Bonded dental bridges, also known as resin-bonded bridges or Maryland bonded bridges, are a popular choice for replacing missing teeth. They offer several advantages over traditional dental bridges and dental implants, making them a favorable option for many patients.
Overview of Bonded Dental Bridges
Bonded bridges are composed of a false tooth or teeth (pontic) that is anchored to adjacent natural teeth (abutments) using resin cement. The pontic is usually made from porcelain or a metal ceramic combo, and it is designed to fit snugly between the abutments. Bonded bridges are less invasive than traditional crowns and bridges because they do not require the complete removal of enamel or the植入 of dental implants.
Indications and Contraindications for Bonded Dental Bridges
Indications
- replacing a single missing tooth in the dental arch, typically front teeth
- maintaining the health and aesthetics of adjacent teeth
- when dental implants are not an option due to cost, lack of neighboring teeth, or patient preference
Contraindications
- significant tooth decay or periodontal disease that affects the abutment teeth
- patients with allergies to bonding materials
- patients with a highRisk of dental plaque accumulation
Techniques for Success with Bonded Dental Bridges
Case Selection
- patient factors: consideration of age, health, expectations, and dental health
- abutment tooth selection: ensure endodontic andperiodontal health, assess bone level and root configuration
- occlusal features: plan for static and dynamic occlusal relationships to optimize success
Abutment Tooth Selection
- ensure endodontic and periodontal health
- assess periodontal support considering bone levels and root configuration
- avoid using abutments with active periodontal disease
Occlusal Features
- wax up on articulating casts to assess amount of interocclusal space available for retainer wings and pontics
- ensure pontic is not involved in guidance during mandibular excursive movements
- adjust opposing teeth or gain space with localised anterior composite build-ups
Bridge Design
- resin-bonded bridges are more successful as cantilevers than fixed-fixed restorments
- choose the appropriate design based on clinical circumstances, such as when porcelain_veneers are planned for aesthetics
Technical Features
- ensure metal bridge retainer does not flex, as this-exerts stress on the cement lute and leads to fatigue failure
- use base metal alloys suitable for bonding
- check thickness of metal retainer before cementation to ensure sufficient rigidity
Aesthetics
- manage soft tissues effectively to avoid exposure of metal connectors
- shade of porcelain should be conveyed to the technician
- use a shade map to include details of characterisation features if appropriate
Pontic Design
- choose pontic design based on pontic-ridge relationship
- modified ridge lap pontic is a popular option for maintaining aesthetics
- ovate pontic is a good choice for the anterior teeth, providing a convex profile to the soft tissue fitting surface
Clinical Techniques
- need for tooth preparation is a topic of debate; most practitioners now recommend minimal preparation
- vertical grooves reduce stresses on the cement bond and increase resistance to debonding forces
Cementation
- use an uncontaminated, etched and primed enamel or dentine surface to generate maximum bond strengths
- sandblasting to create micromechanical interlocking
- Panavia V5 or Panavia F 2.0 are recommended resin cements
Ridge Preparation
- manage soft tissue to create a realistic emergence profile and interdental papilla
- define pontic site with a high speed bur or electrosurgery
- depth of relief should be communicated to the manufacturer
Conclusion
Bonded dental bridges are a highly successful treatment option for replacing missing teeth. They offer several benefits, including reduced pain and stress, less invasion compared to traditional crowns and bridges, and a reduced financial burden in some cases. By carefully selecting patient cases, designing appropriate preparations, and maintaining meticulous cementation, the longevity and success of bonded bridges can be optimized.
