Dental BridgesLosing a front tooth can be extremely distressing.  Who wants to look in the mirror and see a black hole?  And some might feel compelled to cover their mouth when smiling or talking.  There are various ways to replace a missing front tooth, but most are expensive and involve the grinding down of the teeth on either side of the missing one in preparation for placing crowns as part of the bridge to support the artificial tooth.  If there are crowns already present, or dental work needed on the adjacent teeth, that is an option, but you wouldn’t want to unnecessarily destroy healthy teeth.  Fortunately, as long as the side teeth are healthy, this can be treated with the Maryland Bonded Bridge, also known as resin-bonded bridges, or bonded bridges.

This is the least invasive, and also the least expensive way to replace a missing front tooth, or teeth near the front.  This bridge technique was first developed at the University of Maryland, and hence the name.  It was developed to avoid the trimming and crowning of otherwise intact adjacent teeth while providing a “fixed” support for the replacement teeth (pontics).  The procedure is considered reversible, meaning that if the bridge is removed, the natural teeth are virtually unaltered.

How does the Maryland Bridge work?

An artificial tooth, or pontic, usually porcelain fused to metal,* is bonded or baked onto a metal framework that looks like ‘wings’ on either side of it.  These metal wings are prepared to have a porous surface so that they can receive a bondinMaryland Bonded Bridgeg agent, and are then bonded to the backs of the teeth on either side of the missing one to hold the false tooth in place.   The modern resin-retained bridge wing is usually sandblasted with an alumina powder, and needs to engage as much of the sound enamel as possible.

* An alternative is an Encore bridge, which is made entirely of tooth-colored materials.

The Procedure

First Session – Preparation

  • A small area on the back of the surrounding teeth may or may not need to be removed
  • Teeth on either side of the missing tooth are prepared for bonding with acid etching.
  • An impression is made and sent to a dental laboratory, where the bridge is custom made
  • Color matching will be done

Second Session – Fitting

  • Adjustments to teeth or bridge are made if needed
  • Bite and appearance are evaluated
  • Permanent fastening to adjacent teeth is done

Advantages of Maryland Bonded Bridges:

  • Least expensive treatment
  • Well tolerated by patients
  • No need for a local anesthetic
  • Natural teeth are virtually unaltered
  • Minimal impact on the surrounding teeth
  • No need to crown the adjacent teeth
  • No invasive procedure to the gum
  • Can replace two missing teeth if they are side by side
  • Less chance of any dentin being exposed, meaning no increased sensitivity
  • Bonding can actually strengthen adjacent teeth becoming loose due to gum disease
  • Quick to fit – Easy to fit and adjust
  • Failure rates minimal and problems easy to repair
  • Repairs are inexpensive

Typical success rates are quoted as being as high as 80% after 15 years in the anterior maxilla, but are much lower in the posterior mandible.  Indeed, recent contemporary research shows resin retained bridges have better success rates than dental implants.  A major advantage of the resin-retained bridge over a traditional bridge is that the type of failure is likely to be from debonding of the retainer.  In conventional bridges, the type of failure is likely to be complete fracture of the abutment tooth with difficult-to-manage consequences such as root canal treatment.  With a resin-retained bridge the prosthesis can usually be cleaned off and rebonded in position with minimal inconvenience and expense to the patient.

If you are interested in Maryland Bonded Bridges in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.