State-of-the-Art for metal free can til ever bridges:a literaturere view
European Journal of Prosthodontics and Restorative Dentistry (2026) 34(2),60–68
Keywords:Cantilever,PRISMA,invitrotesting
AuthorsINTRODUCTIONReplacing a single tooth, whether in the anterior or posterior region, presents a significant clinical challenge. Traditional solutions, such as fixed dental prostheses (FDP), while effective, often require extensive tooth preparation. Tagami et al. (2021)1 report that a full cap results in a 63-72% reduction of the healthy tooth, increasing the risk of endodontic treatment and associated complications. In response to these limitations, less invasive adhesive alternatives such as resin bonded bridges have emerged. Historically, Rochette (1973)2 introduced a bonded bridge with perforated metal fins, improved in 1982 by the Maryland bridge (1982, Livaditis et al.)3, featuring electrolytically etched solid fins. Although more adhesive, debonding remains the primary cause of prosthesis failure. Hussey and Linden (1996)4 demonstrate the value of cantilever RBFDPs, which are evolving towards allceramic versions, combining aesthetics and biocompatibility. According to Mines et al (2021)5, these restorations offer clinical performance comparable to conventional FDPs, with superior tissue preservation. Cantilever RBFDPs show excellent survival rates6 7 8 9, particularly in the anterior sector (95.4% at 15 years and 81.8% at 18 years) 10, while posterior zirconia versions achieve a 100% survival rate over 53 ± 39 months of observation.11 However, success depends on frame design and bonding protocol, aspects still under discussion for all-ceramic RBFDPs. While randomized clinical trials remain the gold standard for evaluating these restorations, they are time-consuming, expensive and subject to variability. In this context, biomechanical testing, including in vitro testing and finite element analysis (FEA), is an essential alternative for characterizing mechanical performance, optimizing framework design and defining minimally invasive preparations adapted to new materials. This systematic review aims to take stock of these approaches to better understand their impact on the strength and durability of RBFDPs, in order to improve their clinical integration and long-term reliability. MATERIAL AND METHODS Search strategy This systematic review followed the structural protocol provided by PRISMA (Preferred Reporting Items or Systematic Review and Meta Analyses Protocols).12 The search strategy was defined according to the PICO framework as follows: - Population: Patients requiring replacement of a missing anterior or posterior tooth with a cantilever bridge. - Procedure: Placement of a bonded resin cantilever bridge, using different materials (zirconia, lithium disilicate, reinforced composites). - Comparison: Different frame designs, materials and tooth areas (anterior vs. posterior). - Outcome: Biomechanical performance - Timeframe: in vitro, in silico studies Up to November 2024, two online databases, PubMed and Google Scholar, were searched for studies. The present systematic review was conducted for the purpose of addressing the following problem: a comprehensive review of in vitro and digital studies on the performance of cantilever bridges. The search strategy involved the use of keywords, with minor differences in search strategy depending on the restrictions or characteristics of each ••••••••••••••••••••••••••••••• ejprd.org - Published by Riset Publishing Services LLC
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