Resin Bonded Bridges. Dentists Often Blame the Material or the Patient Rather than the Technique

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Posted on By Gerald Benjamin In Composite Resin

Dentists are often quick to say that a particular material is a failure because the material does not live up to the manufacturer's claims.

Fiber reinforced processed resin used to fabricate bridges is such a material. Historically, these bridges are said to last approximately 5 years with the cautionary warning that case selection is vital to the success of the bridge.

In many cases, it is not the material that fails; It is usually also not true that patient habits are a major reason for failure of these bridges. It is my opinion that failure is usually caused by a technique error by failing to follow the critical steps usually outlined by the manufacturer. One such technique failure is not placing a rubber dam when bonding the bridge to place. A second reason for an unsuccessful bridge is that the dentist fails to prep the teeth to the gingival margin in order to get an adequate thickness both buccal lingually AND inciso-gingivally. Neither of these failures has anything to do with the failure rate of Fiber reinforced resin bridges.

The bridge in the photos was placed in the mouth of a hygienist in 2002 which means that the bridge has been in function for 15 years without any repairs. This bridge was laboratory fabricated but I have also fabricated my own 3 unit fiber reinforced bridge using a direct/indirect approach. These bridges have similarly been in function for more than 10 years without a failure.

I received radiographs of a fiber reinforced resin bridge today that has been in serve for 18 years without a repair. These restorations are fabulous LONG TERM treatment options when ideal protocols are followed.

This is the occlusal view of a three unit fiber reinforced resin bonded bridge replacing the lower right first molar.
This is a lateral view of the same bridge. Note the inciso gingival thickness of the material.

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5 Comments

Gerald. I ABSOLUTELY AGREE! This should be the treatment of choice for our younger patients. Best regards. Chuck


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Hi Chuck; Thanks so much!! The patient under discussion was 46 at the time the bridge was seated. She worked in dental offices where implants were not routinely placed and had not seen good outcomes for this modality of treatment. I think that dentists need to pay closer attention to occlusion; Brian Mills presented a full mouth rehab case done in bonded resin in order to change the vertical dimension and overjet/overbite. Once that technique is learned, a lab fabricated fiber reinforced resin bonded bridge should last 20-30 years.s Thanks again, Chuck Regards, Gerald


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Just terrific and I agree with Chuck younger patients and financially strapped individuals benefit enormously from this approach. Do you have nay images of the preps? It would be so helpful? How about anterior Maryland bridges? Preps? wing size? adhesive. Thanks again Maurice


Reply

Hi Maurice; Thanks so much.. The preps are pretty standard MO or DO amalgam preps that must be taken to the gingival floor and the cavo surface margins flared as for any indirect restoration. Anterior Maryland bridges debond especially in the teenage population when the jaws are growing and the strong but brittle adhesive bond gets challenged beyond its limit. As per previous discussions here, a single wing off of a cuspid (a cantilevered pontic) survive better than having 2 abutments. I don't think that adhesives are that significant any more as they are all acceptable. I have used Kerr Optibond 3A-3B for years (1992) and when it was discontinued, I went over to Optibond Solo Plus. I virtually never have fully bonded restorations debond although some of my restorations are pushing 25 years old and I would expect many failures in the near future :) I do not have access to the photos of the preps and bonding procedure because they were taken with film. Regards, Gerald


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Restoration of missing teeth aims to improve oral function, aesthetics and restore occlusal stability. However, intervention should be considered carefully as in some cases it may be detrimental to the remaining dentition. General factors such as the health, age of the patient, their expectations, local factors related to dental health and the missing tooth itself need to be taken into account. For example in older patients with reduced manual dexterity it may be appropriate to accept a shortened dental arch rather than replacing a lost posterior unit. If a tooth must be replaced, a RBB may be preferable to a removable partial denture (RPD) especially where there is a history of significant periodontal disease or dental caries.9 As they are minimally invasive, RBBs can also provide a temporary option for young patients who have suffered the early loss of an anterior tooth. This situation would otherwise condemn the patient to years of denture wear until growth has ceased and an implant or definitive bridge can be considered. RBBs have the advantages of taking minimal clinical time and rarely requiring anaesthetic, therefore they may be appropriate for patients who are apprehensive of dental treatment or unable to commit to more involved treatment involving multiple appointments. However, the patient should still be dentally motivated and caries and periodontal disease should be under control before embarking on fixed prosthodontics. In addition, managing expectations with regard to aesthetic outcome and longevity should be considered an important part of treatment planning. If expectations are unrealistic, patient satisfaction with the final result is likely to be low.


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