Presented by Dr. Mohammed A I-Multaiza (PartA) Dr.

Mislrati Al-Damklr (PuHB)

Supentheit by Dr. W a l i d A l -Wauan Dr. RiyadAkeel

INTRODUCTION
The primary goal of restorative dentistry is the restoration of oral function, esthetics, and lost tooth structure and the preservation of oral health.

There have been constant change and improvements i the health science, n
restorative dentistry has no difference. Improved materials, instruments and
techniques have made it possible for today's operator of average skills to provide
a service whose quality is on par with that produced by the gifted operator of years

gone by. This is possible, however, only if the dentist has a thorough background

in the principles of restorative dentistry and an intimate knowledge of the

techniques required. Two of the most common restorative work delivered to patients are operative

dentistry and fixed prosthodontics. Operative dentistry is the art and science
related to the diagnosis, treatment and prognosis of dental defects which do not

require full coverage for correction of the clinical procedures such as the
restoration of proper tooth form, function, esthetics and maintenance of the
physiological integrity of the teeth io harmonious relationship with the adjacent

hard and soft tissues; all to enhance the general health and welfare of the patient.
Fixed prosthodontics is the art and science of restoring damaged teeth with cast

metal or porcelain restorations, and replacing missing teeth with fixed or cemented
prostheses.

Successfully treating a patient by means of fixed prosthodontics requires the

thoughtful combination of many aspects of dental treatment; patient education and
the prevention of further dental disease, sound diagnosis,

therapy,

operative skills, occlusion and sometimes removable full or partial prostheses and

endodontic treatment. However, the dentist should consider the possible iatrogenic
effect of any procedure when formulating the treatment plan.

"Fixed partial denture and cast gold restorations can be the finest service
rendered for dental patients or the worst service perpetrated upon them. The path
taken depends upon one's knowledge of sound biological and mechanical

principles, the growth of manipulative skills to implement the treatment plan, and
the development of a critical eye and judgement for assessing detail"'. Successful

placement of any restoration requires sound clinical judgement, both mechanical

and biologic, with an accompanying manual skill capable of forming that which

is conceptualized. Excellence in operative dentistry is dependent upon a high level

of manual skills. Any statement to the contrary wouId be mideading. To deliver

quality restoration

to

patients, the dentist should be aware of the criteria for

clinical success and failures. Thoughout each aspect of learning i restorative n

dentistry, self-evaluation should become a principal adjunct, Criteria for clinical

success and failure need to be understood, and their application is demonstrated

in assessing tbe various goals. This requires a welldefined criteria, comprehension, acceptance and training in their use by the student as well as the staff.

THE QUALITY EVALUATION

It is defrned as a method by which the quality of treatment is evaluated. It

can have a grade of exceIIent or good, equivalent to "satisfactory"or poodfail,

equivalent to "non-satisfactory".

TYPES OF EVALUATION
Patient general evaluation

General and dental health

Evaluation of the abutment and pontic site in case of fixed partial denture. Evaluation of the tooth before starting cavity preparation in case of operative

or in tooth preparation in case of a single crown preparation. Evaluation of the quality of the treatment which is important part in the
treatment steps. To reach for high quality treatment these precaution should

be considered which will be discussed later.

I)
2)

Monitors the patient dental health.

Stimulates meticulous plaque control habits.

Identifies any incoming disease. Introduces whatever corrective treatment measures needed before
L

3)
4)

irreversible damage occurs.

DIFFERENCEBETWEEN MAINTENANCEAND QUALITY EVALUATION

Quality e v a M o n is the method by which the quality of treatment delivered
to patients is evaluated. It can have a grade either satisfactory or non-satisfactory.

Maintemce is the follow-up of patients i an effort to maintain the n

treatment and prevent furture deterioration t sustain normal physiological status. o

TIME FOR MAINTENANCE FOR FUTURE HEALTH AND QUALITY

I.
Post insertion visits

The appointment is scheduled within a week of the cementation of a fixed

partial denture. In this appointment the dentist should check the following:

Gingival sulcus remains dear of any residual cement.

Occlusion, if it is satisfactory or not. On occasion, some occlusion

adjustments will be necessary.

This appointment should be at least every 6 months. Recall appointments

can be coordinated by the restorative dentist or the periodontist and the'

following procedures should be checked and done:

History and general examination

Periodontal disease
Dental caries

Oral hygiene and diet Occlusal dysfunction

Pulp and periapical health.

CRITERIA FOR ACHlEVING QUALITY RESTORATION

It is important to stress that a restorative treatment is an important factor that

determines the long term oral health of the patient,

Restoration with poor

anatomical contour, poor margins, or a rough surface will become habitats for an
undesirable plaque communities and make oral hygiene procedure difficult or
impossible. Excellence i restoration treatment is essential for the prevention of n
both recurrent caries and periodontal disease.

I.

treatment evaluation

Evdu&n

o orid health f

There are several things to be observed during oral examination.

Among these are the patient's general oral hygiene, plaque accumulation,

periodontal condition, presence or absence of inflammation, existence of

pockets and the presence and amount of mobility. All these should be

examined and any changes should be recorded with attention to potential

abutment teeth.

Examine edentulous ridges and note the relationship of spaces if there

are more than one. The amount and location of caries, previous restoration

and prosthesis should be examined carefully. This will make it possible to

determine their present suitability of need to be replaced. It will also offer

some prognosis for future work to be done.

Finally, an evaluation shouId be made of the occlusion. Are there any

large facets of wear? Are they localized or wide spread? Are there any non
working interferences? The amount of slide between the retruded position
and the position of maximum intercuspation should. be noted. Is the slide
a straight one, or does the mandible deviate to one side or the other? The

presence or absence of simultaneous contact on both sides of the mouth

should be observed. The existence and amount of anterior guidance is also important. Restorations of anterior teeth must duplicate existing guidance

in some cases, replace that which has been lost through wear or trauma.

Evaluadion of the i n d i c d n

Crown fixed partial denture is the optimal restoration of choice.

A more conservative restoration could be placed, but a crown of fixed

partial denture is acceptable.

No clear indication for crown or fixed partial prosthesis.

Restorations may cause damage or adversely affect the prognosis for
tooth or twth.

Crowns are made without consideration of other treatment

possibilities, or

Special conditions requiring re-evaluation are not discovered or taken

into consideration.

Evaluhre o patient cooperation f

To reach successful treatment patient cooperation is very important.

This cooperation start from motivating the patient to listen to the doctor's

instruction (eg. O.H.I.), and until the post-instruction for operative work.
A simple example is listening to the dentist's instructions of controlled chewing on the operation side for several hours after restoration with a large

filling.

Evduationofthaabuhnent
Every restoration must be able to withstand the constant occlusal
forces to which it is subjected. This is of particular significance when

designing and fabricating a fixed partiaI denture, since the forces which

would normally be absorbed by the missing tooth are transmitted, through

the pontic, connectors and retainers, to the abutment teeth. Abutment teeth are therefore called upon to withstand the forces normally directed to the

missing teeth, i addition to those usually applied to the abutments. n

Ideally, an abutment should be a vital tooth. However, a tooth which

has been treated endodontically and is now asymptomatic, with radiographic

evidence of a g o d seal and compIete obliteration of the canal, can be used
as an abutment. Some compensation must be

made for the loss of coronal

tooth structure. This can be accomplished through the use of a cast dowel-

core, or a pin retained amalgam or composite core,

Normally, abutment teeth should not exhibit mobiIity, since they will

be carrying an extra load. The roots and their supporting tissues should be

evaluated for three factors:

1)
2)

Crown-root ratio
Root configuration
Periodontal surface area

3)

Potrficevaludbn
Pontics should replace the function and esthetics of lost teeth, and at
the same time be non-irritating to the mucosa and allow effective plaque

control. Gingival irrigularities and abnormal contour should be corrected surgically i the area where missing teeth are to be replaced. This may n

require both soft tissue and bone recontouring. If only soft tissues are
involved, the recontouring is accomplished by gingivoplasty (cold steel or electrosurgery), but if bone needs recontouring a flap procedure should be
.

used t expose the bone. o

Ridge saddle pontic make plaque removal under the pontic almost impossible and therefore, lead to mucosal irritation. Decision of the proper

pontic size can be made after evaluation of the pontic site. Too wide

pontics should be avoided because they may infringe on the normal space
of the interproximal papillae between the pontic and the abutment tooth. It

is also important that the interproximal soldering points are convex, occlusaIly located and easy to clean. It has been documented that even well constructed pontics wiIl increase pIaque retention, gingivitis levels and
pocket depth compared with surfaces not adjacent to pontics.

It may be advisable to seat bridges temporarily with a weak zince-

oxide eugenol cement, instruct the patient i proper home care, and remove n the fixed partial denture (F.P.D.)in a week or two to be evaluated, and see

if gingival irritation bas developed, If there is evidence of inflammation, the

appliance has to be modified and the patient reinstructed. The F.P.D.

should not be seated permanently until there is evidence that it is well

tolerated i functional state. n

II.

Precaution during treatment

The biological precaution is important to avoid unnecessary damage.

In tooth preparation, the structures easily damaged are the proximal teeth,
and the pulp of the tooth being prepared.

Conservation of tooth structure

One of the basic tenets of restorative dentistry is to consewe as much
tooth structure as possible during tooth preparation that is consistent with.

mechanical and esthetic principles. This will reduce the harmful pulpal
effects of the various procedures and materials used and enhance the success
of restorative treatment.

Tooth structure is conserved by employing the following guidelines:

1)

Use of partial rather than complete coverage restorations when indicated.

2)

Preparation of teeth with the minimum practical convergence angle

(taper) between the walls.

3)

Preparation of the occlusal surface so, reduction follows the anatomic planes to give uniform thickness in the restoration,

4)

Preparation of the axial surfaces so that tooth structure is removed evenIy , if possible.

5)

Selection of a conservative margin compatible with other principles

of tooth preparation.
6)

Avoidance of unnecessary apical extension of the preparation.

B.

Prevention o darnage duting tuoih preparafion f

teeth

Iatrogenic damage to an adjacent tooth is a common fault in operative dentistry. Even if a damaged proximal contact area is carefully reshaped and polished, it will be more susceptible than the original undamaged tooth

surface to dental caries. This is presumably because the original surface

enamel contains higher flouride concentration and the intempted layer is
more prone to pIaque retention. The technique of tooth preparation must

avoid damage to adjacent tooth surfaces, by making a thin "lip"of enamel

as the bur passes through a proximal contact.

-S
Damage to the soft tissues of the tongue and cheeks can be prevented
by careful retraction with aspirator tip, rnouth mirror, or flanged saliva ejector. Great care is needed when the lingual surfaces of mandibuIar molars are being prepared.

Pulr,
Great care is also nesded to prevent pulp injuries during restorative

procedures, especially complete crown preparation and large and deep

caries. Extreme temperatures, chemical irrjbtion or microorganisms can

cause an irreversible pulpitis, particularly when they occur on freshly

sectioned dentinal tubules.

Prevention of pulpal damage necessitates

selection of techniques and materials that will reduce the risk of damage

while preparing tooth structures.

Causes of iqjury

Temperature
Considerable heat is generatd by friction between a rotary

instrument and the surface being prepared. Excessive pressure, higher rotational speeds, and the type, shape and condition of the
cutting instrument may all increase the generated heat. With a high

speed bandpiece, a feather-light touch allows efficient tooth removal

with minimal heat generation.

Nevertheless, even to the lightest touch, the tooth will be over-

heated unless a water spray is used as a coolant. This must be

accurately directed at the area of contact between the tooth and bur.

The water spray will also remove debris (important because clogging

reduces cutting efficiency) and prevent desiccation of the dentin (a

cause of severe pulpae irritation). If water spray prevents adequate

visibility, as may be the case when finishing a lingual margin, a slow

sped handpiece or hand instrumentation should be used. Relying on

air cooling with a high speed is hazardous, for it can easily over beat
a tooth and damage the pulp.

Particular care is needed wben preparing grooves or pin holes

because coolant cannot reach the cutting edge of the bur. These retention features should always be prepared at low rotational speed
to prevent heat build up.

Chemical action
The chemical action of certain dental materials (bases, restorative resins, luting agents) can cause pulpal damage, particularly

when they are applied directly to freshly cut dentin. Chemical agents are sometimes used for cleaning and decreasing tooth preparations.
However, they have been shown to be pulpal irritants. Thus, their
use is generally contra-indicated, particularly since they

do not

improve the retention of cemented restorations.

Pulpal damage under restorations has been attributed to the

action of bacteria that either were left behind or gained access to the

dentin because of microleakage. In case of preparation for fixed

prosthesis, it is important to remove all carious dentin before placing
a restoration that will serve as a core for a fixed prosthesis. An

indirect pulp cap is recommended when its later failure would jeopardize extensive prosthodontic treatment.

C.

Factors qffecgng Quality Evduabion Of Restorah9'veTkeatntent

An improper tooth preparation during restorative treatment may also

have an adverse effect on long term dental health. To avoid this, proper
care should be taken during tooth preparation. Any alteration or poor

preparation will affect the quality o the treatment. f

For example, the

proximal box for C1 II amalgam filling with inadequate width and depth may

lead t fracture or displacement of the filling. Also, poor preparation leads o

to inadequate marginal fit or poor crown contour. Plaque control around a

fixed restoration will become difficult and this in turn will impede long term

dental health maintenance.

&l

reductioa
Gingival inflammation is commonly associated with crowns and FPD

abutments having excessive axial contours. This may be because it is difficult for patient to maintain plaque control around the gingival margin.

It is essential that a tooth preparation provide sufficient space for the

development of good axial contours. This will enable the junction between
the restoration and the tooth to be smooth and free of any ledges or abrupt
changes in direction,

Under most circumstances a crown should duplicate the profile of the original tooth (unless the restoration is needed to correct a malformed or
malpositioned tooth). If an error is made, it is better to have a slightly flat,

under contoured restoration because this is easier to keep plaque free.

Sufficient tooth structure must be removed to allow the development of

correctly formed axial contours, particularly in the interproximal and furcation areas, where periodontal disease often begins.

Marain Placement
Whenever possible, the margin of the preparation should be
supragingival. The supragingival margins are easier to prepare accurately

without trauma to the soft tissues. It can also be situated on hard enamel

whereas subgingival margins are often on dentin or cementum,

A 1ongitudinal study, extending over a period of 1 years, was carried 0

out on a group of 114 patients for whom full

crowns were placed. A higher

gingival index scores were found when the crown margins were locatd

subgingivdly as compared to location at the gingival margin or

supragingivally. Also, this study mentioned about the incidence of carious
lesions which was about the same whether the crown margins had been

located subgingivally, at the gingival margin or supragingivally.

The other advantages of supragingival margins include the following:

1
2)

They can be easily finished.

They are more easily kept clean.

3)

Impressions are more easiIy made, with less potential for soft tissue damage.

4)

Restorations can be easily evaluated at recall appointments.

However, a subgingival margin is justified, if modification of the axial

contour is indicated.

m G $ p

The junction between a cemented restoration and the tooth is always

a potential site for recurrent caries because of dissolution of the luting agent.
Where possible, it should kept as short as possible. Rought or irregular

junctions greatly increase the length of the margin and reduce the possibility
of obtaining a good-fitting restoration. The importance of smoothing
margins properly is emphasized. Time spent obtaining a smooth margin will
make the subsequent steps of tissue displacement, impression making, die

formation, waxing and finishing much easier and ultimately will provide the patient with a longer - lasting restoration.

Occlusal consider~ioq
A satisfactory tooth preparation should allow sufficient space for

developing a functional occlusal scheme in the finished restoration. T n operative work, the filling should follow the proper condensation of the

filling, proper cawing and fmally proper and exact check-up of the occIusion before the patient Ieave the dental chair.

Sometimes, even

endodontic treatment is necessary to make enough room to avoid traumatic occlusal scheme.

SEQUENTIAL TECHNICAL PRECAUTION FOR QUALITY TREATMENT

The design of tooth preparations for restorative treatment folIow certain
mechanical principles, otherwise, the restoration may become dislodged or may

distort or fracture during service.

Retenlion form
To provide adequate retention, the following factors must be considered:

magnitude o the dislodging forces f

Forces that tend to remove a cemented restoration along it is path of

withdrawal are small compare to those that tend to seat it or tilt it. The

magnitude of the dislodging forces depends on the stickness of the food and
the surface area and texture of the restoration being pulled,

geometry o the prepararion f

Restorative treatment depend for retention on the geometric form of the

preparation rather than on adhesion. The available cement act by increasing
the frictional resistance between tooth and restoration. Cement is effective only if the restoration has a single path of withdrawal; that is, the tooth is

shaped to restrain the free movement of the restoration.

Theoretically, maximum retention is obtained if a tooth preparation bas

paraIlel walls; however, it is impossible to prepare a tooth in this way using
current techniques and instrumentation without the risk of slight undercuts.
A slight taper, is necessary when preparing a tooth. As long as this taper

is small, the movement of the cemented restoration will be effectively

restrained by the preparation and will have what is known as limited path

of withdrawal. The recommended convergence is 6 degrees.

Surface are play an important role in the retention, therefore, crowns with
Iong axial walls are more retentive than those with short axial walls and

molar crowns are more retentive than premolar crowns of similar taper.

roughness o bhejWing su@ce o she restoration f f

When the internal surface of a restoration is very smooth, retentive failure
occurs not through the cement but rather at the cement-restoratio interface.

materials being cemented

Retention will be affected by both the casting alloy and the core or build-up

material,

type o Mng agent f

The type of luting agent chosen affects the retention of a cemented

restoration, although the decision regarding which agent to use also based
on other factors. In general, the data suggest that the glass ionomer cements
are the most retentive but it is difficult to correlate retention with any single

mechanical property of the cement, and long-term clinical evidence is not

available.

Jlm thickness of the hting agem

There is conflicting evidence on the effect of increased thiclmess of the

cement film on retention of a restoration.

Resistance form
There are certain features which must be available to provide adequate resistance.

magnitude and direction o the dislodging forces f

The restorative treatment sbourd be carefully made and prepared with

properly developed occlusal surfaces, the loading should be well distributed
and favorably directed.

geomtry o the tooth preparutiun f

Preparation geometry play a key role with resistance form. The tooth
preparation must be so shaped that particuIar areas of the axial wall in case
of crown and axial wall-pulpal floor, proximal box and groove in some
cases which will interfere with rotation of the restoration. Short tooth

preparation with large diameters were found to have very little resistance

form.

physical propedes o the luring agew f Resistance to deformation is affected by physical properties of the luting
agent such as compressive strength and modulus of elasticity.

eformat~on
A restoration must have sufficient strength to prevent it from being

permanentIy deformed during function, otherwise, it will fail. To avoid this

type of failure, the following factor must be considered:

alloy selection
adequate tooth reduction

margin design

- -

FAILURES I. Biologicd Failures

An abscence of previous radiographs and charting, as is often the case for

new patients, makes it impossible to ascertain whether furtber bone and

attachment loss occurred since the restorations were placed. It is highly

probable that clinical signs are primarily indicators of past disease and not

predictors of future disease. The problem for the researcher, as for the

clinician, is that the diagnostic criteria are so unreliable, that we are unable
to determine which sites will i the absence of treatment, deteriorate i the n n

future. Further, it is very difficult to assess the true efficacy of treatment,

This is usually perceived by the patient as:

Looseness of teeth o fixed partial denture r

Drifting teeth

Bleeding tissues
Changes i colour of the gums n

Bad taste Bad breath

Pain, which is sometimes relieved by applying sideways pressure

from an opposing tooth.

u r y m4 - -

24

Abscess formation

Caries - This is usually perceived by the patient as:

Pain or sensitivity to hot, cold or sweet foods and liquids.

Bad taste
Bad breath
Loose restorations

Fractured teeth DiscoIoured teeth

mlpd - This is usually perceived by the patient as:

Pain either spontaneous o related to hodcold or sweet stimuli. r

Pain which is accentuated by lying down or exercise.

i f -C

- Cracks through the enamel and dentine of the tooth may

Pain to hot and coId foods and to biting or on release of biting

occur and are usually perceived by the patient as:

pressure, Loss of tooth substance following actual fracture.

ontic i n f l a m This is usually perceived by the patient as:

Pain, swelling, bad breath, bad taste, bleeding gums and poor

aesthetics.

- Bony resorption and soft tissue shrinkage in an

extraction site can result in an unaesthetic pontic ridge relationship.

Technical Failure
Cementation failure is often unnoticed by the patient. It can be due to the
following:

Inadequate tooth preparation

Poor fitting of the casting

Incorrect manipulation of the cement
Poor cementation techniques
Ocdusal mismanagement Different mobilities between abutments, so that the most mobile

abutment is hydraulically displaced during cementation.

Poor mechanical design of restoration

Poor choice of materials
Excessive forces, such as in cantilever fixed partial denture

. -

. -

As a general rule, when porcelain fracture occurs splinted units give rise to
greater problems than solitary units do, since the latter can be more readiIy

replaced.

J i taue Fracture of joints between restorations or between the o fi r n l

restoration and a pontic can be due to:

Incomplete casting or soldering of the joint porosity.

Inadequatejointareaforposteriorunits

The osseu-cervical dimension is more important than bucco-lingual

dimension.

For anterior units, the bucco-lingual dimension is more

important than the occluso-cervical dimension.

111. Esthetic Fdure

In addition to the technical and biological failure, aesthetic failure can occur
at the time of cementation or

subsequently to the time of cementation. This

can be due to actual failure such as color mismatch, poor tooth contour,
poor gingival contour and/or color, poor margin placement, poor pontic

placement, poor residual pontic ridge contour, or porcelain fracture during

cementation.

Color blaness

It is prudent to remember that male dentists and

technicians may be partially or totally color blind. Testing is advisable.

The dentist and technician may have different color perception and each may

differ from that of the patient.

Porcelain failure - This can be due to factors related to:

Tbe porcelain itself

The bond between porcelain and metal substructure

The substructure itself, i the case of cerarno-metal restorations n

Occlusal factors
Trauma

pel e-

_
- This particularly occurs with thin gingival tissue and

Gi~giva recession

long narrow teeth as opposed to short wide ones. It can also be caused by

subgingival margins positioned close to the junctional epithelium, prominent

roots, poorly fitting crowns and excessive trauma during preparation and

impression taking. It tends to occur where there is loss of approximal

attachment, since the tissues tend to remodel so as to conform to "genetic

memory". This results in a more apical location of the buccal attachment.

Thus, it rnay occur if anterior crowns are prepared without respect for the
fact that the approxima1 amelocemental junction is located more coronally

than the buccal and lingual junctions. A shoulder preparation which is at

the same level approximally and buccally will cut accross the attachment and cause buccal recession. Recession is of particular

concern for the patient

with a high maxillary or low mandibular lip line.

Porosity - Poor glazed porcelain can appear satisfactory at cementation and

subsequentIy develop black specks. This particularly is likely to occur if the
porceIain is exposed to acidulated phosphate gels as part of a preventive programme.

The gel removes surface glaze and exposes subsurface

porosity.

Drfling o anterior teeth - This can result from loss of periodontal support, f

periodontal inflammation, habits, loss of posterior occlusal vertical

dimension, posterior occlusal instability leading to an anterior displacement

of the mandible, posterior occlusal coatact leading to lack of anterior contact

i excursive movements and subsequent anterior over eruption. n

Wear - This is particularly likely to occur on lower anterior teeth when these

oppose adjusted, unpolished and unglazed porcelain.

RATING SYSTEM FOR QUALITY EVALUATION

The Task Force on Qualiv Evaluation has given top priority to developing

an evaluation mechanism for those procadures most commonly performed in

dentistry. The guidelines, sometimes referred to herein as criteria, are designed
to

be applied to evaluating the cIinica1 quality and professional performance of a

procedure, without regard to whether the dentist is a general practitioner or a

specialist. Due consideration must always be given to various treatment modalities

used by different practitioners. These guidelines do not, in and of themselves,

represent standards. Such standards can only be determined after such time as

substantial field testing is completed and anaIyzed.

The rating system for each dental service category or care component
provides the rationale for the rating of clinical quality andlor professional
performance into two main categories: Satisfactory vs. Not acceptabIe. Two

subratings are available within each main category:

SATISFACTORY
1 1

Clinical quality andlor professional performance rated i the range of n

m.

Clinical quality andlor professional .. performance rated in the range of ~ t a b h t y .

NOT ACCEPTABLE

Clinicai quality andlor professional performance which should be repeated, replaced, repaired or corrected for preventive reasons and is likely to cause future damage t o the patient's general o dental health, or to r individual components of the patient's masticatory system.
Clinical quality and/or professional

II -

performance that must be repeatd, replaced andlor immediately treated because damage is

every dentist must make in order to provide appropriate care to each individual
patient and to decide whether existing dental care services are Satisfactory or Not

a m ptable.

Rating of clinical quality andlor professional performance should not be confused with the grading of dental services on a "numericalscale" or on a "letter
scale" with numerical equivalents (such as grading in educational institutions). It
is recognized that the rating system delineates the existence of "ranges"as opposed
to "exacts" and stresses the importance of the "judgment factor'

in individual

instances.

The quality-evaIuation criteria should be considered merely as aids for the

discrimination between the four ratings for each characteristic. The determination

of the rating of any given dental semict is dependent upon the sound judgment of
the pcer-xeview examiners.

QUALITY EVALUATION CRITERIA (Modified after the CDS system)

What to evaluate?

All fillings and crowns

Degrees of quality = CDA for operative dentistry

SATISFACTORY

quality. Future damage to the tooth andlor its surrounding

ACCEPTABLE
acceptable quality. Damage to the tooth andlor its surrounding

QUALITY OF FIX1ED PARTIAL DENTURE IN KING S A W UNIVERSITY, COLLEGE OF DENTISTRY

It is difficult or impossible to draw general conclusions regarding the prognosis of

restorative treatment performed i a general dental practice. I the attempt to n n

determine tbe expected longevity of the fixed partial denture, longevity is only one
factor influencing a patient's decision to undertake fixed partial denture, low life
expectancy coupled with the perceived higb cost of the prosthesis may out weigh

the patients perceived benefits from the work.

Schwa*

et a1 (1970) found that the mean service time of fixed partial denture

after 1 . years, with more than 20% of restorations failling within three years. 03

Roberts (1970) reported on fixed partial dentures placed over a 12-year period and

found a failure rate per year which varied from 0.5% for posterior full crowns to
a high of 8% for class

I inlays used

as bridge abutments. Roberts (1970) in

another study, investigated the faiIure rate of fixed partial denture in relation to
age of the patient at insertion, and found a failure rate of 2-6% per year,

depending on the age of the patient at insertion. Glantz et al (1984) found, in a

five-year follow up, that only 2%of the restorations had been lost and that 90%

of the crowns and pontics were rated as satisfactory at five years. Leempoel et a1

(1985) evaluated fixed restorations placed during an 11.5 year period, and found

a total of only 1.9%failure over that period. Leempoel estimated that the number

of restorations that would be present after 11 years ranged from 75% for jacket

crowns to 95-97 A for full, partial and porcelain fused-to-metal crowns. Karlsson
(1986) in a 10-year f01low-up study, found that 93.3 % of the fixed partial denture were still functioning, although 12.6%had a loose retainer, which may predispose
those fixed partial denture to failure in the future. Wslton (1986) found the

mean

length of service of fixed restorations to be 8.3 years, with a range of 6.3 yean
of service for ceramic metal crowns to 14.7 years for resin veneer crowns.

From available data, indications are that at 10 years after the insertion of fixed restorations, approximately 90% will still be in service. The mean length of
service is in the eight to 11 year range. This is in agreement with a study by

Maryniuk, who surveyed practising dentists concerning their expectations and observations of restoration longevity. He concluded that, based on the average and

minimum acceptable vaIues given the respondents, a minimum longevity range for
fixed restorations was eight to 13 years.

Fayyad and Rafee (1997)i their study on the relationship between fixed partial n

denture failure and the periodontal ligament area of their abutments found that in

radiographic evaluation of abutment teeth in 56 failed fixed partial dentures

revealed that there were only two cases with evidence of over loading fhe abutments, and the longevity of failed fixed partial dentures war 6.1 years while
the duration of service of the satisfactory ones was 4.5 years.

MATERIALS AND METHODS

Clinical examination by means of California Dental Association Quality
(CDA) Evaluation System were coined out in a group of patients who had recieved
fixed restoration either bridges or crowns 3 years at least before this study.

The studied group consist of 57 persons (33.5%) who agreed to cooperate and
participate in this study from an original group ( 7 ) Selected at random from 10.

the College of Dentistry records, of the original group 34 (20%) had traveled, 79
(46%) were not traceable or not cooperative.

These examination were conducted by two trained examiners who worked

in the College of Dentistry in the general clinic. They previously standardized i n

(CDA) Quality Evaluation System. This system is based on application of tested

cIinical criteria. When these are applied by standardized examiners, the system

has been shown to be precise and accurate i the evaluation of dental restorations n
and dental care.

RESULTS AND DISCUSSIONshall be presented in the seminar.

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