The Maryland bridge, also known as a resin-bonded fixed dental prosthesis (RBFPD), is a minimally invasive solution for replacing missing teeth, particularly in the anterior region.
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✅ Introduction
Tooth loss in the esthetic zone presents both functional and psychological challenges. The Maryland bridge offers a conservative alternative to conventional fixed prostheses and dental implants, preserving tooth structure while restoring function and esthetics. Its success depends on proper case selection, material choice, and bonding protocols.
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A Maryland bridge is a type of resin-bonded prosthesis that replaces a missing tooth using metal or ceramic wings bonded to the lingual surfaces of adjacent teeth. Unlike traditional bridges, it requires minimal or no tooth preparation, making it a preferred option in young patients or cases where conservation is critical.
✅ Materials Used in Maryland Bridges
1. Metal Frameworks
▪️ Typically made from nickel-chromium or cobalt-chromium alloys
▪️ High strength and long-term durability
▪️ Require micromechanical retention (e.g., sandblasting)
2. All-Ceramic (Zirconia)
▪️ Excellent esthetic outcomes
▪️ Increasingly popular due to biocompatibility and strength
▪️ Requires specialized adhesive systems
3. Fiber-Reinforced Composite
▪️ Conservative and cost-effective
▪️ Suitable for temporary or semi-permanent restorations
▪️ Lower fracture resistance compared to zirconia
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1. Conventional Maryland Technique
▪️ Minimal enamel preparation
▪️ Surface conditioning (etching and priming)
▪️ Adhesive cementation using resin cement
2. Modified Designs
▪️ Single-wing (cantilever) design: reduces stress and debonding risk
▪️ Double-wing design: increases retention but may cause differential tooth movement
3. Digital Workflow
▪️ CAD/CAM fabrication improves precision and fit
▪️ Facilitates use of high-strength ceramics like zirconia
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▪️ Minimally invasive (preserves enamel structure)
▪️ Reduced chair time and cost compared to implants
▪️ Good esthetics, especially with ceramic materials
▪️ Reversible procedure in many cases
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Youtube/ Dentapreg & Fibrafill
✅ Disadvantages
▪️ Risk of debonding, especially in high occlusal stress areas
▪️ Limited indication in posterior regions
▪️ Technique-sensitive bonding procedure
▪️ Possible metal shine-through in older designs
✅ Indications
▪️ Single missing anterior tooth
▪️ Young patients with incomplete skeletal growth
▪️ Patients contraindicated for implants
▪️ Adequate enamel for bonding
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▪️ Prefer single-wing designs in anterior cases
▪️ Use zirconia or fiber-reinforced materials for improved esthetics
▪️ Ensure strict isolation and bonding protocols
▪️ Avoid use in patients with heavy occlusion or parafunctional habits
▪️ Schedule regular follow-ups to monitor bond integrity
📚 References
✔ Kern, M., & Sasse, M. (2011). Ten-year survival of anterior all-ceramic resin-bonded fixed dental prostheses. Journal of Adhesive Dentistry, 13(5), 407–410. https://doi.org/10.3290/j.jad.a19890
✔ Pjetursson, B. E., Tan, K., Lang, N. P., Brägger, U., Egger, M., & Zwahlen, M. (2004). A systematic review of the survival and complication rates of fixed partial dentures after an observation period of at least 5 years. Clinical Oral Implants Research, 15(6), 667–676. https://doi.org/10.1111/j.1600-0501.2004.01117.x
✔ Rochette, A. L. (1973). Attachment of a splint to enamel of lower anterior teeth. Journal of Prosthetic Dentistry, 30(4), 418–423. https://doi.org/10.1016/0022-3913(73)90095-8
✔ Sailer, I., Makarov, N. A., Thoma, D. S., Zwahlen, M., & Pjetursson, B. E. (2015). All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review. Dental Materials, 31(6), 603–623. https://doi.org/10.1016/j.dental.2015.01.013
✔ Thoma, D. S., Sailer, I., Ioannidis, A., Zwahlen, M., Makarov, N., & Pjetursson, B. E. (2017). A systematic review of the survival and complication rates of resin-bonded fixed dental prostheses after a mean observation period of at least 5 years. Clinical Oral Implants Research, 28(11), 1421–1432. https://doi.org/10.1111/clr.13007