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References

Durey KA, Nixon PJ, Robinson S Resin bonded bridges: techniques for success. Br Dent J. 2012; 211:113-118
Burke FJT. ‘Two sisters’ again. Dent Update. 2012; 44
Shimizu H, Kawaguchi T, Takahashi Y. The current status of the design of the resin-bonded fixed partial dentures, splints and overcastings. Jap Dent Sci Rev. 2012; 50:23-28
Pjetursson BE, Tan WC, Tan K A systematic review of the survival and complication rates of resin-bonded bridges after an observation period of at least 5 years. Clin Oral Implants Res. 2012; 19:131-141
Wei Y-R, Wang X-D, Zhang Q, Li X-X, Blatz MB, Jian Y-T, Zhao K. Clinical performance of anterior resin-bonded fixed dental prostheses with different framework designs: a systematic review and meta-analysis. J Dent. 2012; 47:1-7

Technique tips: information for patients receiving resin-bonded bridges

From Volume 44, Issue 9, October 2017 | Pages 908-909

Authors

Samantha Cottam

Oral Surgery Associate, Hampshire Oral Surgery and Sedation Clinic, Basingstoke

Articles by Samantha Cottam

Article

Designs for resin-bonded bridges (also known as resin-retained bridges) have evolved since their first incarnation as the Rochette bridge, progressing to the Maryland design in order to improve micromechanical retention and longevity of the bridge.1 Resin cements allow chemical adhesion of the wings to the etched enamel of the tooth, but mechanical retention is also desirable to help protect the bond. In this regard, it is also important to consider that any bridge should rely more on the preparation of the tooth and shape of the units, rather than the cement used.1

The choice of material and design should be made for the patient, depending on the purpose of bridge, the occlusion, previous treatment and anatomy of the teeth (both crown and roots). Traditionally, resin-bonded bridges are minimally invasive so, in many situations, these present a good treatment option for replacing missing teeth for functional or aesthetic reasons, with minimal compromise to the abutment teeth.1 A recent publication has indicated good survival rates for resin-bonded bridges.2 Other evidence suggests that resin-bonded bridge survival at 5 years is 87%, with failures mostly due to debonding, especially anteriorly.3,4 Biological complications, such as periodontitis or caries, also caused failure, but these statistically were much lower than debonding.3,4

Consideration of bridge design is important for each patient as an individual. In most instances, a cantilever design is most effective,5 unless there is a large pontic span (as this is more likely to debond due to additional stresses) or for use as an orthodontic splint anteriorly (as in the case presented in Figure 1 in which Emax (Ivoclar Vivadent, Leichtenstein) was used). For this particular patient, due to the short crown and root height of the canines and central incisors, numerous catastrophic failures of previous Maryland bridges and the orthodontic treatment which had been undertaken, it was decided to use a fixed-fixed design for the Emax bridge. The fixed-fixed design also facilitated orthodontic retention. In this case, the patient had an anterior open bite, so that there was no need to create space for the retaining wings. Minimal preparation, however, was carried out in order to create parallel sides of the crowns, to aid resistance and retention form, and allow the wings to wrap around the teeth as much as possible in order to achieve maximum coverage.

Figure 1. All-ceramic resin-bonded bridges replacing UL2 and UR2.

However, given the unique nature of the resin-bonded bridge and its reliance, to a degree, on the resin cement to retain the bridge in position, it is important that patients are provided with information which will maximize the survival of their resin-bonded bridgework. This is presented in Table 1.


You have been provided with a resin-bonded (also called resin-retained or Maryland) bridge in which the pontic (your replacement tooth) is attached to adjacent tooth/teeth using adhesive resin cement. This means that little or no drilling needs to be done to prepare your teeth. Your new bridge therefore relies mainly on its adhesive cement to keep it in position. This may be seen as a disadvantage, but the advantage is that less healthy tooth tissue is removed in comparison to a crown preparation, which is necessary for a conventional fixed bridge. A resin-bonded bridge allows one or more spaces in your mouth to be filled. There are many different designs which your dentist will discuss with you in order to provide you with the best bridge for the situation. They may be attached at one end or both, may be made of metal and ceramic or all-ceramic and may be purely for appearance (aesthetics) or for functional replacement. They can be used at the front or the back of the mouth, but are more commonly to replace front teeth, due to lower forces on the teeth. Your dentist will design the bridge, thinking about the spaces that need filling, the state of the teeth that will be used for attaching the replacement tooth (pontic), how your teeth bite together, the shape and size of the teeth (crowns and roots). There are many different designs which your dentist will discuss with you in order to provide you with the best bridge for the situation.It is important that you know what to expect and how to care for your bridge after it has been cemented: here is some information about your bridge and tips to enhance its longevity:
  • Lisping/difficult speech may occur for the first few days whilst your mouth, in particular your tongue, adapts to the ‘wing(s)’ which attach your new bridge to your teeth.
  • Try to avoid eating hard and sticky foods on your bridge (especially just after cementation) as there is no/very little retention from the tooth structure due to the lack of preparation, meaning that retention comes mechanically from the bridge design and chemically from the adhesive cement.
  • Your dentist will give you advice on how to keep your bridge and surrounding tissues clean, in particular, using Superfloss which is used by threading it under the bridge and using a back and forth motion before pulling it through.
  • If your bridge is connected to your teeth at both ends (your dentist will call this a fixed-fixed design), you need to be aware that, if one wing becomes unattached, there is potential for food trapping and risk of bacterial accumulation, leading to decay under that wing. Ultimately, this may progress to extensive decay of the abutment tooth, tooth loss and bridge failure. Therefore, if you hear a crunch or crack sound from your bridge, or simply feel that the bridge has become loose, you must phone the practice urgently, even though there is no catastrophic failure.
  • Your dentist may give you a denture to wear just in case the bridge falls out so that you won't be without teeth if that should happen.
  • How long will my resin-bonded bridge last? At present the evidence suggests that resin-bonded bridge survival at 5 years is 87%, with failures mostly due to debonding, especially in anterior teeth. Biological complications, such as gum disease (periodontitis) or decay, also cause failure, but these statistically are much lower than debonding.
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