Sunday, 15 March 2015

#Tubuleslive Event: A Novel Approach in the use of Maryland Bridgework as Provisionals

This post is based on the latest #Tubuleslive Event by Dr Ken Hemmings

This Maryland bridge that I provided for a patient recently was a definitive restoration

Dr Hemmings raised the issue of ways to temporise spaces following tooth extractions in the interim period where the tissues are able to heal enough for a definitive restoration. 
Usually, I offer patients a removable partial denture in this interim period but Dr Hemmings pointed out that if it was your mouth, would you prefer a RPD or a fixed bridge? You may worry that decementing a Maryland bridge can be difficult, but Dr Hemmings gave us a few tips to help us plan for this use of the restoration.
  • Maryland bridges or even conventional bridgework can be used in interim periods, especially when providing implant work
  • The material used can be heat-cured acrylic for short term replacements, or longer term composite bonded to metal work could be used
  • There is also the option of using the extracted tooth for the pontic as long as the tooth is intact enough (usually more useful for periodontally involved teeth)
  • If using the patient's own tooth, you can have the metal work made in the lab and then bond it to the tooth using Panavia after you have performed a rudimentary root canal treatment in the coronal portion to prevent discolouration
  • To make decementation easier, you should use a smaller bonding area on the tooth and create a bevel coronally on the metal wing so that you have an application point for the chisel on removal
  • Cement with permanent cement e.g. Panavia and due to the bevel you will have a greater cement lute than normal which you may need to remove with an ultrasonic prior to applying the chisel
  • Remember to sharpen the chisel every time you use it as the autoclave will blunt the surface
  • There is no need to cement the Maryland under Rubber Dam as this is it a provisional restoration
  • Other options for adhesive bridge provisionals include Rochette bridges or using GIC as the cement 
  • Always use a floss tie when attempting decementation as a safety measure
  • Top tip to remove excess cement on the abutments is to use a fluted Tungsten Carbide bur carefully. Do not press hard as this will remove enamel
  • Another way to remove excess cement is with an ultrasonic which can be safer but takes longer
  • If removing cement from the bridge over the sink, remember to put the plug in the sink!
  • To remove residue and get a cleaner impression, use a cotton wool pledget soaked in chlorhexidine 
  • For a more stable bite record use Beauty Wax reinforced with metal foil which prevents distortion n transit to the lab
  • When removing conventional cantilever bridges, try to remove with a Towel Clip and if that doesn't work use a Bridge remover with smaller and then bigger taps to break the cement
  • When designing the occlusion for the bridgework, try to create a static single contact on the abutment and none on the pontic
  • Bond failures with Marylands can either be due to poor treatment planning or poor execution in cementation
  • If the debond occurs and there is no cement on the bridge, that means that the metal wing was not prepared enough i.e. sandblasted prior to cementation
  • If the debond occurs and there in no cement on the tooth, that means that there was a moisture contamination on cementation
  • For a good aesthetic result, ask the lab for an ovate pontic and for 0.5mm gingival relief on the cast itself
This week's #Tubuleslive was a bit different, with videos of the cases shown to us with Dr Hemmings commentating over the top which was really helpful in demonstrating some of the cases he treats. 


The next #Tubuleslive event will be next week the 26th of March: Principles of bone augmentation for implant dentistry with Dr Koray Feran.

Why not attend the live audience where you can get FREE CPD! 

To see my other posts about previous #TubulesLive events see here

Have you ever used a Maryland Bridge as a provisional restoration? What do you think about applying this technique in practice? Please leave your comments in the section below!



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