A bonded bridge (Maryland bridge) is a conservative dental prosthetic designed to replace a single missing tooth. Unlike a traditional bridge, it is secured to the adjacent teeth using a strong dental resin cement. This approach preserves natural tooth structure because it avoids the extensive drilling and alteration required for neighboring teeth. It restores both the appearance and function of the missing tooth, making it a popular choice, particularly for the front teeth where biting forces are lower.
Understanding the Design
The bonded bridge consists of two main components: the pontic and the retainer wings. The pontic is the artificial tooth that fills the space left by the missing tooth and is designed to match the color and shape of the natural teeth. Extending from the pontic are small metal or ceramic extensions, known as wings or retainers, which hold the bridge in place.
The wings are precisely contoured to lie against the inner (lingual) surface of the adjacent natural teeth. This technique is minimally invasive, requiring minimal or no removal of the surrounding tooth enamel, which preserves the abutment teeth. The inner surfaces of the wings are often specially treated, such as by sandblasting, to create a microscopic texture that enhances the mechanical grip of the bonding agent.
The Installation Process
The process usually spans two appointments, beginning with a diagnostic stage. After confirming the patient is a good candidate, the dentist performs any necessary, minimal preparation on the inside surface of the neighboring teeth. This preparation may involve slight roughening or placing small grooves to ensure a secure fit and optimal bond strength.
Precise dental impressions or digital scans are taken of the prepared area and sent to a laboratory for custom fabrication. The technician constructs the pontic and attached wings, often using materials like porcelain fused to metal or all-ceramic compounds. The final appointment involves the bonding procedure.
Before placement, the abutment tooth surface is cleaned and treated with a dental etch to prepare the enamel for the resin cement. The bonding agent is applied to the wings, and the bridge is firmly seated against the tooth surface. A special curing light rapidly hardens the resin cement, creating a strong, fixed connection. This procedure is quicker and involves less discomfort than more invasive restorative options.
Caring for Your Bonded Bridge
Maintaining a bonded bridge requires diligent oral hygiene for long-term success and the health of the supporting teeth. Brushing twice daily with a soft-bristled toothbrush and fluoride toothpaste is necessary, paying careful attention to the areas around the bridge. Daily flossing is important and requires a specialized tool like a floss threader or Superfloss.
The floss must be guided underneath the pontic, where food debris and plaque can accumulate, and around the retainer wings. Regular dental check-ups and professional cleanings are needed to monitor the bridge’s condition and the health of the gum tissue.
Bonded bridges are durable but are susceptible to debonding if the cement fails. Patients must avoid placing excessive force on the prosthetic, limiting the chewing of hard foods like ice or hard candies. The lifespan for a well-maintained metal and porcelain bonded bridge is typically five to fifteen years. If the bridge comes off, it can often be re-bonded by a dentist, provided it remains intact.