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The replacement of crowns and bridges is a common procedure for many dental practitioners. When correctly planned and executed, fixed prostheses will provide predictable function, aesthetics and value for money. However, when done poorly, they are more likely to fail prematurely and lead to irreversible damage to the teeth and supporting structures beneath. Sound diagnosis, assessment and technical skills are essential when dealing with failed or failing fixed restorations. These skills are essential for the 21st century dentist. This paper, with treated clinical examples, illustrates the areas of technical skill and clinical decisions needed for this type of work. It also provides advice on how the risk of premature failure can, in general, be further reduced. The article also confirms the very real risk in the UK of dento-legal problems when patients experience unexpected problems with their crowns and bridges.
Clinical Relevance: This paper outlines clinical implications of failed fixed prosthodontics to the dental surgeon. It also discusses factors that we can all use to predict and reduce the risk of premature restoration failure. Restoration design, clinical execution and patient factors are the most frequent reasons for premature problems. It is worth remembering (and informing patients) that the health of the underlying supporting dental tissue is often irreversibly compromised at the time of fixed restoration failure.
Article
The provision of conventional crowns and bridges is a common procedure for most general and specialist dental practitioners. It is estimated that more than one million crowns are placed per year under the NHS General Dental Services (GDS) in England and Wales contract with an unknown number placed independently of this.1 This represents a yearly spend of £117.5 million under the GDS contract alone in the year ending March 2005. It is likely that the total number of crowns placed (NHS, insurance and self-funded) is double that figure.
All qualified dentists will have encountered the failure of crowns and bridges (Figure 1). The most recent Adult Dental Survey2 confirmed that 37% of adults have one crown or more (mean = 3) and 7% of adults have a bridge (3% aged 16–44 years and 14% aged 55–74 years). Unfortunately, the number of resin-bonded bridges still remains disappointingly low.3 Bartlett and co-workers have previously commented that practitioners are more likely to prescribe conventional bridges than adhesive alternatives.4
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