Conservative and esthetic cast gold fixed partial dentures-inlay, onlay, and partial veneer retainers, custom composite pontics, and stress-breakers: part I: fundamental design principles. 2009

Richard G Stevenson, and Jane A Refela
Division of Restorative Dentistry, UCLA School of Dentistry, 33-009A CHS, 10833 Le Conte Ave, Los Angeles, CA 90095-1668, USA. rstevenson@dentistry.ucla.edu

Although in today's dental world implant restorations are considered the standard of care in the replacement of missing teeth, clinical contraindications and patient nonacceptance of implant placement can be encountered. Several scenarios are discussed here in which a single missing tooth can be restored with conservative fixed partial dentures (FPD) that employ cast gold retainers; each with a customized design in order to preserve tooth structure, maintain esthetics, and provide a long-term prognosis. The abutment teeth are prepared for conservative partial coverage restorations by using Brasseler burs (Brasseler USA, Savannah, GA, USA). Impressions are taken of the preparations, along with any retentive features, utilizing either the Vented Pin Channel technique or the Shooshan Plastic Pin technique. The latter technique utilizes Kodex twist drills and corresponding impression pins (Coltene Whaledent Inc., Mahwah, NJ, USA). The conservative FPD with non-rigid connectors is fabricated by using type III gold alloy. The pontic cage portion is chemically prepared utilizing the Panavia F2.0 cement kit (Kuraray America Inc., Houston, TX, USA) or other dual-polymerizing resin cement and restored with any type of direct composite resin material. A palette of opaquers and tints are used for chairside characterization of the esthetic pontic facing. The final polish of the pontic is completed by using FlexiDisc and FlexiBuff discs (Cosmedent Inc., Chicago, IL, USA). CLINICAL SIGNIFICANCE In cases where an implant restoration is contraindicated for replacement of a single tooth, a semi-precision FPD is a conservative, functional, and esthetic alternative.

UI MeSH Term Description Entries
D007284 Inlays Restorations of metal, porcelain, or plastic made to fit a cavity preparation, then cemented into the tooth. Onlays are restorations which fit into cavity preparations and overlay the occlusal surface of a tooth or teeth. Onlays are retained by frictional or mechanical factors. Dental Inlays,Dental Onlays,Onlays,Dental Inlay,Dental Onlay,Inlay, Dental,Inlays, Dental,Onlay, Dental,Onlays, Dental,Inlay,Onlay
D002484 Cementation The joining of objects by means of a cement (e.g., in fracture fixation, such as in hip arthroplasty for joining of the acetabular component to the femoral component). In dentistry, it is used for the process of attaching parts of a tooth or restorative material to a natural tooth or for the attaching of orthodontic bands to teeth by means of an adhesive. Cementations
D003188 Composite Resins Synthetic resins, containing an inert filler, that are widely used in dentistry. Composite Resin,Resin, Composite,Resins, Composite
D003442 Crowns A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. Dental Crowns,Crown, Dental,Crowns, Dental,Dental Crown,Crown
D003734 Dental Casting Investment Material from which the casting mold is made in the fabrication of gold or cobalt-chromium castings. (Boucher's Clinical Dental Terminology, 4th ed, p168) Casting Investment, Dental,Casting Investments, Dental,Dental Casting Investments,Investment, Dental Casting,Investments, Dental Casting
D003761 Dental Impression Technique Procedure of producing an imprint or negative likeness of the teeth and/or edentulous areas. Impressions are made in plastic material which becomes hardened or set while in contact with the tissue. They are later filled with plaster of Paris or artificial stone to produce a facsimile of the oral structures present. Impressions may be made of a full complement of teeth, of areas where some teeth have been removed, or in a mouth from which all teeth have been extracted. (Illustrated Dictionary of Dentistry, 1982) Dental Impression Technic,Dental Impression Technics,Dental Impression Techniques,Impression Technic, Dental,Impression Technics, Dental,Impression Technique, Dental,Impression Techniques, Dental,Technic, Dental Impression,Technics, Dental Impression,Technique, Dental Impression,Techniques, Dental Impression
D003775 Dental Polishing Creation of a smooth and glossy surface finish on a denture or amalgam. Dental Burnishing,Dental Finishing,Burnishing, Dental,Finishing, Dental,Polishing, Dental
D003779 Denture Design The plan, delineation, and location of actual structural elements of dentures. The design can relate to retainers, stress-breakers, occlusal rests, flanges, framework, lingual or palatal bars, reciprocal arms, etc. Denture Designs,Design, Denture,Designs, Denture
D003781 Denture Retention The retention of a denture in place by design, device, or adhesion. Denture Stability,Retention, Denture,Stability, Denture
D003801 Dental Veneers The use of a layer of tooth-colored material, usually porcelain or acrylic resin, applied to the surface of natural teeth, crowns, or pontics by fusion, cementation, or mechanical retention. Dental Laminates,Dental Laminate,Dental Veneer,Laminate, Dental,Laminates, Dental,Veneer, Dental,Veneers, Dental

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