A contemporary approach to the provision of tooth-supported fixed prostheses part 2: fixed bridges where the abutment teeth require minimal or no preparation

The first part of this two part series described the changes that have taken place in the design principles for tooth-supported fixed bridgework retained by crowns. It emphasized that there are fewer indications for these types of bridge due to the decrease in dental disease, the availability of effective, more conservative options and the use of dental implants. However, as is described in the first section of Part 2, the preference of the patient may influence the choice of prosthesis. The second part of this article will then describe the provision of tooth-supported fixed bridges that involve little or no tooth preparation.

Where a tooth-supported fixed prosthesis is indicated and the abutments are generally sound, resin-retained bridges are preferred, whilst recognizing that patient choice may be a factor limiting their use.

On very rare occasions, it may be necessary to use entirely sound teeth as the abutments for a fixed bridge retained by crowns, but this should be very much the exception rather than common practice. The patient whose anterior teeth are shown in Figure 1 had previous multiple episodes of peri-radicular surgery carried out on all four maxillary incisors over a number of years. The treatment had not been successful and the teeth were deemed too compromised and damaged to be retained. The most appropriate treatment from a dental perspective was the loss of the maxillary incisors, followed by the placement of two implants to retain a fixed prosthesis. However, the patient expressed a wish to avoid further surgery. With that in mind, the option of a resin-retained adhesive bridge was recommended, but the patient asked about the likelihood of debonding as she had a job that involved travelling overseas and public speaking and she was concerned about how she would manage if the prosthesis became loose or was lost, which is a potential complication. It was indicated that the only other alternative was a fixed bridge retained by full crowns and the disadvantages of this in terms of loss of tooth structure and damage to the abutment teeth long-term were explained. Nevertheless, as the risk of complete loss of cementation is improbable, she selected this option for treatment. The replacement of four missing incisors constitutes a relatively long span and control of loading is essential with a fixed-fixed design being indicated.