The Success Of Crowns And Bridges

Success in crown and bridge

All professional success in their restoration work, mainly because of their desire to do better for their patients, but increasingly the pursuit of success, ie, avoidance of failure are considered necessary for the spectrum of litigation. The number of disputes led by patients is increasing and greater participation of crowns and bridges.

Failure in restorative dentistry can often be traced to the treatment planning stage and of course much can be written about treatment planning and its various phases. It can be useful however to summarise the key elements of treatment planning as:

1. Determining patient's expectations

2. Ensuring the health of the soft tissues before treating the hard tissues.

Many examples of failure in crown and bridge work can be cited where the cause has been poor periodontal support or an unhealthy pulp.

There is an oft-repeated quote by De Van in 1956 who wrote -

'We should seek to preserve what remains rather than replace what is lost.'

This concept is similar to the principle that in treatment we should do no harm. The literature in restorative dentistry, however, is rich in examples of publications describing the incidence of the need for endodontic treatment after crown or bridge provision on vital teeth, with percentages of post treatment non vitality ranging from 3 to 21%.

There must therefore be a positive indication for replacing a missing tooth or teeth by a fixed restoration in order to make the potential risk, expense etc. worthwhile.

It is generally accepted that the indications for replacing missing teeth are as follows:

• Function
• Comfort
• Occlusal stability
• Aesthetics.

In many cases it is the desire for aesthetic improvement which is the driver for the patient to seek treatment and it is therefore incumbent on the dental practitioner to provide an appropriate cosmetic appearance. Unfortunately patients' dissatisfaction with the final appearance is a common cause of complaint and there can be a number of reasons for this. The first and obvious reason is that the shade or shape of prosthetic tooth or position of the restoration is out of harmony with the rest of the dentition and clearly this should be corrected by the practitioner.

More difficult to manage are the situations either where the patient's expectations of excellence in appearance are far beyond anything which could reasonably be provided, or the patient's view of aesthetics is 'individual'.

It is important to recognise these potential problems at the treatment planning stage and act accordingly — even to the extent of declining to treat the patient if it is felt that they are unlikely ever to be satisfied — and consider an onward referral.