Why the Cantilever Off the Healthy Tooth Is Not Recommended
Cantilever dental restorations, particularly fixed partial dentures (FPDs), involve supporting a pontic (artificial tooth) using a single abutment tooth. While this technique offers a simplified alternative in specific clinical cases, using a healthy tooth as the sole abutment for a cantilever is not recommended due to biomechanical, biological, and long-term prognostic concerns. Recent evidence from journals such as the Journal of Prosthodontics and Clinical Oral Investigations highlights increased risks associated with this practice.
Biomechanically, cantilevers create an unbalanced distribution of occlusal forces. When a pontic is extended distally or laterally from a single abutment, a lever arm effect occurs. This produces torque forces on the abutment tooth during function, leading to increased mobility, periodontal breakdown, or fracture.
A 2022 clinical review in the International Journal of Prosthodontics found that cantilever FPDs have a significantly higher failure rate than conventional two-abutment bridges, especially when the abutment is a natural, unaltered tooth.
From a biological standpoint, placing such stress on an otherwise healthy tooth may compromise its periodontal ligament and surrounding bone. Natural teeth exhibit physiologic mobility, unlike implants, and are not designed to bear the added stress of lateral forces. Studies published in the Journal of Clinical Periodontology confirm that overloaded abutment teeth are more prone to pocket deepening, attachment loss, and root resorption. This is especially problematic in patients with a history of periodontal disease or parafunctional habits such as bruxism.
Additionally, cantilevering off a healthy tooth often violates the principle of minimal intervention. A tooth that may have no caries or restorations must undergo significant preparation to accommodate the retainer, sacrificing healthy enamel and potentially leading to pulp trauma. The 2023 consensus statement by the European Federation of Periodontology discouraged aggressive preparation of intact teeth for prosthetic reasons, emphasizing long-term tooth preservation.
Esthetically, cantilevers can lead to complications in the anterior region, such as tipping of the pontic, black triangle formation, or gingival recession around the abutment tooth. These issues compromise both patient satisfaction and clinical success. The Art of Aesthetics dental lab, known for precision and aesthetics, does not recommend cantilevers off single natural teeth for these reasons.
Instead, alternative restorative options should be considered. These include resin-bonded bridges for minimal prep, implant-supported crowns, or conventional fixed partial dentures using at least two abutments. Each offers improved load distribution and long-term predictability. Multidisciplinary consultation with periodontists, prosthodontists, and skilled dental laboratories ensures optimal treatment planning.
In conclusion, cantilevering off a healthy tooth may appear conservative initially, but it poses considerable risks over time. Modern clinical guidelines, biomechanical evidence, and ethical standards in restorative dentistry all support preserving natural teeth and avoiding unnecessary load. A collaborative approach with a trusted dental lab ensures treatment choices prioritize both functional success and patient health.