HANDBOOK OF ADHESIVE BRIDGES

Handbook of Adhesive Bridges

  • Adhesive Bridges- Posterior
  • This material  covers  Posterior Adhesive Bridges (Yamashita -design Resin-Bonded Fixed Partial Dentures). Learn how to fabricate bridges, often without anesthesia, retraction cord or dentin and pulpal  involvement.
  • Adhesive Bridges- Anterior- Inlay-Flange
  • This material covers a protocol for the next-generation bonded retainer for anterior teeth. It supersedes the flawed “Maryland Bridge”, known for its propensity for de-bond,  greying of abutments, and restrictive conditions for placement.
  • Named the ” Inlay-Flange Bridge” , this new retainer was originated originated by Dr Walford in 2003, and  underwent rapid progressive development, reaching maturity a year later..

WHY CONSIDER LEARNING THIS MODALITY?

  • More than 95% retention over a 15 year period with over 500 retainer placements.
  • It is a simple in concept and execution: a lingual inlay is mated to a flange of metal covering lingual enamel. Normal burs are used, little time is taken to prepare,impression is simple and conventional, temporary is quick and straightforward, lab aspect is simple,  insertion follows conventional approaches, and there is an existing fee guide entry for dental plans.

 

  • No interproximal greying as usually seen in old-school adhesive (Maryland-style) bridges.
  • Application is almost without restriction:  previous anterior (Maryland) restrictions on mobile teeth, teeth recently treated orthodontically, and rotated and malposed teeth can be treated. The prosthesis can be extended to longer spans, to include bicuspids as well as the 6 anteriors, to spans up to 10 teeth,  provided the path of insertion and integrity of abutments allow. The only insurmountable contraindication is insufficient  lingual enamel area.

CATEGORIES OF INLAY FLANGE BRIDGES: See Categories of Inlay Flange Bridges


 CLINICAL CASE TO ILLUSTRATE:

Look at the before and after photos of this case below replacing bilateral missing lateral incisors. Previous double-abutment Maryland bridges had de-bonded and been re-luted numerous times in another dental practice. The patient was referred to me for treatment.The cuspids were destroyed: they presented with advanced lingual decay under the double-abutment bridges.The centrals were intact.

  • The destruction of the cuspids made them unusable as abutments, necessitating cantilever pontics from the central incisors if the patient wished to retain his natural facial surfaces and be treated with Inlay-Flange retainers
  • The patient refused full coverage restoration
  • There were size dissimilarities in the edentulous spaces.
  • The patient fortunately had
    • shallow overbite
    • large root volume of the central incisors
    • robust physique
  • This  rendered  the unusual abutment choice feasible.
  • from radiographs, implants were clearly not possible due to root convergences..
  • His dental plan would cover the bulk of the treatment costs, a deciding factor for a father of two young children building a new house.

TREATMENT RENDERED

The  decay on the cuspids was treated with composite resin. the centrals were prepared with inlays into the lingual surfaces, and an anti-rotation dimple on the cuspid. Convincing pontics were fabricated in low noble alloy,with an ovate undersurface which was inserted under a mini-flap raised at the time of insertion. A small amount of crestal bone was removed to allow sufficient room for the differentiation of bone, connective tissue and epithelium.

Hemostasis was achieved using Hemostatic Etch and Retraction Cord and cementation with a durable opaque cement took place under proper conditions of isolation

  • The patient suffered no pain from these procedures and was very pleased with the result, despite the compromise of pontic size discrepancy . The pontics are flossable because floss passes under the rounded anti-rotation dimple set against the cuspids.
  • He reports that his friends could not believe the teeth were not real.
  • The lack of inflammation around the pontic emergence, the bulk to the pontics at the  cervix, healthy response of the tissues to the adjacent porcelain, and the almost normal tissue line combine to form a convincing end result.
  • BEFORE
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  • AFTER
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