Occlusal Stability of Cantilever Fixed Partial Denture: A Systematic Review with Meta Analysis

Abstract

Background: The cantilever fixed partial denture (CFPD) is a type of fixed partial denture in which one or more than one abutments are present at one end while there is no abutment support on the other end.Dental professionals have been using these cantilever based prosthesis since many years but the success achieved have been moderate. There have been failures in large number of cases. This large number of failures cannot be attributed as mere accidents. Therefore, there was necessity to investigate the problem in details.

Aim: To carry out systematic review and meta-analysis on the available research regarding occlusal stability of cantilever fixed partial denture.

Methods and Materials: An extensive search was carried out and literature was obtained from the reliable database like Pubmed, Scopus, Web of Sciences. Initially there was search using keywords like cantilever fixed partial denture, removable partial denture, occlusal stability. There was elimination of article according to the inclusion and exclusion criteria and analysis of abstracts and title. Full text was obtained for the selected articles which were screened further. There was systematic review focussing on characteristics of occlusal stability. Meta analysis was carried out with proper statistical analysis which involved calculation of 95% CI for various features.

Results:  A total of 121 articles were identified after the extensive search using the keywords. Then 64 articles were excluded after screening of the title and abstracts. Complete text was sought for 57 articles. There was thorough screening of the full text of articles after which 27 articles were excluded. Finally, forty articles were included in the study.  Studies included were randomized control trials, prospective studies, cross sectional studies. It was observed that studies which carried out comparison between the removable partial denture and cantilever fixed partial denture regarding occlusal stability concluded that there was significant difference between these two types of prosthesis regarding masticatory function (95% CI -3.0 to 3.6). But the patient satisfaction was greater in case of patients treated with cantilever fixed partial denture (95% CI 42.6–52.3). When there was further analysis then it was observed that patient using removable partial denture were found to have more proportion of caries (95% CI 2.4–6.0), gingival inflammation (95% CI 2.1–6.2) and compromised oral hygiene (95% CI 2.1–6.2).

Conclusion: Increasing abutment teeth while reducing the number and size of cantilevered pontics is widely agreed to be crucial to achieving greater occlusal stability in cantilever fixed partial dentures. Although the cantilever is considered a compromise, it is favoured over the RPD in cases with unilateral edentulous dentitions.