‘Two sisters’ again

A year ago, when in the throes of moving from the old to the new dental school in Birmingham, I came across a paper that I had written in 1998. This described two identical twin sisters with missing lateral incisors, one who I had treated with conventional fixed bridgework, the other with (the then new) resin-bonded bridges (RBBs). In an editorial last year, I stated that, with the benefit of hindsight, I would have done things differently and both might have been better served by having RBBs. Life rarely stands still, so, just over a year on, there are a number of recent publications providing stronger evidence (either by including high numbers of bridges, or lengthy observation periods) than was available when I last addressed the subject. Let‧s take a look at these.

Mattias Kern¹ has examined the performance of glass-infiltrated alumina ceramic cantilever RBBs. Twenty-two of these were provided for 16 patients who had one or more missing lateral incisor teeth (a much-used indication for RBBs), with the bridges being luted with Panavia 21 (Kuraray). The mean observation time was 188 months: the abutment preparation included a lingual veneer, a shallow cingulum groove and a small proximal box preparation. No bridges lost retention and the two failures were due to fracture of the alumina framework, giving an overall 10-year survival using Kaplan-Meier methodology of 95.4%. However, in a recent review of all-ceramic resin-retained bridges in Dental Update by Shah and Laverty,² the authors concluded that the research that is currently available favours the use of metal RBBs.