17yearoldI recently restored a 17-year-old female with congenitally missing maxillary lateral incisors that had recently completed her orthodontics. Her mother wanted a nice cosmetic result without looking at implants for her daughter just yet, and I found myself proposing Maryland bridges as either a short- or long-term solution.

She presented with a favorable anterior occlusion and no proclination of the teeth, which made her a good candidate for such treatment. When I considered material choices for the bridges I looked at e.max with two wings (the most esthetic but weakest choice), zirconia (a very strong and esthetic choice but not the best option for bonding) or non-precious metal ceramic (a very strong choice and can be bonded but not the most esthetic).

I then started to think about one retainer or two. I read two of the articles citing the long-term statistics on a single retainer and a two-unit and decided to put the retainer on the cuspid and cantilever the pontic. This was a first time that I have ever done this with a Maryland bridge.

When I conversed with my technician at the Winter Lab about my taking the leap of faith on this, he made an additional recommendation that I thought was brilliant. Since the framework was fabricated in zirconia, why not press lithium disilicate to the intaglia surface of the retainer and then bond it in place? Doing this would allow me additional retentive peace of mind and it is precisely what I did.

In the spirit of learning from these Spear articles, I will keep you all posted on the level of success for this patient.

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Comments

Commenter's Profile Image Brent Hehn
May 29th, 2014
Wow, I have the same case coming in next Monday morning, are you concerned about fracture at the interface between the zirconium and the lithium disilicate? My patient finished ortho 8 years ago and had a partial denture so there had been some ortho relapse and probably will need ortho before implants, young man without funds for ortho and implants, I am leaning towards metal framework for durability but afraid of the less than stellar esthetics Good luck Brent hehn
Commenter's Profile Image Kevin Goles
May 30th, 2014
I'm a 4th year dental student and I just recently had a unique case that I worked on with one of our prosth faculty. My pt was 46 yrs old who needed to have all of his molars and incisors extracted due to caries and perio leaving all of his canines and premolars. I stabilized these remaining teeth after SC/RP and we ended up doing a Maryland bridge from #6-11 and #22-27 with cingulum preps on the canines. The wings were on the canines and the pontics were all the incisors. We used a Cr-Co metal substructure and used the white opaque shade for our dual-cure Nexus III cement. This was able to block out the metal from the lingual of canines and looked very good esthetically. All of his excursives and protrusives are on his natural dentition which will hopefully add to the longevity. The mand canines were recontoured so they wouldn't occlude on the metal wings of the max bridge. It's only been a week but he loves it especially with it being fixed and not having the bulky framework of an RPD.
Commenter's Profile Image Bryan Bauer
May 30th, 2014
I have been doing the single wing maryland's on my last few cases and they are really nice (except I had one rotate on me and has me somewhat rethinking the idea). Similar to what you are recommending I think a zirconia framework with emax on the peripheral areas of the wing would allow you 360 degree bonding without the added thickness of two layers of material. Put some Z prime on zir and get weak bond but the emax would be what was holding it. A Yamashita prep design will give added retention
Commenter's Profile Image Barry Polansky
June 2nd, 2014
This month's Journal of Cosmetic Dentistry has a wonderful article on this topic. It documents a case I did with my son Joshua Polansky. All of the questions posed are adequately answered. We used maximum retention on two separate retainers---facial coverage, sleeves and wings. The retainers were made with E-max--and will also act as a guide for future implant placement.