Mandibular Anterior Maryland Bridge - Dental Minute with Steven T. Cutbirth, DDS

[@kazemshakas]

Very beautiful work and thoroughly explained. Thank you Dr Cutbirth.

[@centerforard]

Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Th3Broth3r]

I admire your work ethic and consideration for your patient's doc. God Bless You Sir.

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@aroncarvajal7080]

I'm a dental technician in Dallas Texas, thank you very much doctor for all your great videos they are very informative, great job on this maryland bridge, the shade could've been a little better 😊

[@centerforard]

As you know, matching a single central incisor is near impossible, especially with a Maryland bridge. I am presenting real dental cases in a real, full time practice, not some "ideal" case I spend hours going back and forth with a lab tech to create a "case for presentation" as many presenters do. For a lower central incisor on a Maryland bridge, I felt the shade match was extremely good. It's easy for dentists/technicians who do not present seminars or publish cases themselves to be critical because they do not realize how difficult the process is.

[@aroncarvajal7080]

@@centerforard thank you Dr for taking the time to write back I agree with you on everything you said and for taking the time to educate us on a lot of this subjects one of my favorite videos is the one on fundamentals of occlusion, please keep them coming.

[@centerforard]

Glad you like the videos. Subscribe to DentistryMasterClasses.com for an organized library ofthe best videos. Only $20/month.

[@aroncarvajal7080]

@@centerforard I will thank you

[@RK-su4hs]

@@aroncarvajal7080 handled the left hook like a champ ! 👌

[@khadijaf5046]

Thank you for this video . I have a similar case this week and I am excited .

[@centerforard]

Glad it was helpful! Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@MohamedMohamed-bw3fw]

Great presentation Thank you for the time and efforts Under perfect situation could we just leave the incisal edges without preparation and just prep the lingual and proximal only?

[@centerforard]

Yes.

[@dwi1955]

Thank you for sharing this case Dr, Very outstanding work and I always enjoy to watch your presentation

[@centerforard]

Thank you. Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@cllew3860]

Dr, Maryland bridge is suitable for kids? Thank you

[@madartzgraphics2019]

Didn't know the gaps in between are genetics problem. Just heard the info from my dentist a few days ago. He recommended me a bridge and will surely take one soon.

[@centerforard]

Great!

[@j.cesarbraga]

Thanks for the share, Doctor. Greetings from Brazil!

[@centerforard]

My pleasure! 'Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@docyagamikiko]

Outstanding presentation! Im so inspired to try. I completely (and intentionally) forgot about maryland bridges, but the tooth structure preservation reason specifically for the lower anteriors is on point. I wonder though, if i do a maryland bridge using conventional PFMC (with both wings as metal), will it last? Presuming i will only be preparing the lingual surfaces( no incisal involvement).. Thank you for this video, really.. its really inspiring! 😊👍

[@centerforard]

Ideally, the material should be bondable since there is no retention from the preparation. I have never placed a porcelain to metal Maryland bridge, so I do not know how stable it would be. I tell the patient a Maryland bridge is not long lived, although I have had some mandibular anterior Maryland bridges last 10-15 years if the patient is careful and does not bite anything harder than a soft sandwich with them. Replacing missing mandibular anterior teeth is always a challenge because of the limited facial/lingual bone width. I have some videos in DentistryMasterClasses.com replacing missing lower anterior teeth with 2.5mm diameter small diameter implants and crowns. If 2 adjacent mandibular incisors are missing, I will sometimes remove all 4 incisors and replace them with a 4 unit implant supported fixed bridge. The abutments may be 2.5mm small diameter implants. These implant supported fixed bridges have worked beautifully. Watch the videos in DentistryMasterClasses.com.

[@varshavijayan7840]

Dr, amazing presentation 👏🏻👏🏻👏🏻

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@nohaelwardany7940]

Hello Dr. Thank you for the simplified illustration. My question is: can we attach the maryland bridge wings on crowned abutments? I know you don't place crowns on lower incisors, but this is an existing case. Thank you.

[@centerforard]

If the crowns are PVCs or some material that the zirconium or metal substrate will bond to, then yes, you could bone to an existing crown. I would remove the crowns and place a conventional fixed bridge if there are currently crowns on the abutment teeth. Why not? Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@square4655]

Do you temporarize these? I imagine any temp would break off right after leaving the office unless you bonded it.

[@centerforard]

If you temporize, use a removable acrylic "flipper."

[@jWestdd]

Dr. Cutbirth, I just watched this video after having bridge work done. I also have this missing tooth and an upper smilebtooth missing. Please let me know where you provide services or if you can advise me an office in my city that will do this type of work. Very impressed, thankyou

[@centerforard]

Sorry, I never make dental recommendations.

[@alymohamedalygamaleldin4966]

Very informative dr 🙌🏼 but I have a question Why you put primer adhesive on crowns also and doesn’t use silane coupling agent ?

[@centerforard]

I use Unicem cement which has primer adhesive. I do not use silane for anything because the mechanical retention in the restoration is sufficient, and if you do not use silane correctly it can contaminate the bone. You don't need silane. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@raninej9615]

Hi! What exactly do you ask for when you send this to the lab? Lingual veneer with Pontic and no lingual embrasures? Also does 1 wing work just as well?

[@sinnieleeonUtube]

Wow ! Such a wonderful work without surgery. How long would it last ? Is it strong enough to chew foods ? Can it be done if the missing/broken tooth is on the top, it might be more difficult I would assume if possible at all ?

[@centerforard]

Maryland bridges are more stable and long lasting when the missing tooth is a lower incisor. There is much less stress on the restoration in the lower anterior region than in the maxillary anterior or posterior regions. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@tinahamdami3936]

thank you dr for this video, do you have a video for upper central maryland bridge please

[@centerforard]

Not upper, only lower. I am not a real fan of Maryland bridges on the upper because they are more prone to come off.

[@galaxytab7689]

great case , I've noticed at the beginning of the video thatt you were preparing the lingual side of the teeth without water irrigation , wouldn't that have negative effects on the pulp of the teeth ?

[@centerforard]

Very, very light touch. I was just "roughening" the lingual side of the teeth, creating a fresh surface for bonding and optimizing the alignment/draw of the 2 teeth. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@throwdown47]

Perfect tx and execution for this scenario! Thanks for the share!!!

[@centerforard]

You are welcome. Subscribe to DentistryMasterClasses.com for the best videos.

[@kamelliamehershahi8393]

Thanks for sharing this video. I see you clean the tooth with isopropyl alcohol, how about using zephiran as antiseptic as alternative?

[@centerforard]

I'm not familiar with zephiran, but many different cleaners would work. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@kamelliamehershahi8393]

appreciate your reply @@centerforard

[@nainachopra1983]

very informative video Dr. Cutbirth. is the bondong of zirconia partially coverage restoration like the one you have done here predictable. in my practice i only use lithium disilicate restorations as bonded restoration. plz share your experience as i am always sceptical of doing marylands in all ceramics bz i m afraid about how long wil they last.

[@centerforard]

In my opinion, a Maryland bridge is always looked at as a non-permanent restoration. The longevity of the restoration depends greatly on where the MBridge is located and the ability of the patient not to bite anything harder than a tunafish sandwich on the bridge. I rarely place a Maryland bridge anywhere except the mandibular anterior to replace a missing incisor. Treated zirconia has worked well for me in these cases, but lithium disilicate is also good, just not as strong. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@yc2142]

thanks for the video, Doctor Cutbirth! what would be your tx of choice for missing max central if implant is not an option?

[@centerforard]

A fixed bridge with bone or soft tissue grafting if there is a defect in the bone/soft tissue. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@CD-Jeff-Maurate]

Nice job, Dr Cutbirth. What do you think about a Maryland pontic for anterior-lower incisor all made with composite? Do you think that it still is going to work well?

[@centerforard]

I cannot comment because I have never used composite for a Maryland bridge. It does not sound like it would be very strong. I prefer a zirconia substructure covered with lithium disilicate (e-max). Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513 .

[@zainabnawaz1284]

Is this procedure good for both missing lateral incisors..?

[@centerforard]

Yes, with missing mandibular lateral incisors. Missing maxillary lateral incisors is a different item, with different considerations depending on the contact of the mandibular anterior teeth on the maxillary anterior teeth..

[@hmm_thats_cool_ig2402]

@@centerforard would you recommend it with a maxillary lateral incisor?

[@alienvirus4640]

What do i do to avoid food getting stuck under the bridge (fake teeth)

[@centerforard]

I trim the stone model in the gingival pontic receptor site so the pontic makes intimate contact and actually blanches the gingival tissue in that gingival pontic receptor site when seated. You do not want any space between the pontic and soft tissue or it will collect food. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@DrHRYB]

Good day , great job ! maybe you can create cerconium crown on toth 3.2 and 4.1 why not ? this is just my opinion.

[@centerforard]

I try to never place full crowns on lower incisors. Those teeth are too small and will eventually fracture at the gumline due to the circumferential 1.5mm tooth removal from the crown prep.

[@michellechuah731]

Hello dr . Thank you for the illustration . My question is : can we do 2 separate Mary land bridge for a missing 31 , 41 with one wing on the adjacent laterals ?

[@centerforard]

Yes, you can place adjacent Maryland bridges to replace 2 missing lateral incisors. I am not familiar with the numbering system you are using. I find Maryland bridges to be more long lasting to replace mandibular incisors than maxillary incisors because the biting pressure is more favorable in the mandibular anterior region. I do not use Maryland bridges in the posterior part of the mouth. Encourage the patient not to bite anything harder than a hamburger with their anterior teeth and to wear a Nightguard while sleeping. Place the Nightguard on the arch with the Maryland bridge. With this approach I have some very long lasting Maryland bridges. Be sure to inform the patient that a Maryland bridge is not thought of as a long lasting restoration, but it may be the best restoration if the patient is missing a mandibular incisor and an implant is not possible. You do not want to be responsible for maintenance and replacement of a Maryland bridge. That is especially true if the patient does not really take care of it with excellent home care, wearing Nightguard and not biting hard things on it. You do not want the patient's problem (the missing tooth) to become your problem (maintenance and replacement of a Maryland bridge). If the patient is willing to accept the total responsibility for maintenance and replacement of the Maryland bridge, then it can be a good restoration to replace a missing mandibular incisor. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@ojcksn]

Hi Dr. Cutbirth, I have to have a Maryland on my upper central incisor in a few weeks, how much will it affect chewing and things I can eat?

[@centerforard]

I, personally, do not place Maryland bridges to replace upper anterior teeth or posterior teeth because of the biting force in those areas. If a lower anterior tooth is being replaced, the biting force is "into" the arch alignment, versus an outward or facial direction force with the upper anterior teeth. My personal feeling is there is also too much biting force on posterior teeth for a Maryland bridge. Years ago I placed upper anterior Maryland bridges but have not placed one in that area in 20 years because of the issues I mentioned above. In some cases Maryland bridges would probably work, I just do not personally place them in those areas.

[@AshishPatil-xv4th]

Hello sir , is it necessary to wear night guard after placed lower maryland bridge for single front tooth

[@centerforard]

I feel almost everyone should wear a nightguard to prevent teeth wear and to protect restorations. Our daughters received night guards when they stopped growing at around age 16, In my opinion, nightguard is like brakes on your car. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@RK-su4hs]

Doctor Maryland bridge for missing lower canines In your opinion is Emax a wise choice…or pfm? thanks in advance

[@centerforard]

I would normally not place a Maryland bridge to replace missing maxillary or mandibular canines. I would place either implants or full coverage bridges. There is normally too much stress on cuspid teeth for Maryland bridges. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@FarrellMassiah]

How long do these last?

[@centerforard]

Depends on how you take care of them, what you eat, etc. It's like asking how long a car or house lasts. It depends on many variables.

[@sherry7453]

Thanks for the great effort I did learn a lot from your videos What do you write on the lab prescription to describe the pontic design that flat lingual Is that a saddleback pontic ???? Thanks

[@centerforard]

No, it's a "sanitary" pontic, shaped like the larger, rounded part of an eggshell at the tissue. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@abdelazizslama6402]

Hello doc, which blocking material do you use in this video in the polyether impression?

[@centerforard]

I can't remember the name off the top of my head, but if you are subscribed to DentistryMasterClasses.com I show the material gun and name on any of those restorative videos. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@gabrielalujan2521]

Muy lindo caso Dr., desde Córdoba Argentina

[@centerforard]

Thank you.

[@aly9604]

Hi Dr. I read that 2 wings will have higher chance of failing due to different tooth movement of two abutments. What do you think of single wing Maryland bridge?

[@centerforard]

I have had excellent results with Maryland bridges (2 wings) replacing single missing mandibular incisors. I cannot remember any of them becoming detached. I do not place Maryland bridges anywhere else to replace missing teeth. I have replaced some missing maxillary and mandibular lateral incisors in the past with 2 unit fixed bridges extending from the cuspids to the missing laterals with a full crown retainer on the cuspid. I would not suggest a "single wing" Maryland bridge with the wing cemented only to the lingual/palatal surface of a single adjacent tooth. That sounds very unstable. Remember, you want any restoration you place to hold up. You do not want to be decrementing or repairing restorations. Restorative failures cause the patient to loose confidence in you and it is costly for you to have to recement restorations. Be sure the patient has a night guard and knows not to bite hard things with any of their teeth, especially an area with a Maryland bridge or a cantilevered lateral incisor fixed bridge. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@martarico8604]

Excelente !!!!

[@centerforard]

Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@centerforard]

Thank you. Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@elenapobi5471]

Hi would you recommend maryland bridge for an upper cuspid? Thanks

[@centerforard]

Normally, no, because there is too much lateral pressure on an upper cuspid. Feel M'land bridges are best to replace mandibular lateral and central incisors. Maryland bridges pretty well replacing upper lateral incisors if the patient is not a significant teeth grinder or bruxer, wears a nightguard while sleeping and doesn't bite hard things with the anterior teeth. I, personally, do not place Maryland bridges to replace any teeth but mandibular central and lateral incisors.

[@shilpikachhwaha9462]

Can we do Maryland bridge on upper with 2 wings to increase bonding

[@centerforard]

Yes, but a maxillary anterior bridge is under more stress than a mandibular because the biting force is outward, away from the teeth. I look at a maxillary Maryland bridge as a temporary fix, vs. a mandibular Maryland bridge as a potential long term fix because of less stress on the mandibular anterior bridge. It's important with either maxillary or mandibular Maryland bridges that the patient not bite anything harder than a hamburger with their front teeth and they wear a night guard while sleeping. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@jabbarjaafar5530]

Good job sir .. I am asking if it is possible to do labial veneer to get better esthetic results

[@centerforard]

Sure. Normally, only the incisal 1/4 of the mandibular anterior teeth are seen when smiling or speaking, so "perfect" aesthetics is not as critical as with the maxillary anterior teeth. As with many things in life, it gets down to finances.

[@jabbarjaafar5530]

@@centerforard logical answer ...thank you sir ...I am always follow your nice ideas .

[@centerforard]

Terrific! I hope you are subscribed to DentistryMasterClasses.com for the best videos. An organized library of all the DM videos plus many complete comprehensive cases of all kinds of treatment.

[@AbdulKarimKhankarimkhan8]

love this thank you

[@centerforard]

Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@janinechambersmagee9996]

California, central California. Any dentist willing to perform this technique? Way better option than a bridge

[@centerforard]

Maryland bridges are good in the mandibular anterior region.

[@nellenehenry5282]

How can I get in touch with you

[@centerforard]

Above answer.

[@luisubtil]

What about the new scotchbond universal plus? Have you tried it yet? 3M representative in my country told me scotchbond universal plus is only compatible with relyx universal. For relyx ultimate and relyx veneer I would have to first cure the scotchbond unviersal plus then cure the cement (no, thanks!). In alternative I could continue to use the scotchbond universal (the original not the new S.U. plus) along with relyx ultimate or relyx veneer and cement the combination together like I am used to do. This response seems off to me. Seems like they are pushing to only use relyx universal.

[@centerforard]

I believe most adhesives/resin systems are effective if used properly.

[@Jorge.A.12]

Do you think the other incisor may need endo in the future?

[@centerforard]

Hard to say. I am sure I cold and percussion tested the teeth prior to restoring them and they were vital. Certainly teeth are similar to trees, the nerve can "die" or become symptomatic years after a traumatic event.

[@sapana6481]

Is this procedure good for both missing canine teeth??

[@centerforard]

No, I do not think Maryland bridges are good for missing canines or posterior teeth. They are best for missing lateral incisors. Maryland bridges are probably not a good restoration in areas that are under a lot of biting pressure. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@deia-says]

Hi Dr Cutbirth - I have a big gap on my bottom teeth which looks like I am missing a tooth, it is 4mm. Too small for an implant I was told. Could a Maryland bridge be an option if I dont want to wear braces (I am 34 and don't want to wear braces and afterwards also a night retainer..)? It would mean I have 5 frontal incisors instead of 4. The gap is between lateral incisor and canine.

[@centerforard]

Sorry, I cannot diagnose your condition and recommend treatment without examining you.

[@eyaddassouki]

ذكرتني بشغل النّوَر

[@aamin6933]

Can you show an upper anterior maryland bridge in future ?

[@centerforard]

I rarely place maxillary Maryland bridges. They only work if the mandibular anterior teeth do not contact the Maryland bridge when the patient bites together. If the mandibular teeth contact the maxillary Maryland bridge, the bridge with be prone to coming loose or breaking. The biting angle is not good for a maxillary Maryland bridge because the pressure from biting is in the facial, or outward, direction, pushing the bridge away from the teeth. A Maryland bridge is acceptable for lower incisor replacement because the pressure from biting does not push the bridge off the teeth. I do not view a Maryland bridge as a long term restoration, although, in the right situation with a patient who is careful what they bite, they can last a long time. It is imperative the patient wear a nightguard and not bite anything harder than a sandwich with their anterior teeth if they have a Maryland bridge. I like predictability. I do not place restorations that have a high potential to be an ongoing problem, like dentures without implants or maxillary Maryland bridges.

[@aamin6933]

Thank you for your kind explanation. Would adding retention/resistance form to the preparations such as grooves/slots improve the success rate?

[@centerforard]

Not really, because the bridge is bonded to the teeth, not cemented. Surface area is the key.

[@springsh6678]

Thanks Dr for the explanation but could you please let me know first of all if Crown / Root ratio on adjacent teeth is 1 to 1 no mobility , we can still go with M-land bridge? And my second question is if there is loss of two of these lower anterior teeth lets say both centrals or central lateral on one side we can still go a head with M-land bridge rather than preparing teeth for more unit bridge?

[@centerforard]

I do not like to prepare mandibular incisors for full crowns or bridge retainers because they are too small. If most mandibular incisors are prepared for full crowns, there is minimum tooth remaining, often requiring endodontics and becoming very prone to fracture. If a patient is missing both central incisors, I normally prefer to extract all 4 incisors, place implants in the lateral incisor spaces (sometimes 2.5 mm small diameter implants), and replace the 4 teeth with a 4 unit implant supported fixed bridge. Watch the videos in the library of DentistryMasterClasses.com.

[@springsh6678]

@@centerforard thanks a lot for a great tip Dr.

[@ronaldneal8745]

Hey Doc will a maryland bridge work with tooth #9?

[@centerforard]

Maryland bridges in the maxillary anterior can be tricky. If the patient has a class 2 occlusion, and the mandibular anterior teeth do not touch the maxillary anterior teeth except in protrusive movement, an anterior maxillary Maryland bridge can work if the patient does not bite anything harder than a hamburger or tuna sandwich with the anterior teeth. The problem with a maxillary anterior Maryland bridge is the biting force angle. The biting force angle on maxillary anterior teeth is "outward," not "inward" into the teeth like the mandibular anterior teeth. The cement luting materiol tends to break loose over time if the patient contacts the maxillary Maryland bridge with the mandibular anterior teeth in CO, or if they just clinch on the bridge. You don't want to place something on the teeth that you will have to be recementing or repairing on a regular basis. It will cost you money and time and the patient will think you did not know what you were doing, even if it is their fault the bridge is breaking loose. In other words, the patient's problem has become your problem. I have placed my share of mandibular and maxillary anterior Maryland bridges, and my personal experience is the mandibular Maryland bridges predictably hold up for a long period of time if the patient is careful and wears a Nightguard. The maxillary Maryland bridges are much more prone to become loose. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@ronaldneal8745]

@@centerforard In regards, what do you think is the best option to replace missing tooth #9? I have a slight overbite so my teeth dnt touch directly. Dental implant is way too expensive…What are your thoughts on a traditional bridge at which they would shave the healthy teeth on both sides of #9? Also how long does a traditional bridge last?

[@centerforard]

Watch my video on "Implants vs. Fixed Bridges." It should answer your questions.

[@dentist8535]

Please dr we need presentation about endodontic crown

[@centerforard]

There are many endodontic and crown presentations in the library of DentistryMasterClasses.com.

[@yenhsiang0814]

Great!!

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@hungphanminh5827]

thanks pro.

[@centerforard]

You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@moneyjoyk]

Man you are awesome

[@centerforard]

Thank you. Subscribe to DentistryMasterClasses.com for the best videos.

[@shsss2518]

Thanks sir

[@centerforard]

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[@dakingltroyproductofdade3579]

I bet his mouth hurt after being held open like that lol 😂

[@centerforard]

Not really, he was sedated with an IV.

[@jedihealer]

hi dr. thanks for sharing the enlightening video! are the currently available zirconia frameworks good enough vs. traditional metal wings for maryland bridges? esp tensile strength wise... ?

[@centerforard]

Yes, if placed in the lower anterior region.

[@YOu-jl2bn]

inspiring

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@canaanoghenerobor4319]

How much does this cost

[@centerforard]

Sorry, I never discuss cost because may factors can affect the cost.

[@yooodam8467]

Why prep at all. You dont need the space

[@centerforard]

I like to bond to a fresh surface. The prep is really just roughening the surface when placing a mandibular anterior Maryland bridge.