The Maryland Bridge:

A Conservative Restoration

Alternative for Missing

Maxillary Anterior Teeth

Heather O’Dell

Brian Furukawa

Purpose: Build Confidence and

Beautiful Smiles

Treatment: Crown Bridge

• Conventional full-

coverage 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

• Can’t 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 acid-

etched

– 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 Long-

Term 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):542-

6.

• 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, Resin-

Bonded Bridges: Clinical Case Reports. Journal of Canadian Dental

Association. 2000:66:267-271.

• G. Mohl, R. Mehra, A. Ford. Clinical Evaluation of Etched-Metal Resin-

Bonded 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.