Fixed bridge, Maryland bridge 
Author Message
 Fixed bridge, Maryland bridge

I mentioned yesterday about the perils of constructing a
removable partial denture where a fixed (non-removable)
bridge would be preferable.

The next post shows schematics of two types of fixed bridges.
The one on the left is a 3-unit standard (porcelain-fused-to-
metal) bridge which replaces one single missing tooth. The
objections, of course, are the fact that we dentists have to
grind your anchor (abutment) teeth down quite a bit to
provide room for the metal plus the porcelain. In fact, the
teeth often look like little nubs.  However, when these
bridges are cemented in place, they look and feel pretty

A less invasive replacement is often indicated. One class of
fixed (non-removable) bridge that is less destructive of
tooth structure is the Maryland-type or "bonded" bridge, seen
on the right.  However, many of these bridges are not as good
as we dentists would like.

Occasionally, a good bite on something too hard can knock
this bridge right off!  Even worse is when one side of the
bridge becomes "debonded" and the other side stays attached.
The mouth fluids seep underneath and sometime destroy a
perfectly good tooth.

When I do a Maryland-type bridge I modify the preparations a
bit to ensure that the thing is relatively problem-free.
Note the little metal wings in the drawing at the right. They
are part of a casting which is fabricated by the laboratory.
The wings are bonded behind the anchor teeth adjacent to the

I improve upon this design by cutting a slot into each tooth
immediately adjacent to the space. The slot is thick enough
and deep enough so that the casting fully seats within the
tooth. This provides a positive lock for the bridge. The
entire bridge is now bonded in place.  Even the force of a
hard bolus of">food (or chicken bone - yikes!) is transmitted
to the tooth and therefore the bridge stays in place.

These bridges are an important treatment modality considering
that people sometimes have missing teeth on one side, but not
the other side.  Other indications also include those folks
who staunchly resist grinding their natural teeth down to

Maryland-type bridges. They are quick, they are easy, and
they are not costly!  In fact many laboratories charge a flat
fee for a Maryland bridge, rather than a unit-price as is the
case for standard crown and bridgework.

They are not as aesthetic as standard bridgework as they do
not reflect light the same way that non-metal solutions do.
However, they still have their place within dentistry.



Joel M. Eichen, D.D.S.

PS- The drawings are from a book which we use in the office.
I also hand the patient a bridge and a removable partial
denture. Once its in your hand, it becomes very clear which
treatment choice is best.

Sun, 06 Jan 2002 03:00:00 GMT
 Fixed bridge, Maryland bridge
Hi Joel,

Did the picture come thorough allright?

Mon, 07 Jan 2002 03:00:00 GMT
 Fixed bridge, Maryland bridge


>Hi Joel,
>Did the picture come thorough allright?


I have to fire up Netscoop or Microsoft Exploder to see the picture,
because I use a text-only newsgroup reader (Forte Free Agent).

Looks very good!




Mon, 07 Jan 2002 03:00:00 GMT
 Fixed bridge, Maryland bridge
Inlay retained cantilever bridge, using the bicuspid as abutment
(anchor) and no other abutment..


Space is small. By making an inlay-slice preparation, I could widen
the width of the pontic (false tooth). Because its an upper, the metal
would not show, or space age (non-metal) materials would be good too.
The molar is unscathed and I would prefer to leave it that way. The
pontic would be narrow and would promote little stress on the

Even a Maryland-type bridge would be overkill in my opinion, because
it places the underlying abutment at risk for debonding.



PS- nice pic!

Mon, 07 Jan 2002 03:00:00 GMT
 [ 5 post ] 

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