Dental Maryland bridge : A better and cheaper solution

 

Dental
Maryland bridge

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A dental Maryland bridge, also known as an adhesive bridge or a
resin-bonded bridge, is a dental prosthetic replacing a missing front  tooth. Unlike traditional bridges that  require to remove some of the enamel on the
adjacent teeth, because the restoration is supported by a crown on either side
of the missing tooth, a dental Maryland bridge does not require to drill away
any of the adjacent  tooth’s natural
enamel  and place a dental crowns on them.

On the other hand, a dental  Maryland
bridge consists of a prosthetic porcelain  tooth with two metal wings that attach to each
of the adjacent teeth from the back, without the need to drill healthy teeth
enamel.

 

Indications of dental Maryland bridge

  • Replacement of single missing front teeth
  • Replacement of two missing mandibular incisors
  • Before placing a dental implant
  • To Keep the healthy enamel of the adjacent teeth
  •  Periodontal Splinting
  •  Prosthodontic splinting
  • Healthy adjacent teeth
  • Temporary bridge for children
    before growth age
  • Good oral hygiene

 

Contraindications of dental
Maryland bridge

  • Pathologic occlusions
  • Bruxism
  • More than one missing tooth in row
  • high caries rate or risk
  • Carious adjacent teeth
  • Hypomineralized enamel: Enamel
    Hypoplasia
  • Sensitivity to metal alloys
  • short clinical crown on the
    adjacent teeth
  • unilateral chewing habit on the
    side of the future dental Maryland bridge
  • Narrow embrasures

 

Dental Maryland bridge pros and
cons

The Maryland bridge is surely very
different from the traditional bridges, it is considered simple and advantageous
in many cases, Dentists around the world started to use it more often, although
this technique has many disadvantages that you should consider and know.

 

The advantages of the Maryland bridge

  • Affordable price compared to other
    dental procedures like dental implants or traditional bridges.
  • Easy procedure: The preparation and
    bonding of a Maryland bridge is very simple and fast.
  • Less time-consuming: The whole work
    is done in two or three appointments.
  • minimally invasive procedure: the
    preparation of a dental Maryland bridge does not require drilling the adjacent
    teeth, which makes it very conservative for the tooth’s natural tissues.
  • Pain free technique: making and
    bonding a Maryland bridge is painless and doesn’t require anesthesia.
  • Can be made out of Porcelain,
    Zirconia or E-max.
  • Great Aesthetic results.
  • Can be used as a temporary
    restoration before putting a dental implant.

 

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The disadvantages of the Maryland
bridge

  • Too weak to replace a posterior
    teeth.
  • Breaks under strong chewing
    mechanical forces.
  • The bonding material needs to be
    replaced often after a couple years.
  • Because the wings are thin, the
    bonded surface of the Maryland bridge is small.
  • You can not chew directly on a
    Maryland bridge.
  • Metal wings might be slightly
    visible if the patient has diastema.
  • Metal wings may darken the adjacent
    teeth’s enamel.
  • Not permanent – will need to be
    re-bonded very 3 to 5 years.

The types of dental Maryland bridge

Metal framed Maryland bridge:

The framework of the bridge is made
of metal, which increases the rigidity and mechanical resistance of the bridge,
but the metal can appear on the adjacent teeth and even darken their enamel.
Some people are also allergic to some dental metal alloys.

Composite Maryland bridge:

This type of bridge is made out of Fiber-reinforced
composite, which give good aesthetics results and a better adhesion to the
adjacent teeth enamel. It is cheaper and can also be made in one appointment.

Porcelain Maryland bridge:

It can be entirely made out of
porcelain or have metallic wings, It gives the best aesthetic results. The
shades, texture of porcelain are very close to a natural tooth. And it is very
biocompatible and does not cause any allergies, however it is more expensive
that the other types.

Maryland bridge dental code

Maryland bridge dental code is not very known to both dentists and
patients, so we decided to remind in this paragraph with the Maryland bridge
dental code in 2021

The following CDT dental codes for Maryland bridge have been deleted
from CDT 2021.

Rationale for adding D6549: D6545 Maryland bridge dental code is
used to report a cast metal retainer on a resin bonded fixed prosthesis (Dental
Maryland bridge). D6548 is used to report a porcelain/ceramic Maryland bridge
retainer. But, CDT has provided any  code
for a resin retainer for a Maryland bridge.

A typical coding scenario for D6549 Maryland bridge dental code
involves the patients presenting  a
missing tooth, but is not a good candidate for a single crown, conventional
bridge or an. The dentist concludes that the patient’s needs  a single unit fixed prosthesis with a
preparation and placement of a dental Maryland bridge where both the pontic and
“wings” are made of resin, porcelain materials.

 

Components of a dental Maryland
bridge

The Framework: A Maryland bridge consists of a metal framework that is
cemented with resin composite to an abutment.

The wing: It is the part of the bridge that fits closely to the abutment tooth. The metal wing needs to engage
as much of the sound enamel in order to have better adhesion. It can be made
out of metal alloys, porcelain or zirconia.

The pontic: Is usually made from Zirconia or porcelain. It is an
artificial prosthetic tooth that will replace the missing tooth.

 

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Maryland bridge preparation:

A dental Maryland bridge
preparation requires a slight enamel adjustment in order to have a better
retention surface for the Maryland bridge. Using special small diameter burs,
the dentist adjust the enamel in order to have the best retention of the future
bridge, after that an impression is made and sent to the dental laboratory to
make the bridge.

A dental Maryland bridge pontic;
which is the part that replaces your missing tooth is made of porcelain or
zirconia, the shade and form of the tooth will be matching to your natural
teeth. This pontic will be then attached to the wings that should perfectly fit
to the enamel of the adjacent teeth, it can be out of metal or for better
aesthetics out of porcelain or zirconia.

After your Maryland dental bridge
is ready, your dentist will verify that it adapts perfectly to the preparation,
and then it is ready for cementation.

The most used brands for Maryland
bridge cementation are Panavia and Nexus. Panavia has shown to have a higher
survival rate than other brands. Dental Maryland bridge cementation is either
autocure or dual-cure luting to ensure complete polymerization of the cement
under the wings. Great care must be taken during the cementation  of the bridge to avoid contamination and then
premature failure. For this reason rubber dam is essential for placement,

Maryland bridge problems

A dental Maryland bridge is surely a
great invention that can be the best treatment in many cases mainly because it
doesn’t need much retention and preparation but this fact also makes it a
source of many problems like:

  • Cement debonding
  • Framwork fracture due to mechanic
    stress
  • Pontic fracture: Porcelain and
    Zirconia can break under pressure
  • Caries: the wings can be the point of
    caries formation
  • Dental sensitivity: It appears on the
    adjacent teeth because of an exaggerated preparation, light curing temperature
    release, dentine exposure, enamel fracture.
  • Metal wings allergy
  • Difficulty in flossing: The wings make
    it very hard to floss in between the teeth

 

How long does a Maryland bridge last

Many studies have been done in order
to determine how long does a Maryland bridge last and they concluded that the survival
rate of dental Maryland bridge after 5 years is around 83.6% and after ten year
is around 64.9%. After this period the bridge begins to fall and needs bonding
again.

Dental Maryland bridge is a minimally invasive procedure that
requires only a small retention surface, this is the main reason behind the deboning
after the 5 years. But your dentist can always cement the bridge back if it is
possible.

Dental Maryland bridge cost

Dental Maryland bridge is a very
effective procedure when replacing a single front tooth. It is also one of the cheapest types of dental bridges but as we all know, it
is impossible to set one price for it because it depends on the country,
dentist, the dental laboratory and many other things. But we tried to bring you
an estimate of dental Maryland bridge price in different countries this year:

  • USA: $1000 – $2500
  • UK: £800 – $2000
  • Australia: $1400 – $3000
  • Canada: $1500 – $2500
  • India: $500 – $1000
  • South Africa: $1000 – $2000
  • Philippines: $500 – $1500

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