Journal of Advanced Clinical & Research Insights (2020), 7, 51–54

REVIEW ARTICLE

Current Trends in Fixed Prosthodontics

Kokila Vellingiri, Deviprasad Nooji, K. Suhas Rao, Brijesh Shetty, Manoj Kumar, K. Meghashri
Department of Prosthodontics, KVG Dental College and Hospital, Sullia, Karnataka, India

Keywords: Abstract
Dental ceramics, dental handpiece, luting Prosthodontics has evolved largely in response to the changing needs of esthetics,
cements, provisional restorations, tooth
function, comfort, and health of the patients and it is doubtless that this change will
preparation
continue to occur in future. The best way to forecast the future is to try understanding
Correspondence:
the present. Hence, the knowledge about the emerging materials and latest technologies
Kokila Vellingiri, Department of in the field of prosthodontics aids the prosthodontists to take their practice to higher
Prosthodontics, KVG Dental College and levels. There are no previous articles in the literature describing the recent and ongoing
Hospital, Sullia, Karnataka, India. researches in fixed prosthodontics. Hence, this article aims to give an overview of the
Phone: +91-8508990899. recent advancements in the field of fixed prosthodontics and also provides an outlook on
E-mail: kokila.prostho@gmail.com how it might influence the emergence of prosthodontics in future.

Received: 18 June 2020;

Accepted: 20 July 2020

doi: 10.15713/ins.jcri.303

Introduction Evolution of Fixed Prosthodontics

Prosthodontics, one of the pioneer specialties of dentistry, The emergence of fixed prosthodontics dates back to 1746 when
was officially declared as separate dental specialty in the year Claude Mouton used a gold crown and post, which was retained
1947.[1] From then, it had evolved drastically and significantly, in the root canal.[2] In 1825, production of commercial porcelain
and now, it ensures to meet all the expectations not only crowns started in Philadelphia.[3] Later, Winder introduced
of geriatric population but also the younger age groups by screw joint retention between the pontic and abutment, which
resolving the problems in occlusion, mastication, deglutition, made a shift of fixed prosthodontics from single crowns to
and esthetics. multiunit restorations.[4]
In the past two decades, the focus on oral rehabilitation has Evolution of fixed prosthodontics in the 20th century
changed from removable to fixed prosthodontics. Furthermore, is exponential.[4] In 1903, Dr. Charles H Land introduced
the treatment options in fixed prosthodontics have changed
porcelain jacket crown.[4] In 1907, the description of lost
considerably in the past few years, mainly due to advancements
wax technique was given by William H. Taggart which
in the adhesive system along with the restorative materials, which
revolutionized the prosthetic dentistry.[5] In 1926, Ante’s law
have translucent properties comparable to those of natural teeth
and digital technologies such as computer-aided design and was postulated which is the standard principle for abutment
computer-aided manufacturing (CAD/CAM), robotics, laser, selection till date.[6] In 1957, a major breakthrough was made in
and 3D printing. dentistry when John Borden introduced high-speed air turbine
Prosthodontists should be aware of all current trends and hand piece which operates up to 300,000 rotations/minute.[7]
use them judicially in their everyday practice to meet today’s In 1962, porcelain fused metal crowns were introduced based
patients needs and thereby improve their clinical practice. This on the formulations given by Weinstein et al.[4] In 1973,
article is an attempt to describe few of the cardinal trends in the Rochette bridge was introduced, which lead to an idea of
field of fixed prosthodontics and to provide a contemporary minimal tooth reduction.[8] In 1985, introduction of CAD/
perspective on how this changing trend will shape the future of CAM transformed the practice of dentistry for both patients
prosthodontics. and practitioners.[9]

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Vellingiri, et al. Trends in fixed prosthodontics

Advancements in Ceramics of the cementation procedure.[17] Although a wide variety of

cements are in use, most recent trends include self-adhesive resin
There have been immense advances in the composition,
cements and Ceramir material.[17,18]
mechanical properties, and the processing techniques of ceramics
in the past few years.[10] Most recent advances in dental ceramics
Self-adhesive resin cements
includes (1) monolithic zirconia, (2) multilayered zirconia, (3)
polymer infiltrated ceramics, and (4) processing techniques. These cements were developed in 2002 with the aim to
combine the favorable properties of different luting cements
Monolithic zirconia into single product. This material was introduced to deliver the
property of simple application similar to zinc phosphate and
Zirconia, the toughest and strongest material among all
polycarboxylate cements; pH range, moisture tolerance, and
dental ceramics, was in use in dentistry since the early 1990s.
fluoride release comparable to glass ionomer cement (GIC)
However, because of their insufficient translucency, zirconia
cores always required porcelain veneering to achieve acceptable along with optimal mechanical properties and good esthetics of
esthetics.[11] This often resulted in chipping or cracking of the resin cements.[17]
veneered ceramic.[12] Rates of chipping were reported to be about
Calcium aluminate GIC/Ceramir
3–36% after 1–5 years for fixed partial dentures.[13] To overcome
this, monolithic zirconia restorations without porcelain This cement is a recent hybrid combination of calcium
veneering have been introduced more recently.[12] aluminate and GIC. It combines the pH, early strength, and
Microstructural modifications and altered processing adhesive property of glass ionomer with the long-term strength,
techniques have led to better translucency of this novel better sealing, and biocompatibility of calcium aluminate
material.[10] These restorations, exclusively manufactured by cement.[18]
CAD/CAM, can be used in areas of limited interocclusal space
because of its ability to withstand forces with occlusal thickness
of just 0.5 mm.[12] Advancements in Dental Handpieces
Handpieces with speed-sensing intelligence
Multilayered zirconia
These handpieces have inbuilt sensors that detect the frequency
Multilayered zirconia system was introduced in 2015, aiming of vibrations of the bur and adjust the speed accordingly.
for superior esthetic properties. They showed gradation chroma When higher load is encountered by the bur, chips send
and translucency, imitating the shade gradient of natural teeth: signals to increase air pressure and maintain speed, thereby
Gradual increase in translucency from incisal area of the crown eliminating stalling. When bur is not under load, speed reduces
to the gingival region.[14] automatically. The sensor monitors the speed several times per
second.[19]
Polymer infiltrated ceramics
Recently, a new material called “polymer-infiltrated ceramic- Microturbine head
network” (PICN) was introduced by combining the properties
Recently, handpieces that are lighter and smaller than the
of ceramics and resin composites.[15] The structure of PICN
conventional ones were introduced to allow for greater
consists of 86 weight % of ceramic matrix infiltrated with
accessibility and visibility. Turbine head of <9 mm and height
14 weight % of polymer matrix. These materials have elastic
of 10 mm provide better control and maneuverability, increasing
modulus similar to resin composites along with long-term
the efficiency of practice and comfort of patient.[19]
esthetic stability similar to ceramics.[16]
Light-emitting handpieces
Processing techniques
In recent decades, handpieces with integrated light sources
Two recent ceramic processing techniques that come under
the spotlight include stereolithography and selective laser that can directly illuminate the treatment area have been
sintering. Ceramic stereolithography is a process in which introduced. Such instrument was first marketed in 2007
photopolymerizable suspension of ceramic powders is converted with 25,000 lux light intensity. In 2013, at International
into solid resin under ultraviolet polymerization system. In laser Dental Show Cologne, multi-LED light turbine with 5x-LED
sintering, powder granules are directly fused into single coping ring was presented. This innovation is a breakthrough in
with the use of high-energy laser beam.[10] dentistry that provides complete shadow-free illumination
intraorally.[20]

Advancements in Luting Cements Handpieces with multiple spray channels

Long-term success of any indirect restorations relays greatly on In 2007, handpieces with five spray channels were launched to
the meticulous selection of luting cement and proper execution ensure guarantee sufficient cooling.[20]

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Trends in fixed prosthodontics Vellingiri, et al.

Advancements in Tooth Preparation chemistry provides high impact resistance and dimensional
stability.[25] This material does not undergo polymerization
Ultrasonic tooth preparation
shrinkage and grips tightly to the teeth with perfect marginal
Recently, a study done by Ellis et al. concluded that ultrasonic adaptation.[26] Furthermore, margin refinement is very easy
crown preparation can produce extremely precise margins with because the materials gets grinded without distortion or
greater accuracy and closer adaptation of restorations.[21] It was softening.[25]
found that the margins prepared with ultrasonic instruments
were approximately twice as smooth as the ones prepared with The Structur
regular rotary instruments.[22]
Structur 3 and Structur Premium are the recently developed
materials in the Structur family of provisional materials. With
Laser tooth preparation
the application of nanotechnology, Structur 3 was made highly
Lasers have been successfully tried for the hard tissue ablation fracture resistance and with greater compressive strength of
in the past few years. Er-doped:YAG laser with the wavelength about 500 MPa. This material is highly esthetic material with
of 2.94 µm proves to be most promising with diminished heat gloss and fluorescence similar to natural teeth.[25]
distribution and improved efficacy for tooth preparation. “Laser Structur Premium was developed to provide high fracture
application for wide area” is made possible by adding a scanner resistance making it ideal for long-term bridges along with
system to the existing dental laser units.[23] excellent gloss, tooth- like fluorescence, and fast setting.[25]

Robotic tooth preparation CAD-CAM PMMA provisionals

Shortcomings with manual tooth preparation are insufficient or CAD-CAM polymethyl methacrylate provisionals are the recent
excessive preparation and iatrogenic soft-tissue damage which are trends in provisional restorations that provide meticulous
mainly attributed to insufficient vision and accessibility intraorally. anatomic details. These restorations are milled out from dense
Patient’s and dentist’s discomfort caused by high-pitched noises block with much reduced porosity compared to traditional
from the rotary instruments is another disadvantage.[24] materials.[26]
To overcome these drawbacks, in 2019, a robotic system
with ultrashort pulse laser system was invented in China for
tooth preparation. Study was conducted on 15 extracted human Digitization in Fixed Prosthodontics
teeth and results concluded that the automated robotic tooth In the recent years, digitization has revolutionized the field of
preparation showed better accuracy compared to manual prosthodontics. In the current scenario, digital technology is a
preparation. However, a more in-depth research on safety, part of every procedure in prosthodontics starting from patient
efficacy, and ablation range is needed.[24] education and treatment planning to make impression, digital
shade selection, digital facebow, and virtual articulations.[27]
Advancements in Provisional Restorations
Digital impressions
Luxatemp materials
High precision impressions are possible now a days within few
It is a composite provisional material available as self-cure and minutes with the use of optical oral scanners. iTero, Lava chair
light cure system. Recently, several modifications were made in side scanners, and CEREC AS are the recently invented oral
this line: Luxatemp fluorescence which has superior esthetics and scanner systems. Instant visualization of preparation from all
unique handling properties, Luxatemp Ultra with high flexural perspective is possible with the digital scanners.[28]
strength by incorporation of nanotechnology, and Luxatemp
Solar which is a light-cured material. Light curing enables for Shade matching
flexibility in working time.[25]
Digital shade matching eliminates the subjectivity in analysis of
Protemp crowns
color thereby providing an exact color matching for the prosthesis
and also reducing the chair side time. Various currently available
These are the first prefabricated provisional crowns introduced. devices such as Vita Easyshade, Shadescan, and Clear match
They are malleable, adjustable and with exceptional compressive system provide exact color matching with instant display of
strength of 395.6 MPa.[25] The complete kit consists of 42 crowns color.[29]
in nine preformed sizes to fit onto canines, premolars, and molars.
Main advantage is its fast and simple fabrication process.[26]
Conclusion
Tuff-temp plus
With the advancements in digital technologies and latest
This is a rubberized resin available in six shades and is either materials, clinicians have a wide range of treatment options
self-curable or light curable. Advanced rubberized urethane in fixed prosthodontics that will meet the changing demands

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Vellingiri, et al. Trends in fixed prosthodontics

of esthetics and function. Furthermore, with the latest translucency. Dent Mater 2019;35:797-806.
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54 Journal of Advanced Clinical & Research Insights  ●  Vol. 7:4  ●  Jul-Aug 2020