Dental Procedures

narddog

Hi,
I have a question on Dental procedures. I've had a lot of dental issues over the years. A few years ago, in Ireland, I had a Maryland Bridge done on a front tooth. I'm currently in the US and the MB became loose. The dentist told me a) Most practices in the US don't do MB work any more, and b) The quality of the MB I had was borderline negligent. My question is, are some of the dental procedures being done in Ireland outdated?

Regards,
K.

davo10

maryland bridges are not routinely placed anymore, but they are indicated in some cases. The advantage is that there is minimal preperation of the teeth adjacent to the space therefore if you want a permanent replacement tooth but do not want other teeth worked on, it is ideal. The problem is that the retainers "wings" on the bridge are attached to adjacent teeth with a resin cement. There is little mechanical retention therefore the bridges do debond quite easily, they also are difficult to clean around and the metal retainers can be seen through the teeth sometimes. The only time I have placed these in recent years is as a temporary non-removable replacement of a tooth while patients are waiting for tissues to heal prior to implant placement.

Maryland bridgework is also cheaper than conventional bridgework/implants and therefore may be a more afordable option at the time of treatment.

Maryland bridges have been successfully placed for forty years, they are a well regarded treatment option not just here but also in the US, and all over the world, (in fact their indications, design and placement are taught as part of post grad prosthodontic courses in US), they have just been succeeded by better treatment options (conventional bridgework/implants) in recent years.

I suspect your US dentist may be blowing his own trumpet a bit and advising you to have more expensive bridgework/implants.

vishal

any american dentists that i have spoken with are surprised when i mention maryland bridges. it's done a lot less in the united states than they are done europe.

conventional bridge are routinely done on virgin teeth in the united states which in my opinion is not the right treatment. these are highly destructive, but are appropriate in the right circumstances.
But every dentist has their own treatment philosophy.

btkm8unsl0w5r4

I do tons of maryland bridges, and rochettes for temps. They are a great restoration, conservative, cost effective. They dont last as long as standard bridges or implants, but they are a good medium term restoration. After they fail you can get aonother one, a implant, a standard bridge etc. No problem at all cause your own teth have not ben cut to pieces to make int in the first place.

There is tons of really good research show excellent long term results with marylands, if a dentist tell you they dont do them its only because they were not trained to do them. American dentists have certain attitudes towards treatment not shared by Europian dentists and vica versa, does not mean your treatment was in any way negligent.

BryanL

I wonder what he uses as an anterior temp. when restoring with an implant.
American dentists sometimes come across as though Enamel is the Enemy.

http://solutions.3m.com/wps/portal/3M/en_US/3M-ESPE/dental-professionals/solutions/dental-lab/lava-indications/
The link is american,bottom right,Maryland Bridge,go figure?

Borderline negligent, is very easy to say, but it has lasted a few years and should only need re gluing. The least damaging thing a dentist could do to a tooth is to prepare it for a maryland type bridge. It's the cheapest ways of restoring a space without a denture.

Bryan

Big_G

Marylands are technique sensitive. They need to have a correct design to reduce flexure of the wings and the dentist needs to have a good knowledge of bonding science to make these work.

I have one in the anterior that I am getting replaced with an implant. I think it is the greatest pain in the ass in terms of the number of times it has debonded. But I would still rather that than a conventional bridge in the anterior. Much less destructive to the abutment (supporting) teeth.

Negligent - this dentist needs to climb down. I've seen a double pontic distally cantilevered from a lower premolar. You won't know what that means, but the dentists here will know that that is negligent.

Judging by some of the posts on an American forum for dentists, there seems to be a lot of that ego based backstabbing amongst dentists there. I wouldn't worry about it.

btkm8unsl0w5r4

Ceramic or zirconia Maryland’s are ludicrous,

Indeed if a Maryland is to last it need:
Good enamel to bond to, circumferentially around the margins (I do little if any prep) and the retainers need to be thick (0.5 - 0.7mm high modulus ally). The cement should be dual or chemically cured with a 4-meta primer. I usually Dahl in the retainers to avoid preparation. Also the fit of the retainers to the tooth is very important. No spacer, excellent impressions, and sometimes a refractory die technique. I also re blast the retainers, don’t trust to lab to do this. WATCH the guidance and protrusion and excursion.

I have been looking at some of these for 7-8 years now and they hold up well. For temps I do the exact opposite, keeping them thin so I can flex them off. My own father has one with 4 pontics in the lower anterior, been there for 8 years no problems against a implant prosthesis.

I usually don’t do them as a restoration of choice, that a single implant, however if economics, age, patient wishes dictate they are a great restoration. and yes I do posteriors, but these are mostly 3/4 crown design.

Big_G

That is what was done in my case (retainers were Dahl'ed in). Problem is, I am skeletal 3 with dento-alveolar compensation and edge to edge contact on 42. Plus, I'm a clencher/bruxor. It was Rochette in design. Bridge got absolutely battered by occlusion .

Now I've had 41 extracted and ortho to lingualise the lower incisors. Next is bone graft for 21 and ortho to correct some of the incisor angulation created by the wings of the Rochette. Then implant/crown. Then happy days hopefully. I'll be pretty. Pretty expensive.

btkm8unsl0w5r4

Rochette - only for temp,

Big_G sounds like fun,