tooth replacement. It is likely that the majority of patients would prefer a fixed replacement for their missing teeth, however, it may not always offer the best aesthetic outcome. Deficiencies of hard and soft tissues are more easily managed with removable prostheses than fixed.

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