INDICATIONS

The following indications have been suggested for the use of cast-metal resin bonded bridges: 1) In young people The teeth of young people may have short clinical crowns with large pulps where conventional tooth preparation is not usually recommended. Cast-metal resin bonded bridges allow postponement of conventional fixed techniques until the tooth matures, whilst providing many of the advantages of a fixed prosthesis(Cunningham, 1979; Livaditis, 1981; Denehy, 1982; Yanover etal, 1982; Wiltshire and Ferreira, 1983). The clinical procedures are short and do not require a local anaesthetic. This can also be an advantage in young people (Livaditis, 1981; Simonsen et al, 1983). 2) For the caries-free abutment tooth Conventional fixed prosthodontic techniques would necessitate the removal of much undiseased tooth structure (Cunningham, 1979; Simonsen et al, 1983; Wiltshire and Ferreira, 1983). 3) In the elderly The teeth of the elderly can exhibit long clinical crowns as a result of gingival recession. These teeth can be difficult to prepare conventionally (Simonsen, 1985a). The elderly may also find lengthy conventional procedures taxing and the short chairside time involved in resin bonded techniques may be an advantage (Cunningham, 1979;- Livaditis, 1981; Wiltshire and Ferreira., 1983; Simonsen, 1985a). 4) For the medically compromised patient For the patients in poor health such as those with heart or kidney transplants or serious debilitating diseases, Cast-metal resin bonded bridges can be constructed quickly and relatively economically with a minimum of soft and hard tissue trauma (Cunningham, 1979; Yanover et al, 1982; Wiltshire and Ferreira, 1983). 5) For the compromised abutment tooth In situations where the expected life of the abutments is short due, for example, to periodontal. Resin bonded bridge techniques that do not involve cast-metal frameworks may be more appropriate in these cases. Periodontal splinting may be achieved through this prosthesis. 6) In socio-economically deprived patients The reduction in costs to the patient, that cast-metal resin bonded bridges provide when compared to conventional techniques, may allow some patients the option of a fixed prosthesis (Cunningham, 1979; Livaditis, 1981; Wiltshire and Ferreira, 1983). The elderly may fall into this category (Simonsen, 1985).

CONTRAINDICATION
1) The resin to enamel bond is, however, limited in that it requires sufficient sound enamel and is finite in its strength. Thus abutments that are heavily restored, short clinical crown height, or enamel affected by abrasion, erosion, or amelogenesis imperfecta cannot be used. 2) Most authors recommend that patients exhibiting parafunctional habits are not suitable for resin bonded techniques. However there is some disagreement on this point. 3) There are some occlusal relationships in which adequate occlusal clearance for the lingual retainers cannot be obtained. Deep overbites are particularly difficult in this respect. Class III edge to edge relationships have been both recommended and criticized as a suitable occlusal relationship for cast-metal resin bonded bridges. 4) Most authors recommend that the edentulous span length should be limited to two units although there is no clinical evidence to support this. 5) Patients with known sensitivities to nickel or other constituents of non-noble alloys should not be provided with Maryland bridges. Rochette bridges constructed from noble alloys may be used in these patients. 6) Resin bonded techniques do not allow recontouring of the abutments which means that unaesthetic abutment teeth or poor pontic space cannot be compensated for. Pontics that require a diastema may also present a problem although a design to overcome the difficulty has been suggested. Whilst some authors do not recommend cantilevered pontics, others have used this design, clinically, with success.