Koizumi et al.

Int Chin J Dent 2009; 9: 15-18.

A three-unit posterior resin-bonded fixed partial denture seated
one year after extraction of second molar: A clinical report
Hiroyasu Koizumi, DDS, PhD,a,b Naomi Tanoue, DDS, PhD,c Daisuke Nakayama, DDS,aTakaya Ishii, DDS,a and Hideo Matsumura, DDS, PhDa,bab

Department of Fixed Prosthodontics, and Division of Advanced Dental Treatment, Dental Research
cCenter, Nihon University School of Dentistry, Tokyo, and Nagasaki University Hospital of Medicine andDentistry, Nagasaki, Japan
This article reports a resin-bonded fixed partial denture (RB-FPD) applied to a diabetic. Before seating theRB-FPD, a removable partial denture was used for about one year after extraction of a second molar. TheRB-FPD framework was cast from silver-palladium-copper-gold alloy (Castwell M.C. 12), and the surface to bebonded was air-abraded with alumina. The RB-FPD was then treated with a metal priming agent (V-Primer),and bonded with an adhesive resin (Super Bond Opaque). After an observation period of six years and sixmonths, the FPD was functioning satisfactorily. The materials and procedures reported here are applicable as anoption for a prosthodontic treatment for medically compromised patients. (Int Chin J Dent 2009; 9: 15-18.)
Key Words: adhesive, alloy, primer, resin-bonded fixed partial denture, removable denture.

Introduction
Replacement of missing teeth in the posterior region is important for recovering tooth anatomic form,mastication, and other oral functions. Prosthodontic treatment for medically compromised patients is moredifficult as compared with physically healthy patients. Either removable or fixed dentures are used according tothe location and number of teeth to be recovered, as well as periodontal condition of the abutments. Among theprosthodontic appliances, resin-bonded fixed partial dentures (RB-FPDs) with minimal tooth reduction are
applicable and acceptable as an option for the replacement of missing teeth adjacent to abutments with sufficientcoronal tooth structure.
Silver-palladium-copper-gold alloys are used extensively in Japan in fabrication of denture frameworks. Inaddition, single liquid primers that contain a thione monomer have been introduced for bonding dental noble
metal alloys.1-11 Although a number of prosthodontic applications of metal priming materials and luting agents
have been reported,2-11 only limited information is available concerning the long-term clinical performance of
metal bonding systems.6,9 This article describes the 6-year clinical performance of a RB-FPD applied to adiabetic one year after extraction of a second molar.

Clinical Report
A 60-year-old male patient presented with functional disturbances as a result of a missing maxillary rightsecond molar. The patient was a diabetic, and had undergone extraction of second molar due to periodontitis(Fig. 1). Several treatment options were therefore proposed: 1) single-tooth implant, which is generally acontraindication for diabetics; 2) a removable partial denture (RPD); 3) FPD with considerable tooth reduction;and 4) RB-FPD after application of a transitional RPD. The patient chose the fourth of the proposed options.
The prosthodontic procedure was then explained in detail and consent was obtained from the patient.
A removable partial denture was fabricated as a transitional prosthesis (Figs. 2-4). A buccal retentive arm forthe first molar was made of Co-Cr alloy wire 0.9 mm in diameter. A metal framework with three clasps and apalatal bar was made of a Co-Cr casting alloy. The wire clasp and the cast framework were soldered. A
composite resin tooth (Endura, Shofu Inc., Kyoto Japan) was arranged in the missing area. The denture was15

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Int Chin J Dent 2009; 9: 15-18.

used for about one year during the periodontal therapy.

Fig. 1.

Maxillary second molar is missing.

Fig. 2.

A removable denture with three clasps.

Fig. 3.

Metal framework structure.

Fig. 4.

Seated removable partial denture.

Fig. 5.

Resin-bonded fixed partial denture.

Fig. 6.

Six years and six months after bonding.

For the second step, fabrication of a fixed partial denture was planned. This was due to improvement in thecondition of the periodontal tissues of abutments, as well as a request for a fixed prosthesis by the patient.
Intercuspal position and lateral mandibular movement were examined intraorally with articulating paper andextraorally using a stone cast. After examination of the maxillo-mandubular relation, the areas to be reduced
were determined. Reduction of cusps was judged as unnecessary. However, inlay restorations of both first andthird molars were removed and a base material was placed. An FPD consisting of two retainers and a flat backpontic was cast from a silver-palladium-copper-gold alloy (Castwell M.C. 12, GC Corp., Tokyo, Japan).
The completed FPD was tried-in at the next appointment. The inner surfaces of the retainers were air-abradedwith 50- to 70-µm grain sized alumina (Hi-Aluminas, Shofu Inc., Kyoto, Japan) using an airborne particle

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Int Chin J Dent 2009; 9: 15-18.

abrader (Micro Blaster MB102, Comco Inc., Burbank, CA, USA), and treated with a single liquid primer
designed for noble metal alloys (V-Primer, Sun Medical Co., Ltd., Moriyama Japan). The abutment enamelsurfaces were etched with 40% phosphoric acid gel (K-Etchant, Kuraray Co., Ltd., Osaka, Japan), washed withwater, and air-dried. The FPD was then seated with a tri-n-butylborane (TBB) initiated adhesive resin (SuperBond Opaque, Sun Medical Co., Ltd.). The patient then entered a maintenance program (Fig. 5). After anobservation period of six years and six months, the RB-FPD was still functioning satisfactorily (Fig. 6).

Discussion
One of the problems associated with prosthodontic treatment for diabetics is unpredictable prognosis ofperiodontal diseases around abutment teeth. Due to chronic marginal periodontitis of maxillary dentition,mobility of molars was moderate for this patient. The dentist in charge of the patient proposed options forprosthodontic treatments, and the patient accepted the two-stage procedure, i.e., seating a conventional RPD
followed by seating a RB-FPD. A removable partial denture was fabricated for use as a transitional prosthesis.
The denture was equipped with a combination clasp and two cast clasps. The cast clasp was placed around thefirst premolar and a cast palatal bar was additionally designed for convenience of removal-insertion of thedenture, since the physical condition of the patient was not ideal. A combination clasp was placed around thefirst molar. This was due to convenience of control of retentive characteristics of the buccal wire arm. Thepatient was satisfied with the recovery of his oral function using the transitional RPD. In addition, treatment ofperiodontitis in the maxillary molar area was performed successfully.
One year after seating the RPD, condition of periodontal tissue around the first and third molar improved
considerably. The patient requested change to a RB-FPD from the RPD, which was somewhat bulky anddetachable during functioning. A RB-FPD was fabricated as the second step. Unfortunately, the first molar
abutment moved slightly from its original position to the lingual side during fabrication of the FPD. The
completed RB-FPD did not fit perfectly at the tri-in procedure. The dentist cemented the FPD temporarily witha soft-type polycarboxylate cement. After several weeks, adaptation to the abutments of the RB-FPD wasjudged as acceptable. The RB-FPD was seated with the technique described in the previous section.
One of the advantages of RB-FPD is that the reduction of intact enamel can be minimized. It is beneficial for
medically compromised patients to apply a RB-FPD rather than a conventional FPD, which requiresconsiderable reduction of sound tooth structure. Clinicians, however, should note that the prognosis of RB-FPDs
applied to mobile abutments is not as good as that of conventional FPDs.
Acknowledgments
This clinical report associated with adhesive bonding of dental casting alloys is supported in part by Grant-in-Aid for
Scientific Research C 20592302 (2008) from the Japan Society for the Promotion of Science (JSPS), and a Grant from Dental
Research Center (A), Nihon University School of Dentistry (2008).

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Correspondence to:Dr. Hiroyasu Koizumi
Department of Fixed Prosthodontics, Nihon University School of Dentistry
1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
Fax: +81-3-3219-8351 E-mail: koizumi@dent.nihon-u.ac.jp
Received February 10, 2009. Accepted March 30, 2009.
Copyright ©2009 by the International Chinese Journal of Dentistry.

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