A missing tooth can have a significant impact on both your oral health and your self-confidence. Fortunately, there are several treatment options available for replacing a missing tooth, including dental implants, conventional (traditional) bridges, and resin bonded Maryland bridges. In this blog post, we will focus on the Maryland bridge, a minimally invasive and affordable option for tooth replacement.
What is a Maryland Bridge?
A Maryland bridge, also called a resin bonded fixed partial denture, is a type of dental bridge used to replace a missing tooth. Unlike traditional bridges, which require the adjacent teeth to be prepared and fitted with crowns to support the bridge, Maryland bridges use a metal or ceramic framework with wings that are bonded to the back of the adjacent teeth that require no or only minimal preparation. A pontic, or false tooth, replaces the missing tooth.
The wings of a Maryland bridge are typically made of a high strength ceramic material or non-precious metal, and the false tooth is designed to match the color of the adjacent teeth for a natural-looking result. The pontic is typically made of porcelain or a combination of metal and porcelain, depending on the location of the missing tooth and the aesthetic requirements of the patient.
Appearance of a resin bonded bridge
The following images show the appearance of two typical resin bonded (Maryland) bridges to replace front teeth. These bridges were placed at our office in uptown Waterloo, Canada:
The images above show the appearance of a narrow gap that was treated by means of a resin bonded bridge with two wings. The adjacent teeth were sound without any fillings and the gap was too narrow for a dental implant.
A resin bonded bridge with only one wing was used to replace a missing upper front tooth in the images above. Both adjacent teeth are sound teeth without any fillings. This type of bridge is also called a cantilever bridge, since the fake tooth (pontic) is supported by a tooth on only one side of the gap.
Why is it called Maryland Bridge?
Minimally invasive techniques to replace missing teeth with a fixed false tooth (bridge), that are anchored to adjacent teeth, have been promoted for a long time. (see also: The origin of the Maryland bridge)
The faculty from the University of Maryland promoted a specific technique with chemically etched, resin bonded wings, which was ultimately referred to as the Maryland bridge.
How is a Maryland (resin bonded) Bridge Placed?
The placement of a Maryland bridge typically requires two appointments with your dentist. During the first appointment, the dentist will minimally prepare the adjacent teeth by removing a small amount of enamel to accommodate the wings of the bridge. Minimal preparation of the adjacent teeth (e.g. parallel vertical grooves and horizontal steps) will improve the mechanical retention and resistance of a Maryland bridge and lead to a better long-term outcome by preventing the wing from becoming uncemented. Then, an impression of the prepared teeth and the gap is taken and sent to a dental lab to fabricate the bridge. A temporary tooth replacement may be placed while the Maryland bridge is being made. This can be a removable temporary replacement such as a simple clear splint with an added acrylic tooth.
At the second appointment, the dentist will cement the Maryland bridge. The wings of the bridge are bonded to the back of the adjacent teeth (also called abutment teeth) using an adhesive resin cement. The abutment teeth are prepared by thorough cleaning and preparation of the surface with special bonding agents for adhesive resin cements. Metal wings can also be prepared by a special technique (silicoating) to improve the bond strength between the metal wing and cement. This can be achieved by a special technique (e.g. 3M CoJet), which is used at our office in Waterloo, Canada.
The pontic is then positioned in the gap and bonded to the adjacent teeth. The dentist will check the fit and adjust the bridge as necessary.
Advantages of Maryland Bridges
There are several advantages to choosing a Maryland bridge for tooth replacement. Some of these include:
- Minimally Invasive: Maryland bridges require minimal preparation of the adjacent teeth, making them a more conservative option than traditional bridges.
- Affordable: Maryland bridges are generally less expensive than other types of dental prostheses, such as dental implants.
- Quick Procedure: The placement of a Maryland bridge can typically be completed in just two appointments, making it a convenient option for busy patients.
- Aesthetic: Maryland bridges are designed to match the color of the adjacent teeth, providing a natural-looking result.
- Easy Maintenance: Maryland bridges can be maintained with regular brushing and flossing, just like natural teeth.
- Small gaps: Maryland bridges can be used to fill small (narrow) gaps, which could not be filled by means of implant supported restorations, especially if there is insufficient space to place an implant.
Disadvantages of Maryland Bridges
While Maryland bridges offer several advantages, there are also some potential drawbacks to consider. These include:
- Limited Application: Maryland bridges are typically best suited for replacing front teeth, as they may not provide enough support for posterior teeth.
- Limited Longevity: Maryland bridges may not last as long as other types of dental prostheses, such as dental implants or conventional bridges.
- Limited Support: Maryland bridges may not be suitable for all patients, especially those with weak or damaged adjacent teeth.
Is a Maryland Bridge Right for You?
If you are considering a Maryland bridge for tooth replacement, it is important to consult with a dental professional to determine if it is the right choice for you. Your dentist will consider factors such as the location of the missing tooth, the condition of the adjacent teeth, and your overall dental health to determine the best treatment option for you.
Conclusion
In general, Maryland bridges are a good option for patients who have one or more missing front teeth and who have healthy, strong adjacent teeth that can support the bridge. While a Maryland bridge offers several advantages as a dental prosthesis, it may not always provide a long-lasting solution due to issues with retention. Proper preparation of the adjacent teeth, high-quality bonding materials, proper bite alignment, good oral hygiene, regular dental checkups, and avoiding excessive force can all help improve the retention of a Maryland bridge. If you are experiencing problems with your Maryland bridge, it is important to consult with your dentist as soon as possible to prevent further damage or complications.
Overall, the Maryland bridge can be an effective and conservative option for replacing a missing tooth, but it is important to consult with a dental professional to determine if it is the right choice for you.
Further Reading
- Pubmed: The origin of the Maryland Bridge
- Pubmed: Thirteen-year follow-up study of resin-bonded fixed partial dentures
- Pubmed: Resin-bonded fixed partial dentures: what’s new?
- Canadian Dental Association: Bridges
