For over 40 years, the Maryland bridge served patients with a restorative solution for anterior missing teeth. However, advancements in dentistry may have supplanted these appliances with better—and more permanent—options.
So, with these other options available, the question becomes, should you move on from the Maryland bridge in dental treatment plans? In other words, are Maryland bridge problems more significant than their solutions?
Maybe, or maybe not. Let’s look at what a Maryland bridge is good for, what it isn’t, and what might be a better option for your patient outcomes.
What is a Maryland bridge?
Faculty from the University of Maryland introduced Maryland bridge dentistry in the 1980s. The Maryland bridge is an adhesive-retained, fixed partial denture with an artificial tooth between one or two wings bonded to abutments. They are made from porcelain-fused-to-metal (PFM) materials or ceramics.
What are Maryland bridges generally used for?
The reduced impact on adjacent teeth is a significant benefit of the Maryland bridge. A Maryland bridge doesn’t require crowns on the teeth adjacent to the missing tooth. The dentist adheres the wings to the back of the surrounding teeth to hold them in place.
There are other critical benefits, too. For example, they are affordable, minimize the patient’s chair time, and do not require anesthesia, recovery time, or a temporary.
A Maryland bridge has patient-specific benefits, too. The Maryland bridge is low maintenance and allows patients to talk, eat, and clean their teeth like always.
When should you prescribe a Maryland bridge?
Maryland bridges are best for temporarily replacing single anterior teeth, preferably in adolescent patients. Research shows that the overall survival rate was 77% after ten years. However, the survival rate increased to 87% after eight years if the appliance is rebonded or reconstructed after debonding.
There are multiple keys to success with the Maryland bridge. These include careful case selection, sound design and treatment planning, proper preparation, and excellent cementation technique.
When should you use an alternative to a Maryland bridge?
Of course, there are also Maryland bridge problems, including a few situations where a Maryland bridge isn’t the best option. First, they can’t hold up to occlusal forces in the posterior. Also, they aren’t great when the patient’s edentulous span is more than two teeth, nor are they recommended when the patient has poor home care habits or poses a high caries risk.
In addition, the aesthetics aren’t always optimal especially if you are using one with metal wings that can be visible at certain angles. Plus, if you aren’t using one of the new all-ceramic options, adhering metal to the back can make supporting teeth appear darker.
Alternatives to Maryland bridges
There are alternatives for the Maryland bridge. For example, dental implants, partial dentures, or fixed- or implant-supported bridges can all restore function and aesthetics for patients with missing teeth.
Dental implants that osseointegrate into the jaw and support a crown have many patient benefits. Implants provide a restoration that looks and feels natural and has a success rate of nearly 97% at 10 years and 94% at 15. Implants also allow patients to chew and talk like they always have. Additionally, the implant helps slow bone resorption in the alveolar ridge. Plus, they keep the surrounding dentition in place, preventing a change in the patient’s bite.
The biggest drawback of dental implants is that they are expensive, and few dental insurance policies cover much of the cost. There is also a significant recovery time involved, and the patient must have a clean bill of health before surgery, which might mean additional treatments like bone or gum grafting, which add to the costs.
Dental implants aren’t for every patient, either. If the jaw bone has experienced deterioration to a point where it can no longer support an implant, the patient would benefit from another restoration. Patients with thinning gums might not like how the implant shows at the gumline.
Partial dentures replace one or multiple teeth using a plastic or metal base. The partial denture often uses clasps around surrounding teeth to hold them into place. There are also flexible partial dentures with a non-rigid base that is more comfortable for some patients.
Partial dentures provide an aesthetic and affordable option for tooth replacement that enhances the patient’s ability to smile, eat, and talk. However, patients cannot wear them all the time, and they require much maintenance. Also, they are considered temporary replacements, with many needing replacements at around five years.
Partial dentures are an option for patients who have three or missing teeth next to each other. Sometimes, they replace teeth after extractions from trauma or disease until a more permanent option is delivered. They can also be an option for patients who need a more affordable option than dental implants.
Fixed- or implant-supported bridge
Fixed- or implant-supported bridges are a popular way to replace missing teeth. The traditional fixed-bridge uses crowns on the adjacent teeth to hold a replacement tooth in place. Sometimes, in the case of a cantilever bridge, it only has one crown supporting it. They are usually made of porcelain-fused-to-metal or ceramics. Sometimes, you can also use a dental implant to support the replacement tooth, called an implant-supported bridge. Proper oral care helps a bridge last five to seven years and, in some cases, more than ten years.
Dental bridges have several benefits. They are a natural-looking solution that can restore the patient’s ability to chew and speak as usual. Plus, they keep the neighboring teeth from shifting into the open space. However, success with a bridge requires good oral health care, including preventing decay or damage to the abutment teeth. And sometimes, despite one’s best effort, the bridge can break, requiring a replacement, which can be expensive and inconvenient.
Dental bridges are best for patients with solid teeth with good support surrounding the edentulous space. Those with poor oral health or high-risk risk might not be the best candidates for this restorative procedure, as the supporting teeth and bone need to be able to take on the load of the missing tooth. As a more affordable option than implants and a type of restoration that enjoys a longer restorative life, a dental bridge might be an excellent choice for patients who would otherwise be in a Maryland bridge or partial denture.
Crown and bridge restorations that last with Dandy
Whether you’re a practitioner who is steadfast on providing Maryland bridges as a prosthesis or are ready to look into alternatives for your patients, Dandy is here as your crown and bridge lab. From zirconia crowns, inlays, onlays, and yes—even Maryland bridges—we can help you provide best-in-class care for your patients. Ready to get started?
Join us today!
What Are the Different Types of Partial Dentures? (2021) Available at: https://www.dentureliving.com/en-us/advice-tips/types-of-dentures/partials/types-of-partial-dentures (Accessed: 22 September 2023).