Predictability of resin bonded bridges - a systematic review

Objective The objective of this systematic review is to evaluate the survival rate of resin bonded bridges (RBBs) and understand the relationship between various prognostic factors and survival rate.Methods An electronic medline and hand search were carried out to identify prospective studies on RBBs. Critical appraisal of the studies was done and data was extracted from selected studies. Survival rate was estimated with random effect Poissons regression using R software. Influence of location and luting cements was estimated using odds ratio and forest plots using CMA software.Results The predicted survival rate for 5 and 10 years are 83.6% and 64.9%, respectively. Functional survival after rebonding has not been considered in this study. It is expected that functional survival will be higher than event free survival. Debonding of the restoration (78%) is the most common type of failure followed by porcelain fracture (13%). Bridges cemented with Panavia showed the highest survival rate (67%) among the luting cements analysed for 5 years. Retentive tooth preparation, preparation confined to enamel, silicoating, supra gingival margins, Ni-Cr or Co-Cr alloys and no occlusion on pontic in lateral excursions have been reported to be associated with better survival rates. Anterior RBBs were found to be more retentive than posterior RBBs. Pooled odds for retention of RBB in anterior segment when compared to posterior is 1.915 (95%CI - 0.847-4.329). RBBs placed in maxilla were found to be more retentive than bridges placed in mandible. Pooled odds for retention of RBB in maxilla when compared to mandible is 1.774 (95%CI - 0.803-3.917).Conclusion and recommendations Replacement of missing teeth with resin-bonded fixed partial dentures is a conservative alternative to conventional fixed partial dentures and should be included as a treatment option wherever possible. There are numerous factors that influence the longevity of RBBs. To achieve successful long-term survival, careful case selection and consideration of various variables is crucial. There is a clear and urgent need for well controlled studies to better understand the effects of these prognostic factors.