Case Report: Rehabilitation of missing lower anterior teeth with Maryland bridge

Introduction

A resin bonded bridge’s fundamental design comprises a metal framework that supports a pontic. The lingual surface of one or more abutment teeth is connected to this with composite resin and the acid-etch technique for tooth enamel. The composite resin can be attached to the structure in a variety of ways.¹ In cases of good survival rates, resin bonded bridges can be considered as a good treatment option in aesthetic region of missing teeth.² In spite of disadvantage such as debonding of restoration resin bonded bridges shows high success rates, and minimally invasive procedure in general dental setup.² Rehabilitation with resin bonded bridge retentive vertical grooves and wing shaped preparation should be done on adjacent teeth³ The prevailing consensus is that implants shouldn’t be placed until definitive evidence of growth completion has been gathered, such as consecutive-year cephalometric radiographs that show growth is incomplete.¹ Studies conducted over an extended period of time have demonstrated that implant-supported crowns are the most durable, aesthetically attractive, and stable restoration currently available.²

Resin bonded bridges are not a no-prep method, but rather need extensive treatment planning and technical abilities.⁴ Successful resin-bonded fixed partial denture (FPD) abutment preparations are particular and unique, relying on appropriate enamel changes to establish a distinct incisal-gingival path of insertion and resistance form.⁴ This clinical report describes a conservative technique for replacing missing lower lateral incisors is described. This technique involves a Maryland bridge, a resin-bonded fixed partial prosthesis.

Case report

A 15-year-old Asian male patient who was a student at school came with the main complaint of missing lower anterior teeth and the unfavorable appearance brought on by the missing teeth to the Department of Prosthodontics in Sharad Pawar Dental College and Hospital, Sawangi, Wardha. The patient had congenitally absent right and left lateral incisors and showed excellent general oral health condition (Figure 1, 2). He had been receiving orthodontic treatment for crowding in the lower arch for the past two years and had been wearing a prosthesis in lower lateral incisor regions that was stabilized along with orthodontic braces. After his orthodontic treatment was finished, he was eager to replace the missing tooth with a durable aesthetic option. He had not yet reached full physical development, according to a series of cephalometric radiographs, hence he was not yet a candidate for implant placement. He decided to get a Procera Maryland Bridge as a temporary fix after considering his options. His psychological profile was sound, and his expectations were realistic.

Figure 1. Pre- operative frontal view.

Figure 2. Pre- operative occlusal view.

Only the lingual surfaces of the abutments required minimal tooth preparation using the standard guidelines as follows:

Figure 3. Post- operative frontal view.

Figure 4. Post- operative occlusal view.

Discussion

Rehabilitation of congenital partial hypodontia includes various treatment options, however minimally invasive approach with resin bonded Maryland bridge was the treatment of choice. In the literature there are a number of citations providing satisfactory outcomes of the Maryland Bridges.^1,2 Success of Maryland Bridge depends on electrolytic etching, micromechanical bonding, accurate construction and fitting of the prosthesis.¹ In order to replace lost teeth with a typical fixed partial denture, all of the abutment teeth’s surfaces must be prepared, which, given how big the pulp chambers are in young patients, increases the risk of pulpal damage.³ In this situation, resin bonded fixed dental prostheses are a good option. The “Maryland Bridge” is a resin-bonded permanent dental prosthesis that was created at the University of Maryland. The retention of the resin-bonded prosthesis has improved thanks to the creation of new resin cements that chemically connect to both the tooth surface and the etched metal alloy.⁴ Micromechanical retention is used to keep the Maryland Bridge in place. Since precious alloys cannot be etched to provide the micromechanical retention, only non-precious alloys can be used with Maryland Bridges.⁵

Factors contributing to success of Maryland Bridges include proper case selection, ultimate abutment selection, bridge designs such as retainer wing coverage, vertical depth grooves and technical considerations. With confluence and balance with all these factors, the success rates of Maryland Bridges can be raised.⁶

Maryland Bridges have a number of benefits, including minimal tooth preparation, which preserves the enamel, minimal pulpal trauma, a lower risk of gingival irritation, a single insertion path that prevents displacement, improved aesthetics, patient satisfaction, and the avoidance of local anaesthesia.⁶ However, it also has several drawbacks, such as its technique-sensitive placement and the metal retainer’s tendency to show through the anterior teeth. For the prevention of caries, certain precautions are required, such as appropriate sealing of the prosthesis and tooth surface margin.⁷ To maintain healthy gingiva, the pontic’s gingival surface should be heavily glazed and in passive contact with the tissue.⁸

Conclusion

When it comes to replacing missing teeth, restoring dental function and aesthetics, and increasing patient satisfaction, resin bonded bridges can be quite effective. The resin bonded bridge should be taken into consideration more frequently as the restoration of choice for small spans, given extensive patient assessment and the application of meticulous clinical methods.

Consent

Written informed consent for publication of their clinical details and clinical images was obtained from the patient and the patient’s father.