The Maryland Bridge: A Conservative Restoration Alternative for Missing Maxillary Anterior Teeth

Heather ODell Brian Furukawa

Purpose: Build Confidence and

Beautiful Smiles

Treatment: Crown Bridge

Conventional fullcoverage bridge Abutment teeth preparation

Treatment: Crown Bridge

Treatment
Rochette Bridge
Perforated

Maryland Bridge
Electrolytically etched

Advantages
Tooth preservation Reversible

Esthetically pleasing
Less chair-side time Cost effective

Disadvantages
Technique Sensitive Cant be used on broken down teeth Graying

Factors for Success

Case Selection General Design
Anterior Design

Choice of Metal Fitting Placing the Bridge Recall/Review

Case Selection
Healthy teeth
Free of caries Sufficient enamel

Mobility of abutment teeth

Case Selection
Occlusion clearance of 0.5 mm

General Design: Framework

Purpose Providing support for the pontic Limit the stresses placed on the luting agent and bonding interface Increasing the enamel available for bonding Provide resistance withdrawal

General Design: Pontic

Match shading of pontic

General Design: Wings

General Design: Impression

General Design: Cast with Pontic and Bridge

Receiving Site on the Edentulous Ridge

Purpose
Enhance esthetic placement

Contouring of the gum line

Edentulous Ridge Modification

Flipper

Molds and Contours

Edentulous Ridge
Without Modification Modification 4 months later

Edentulous Ridge
Without Modification Modification

Metal Choice
Numerous alloys available Higher density metal Gold Alleviate graying Gold collar produces a better fitting restoration Reduce the occurrence of caries and gingival inflammation

Try-In
Purpose: Ensure esthetic success
Fitting Color Contour Occlusion Graying

Placing the Bridge

Abutment teeth are thoroughly cleaned The area is isolated and the abutment teeth are air-dried Enamel of abutment teeth are acidetched Phosphoric acid(30-50%)

Placing the Bridge

Acid etched teeth are rinsed thoroughly Resin is applied to enamel and internal portion of framework Followed by a composite resin that will adhere to the resin

Review
Check-up appointment
Partial debonding can occur without patient noticing looseness Remove calculus Reinforce oral hygiene

Longevity
Barrack, 1993: Success of 80%
Attribute failure to:
Caries Learning curve Unplanned design Unaesthetic appearance

Priest, 1998: Reported a high retentive rate and classified Maryland Bridge as a long-term restoration or permanent restoration

Conclusion
Basic advantage: Conservation of tooth structure Preplanned design and meticulous attention to procedural details Long-term restoration for replacement of an maxillary anterior teeth

Future of Maryland Bridges

Reinforced fiber polymer framework with porcelain veneer Main advantages
Conservative Allows mobility High bond strength No graying

Future of Maryland Bridges

Thanks
Dr. Cutbrith Dr. Wilson

3M

References

Gerald Barrack. The Etched Cast Restoration-clinical Techniques and LongTerm Results. Quintessence International. 1993:24:701-13. Thomas L. Berekally. Post-Insertion Sensitivity With a Bonded Etched Cast Metal Prosthesis. Case report. Australian dental Journal. 1990:35(5):413-5 Ronald Berger. The Maryland Bridge Signals a New Era in Restorative Dentistry. National Association of Dental Laboratories Journal. 1982:29(9):11-13 Christian Besimo. Resin-Bonded Fixed Partial Denture Technique: Results of medium-Term clinical Follow Investigation. Journal of Prosthetic Dentistry. 1993:69(2):144-148. John Burgess, James Mccartney. Anterior Retainer Design for Resin-Bonded Acid-Etched Fixed Partial Denture. Journal of Prosthetic Dentistry. 1989:61:433-36. Huan-Kong Chang, Omar Zidan, et al. Resin-Bonded Fixed Partial Dentures: A Recall Study. Journal of Prosthetic Dentistry. 1991:65:778-81.

References
Brady T. Doukaoudakis, A. ramussen ST. Experimental Comparison Between Perforated and Etched-Metal Resin-Bonded Retainers. Journal of Prosthetic Dentistry. 1985:54:361-5 G.F. Priest, H.A. Donatelli. A Four_Year clinical Revaluation of Resin-Bonded Fixed Partial Dentures. Journal of Prosthetic Dentistry. 1998 May:59(5):5426. Richard E. Boyd. The Resin-Bonded Pontic. Clinical Impressions. 1996:5(4):18-27. Ellen Roberta Dietz. The Maryland Bridge as Restoration Alternative. Dental Assisting. 1983 Mar/Apr:2(4):30-1,38. Andrew M. Flood. Resin-Bonded Prosthesis : Clinical Guidelines.  Australian Dental Journal. 1989:34(3):209-18. Howe DF, Denehy GE. Anterior Fixed Partial Dentures utilizing the Acid-Etch Technique and a Cast Metal framework. Journal of Prosthetic Dentistry. 1977:37:28-31.

References

Greg Libby, Michael Arcuri, et al. Longevity of Fixed Partial Dentures. The Journal of Prosthetic Dentistry. 1997:78:127-31. Livaditis, Gj. Cast Metal Resin-Bonded Retainers For Posterior Teeth. Journal of American Dental Association. 1980:101:926-29. Livaditis Gj, Thompson VP. Etched Casting: An Improved Retentive Mechanism for Resin-Bonded Retainers. Journal of Prosthetic Dentistry. 1982:47:52-8. Paul S. Olin, Elaine M.E. Hill, James L. Donahue. Clinical Revaluation of Resin-Bonded Bridges: A Retrospective Study. Quintessence International. 1991:22(11):873-876. Sanford Plainfield, Vincent Wood, and Ralph Podesta. A Stress-Relived Resin-Bonded Fixed Partial denture. Journal of Prosthetic Dentistry. 1989:61:291-3. Rochete AL. Attachment of a Splint to Enamel of Lower Anterior Teeth. Journal of Prosthetic Dentistry. 1973:30:418-423.

References
Stephen M. Roser. Prosthodontics-Replacing Missing Teeth. The Columbia University College of Physicians and Surgeons Complete Home Medical Guide. 3rd ed. NY. Crown Publishers Inc:1995. James F. Simon, Robert Gartrell, Anthena Grogono. Improved retention of Acid-Etched Fixed Partial Dentures: A Longitudinal Study. Journal of Prosthetic Dentistry. 1992:68:611-15. Frank M. Spear, David M. Mathew, and Vincent G. Kokich. Interdisciplinary Management of Single-Tooth Implants. Seminar in Orthodontics. 1997:3(1):45-72. Paul Van Wijlen. A Modified Technique for Direct Fiber-Reinforced, ResinBonded Bridges: Clinical Case Reports. Journal of Canadian Dental Association. 2000:66:267-271. G. Mohl, R. Mehra, A. Ford. Clinical Evaluation of Etched-Metal ResinBonded Fixed Partial Dentures. Journal of Prosthetic Dentistry. 1988:59(4)403-4. J.W. Brooks, Bob Twyman, et al. The Maryland Bridge: Is it Here to Stay? Dental Laboratory Review. 1983:58(5):16-19.