Editorial Type:
Article Category: Case Report
 | 
Online Publication Date: 30 Jun 2025

Posterior Cantilevered Single-Retainer All-Ceramic Resin-Bonded Fixed Dental Prostheses: A 12-Year Clinical Case and Proposed Clinical Recommendations

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Page Range: 235 – 244
DOI: 10.2341/24-116-S
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SUMMARY

Objective:

To present a clinical case featuring a posterior cantilevered single-retainer all-ceramic resin-bonded fixed dental prosthesis (PC-RBFDP) with 12 years of follow-up. This FDP was used to restore a missing premolar using a single-retainer canine abutment. The aim was also to draw clinical recommendations based on current data and experience.

Methods:

To address the present case, the missing premolar was replaced with a stratified 3Y-TZP zirconia PC-RBFDP fabricated from a conventional impression using CAD-CAM technology. The prosthesis was bonded using a resin luting cement containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP), and the patient was reevaluated semi-annually. Insights obtained from this case, along with advancements in scientific understanding based on current data, are further explored.

Results:

This clinical case, which occurred 12 years ago, was successful. Building on the insights gained from this case and subsequent ones, modifications to the preparation geometry have been implemented, informed by the in vitro biomechanical findings presented herein. Furthermore, a step-by-step clinical procedure is suggested, drawing from experience with other cases and the current literature on PC-RBFDPs.

Conclusions:

With a necessity of caution due to the limited evidence supporting this therapy, this clinical case shows promising results in the use of ceramic RBFDPs in the posterior region, providing an alternative to implants in contraindicated patients. The comprehensive approach shown in the step-by-step clinical case and the manuscript, including indication assessment, selection of bonding materials, ceramic choice, and preparation geometry, utilizes, to the best of our ability, the most current information and technology available. Continued research is needed to further validate this treatment modality.

Copyright: 2025
Figure 1.
Figure 1.

Vestibular view (a) and radiograph (b) of the left maxillary edentulous area. The benefit/cost/risk ratio does not appear to favor a new tooth-supported FDP.

Figure 2.
Figure 2.

The image (a) displays the anterior abutment preparation of the PC-RBFDP, revealing exposed dentin in certain areas. The plaster cast (b) illustrates the extent of the preparation. We now believe that this preparation was too aggressive.

Figure 3.
Figure 3.

(a) PC-RBFDP after milling, sintering, and stratification; (b) view of the plaster cast.

Figure 4.
Figure 4.

(a) PC-RBFDP after bonding with Panavia F2.0. (b) Proper cleaning of the pontic with dental floss. (c) Postoperative radiograph.

Figure 5.
Figure 5.

Debonding of the PC-RBFDP at 5 years (a), with mixed failure (adhesion at the PC-RBFDP/resin luting cement interface and the tooth/resin luting cement interface). The gray scratches made with the probe (b) show the areas where the adhesive remained on the tooth.

Figure 6.
Figure 6.

Occlusal (a) and buccal (b) views of the PC-RBFDP at 11 years, 6 months. Note the degradation of the resin composite bonded to the mesial surface tooth #13 to limit the span of the edentulous space. Radiographic evaluation (c) revealed excellent dental and periodontal stability.

Figure 7.
Figure 7.

The beam deflection theory. The maximum force (in Newtons) that a cantilever construction can withstand is represented by F. The strength of the beam material is represented by Rm (in MPa), while b (width) and h (height) represent the dimensions of the beam (in mm), and h is the dimension of the beam in the direction of the force (in mm). L represents the distance (in mm) between the point of application of the force and the bridge connection.

Figure 8.
Figure 8.

During preparation of the abutment teeth, flattening the proximal surface increases the height (h) of the connector while remaining in the enamel. This procedure also provides a more favorable insertion axis.

Figure 9.
Figure 9.

On these PC-RBFDPs, which replace a premolar (a) and a molar (b), the occlusal contacts (circles) of the pontics must be relieved because of their distance from the connection.

Figure 10.
Figure 10.

Schematic illustrations, inspired by Yazigi and Kern13 and Kasem and others,19 of the main designs found for PC-RBFDP retainers in the literature. (a): two wings (lingual and buccal), (b): one wing lingual, (c): mesio-occluso-distal inlay, (d): mesio-occluso-distal inlay with a lingual ring, (e): two cusps covered, (f): two lingual cusps covered, (g): occlusal full coverage.

Figure 11.
Figure 11.

Many strategies can be used to maintain the enamel during abutment tooth preparation for PC-RBFDPs. The use of burs calibrated to 0.5 mm, the reduction of preparation thickness in areas less subject to occlusal stress (a), and the achievement of antagonistic coronoplasty (0.2 mm) within the enamel (b) to obtain the 0.7 mm needed.

Figure 12.
Figure 12.

Clinical illustration of these strategies when performing PC-RBFDPs. (a-b) Antagonistic coronal enameloplasty to increase the prosthetic space, as in this maxillary PC-RBFDP case in which a premolar was replaced, combined with a retainer in the form of an occlusal veneer. (c) Pencil marking to guide 0.5 mm occlusal calibration burs to remain within the enamel, as in this PC-RBFDP to replace a molar using a complete occlusal veneer retainer. (d) Although the impression of PC-RBFDPs can be made conventionally or optically, the use of a prep-checker can greatly improve these low preparation thicknesses to ensure their correct completion. In this case of a maxillary molar PC-RBFDP retained by an occlusal veneer, insufficient occlusal preparation was detected with a prep-checker (CEREC Primescan, Dentsply Sirona).

Figure 13.
Figure 13.

Clinical examples and illustrations of dental preparations for PC-RBFDPs. Column a: Mandibular PC-RBFDP to replace a premolar with a lingual veneer retainer on a canine. Column b: Mandibular PC-RBFDP to replace a premolar with a partial occlusal veneer retainer on the premolar. Column c: A maxillary PC-RBFDP was used to replace a premolar with a partial occlusal veneer retainer on the molar.

Figure 14.
Figure 14.

Example of a situation where a resin composite was applied distal to a premolar to reduce the extent (L) of the final (l) PC-RBFDP pontic.

Figure 15.
Figure 15.

Occlusal embrasure between the retainer and the pontic should not be too deep for PC-RBFDPs (a). This means increasing the radius of curvature of the occlusal space (b). Cervical embrasures can be pronounced, if necessary.

Contributor Notes

*Corresponding author: Faculté de Chirurgie Dentaire, 1 rue Maurice Arnoux, 92120 Montrouge, France; e-mail: philippe. francois@parisdescartes.fr
Accepted: 10 Nov 2024
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