Crown & Bridge Prosthodontics
Lecture 13 Dr. Lamis A. Al-Taee
Minimally-prepared Bridges
Resin bonded bridge (Adhesive bridge, acid etched bridge)
Resin-bonded bridges are fixed dental prostheses that are luted to unprepared
or minimally prepared surfaces of abutment teeth permanently through acid
etching of enamel with resin bonding agents and composites, or resin cements.
It is the most conservative design as compared to the
conventional bridge, in which, the pontic attaches to
unprepared lingual surface of the abutment teeth by
metal or ceramic plates. This attachment is achieved
by using composite resin material after acid etching of
tooth enamel. However, it is used when the abutment
teeth have sufficient intact enamel & usually used in
younger patient.
Indications:
1. Adolescents with single missing teeth (traumatic or congenital) adjacent to
intact teeth.
2. Aesthetic is the primary concern.
3. Caries- free abutment teeth and good oral hygiene.
4. Maxillary incisor replacements (most favorable prognosis) and mandibular
incisor replacements.
5. Anterior periodontal splinting.
6. Post orthodontic fixed retention.
7. Short span edentulous areas (Single posterior tooth replacements).
8. Transition to fixed prosthesis.
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Contraindications:
1. Small sized abutments (peg laterals), with inadequate lingual enamel.
2. Extensive caries, or heavily restored abutments.
3. Deep vertical overlap.
4. Misaligned abutments
5. Significant pontic width discrepancy.
6. Heavy anterior occlusion with excursive movement.
7. Parafunctional habits.
8. Long span edentulous area.
9. Allergy to base metal alloys.
Advantages:
1. Conservative, less tooth reduction, kind to young patients or large pulp.
2. Maximum esthetic.
3. Easily cleaned.
4. Minimum clinical chairs time.
5. Less expensive than conventional.
6. Rebonding is possible if failure occurs.
7. No permanent damage to enamel.
8. Lab procedure is easy & short.
9. No irreversible procedures are involved.
Disadvantages:
1. Uncertain longevity.
2. Not strong as conventional bridge.
3. Increase the thickness of retainers.
4. Limited use because abutment teeth should have sufficient enamel for
etching.
5. Tendency to de-bond.
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6. The water sorption and dissolution of resin-containing materials
(composite or bonding agents) over time.
7. No space correction.
8. No alignment corrections.
9. Difficult temporalization.
Types of Resin-bonded restorations
A- Direct:
This type is made by using the crown of the patient own tooth as pontic, for
example the rapid replacement of a tooth lost by traumatic injury. In order to
increase the strength of the bridge (attachment), we add metal mesh or wire
(temporary replacement). It is simple & rapid way, conservative, an acrylic
denture tooth can be also used.
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B. Indirect adhesive bridge:
It is based on the mean or way of retention of the metal frame work to the
abutment teeth. There are different types: a) Macro mechanical retention
(Rochette), b) Medium mechanical retention (Virginia), c) Micro mechanical
retentive (Maryland) and d) Chemically retention (resin cement).
A) Macromechanical retention (Rochette)
In this types there are multiple funnels shaped undercut perforations in the cast
metal frame of the retainer used for retention & through which the composite
flow during cementation and make the mechanical interlocking after setting.
- Wing- like retainers
- Funnel-shaped perforations through the cast-metal
plate to enhance the resin retention.
- Combined mechanical & chemical retention with a
silane coupling agent to produce adhesion to metal.
- Drawbacks:
- Weakening of the metal retainer by perforations.
- Limited adhesion of metal provided by the
perforations.
- Wear of composite resin.
- Thick lingual retainers.
- Plaque accumulation.
- 50% fail in about 1-10 months.
B) Medium mechanical retention (Virginia):
The retentive feature is casted as a part of the metal frame work (non-undercut
lumps, mesh, on the fit surface of the retainer). The size of the retentive feature
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is intermediate between macro mechanical & micro mechanical retentive
system.
o Virginia salt technique, or Lost salt technique
o Particle-roughened retainers by incorporating salt
crystals in to the retainer patterns to produce
roughness on the inner surfaces.
o The retentive features are casted as part of the
metal frame work.
o Thicker retainers.
C) Micromechanical retention (Maryland):
The tooth side of the frame work is electrolytically etched with hydrofluoric acid
to produce a microscopic undercut, the bridge attached with a resin luting agent
that lock into these microscopic undercuts of both the etched retainer & etched
enamel.
o Casting metal or ceramic retainers.
o Etching: Electrolytic etching in acid, or chemical
etching with a hydrofluoric acid gel.
o Thinner metal retainers & cement film.
- Advantage over the cast perforated restorations:
o The retainers can be thinner & still resist flexing
o Oral surface of the cast retainers is highly polished
& resist plaque accumulation.
Disadvantages:
o Technique sensitive
o Lab dependent
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o Varies with the metal type.
o Prone to contamination.
o Cannot be done with Nobel metal alloys.
d. Chemically retention (resin cement):
The resin adheres chemically to recently sand-
blasted metal surface and is retained on the tooth by
conventional acid etching of the enamel.
Fiber-reinforced composite (FRC) fixed prosthesis
- They represent an innovative approach in restorative dentistry, combining
the esthetics, functionality, and the mechanical strength, to offer an
effective and visually pleasing solutions for tooth replacement.
- They use composite materials, reinforced with
fibers to improve their mechanical properties and
functional performance.
- FRC fixed prostheses can be used in the
fabrication of anterior and posterior bridges,
replacing missing teeth by distributing occlusal
forces more evenly than traditional materials. It is
used for single tooth restorations, often in
aesthetics-focused areas, while preserving the
tooth structure.
- The primary constituents are composite resins matrix and reinforcing fibers,
such as glass fibers, carbon fibers, or aramid fibers. Glass fibers are
particularly prevalent due to their good tensile strength and biocompatibility.
It might be in the form of a FRC substructure veneered with a particulate
composite material.
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- These prostheses can be made using various techniques, such as direct
fabrication in the mouth or indirect fabrication in a dental laboratory followed
by cementation.
Advantages:
- Conservative approach
- Exhibit better physical properties (hardness & wear resistance)
- The addition of fibers enhances the tensile strength, flexural strength,
and fracture toughness of composite material, making it more resistant
to forces encountered in the oral environment.
- Light weight: FRC materials are generally lighter than traditional metal or
ceramic prostheses.
- Aesthetic Properties: They can be color-matched to natural teeth and can
be polished to a high-gloss finish, providing a more natural appearance.
- Bonding: The ability to bond effectively to tooth structures is an important
feature, allowing for minimal invasive procedures.
- Clinical studies indicate that with proper techniques and care, FRC fixed
prostheses can demonstrate satisfactory results in terms of longevity and
performance.
Disadvantages:
o Lower wear resistance relative to natural enamel,
o The need for proper isolation during placement to ensure complete
polymerization.
