Resin-retained bridge

Last updated

A resin-retained bridge (also known as resin-bonded-bridge or resin-bonded fixed dental prosthesis (RBFDP)) is a bridge (a fixed dental prosthesis) replacing a missing tooth that relies for its retention on a composite resin cement. It is one of many available dental restoration methods which is considered minimally invasive and conservative of tooth tissue. [1] The resin-retained-bridge has gone through a number of iterations. Perhaps the best known is the Maryland bridge and other designs used in the past include the Rochette bridge. The five-year survival rate is around 83.6% and the ten-year rate at 64.9%. [2] The case selection is important and as with any dental prosthesis, good oral hygiene is paramount for success. In recent years, the indications for the use of resin-retained-bridges have diminished significantly and there have been changes in the principles underpinning their design. Resin-retained-bridges should be considered when a fixed prosthesis retained by natural teeth is required. [3] The use has been driven by the advent of evidence-based dentistry showing the benefits to patients of reduced tooth preparation and the importance of an intact enamel structure for the long-term health of the teeth. The bridge is currently in favour in the United Kingdom for these reasons. Indeed, recent contemporary research shows resin retained bridges have better success rates than implants and are a cheaper alternative. [4]

Contents

Types of material used for resin-retained-bridges

Traditionally resin-bonded-bridges were composed of ceramic bonded to a substructure made of non-precious metal. In recent years fibre-reinforced and high strength all-ceramic resin-retained-bridges have become popular. [5]

Metal framed

Conventionally made a substructure that is a non-perforated and sandblasted non-precious metal that is cemented with a chemically active resin cement. A disadvantage to this type of bridge is the appearance of the abutment tooth which can appear grey due to the decreased translucency. The metal substructure can also be visible and will not suit every aesthetic need. [5]

Fibre-reinforced composite

Bridges made from fibre-reinforced composite are considered to have better aesthetics and adhesion of luting agent to the framework as well as lower costs. Composite is usually fibre-reinforced with glass, ultra-high molecular polyethylene or Kevlar fibres. Areas predicted to have high stress, benefit from having fibres in one direction (unidirectional) which can improve the mechanical properties. These bridges can be fabricated in the mouth during a single visit or indirectly in a dental laboratory. Fracturing and wear of the composite can sometimes be seen. [5]

All-ceramic

Previously glass-infiltrated aluminium oxide ceramic frameworks have been used. More recently, yttrium tetragonal zirconia polycrystal-based materials such as Lava (3M ESPE) and Cercon (Degudent) have come into use. These frameworks can be designed by wax-ups or using CAD-CAM. The main advantage of this type of bridge is the aesthetics as well as good biocompatibility and lower levels of plaque accumulation. Connector dimensions however are greater than those needed for in the other types of resin-retained-bridges. [5]

Types of designs used for resin-retained-bridges

Resin-retained bridges have a variety of designs: [3]

Fixed-fixed

In this design the connectors are rigid and there are one or more abutments at each end of the span; allowing load to be distributed more equally on abutment teeth.

Fixed-movable

This design includes one movable connector, allowing differential movement between abutments.

Cantilevers

This design is simple without the requirement of linking abutments at each end of the bridge span. However, it is the most mechanically unsound out of all the designs as the load is transmitted to one abutment.

Complex or Hybrid

Complex bridge is the traditional term to describe fixed prosthesis with different types of bridge making up the overall prosthesis. More modernly, the term hybrid has been used as it permits the inclusion of fixed prosthesis using a variety of both designs and retainers.

Principles of design for resin-retained-bridges

A resin-retained bridge requires a very specific set of design principles. The following should be followed when designing the bridge: [3]

Components

Framework

A resin-bonded bridge consists of a cast metal framework that is cemented with resin composite to an abutment(s) which has preparation(s) confined either entirely or almost entirely to enamel. [6]

Wing or retainer

The wing or retainer must be rigid and is usually fabricated from a metal alloy. The inner surface must fit closely to the abutment tooth. The intaglio is treated in some way to enhance the micromechanical adhesion between the prosthesis and the composite resin cement. In the past various methods have been used, ranging from metal-weave patterns to tin plating. The modern resin-retained bridge retaining wing is usually sandblasted with an alumina powder. The metal wing needs to engage as much of the sound enamel. In the majority of cases the metal wing is taken to the incisal edge of anterior teeth and overlapping of the occlusal (biting) surface of the teeth for posterior teeth.

Pontic

The pontic is usually made from dental porcelain. The whole restoration is thus a porcelain fused to metal restoration.

Cementation

Current cement brands commonly used for this procedure include Panavia and Nexus. The use of Panavia is shown to have a higher survival rate compared to other luting cements. [2] All are either autocure or dual-cure luting cements to ensure complete polymerisation of the resin under the wing. Great care must be taken during cementation to avoid contamination of the operative field as this will lower the bond strength of the cement and lead to premature failure. For this reason rubber dam is often advocated for placement, though this can bring its own difficulties. In the majority of cases, with good four handed dentistry, rubber dam is not required and does not improve success.

Complications

One major advantage of the resin-retained bridge over a conventional bridge is the failure mode is likely to be debonding of the retainer. In conventional bridges, the failure mode is likely to be complete fracture of the abutment tooth with difficult-to-manage sequelae, possibly requiring root canal treatment. With a resin-retained bridge the prosthesis can usually be cleaned off and rebonded in position with minimal inconvenience to the patient.

There are a number of complications from resin-retained-bridges, the most common being debonding and porcelain fracture. [2]

Related Research Articles

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance of teeth, gums and/or bite. It primarily focuses on improvement in dental aesthetics in color, position, shape, size, alignment and overall smile appearance. Many dentists refer to themselves as "cosmetic dentists" regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.

<span class="mw-page-title-main">Dental surgery</span>

Dental surgery is any of a number of medical procedures that involve artificially modifying dentition; in other words, surgery of the teeth, gums and jaw bones.

<span class="mw-page-title-main">Bridge (dentistry)</span>

A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.

Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure supported by dental implants. They are of two broad types—direct and indirect—and are further classified by location and size. A root canal filling, for example, is a restorative technique used to fill the space where the dental pulp normally resides.

<span class="mw-page-title-main">Dental technician</span> Technologist working on dental appliances

A dental technologist is a member of the dental team who, upon prescription from a dental clinician, constructs custom-made restorative and dental appliances.

<span class="mw-page-title-main">Dental implant</span> Surgical component that interfaces with the bone of the jaw

A dental implant is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biologic process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic is attached to the implant or an abutment is placed which will hold a dental prosthetic/crown.

<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown most commonly refers to a dental cap, a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large cavity threatens the health of a tooth. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Inlays and onlays</span>

In dentistry, inlays and onlays are used to fill cavities, and then cemented in place in the tooth. This is an alternative to a direct restoration, made out of composite, amalgam or glass ionomer, that is built up within the mouth.

A removable partial denture (RPD) is a denture for a partially edentulous patient who desires to have replacement teeth for functional or aesthetic reasons and who cannot have a bridge for any reason, such as a lack of required teeth to serve as support for a bridge or financial limitations.

<span class="mw-page-title-main">Veneer (dentistry)</span> Layer of material placed over a tooth

In dentistry, a veneer is a layer of material placed over a tooth. Veneers can improve the aesthetics of a smile and protect the tooth's surface from damage.

<span class="mw-page-title-main">Temporary crown</span>

A temporary crown is a temporary (short-term) crown used in dentistry. Like other interim restorations, it serves until a final (definitive) restoration can be inserted. Usually the temporary crown is constructed from acrylic resins (monomethacrylate-based/polymethacrylate-based) or, chemical-cure/light cure composite (dimethacrylate-based), although alternative systems using aluminium crown forms are occasionally used. Temporary crowns function to protect the tooth, prevent teeth shifting, provide cosmetics, shape the gum tissue properly, and prevent sensitivity.

<span class="mw-page-title-main">Luting agent</span>

A luting agent is an application of a dental cement connecting the underlying tooth structure to a fixed prosthesis. To lute means to glue two different structures together. There are two major purposes of luting agents in dentistry – to secure a cast restoration in fixed prosthodontics, and to keep orthodontic bands and appliances in situ.

<span class="mw-page-title-main">CAD/CAM dentistry</span>

CAD/CAM dentistry is a field of dentistry and prosthodontics using CAD/CAM to improve the design and creation of dental restorations, especially dental prostheses, including crowns, crown lays, veneers, inlays and onlays, fixed dental prostheses bridges, dental implant supported restorations, dentures, and orthodontic appliances. CAD/CAM technology allows the delivery of a well-fitting, aesthetic, and a durable prostheses for the patient. CAD/CAM complements earlier technologies used for these purposes by any combination of increasing the speed of design and creation; increasing the convenience or simplicity of the design, creation, and insertion processes; and making possible restorations and appliances that otherwise would have been infeasible. Other goals include reducing unit cost and making affordable restorations and appliances that otherwise would have been prohibitively expensive. However, to date, chairside CAD/CAM often involves extra time on the part of the dentist, and the fee is often at least two times higher than for conventional restorative treatments using lab services.

Fixed prosthodontics is the area of prosthodontics focused on permanently attached (fixed) dental prostheses. Such dental restorations, also referred to as indirect restorations, include crowns, bridges, inlays, onlays, and veneers. Prosthodontists are specialist dentists who have undertaken training recognized by academic institutions in this field. Fixed prosthodontics can be used to restore single or multiple teeth, spanning areas where teeth have been lost. In general, the main advantages of fixed prosthodontics when compared to direct restorations is the superior strength when used in large restorations, and the ability to create an aesthetic looking tooth. As with any dental restoration, principles used to determine the appropriate restoration involves consideration of the materials to be used, extent of tooth destruction, orientation and location of tooth, and condition of neighboring teeth.

A post and core crown is a type of dental restoration required where there is an inadequate amount of sound tooth tissue remaining to retain a conventional crown. A post is cemented into a prepared root canal, which retains a core restoration, which retains the final crown.

A Rochette bridge is a type of dental prosthesis popular in the 1970s, and described by Alain Rochette in 1973 as a form of resin retained bridge that relied on countersunk holes perforating the metal abutment wing. These would be filled with composite cement on seating the restoration, providing macromechanical retention for the prosthesis.

Dental cements have a wide range of dental and orthodontic applications. Common uses include temporary restoration of teeth, cavity linings to provide pulpal protection, sedation or insulation and cementing fixed prosthodontic appliances. Recent uses of dental cement also include two-photon calcium imaging of neuronal activity in brains of animal models in basic experimental neuroscience.

<span class="mw-page-title-main">Cracked tooth syndrome</span> Medical condition

Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Sometimes it is described as a greenstick fracture. The symptoms are very variable, making it a notoriously difficult condition to diagnose.

<span class="mw-page-title-main">Tooth mobility</span> Medical condition

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.

<span class="mw-page-title-main">Overdenture</span> Removable dental prosthesis

Overdenture is any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants. It is one of the most practical measures used in preventive dentistry. Overdentures can be either tooth supported or implant supported. It is found to help in the preservation of alveolar bone and delay the process of complete edentulism.

References

  1. ↑ Durey, K. A.; Nixon, P. J.; Robinson, S.; Chan, M. F. W.-Y. (2011-08-12). "Resin bonded bridges: techniques for success". British Dental Journal. 211 (3): 113–118. doi: 10.1038/sj.bdj.2011.619 . ISSN   1476-5373. PMID   21836574.
  2. 1 2 3 Balasubramaniam, G. R. (2017-06-09). "Predictability of resin bonded bridges - a systematic review". British Dental Journal. 222 (11): 849–858. doi:10.1038/sj.bdj.2017.497. ISSN   1476-5373. PMID   28703151.
  3. 1 2 3 Ibbetson, Richard (2018). "A Contemporary Approach to the Provision of Tooth-Supported Fixed Prostheses Part 1: Indications for Tooth Replacement and the Use of Fixed Bridges Retained by Crowns". Dental Update. 45: 10–20.
  4. ↑ King PA, Foster LV, Yates RJ, Newcombe RG, Garrett MJ. Survival characteristics of 771 resin-retained bridges provided at a UK dental teaching hospital. Br Dent J. 2015 Apr 10;218(7):423-8; discussion 428.
  5. 1 2 3 4 Miettinen, M.; Millar, B. J. (July 2013). "A review of the success and failure characteristics of resin-bonded bridges". British Dental Journal. 215 (2): E3. doi: 10.1038/sj.bdj.2013.686 . ISSN   1476-5373. PMID   23887555.
  6. ↑ A. Damien Walmsley, Trevor F.Walsh, Phillip J. Lumley, F.J Trevor Burke, Adrian C. Shortall, Richard Hayes-hall, Iain A. Pretty. Restorative Dentistry second edition, Churchill Livingstone, 2007
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.