Adhesive bridge

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An adhesive bridge or adhesive bridge , also Maryland bridge , is a fixed bridge as a dental prosthesis , which is glued to the acid-etched enamel surface of abutment teeth by means of a fastening plastic and consists of a metal or ceramic framework .

Inserted adhesive bridge / view from the front

Development of the adhesive bridge

Maryland bridge to replace three lower incisors, lingual view (inside). The metal wings are not visible from the outside.

The adhesive bridge is based on a procedure developed by Buonocuore (1955) in which the adhesion of plastic to the tooth is made possible by etching the surface enamel. With the help of this technique, artificial teeth were attached to adjacent teeth with special composite plastics for the first time in the 1970s . However, no cast metal substructures were used, so that the long-term result, i.e. long-term adhesion of the plastic, did not materialize.

In 1973, Alain L. Rochette was the first to succeed in attaching metal splints with macroretentions to the lower anterior teeth, thus enabling adhesion for more than 24 months. In a further development of this method by Howe and Denehy (1977), individual anterior teeth were replaced for the first time by adhesive bridges with stabilizing base metal frameworks, even if this was initially only planned as a temporary restoration. Another important step in the development of the adhesive bridge was taken by Gus J. Livaditis and Van P. Thompson from the University of Maryland (hence the name Maryland Bridge). They carried out preparations in the tooth enamel and, after electrolytic etching of the base metal frameworks used, anchored the luting composite micromechanically in the metal.

This method was further advanced by new adhesive cements and the introduction of newer mechano-chemical composite systems, which improved the plastic-metal or ceramic-metal bond and thus also the long-term prognosis (durability) of adhesive bridges. At the beginning of the 1990s, Matthias Kern presented the two-wing all-ceramic adhesive bridge, the better alternative to the metal-ceramic adhesive bridge in terms of aesthetics and biocompatibility. After the two- wing all-ceramic adhesive bridge showed a relatively high fracture rate of one of the two connectors to the neighboring teeth, it was replaced by the single-wing all-ceramic adhesive bridge, i.e. H. the missing tooth was only held by a connector to the neighboring tooth.

Adolescent dentition with a genetic dislocation (gap above right) and a malformation of the lateral incisors in orthodontic treatment

Areas of application and indication

If single tooth implants cannot or should not be used, the adhesive bridge is used for single tooth gaps, which should usually be bordered by adjacent teeth that are free of caries and fillings . There is only an age limit for two-wing splinted adhesive bridges in adolescents who are to wait for the eruption of the permanent canine teeth . Adhesive bridges, which are not used to block two teeth together, can definitely be incorporated into the change of teeth in children and adolescents. Adhesive bridges are mainly used in adolescents if the teeth are missing due to non-placement or accidents, or if gaps have formed after orthodontic treatment . In adults, the most common cause of tooth loss is gum disease .

The adhesive bridge should not replace more than one tooth in the upper anterior and posterior regions. In the lower anterior region of the teeth, a maximum of the four incisors should be replaced and only if there is a straight jawline in this region.

An important prerequisite for the supply of adhesive bridges is the relative freedom from caries of the abutment teeth and sufficient tooth enamel, which is necessary for the adhesive process. Smaller fillings in the abutment teeth can be left in place, but should be specially treated (conditioned) before the dentures are bonded.

It is also important that the size of the gap corresponds to the tooth to be replaced and that parafunctional loads (e.g. grinding or pressing) are taken into account. If the patient has already received orthodontic treatment, an eight to six week retention phase (no more active movement of the teeth) should precede the insertion of an adhesive bridge. In the S3 guideline for all-ceramic crowns and bridges, single-wing all-ceramic adhesive bridges are listed and recommended as evidence-based therapy. In addition, single-span adhesive bridges with ceramic frameworks to replace single or two incisors missing next to each other are the standard care in Germany. All-ceramic adhesive bridges can be subsidized as a similar treatment within the framework of statutory health insurance.

Tooth after preparation for an adhesive bridge, photographed from the palate

Contraindications

In order to achieve a satisfactory result when restoring an adhesive bridge, all the requirements that this denture requires should be met. For example, it is important that the degree of rotated or tilted teeth is not too high. Furthermore, the tooth gap should always be larger than the width of the artificial tooth. It should also be taken into account that the adhesive surface on the fastening tooth must be sufficiently large. If it is so low due to fillings, abrasions , attritions or enamel anomalies that the adhesive bridge cannot be guaranteed to hold, a dental prosthesis using an implant should be considered. Other treatments are also preferred if the patient practices contact sports (e.g. boxing , karate , ice hockey, etc.). In the case of a very deep bite or grinding and pressing, caution is also required when using adhesive bridges, as in these cases they are exposed to loads that can lead to the loss of the denture.

Advantages and disadvantages

In addition to the obvious advantages of the adhesive bridge, u. a. Little loss of substance of the supporting teeth, avoidance of irritation of the dental nerves , good gum prophylaxis, low costs, treatment without local anesthesia , preservation of conventional alternative dental prostheses , the following reasons speak for the treatment with the single-wing all-ceramic adhesive bridge:

  • applicable to adolescents before the completion of jaw growth;
  • unnoticed loosening of an adhesive wing is impossible (no risk of caries);
  • no unphysiological blocking of neighboring teeth;
  • simplified preparation.

The success rates with adhesive bridges are strongly influenced by the techniques used and the precision of treatment. The process of producing and integrating an adhesive bridge is therefore very technology-sensitive. Furthermore, if the adhesive bridge is released, there is a risk that it will be swallowed and get into the airways. However, the complications published in the literature suggest that the risk of aspiration is low.

To support the long-term success of this care, good oral hygiene and regular follow-up care are important. Another disadvantage of this dental prosthesis is the relatively narrow scope of application.

Adhesive bridge on the left incisor seen from the palate

durability

The world's largest clinical study on the success rate of adhesive bridges is the multicenter observational study by Kerschbaum's working group, in which over 2,800 adhesive restorations are recorded. According to this study, the primary failure rate for a three-unit adhesive bridge after five years of wear is 33.9 percent. Beyond the five-year period of use, with a subsequent reattachment, 87.1 percent of the adhesive bridges remained intact. The primary loosening of an adhesive bridge is therefore not to be equated with a final failure of the restoration. In a more recent study from 2011, in which the long-term effectiveness of adhesive bridges made of aluminum oxide ceramic was examined after ten years, the result is: 73.9 percent of all-ceramic adhesive bridges with two adhesive wings and 94.4 percent of all-ceramic adhesive bridges with one adhesive wing were identified as judged to be fully functional. Single-wing adhesive bridges for replacing missing incisors provide even better results if they are made from high-strength zirconium oxide ceramic: After 10 years, 98.2 percent of all adhesive bridges still worked, with 8 percent having to be reattached over this period.

materials

In general, adhesive bridges made of metal veneered with ceramic can be used to replace anterior and posterior teeth, while the use of all-ceramic bridges should be limited to the anterior region. If metal is chosen as the framework material, base metal alloys (usually made of cobalt-chromium) are preferable to precious metal alloys, as the former have a higher modulus of elasticity and are easier to bond.

Adhesive bridges on lower molars with a framework made of metal (above), made of zirconium dioxide (below) and a ready-veneered framework (right)

Guidelines of the Federal Joint Committee

The Federal Joint Committee (G-BA) expanded the guidelines for dental prostheses in 2016.

"For insured persons who have reached the age of 14 but not yet 21 years of age, a single-span adhesive bridge with a metal frame with two wings or two single-span adhesive bridges with a metal frame with one wing each can be used to replace two missing incisors next to each other if there is sufficient oral enamel on the abutment teeth be displayed. To replace an incisor, if there is sufficient oral enamel on one or both abutment teeth, a single-span adhesive bridge with a metal framework with one or two wings may be indicated. In the case of single-wing adhesive bridges to replace an incisor tooth, the tooth adjacent to the pontic of the adhesive bridge, which is not the carrier of a wing, should not need a crown and should not be provided with a crown in need of replacement. "

- Federal Joint Committee

literature

  • Jörg R. Strub among others: Curriculum Prosthetics II. Articulators - Aesthetics - Materials science - Fixed prosthetics . 4th edition, Quintessenz, Berlin 2011.
  • Klaus Ludwig: Metal-plastic composite systems. In: K. Eichner, H.-F. Kappert (Ed.): Dental materials and their processing. Volume 1: Basics and processing. 6th edition. Hüthig, Heidelberg 1996, pp. 251-272.
  • Thomas Kerschbaum (Ed.): Adhesive prosthetics - bridges, attachments, splints, veneers . Urban & Schwarzenberg, Munich 1995.
  • Wolfgang B. Freesmeyer: Clinical Prosthetics. Volume 1: Fixed and implant-supported dentures. Karl F. Haug Fachbuchverlag, Heidelberg 1995, ISBN 3-8304-0125-6 .
  • Matthias Kern : Adhesive bridges: Minimally invasive - aesthetic - proven. 2nd edition, Quintessenz Verlag, Berlin 2018, ISBN 978-3-86867-412-5 .
  • 083/012 - Guideline report on the S3 guideline: All- ceramic crowns and bridges . AWMF registration number: 083-012

Web links

Individual evidence

  1. ↑ a b c d e f Joint statement of the German Society for Dental Prosthetics and Biomaterials (DGPro) and the German Society for Dental, Oral and Maxillofacial Medicine (DGZMK) V 2.0. DZZ, 62 (09); 2007
  2. ↑ MG Buonocore: A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. In: J Dent Res . 34, 1955, pp. 849-853.
  3. ↑ RL Ibsen: One-appointment technique using an adhesive composite. In: Dent Surv. 49, 1973, pp. 30-32.
  4. ↑ LL Portney: Constructing a composite pontic in a single visit. In: Dent Surv. 49, 1973, pp. 20-23.
  5. ^ AL Rochette: Attachment of a splint to enamel of lower anterior teeth. In: J Prosthet Dent. 30, 1973, pp. 418-423.
  6. ↑ DF Howe et al .: Anterior fixed partial dentures utilizing the acid-etch technique and a cast metal framework. In: J Prosthet Dent. 37, 1977, pp. 28-31.
  7. ↑ Van P. Thompson, Gus J. Livaditis: Etched casting acid etch composite bonded posterior bridges. In: Pediatric dentistry. 4, 1, 1982, pp. 38-43.
  8. ^ GJ Livaditis: Cast metal resin-bonded retainers for posterior teeth. In: J Am Dent Assoc . 101, 1980, pp. 926-929.
  9. ↑ VP Thompson: Electrolytic etching modes of various NP alloys for resin bonding. In: J Dent Res. 61, 1982, p. 186, Abstr No 165.
  10. ^ M. Kern et al .: The all-porcelain, resin-bonded bridge. In: Quintessence Int. 22, 1991, pp. 257-262.
  11. ↑ M. Kern et al .: Bonding to alumina ceramic in restorative dentistry over up to five years. In: J Dent. 26, 1998, pp. 245-249.
  12. ↑ M. Kern et al: The cantilevered all-ceramic, resin-bonded bridge. A new treatment modality. Kyoto, Japan 1997, p. 79, Abstr No E17.
  13. ↑ a b C. Mehl et al: Single-wing all-ceramic adhesive bridges - minimally invasive aesthetics. In: Aesthetic Dentistry. 2007, pp. 22-27.
  14. ↑ T. Kerschbaum: Clinical performance of the adhesive bridge. In: Zahnärztekammer Westfalen-Lippe (ed). Greven: Wessels, 1989, pp. 47-55.
  15. ↑ S. Peters et al.: Proof of three-unit adhesive bridges. Statistical control of 922 bridges by a multicenter adhesive bridge register. In: Zahnärztl Mitt. 80, 1990, pp. 31-37.
  16. ↑ B. Haastert et al.: Risk of loss with three-unit adhesive bridges during the restoration period. In: Dtsch Zahnärztl Z. 48, 1993, pp. 161–166.
  17. ↑ B. Haastert et al: Influential factors for the risk of loss of adhesive bridges. In: Switzerland Monthly Dental Medicine. 102, 1992, pp. 416-421.
  18. ↑ M. Kern et al .: Ten-year survival of anterior all-ceramic resin-bonded fixed dental prostheses. In: J Adhes Dent. 13, 2011, pp. 407-410.
  19. ↑ M. Kern et al .: Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors. In: J Dent. 65, 2017, pp. 51-55.
  20. ↑ B. Kohlmeyer et al .: Longevity and influencing factors for the risk of loss of adhesive bridges - a 15-year study. In: Dtsch Zahnärztl Z. 59, 2004, pp. 428–434.
  21. ↑ Dental prosthesis guideline: Adaptation in Section D. II. Numbers 22 and 24 - Adhesive Bridge , Federal Joint Committee, entry into force on May 3, 2016. Accessed on February 7, 2017.