CASE REPORT

The Sieved Resin Bonded Prosthesis

Dr. Mathew C A1, Dr. Sudhakara V Maller2, Dr. Karthik K S3
1
Professor
2
Professor & Head
3
Senior Lecturer
Department of Prosthodontics, Abstract:
KSR Institute of Dental Science & Research, The sieved metal design (Rochette's design) and resin
Tiruchengode, Tamil Nadu. cements can be used to retain fixed prosthesis. Such prosthesis will be
Pin : 637 215 functional, esthetic, conservative, and economical.

Address for correspondence :

Dr. C.A. Mathew, M.D.S.,
Professor,
Dept. of Prosthodontics,
K.S.R. Institute of Dental Science and Research,
K.S.R. Kalvi Nagar, Thokkavadi (Po),Tiruchengode,
Namakkal District, TAMILNADU, INDIA.
Email address: matsden@gmail.com
Cell no: 09789459904

Introduction:
The introduction of enamel acid etching and resin
bonding by Dr. Buonocore in 1955 marked the beginning
of new era of adhesive dentistry 9.
During the past five decades, development of resin
cements and bonding agents have produced extensive
changes in dental treatment procedures like esthetic
restorative procedures and the placement of brackets on
teeth for orthodontic procedures.
Rochette Bridges introduced by Rochette in 1973
with the use of these bonding principles led the way for the
advent of an effective alternative for the conventional
design of fixed partial dentures13. This prosthesis can be
used successfully to replace single missing incisor (figure1).
Figure 1 : Ideal case for sieved resin bonded fixed partial denture.
Congenitally missing permanent maxillary lateral incisors.
This article will describe the use of resin cement to
retain sieved-cast fixed prosthesis. Such prosthesis will be
functional, esthetic, conservative, and economic, thus
providing an alternative to conventional fixed or removable
partial dentures in certain cases.
Review of Literature:
Composite resin has been used to bond a variety of
fixed prostheses. These have included designs in which
avulsed or extracted teeth serve as a pontic for bonding of
natural teeth, or alternatively, where acrylic teeth or a
custom composite resin pontic is used.
Although bonding of such pontics to adjacent
natural teeth using either a chemically or ultraviolet light-
cured resin can provide adequate retention, the use of
retentive rivets in the metal wings and fibers incorporated
into the composite material has been recommended.
Recent evidence confirms that resin bonding provides
satisfactory retention for the bridges1. The choice of which
composite to use as a bonding agent will depend on
technique selected and available information on the bond
strength of such products12, 17.
The first composite cement manufactured for the use
with acid-etched resin bonded prosthesis was Comspan and
became synonymous with this prosthesis. This cement
adhered to the etched metal surface through engaging the
micro roughness, without any kind of chemical bonding with
the casting alloy. Further many resin cements were introduced
which chemically bonded to cast alloy surfaces, one such was
Super-bond C&B in 1981 and Panavia EX in 1984 17.
To improve the success rate for these prostheses many
design modifications were proposed starting with the pioneering
design of Rochette Bridges introduced by Rochette in 1973(used in
this case). Further Livaditis and Thompson proposed Maryland
Bridges excluding the original design of funnel-shaped

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The Sieved Resin Bonded Prosthesis
perforations. They used 3.5% of nitric acid with a current of
250mA/cm2 for 5 minutes, followed by immersion in 18%
hydrochloric acid in an ultrasonic cleaner for 10 minutes to create
surface irregularities for micromechanical retention; this design
was widely accepted with encouraging clinical results. Moon and
Hudging et al introduced “lost salt technique” using Sieved cubic
salt crystals (NaCl) to create micro-retentive surface for retention of
prosthesis. Cast mesh was also included in the inner surface to
create surface for micromechanical retention6,10.
All the above designs were introduced to improve
the retention and longevity of the prosthesis.
Case Selection:
The sieved resin bonded fixed prosthesis can be
used in many clinical situations. It is commonly selected as
the prosthesis of choice for young patients in whom large
pulps and a dynamic gingival margin make tooth reduction
and margin placement for the conventional prosthesis
difficult. It is used as a viable alternative to others that often
lead to gingival inflammation. This design is also useful as a
periodontal splint-prosthesis, providing interim
stabilization until final resolution of the case.
This prosthesis can also be used in patients with
medical conditions that do not let them tolerate the long
appointments and concomitant oral manipulation necessary
for a conventional fixed partial denture. No anesthetic is
usually necessary, an advantage for those whom such a
procedure poses a psychological or physical risk.
The sieved resin bonded fixed partial denture can
be used only where occlusal clearance is available for the
lingual retention frame work. Caution should be used when
placing such prosthesis in a region of heavy occlusal forces,
which may dislodge it. If this is caused by a long span
design, where occlusal forces are high but are distributed
over a long area, double abutment may be used to increase
the retentive area. When caused by other causes, such as
bruxism, those problems should be treated first.
Occasionally, the abutment teeth will have short
clinical crowns; thus the retentive surfaces will not be good
enough to resist any given dislodging force. This might be
solved by exposing more crown surface through
gingivectomy. Similarly where a cantilever design is
selected and thus a minimum surface area covered for
retention, a rest should be placed on the other abutment
teeth to distribute forces more evenly. Where abutment
teeth have been heavily restored and are either too weak or
do not provide enough enamel surface to adequately etch
for retention, an alternate prosthesis should be selected.
This is also the case if defects in enamel, such as
amelogenisis imperfecta, compromise the adhesion of the
resin to enamel.
Tooth alignment and spacing must also be
considered in selecting this prosthesis. If the existing
condition will not allow an adequate path of insertion of the
partial denture or will expose too much of frame work
because of spacing, orthodontics may be considered,
Mathew, Sudhakara Maller & Karthik
because tooth morphology cannot be altered as with a
conventional fixed prosthodontic tooth preparation.
First appointment:
During the first appointment, the decision whether
to proceed with a sieved resin bonded fixed partial denture
is usually made, with consideration given to the information
discussed under case selection. A suitable tooth shade is
then selected, followed, where necessary, by adjustment of
occlusion for lingual clearance. This must be done carefully
to stay with in the enamel of the abutment teeth, but further
clearance can often be obtained by enameloplasty of the
opposing teeth. When no further adjustment is necessary,
impressions and bite registrations are taken. Because the
undistorted contours of soft issues as well as accurate hard
tissue dimensions must be recorded, a suitable impression
material must be used4.
Mounted and articulated casts are prepared to
assist in the design of the prosthesis. This design should
include maximum abutment coverage by the frame work,
excluding 1mm near the incisal edge where it could affect
enamel translucence and 1mm near the gingival margin
where it might lead to an infected plaque retentive area.
The pontic should be of modified-ridge lap design to
facilitate yet be esthetically pleasing. Porcelain bonded to a
non-precious metal is recommended for fabrication
because it provides durability, strength and rigidity with a
minimum of bulk. The models and instructions are now
ready to be sent to the laboratory.
Second appointment:
The framework is tried on to confirm the shade,
occlusion, margins and proper relief for surfaces contacting
tissues. The prosthesis, with floss attached to assist in
relocation, if dislodged, can be held temporarily in place with
a soft wax to facilitate with the procedure. When deemed
satisfactory the prosthesis is thoroughly cleaned and only oil
deposits are removed with an appropriate solvent. (figure2)
Figure 2 : Palatal view of the sieved resin bonded fixed partial denture
replacing missing permanent maxillary lateral incisors.
The arch segment in question is now isolated and
the teeth are cleansed with pumice and washed. This is
followed with etching with a solution of phosphoric acid in a
concentration between 37% - 50% for one minute, copious
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The Sieved Resin Bonded Prosthesis
washing and complete drying of the acid-etched surface
while carefully avoiding abrasion. Bonding resin is
immediately applied to these isolated, etched surfaces and
to the frame work2,3. Composite resin cement combined
with an opaqueing agent to prevent any metal showing
through the tooth surface and the frame work; and the
appliance is seated, allowing the cement to flow from the
margins. Excess cement is trimmed off and again occlusion
checked. A final coat of bonding resin is applied to seal
margins. (figure3)
Figure 3 :
Finished maxillary sieved resin bonded fixed partial denture.
Discussion:
The majority of problems in these appliances will occur
from loss of retention caused by adhesive failure. This may be
caused by rubbing the enamel during conditioning,
incompletely removing the conditioning agent and reaction
product and contaminating the etched enamel with saliva and
water. Occasionally cohesive failure occurs with in the bulk of
resin cement, which is dependent on the condition of the resin
and the proper handling technique. Thus, strict adherence to
the basic principles of application and knowledgeable selection
and use of these materials is important to success.
Patients should be following a meticulous oral hygiene
program because fixed partial dentures contain no “extension for
prevention” and thus may create areas more susceptible for decay. For
those involved in sports a mouth guard, such as a soft vacuum formed
type with appropriate relief of under cuts should be mandatory to
preventanyproblemassociatedwithaccidentaldislodgment.
Because the life span of this fixed prosthesis is
intermediate, suitable recall appointments should be arranged. If
the prosthesis must be removed or becomes dislodged, it can be
recemented after examination of the integrity of the prosthesis,
careful cleaning of the frame work and teeth and re-etching.
This prosthesis can be used successfully as replacement
prosthesis for anterior single tooth missing situations (figure1)1,4,5. It
can also be used for combined orthodontic-prosthetic care,
providing retention and space maintenance after band removal
in case with missing dental units. A concomitant long-term
assessment program of inserted acid-etch bridges has shown
enthusiastic, continued patient acceptance.
Further advancements have been made to
overcome the major draw backs of this metal design with
the advent of all-ceramic systems19.
Mathew, Sudhakara Maller & Karthik
Conclusion:
The foregoing is presented as an available treatment
which when used within the guidelines discussed here, is a
valuable treatment alternative to both removable prosthesis
and conventional fixed partial dentures. In the words of status
report on the sieved resin bonded bridge treatment procedures:
“the introduction of bonding techniques into many disciplines
has resulted in a safe, simple, conservative, and some times
more economic method of treatment. Further, in some
instances, it has extended greater opportunities for treating such
groups as those physically and emotionally handicapped in
whom preventive and restorative procedures are often difficult”.
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retention/resistance of maxillary anterior resin-bonded retainers. J Prosthet
Dent 1995; 74:133-9.
2. Aline SB, Mutlu O, Luiz FV, Lilian GA, Regina A, Marco AB: Microtensile
bond strength of a resin cement to feldspathic ceramic after different
etching and Silanization regimens in dry and aged conditions. Dent Matters
2007;23: 1323-1331.
3. Consuelo C, Karl FL, William RL, William B: Effectiveness of a method
used in bonding resin to metal. J Prosthet Dent 1990; 64:37-41.
4. Creugers NHJ, Van T Hof: An analysis of clinical studies on resin-bonded
bridges. J Dent Res 1991; 70(2):146-149.
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Prosthet Dent 1985; 53(4):471-476.
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37(3):445-455.
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technique for a strong and durable bond of resin cements to Zirconia-based
materials. J Prosthet Dent 2007; 98: 379-388.
17. Omer El-Mowafy, Marcia HMR: Resin-bonded fixed partial dentures- A
literature review with presentation of a novel approach. Int J Prosthodont
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18. Pekka KV, Camilla S: Resin- bonded, glass fiber-reinforced fixed partial
dentures: A clinical study. J Prosthet Dent 2000; 84:413-8.
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dentures with a new modified zirconia surface: A clinical report. J Prosthet
Dent 2009: 102: 68-73.
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