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Maryland Bridge: A case report.

Authors
Dr..Dharmendra Gupta, Professor, Abstract
Dr. Shomik Guha, Reader,
Dr. Dinker Goel, Sr. Lecturer Missing teeth at a young age are often a challenge to replace. Until a mature stage is reached, definitive
Dept. of Prosthodontics, replacement has to be delayed. Adhesive bridges are a practical option in such cases that act as interim
Institute of Dental Sciences, Bareilly.
restoration for short to long time periods till definitive replacement can be done. This case report
demonstrates such a situation.
Keywords: Maryland bridge, self-etch resin luting cements,

Introduction compression-molded technique.

Replacement of missing teeth with fixed artificial The fitting surfaces of the 'wings' were sandblasted
ones usually involves the adjacent teeth as abutments. with alumina 250u[5] to create micromechanical
In young patients with young and immature teeth this retentive surfaces for the cement.
treatment option is not ideal due to large pulp size and The restoration was cemented in place using a
transitory nature of gingiva[1]. Treatment planning for universal self-etch resin cement (Rely X U100, 3M
such cases requires restorations with minimal ESPE, Seefeld, Germany).
preparation of abutments and an essentially interim or The occlusion was checked and adjusted.
temporary nature of the restoration. Many designs A patient was followed up at regular intervals. The
have been advocated, e.g. Maryland bridges, Rochette restoration demonstrated successful retention and
bridges[2,3]. While these restorations have function at 1 year post-operative.
compromised retention and corresponding life spans, Discussion
newer self-etch adhesive systems[4] help to ensure that Large pulp chambers in the abutments, expected
such restorations are retained for reasonably long transition in the position of the gingiva and age of the
periods of time. The following case report patient were factors that precluded the use of
demonstrates the treatment of such a case. conventional fixed prostheses in this case. The
Case report restoration planned was considered ideal because of its
Missing #11 and #12 in a fifteen year old female conservative nature that would allow the tooth and soft
patient had been unrestored for a year. On clinical and tissues to mature before a more conventional and
radiographic examination, the teeth demonstrated definitive restoration be fabricated [1,3]. Poor retention
gingival margins much coronal to the cementoenamel of these restorations usually is associated with early
junctions, and large pulp chambers. Considering the loss of the restoration, resulting in repeated luting
age of the patient and physical characteristics of the efforts. The new self-etch universal resin cement
teeth, a conservative adhesive bridge was planned as systems[4] are valuable tools in ensuring longevity of
interim restoration. such restorations that allow them to be in service for the
Minimal preparation of the abutments (#13 and #21) intended period. Although a 74% success rate at 4
was performed on the lingual surfaces only[3]. Care years[6] is considered satisfactory for adhesive
was taken to ensure that the preparations were not restorations, the uneventful 1-year follow up in this
extended beyond the palato-proximal line angles on case created much optimism regarding its tenure in
the abutments. Parallel retentive grooves were made in service, at the end of which definitive prosthodontic
each preparation on the surface facing the edentulous treatment may be rendered. These restorations
space. essentially remain 'long term provisional restorations'
Impression procedures were carried out with or interim replacement of missing teeth[7].
addition silicone (Express XT, 3M ESPE, Seefeld, Conclusion
Germany). Treatment planning compromised by patient factors
A metal framework with 'wings' [3]extending onto may be compensated by technology of newly
the preparations was fabricated with soft, non-precious developed products. The self-etch universal resin
alloy, on which retention beads and nailheads were cement systems are an invaluable aid to this effect.
created to retain the veneering material inthe Pontic References
Address for correspondence: area. 1) Shilingburg HT, Hobo, S: Fundamentals of fixed
Dr. Shomik Guha,
202, Avas Vikas, Civil Lines, The artificial teeth were fabricated on the prosthodontics, 3rd edition, Quintessence
Bareilly, U.P.- 243001. framework with heat-curing acrylic resin using a Publishing Co Inc, IL, 1997, pg. 85.
E-mail: [email protected]

Journal of Dental Sciences & Oral Rehabilitation 34

Figures and Legends:
Fig.1: Pre-operative view.
Fig.2: Tooth preparations.
Fig.3: Restoration on cast demonstrating 'wings'.
Fig.4: Sandblasted fitting surface of 'wings'.
Fig.5: Self-etch resin cement.
Fig.6: Restoration in mouth.
Fig.7: Restoration in occlusion.
Fig.8: 'Before', 'After' views.
Fig.5

Fig.1 Fig.6

Fig.7

Fig.2

Fig.8

2) Stolpa, JB: An adhesive technique for small anterior fixed partial

dentures, J. Prosthet. Dent, 1975; 34: 513-519.
3) Shilingburg HT, Hobo, S: Fundamentals of fixed prosthodontics,
3rd edition, Quintessence Publishing Co Inc, IL, 1997, pg. 537.
4) Jenkins,CB: The bond strength of new adhesive recommended for
resin-bonded bridges, J. Dent. Res., 1985; 64: 664.
5) Mukai, M, Fukui, H: Relationship between sandblasting and resin-
alloy bond strength by a silica coating, J. Prosthet. Dent., 1995; 74:
Fig.3 151-155.
6) Creugers, NH: An analysis of clinical studies on resin-bonded
bridges, J. Dent, Res., 1991; 70: 146-149.
7) Jordan, RE, Suzuki, M: Temporary fixed partial dentures
fabricated by means of acid-etch resin technique: A report of 86
cases followed up for three years, J. Am. Dent. Assoc., 1978; 96:
994-1001.

Fig.4
Journal of Dental Sciences & Oral Rehabilitation 35