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Article: Volume 39 Number 2 Page 78 - March 2012

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  Dental Update 392: 78-84

Restorative dentistry:  Avoiding and Managing the Failure of Conventional Crowns and Bridges

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Abstract: 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.

Author notes: Peter Briggs, BDS(Hons), MSc, MRD, FDS RCS(Eng), Consultant in Restorative and Implant Dentistry, Maxillofacial Unit, St George’s Hospital, London, SW17 OQT, Specialist Practitioner, Hodsoll House Specialist Referral Practice, Farningham, Kent DA4 0DH and BSSPD council member, Arijit Ray-Chaudhuri, BDS, MFDS RCS(Ed), MJDF RCS(Eng), LLM, Specialist Registrar in Restorative Dentistry, St George’s Hospital, London, SW17 OQT and King’s College Dental Hospital, London, SE5 9RW and Kewal Shah, BDS MFDS RCS(Eng), Specialty Dentist in Restorative Dentistry, St George’s Hospital, London, SW17 OQT.

Objective: To improve understanding about, increase awareness of the risks of, and learn from clinical examples of, the common causes of crown and bridge failure.