What is a Maryland Bridge?


Maryland dental bridges represent a technique designed for the aesthetic restoration of missing teeth in both the front and back regions of the mouth. Functioning as a fixed dental prosthesis, an adhesive bridge serves to replace missing teeth by being securely bonded to the acid-etched enamel surface of the neighboring abutment tooth. The anchoring tooth undergoes minimal preparation and provides support to the false tooth through the attachment of a metal or ceramic wing.


These bridges are commonly referred to as Maryland dental bridges, originating from their development at the University of Baltimore, Maryland, USA. Notably distinct from traditional bridges, this method prioritises the preservation of healthy tooth structure by requiring minimal removal of dental enamel on the inner surface of the abutment teeth. Particularly well-suited for adolescent patients, this approach becomes advantageous when implantation is not feasible due to ongoing jaw growth. Additionally, for adults, Maryland dental bridges present a viable alternative to consider, offering benefits in comparison to the dental implants treatment option.

What is the Appropriate Age for Maryland Dental Bridges?


Maryland dental bridges serve as a viable option for addressing single-tooth gaps when dental implants are either not feasible or not recommended. For optimal use, the dentition that supports the bridge should be free from issues such as caries, cavities, or existing fillings. While there is no specific age restriction for adhesive bridges that are not employed to connect two teeth, a limitation exists for two-winged and splinted adhesive bridges in adolescents awaiting the eruption of permanent teeth.


Adolescents, particularly those anticipating the eruption of permanent teeth, may have age restrictions on the use of two-winged and splinted adhesive bridges. However, adhesive bridges that do not involve splinting two teeth together are generally suitable for children and adolescents. Maryland dental bridges are frequently employed in adolescents when teeth are congenitally missing, lost due to accidents, or when gaps arise post-orthodontic treatment.


In adults, where tooth loss commonly results from gum disease or unsuccessful root canal treatments, Maryland dental bridges remain a practical solution to address missing teeth.

How Many Teeth Can a Maryland Bridge Replace?


Maryland bridges, also known as adhesive dental bridges, offer a convenient and aesthetically pleasing solution for the restoration of congenitally or otherwise missing front or back teeth. These bridges are discreetly cemented to one or two healthy neighbouring teeth, providing a quick and attractive replacement.


In general, the application of an adhesive dental bridge is typically limited to the re-establishment of a single tooth in both the upper front and back regions of the mouth. However, in the lower front teeth region, it is possible to replace a maximum of four teeth, contingent on the straight alignment of the jaw in this area. Notably, the replacement of large back molars using adhesive dental bridges is not advisable due to the substantial chewing forces in this region. The risk of potential fracture to the bond between the bridge and the tooth enamel outweighs the feasibility of replacing multiple teeth in this specific area.

Designing a Maryland Dental Bridge: Options and Considerations


When contemplating a Maryland dental bridge, the design choice often centres around the selection between double-winged or single-winged adhesive bridges. During your consultation at our clinic in London, we collaboratively determine the most suitable treatment option based on your specific needs and presentation.


Primarily, we frequently recommend a single-winged all-ceramic adhesive bridge. This particular design has demonstrated exceptional reliability, backed by evidence from various scientific studies. The single-winged configuration offers a streamlined and effective solution for addressing missing teeth, combining both aesthetic appeal and durability.


For a more in-depth understanding of how we have successfully addressed cases with Maryland dental bridges, we invite you to explore our video library. These resources showcase real-life examples, providing insight into the design, application, and positive outcomes of Maryland dental bridges in various situations.

Prerequisites for a Maryland Bridge and Suitability Criteria


For the successful application of adhesive bridges, several important preconditions must be met. The adjacent teeth serving as abutments should be free from caries or cavities, possessing ample tooth enamel for a durable bond with the false tooth, also known as the cantilever. While smaller fillings in the abutment teeth may be retained, they should undergo special treatment (conditioning) before bonding, ensuring complete envelopment by the bridge’s wings.


Furthermore, the gap size should align accurately with the tooth to be replaced for a seamless fit. Individuals who grind or press their teeth should address this concern. If orthodontic treatment has been received, a retention phase of eight to six weeks, with no active movement of the teeth, should be observed before introducing an adhesive bridge.


In accordance with guidelines for all-ceramic crowns and bridges, single-wing all-ceramic adhesive bridges are endorsed as an evidence-based therapy. Moreover, single-span adhesive bridges with ceramic frameworks are now considered the standard in adolescent dental care, especially for replacing single or adjacent missing incisors.


Determining Suitability for Dental Bridges

While dental bridges are a valuable solution for restoring smiles, certain conditions must be considered for optimal results. The degree of rotation or tilt in teeth should not be excessively pronounced, and the existing gap should correspond appropriately to the width of the prospective false tooth. The adhesive surface on the anchoring tooth adjacent to the pontic should be sufficiently large to ensure stability. If the adhesive surface is compromised due to fillings, abrasions, or other factors, an alternative such as a dental prosthesis with an implant may be more suitable.


Patients engaged in contact sports (e.g., boxing, karate, ice hockey) are advised to consider other dental treatments for durability. Additionally, in cases of a very deep bite or teeth grinding and pressing, caution is warranted when using adhesive bridges, as they may be exposed to pressures that could lead to debonding or the loss of the denture.

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