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References

Burke FJ, Lucarotti PS. Ten year survival of bridges placed in the General Dental Services in England and Wales. J Dent. 2012; 40:886-895

Technique tips: planning for failure

From Volume 44, Issue 10, November 2017 | Pages 1012-1013

Authors

Peter Sands

MSc, BDS, LDS, MCGD

Didcot, Oxfordshire

Articles by Peter Sands

Article

Whilst we all like to think our restorative treatment will last indefinitely, the fact of the matter is that everything will fail, given time. The forward thinking practitioner would be wise to take this into consideration when treatment planning.

A 60-year-old businessman wanted a fixed solution for missing UL45. He dismissed both removable and implant solutions. A bridge was acceptable and thoughts around the bridge design were considered. A fixed/fixed design with full coverage restorations at UL3 and UL6 was considered, however, the UL3 was an unrestored, sound tooth and it was felt that this was overly destructive.

The UL6 had previously been root-filled and so a full coverage restoration was indicated. A minimally invasive, resin-retained retainer at UL3 was considered as the mesial retainer. However, given that in my experience at the time, adhesive retainers were probably more likely to fail than fixed retainers, something which was subsequently confirmed by research by Burke and Lucarotti,1 thought was needed as to how this might affect the long-term survival of the bridge if there was a debond of the adhesive retainer.

The solution was to make a gold coping for the UL6, a ‘Maryland’ wing with a precision attachment as the mesial (minimally invasive) retainer and then to cement the bridge over the gold coping with a provisional cement. Sufficient resistance and retention form was provided on the UL6 by the parallel sides of the gold coping and retainer.

This hybrid, fixed/movable bridge UL6543 was cemented in 2004 and survived, intact, until September 2017, when the resin-retained wing debonded (Figures 1 and 2).

Figure 1. Hybrid bridge on cementation (2004).
Figure 2. Bridge on removal and cleaned and sandblasted (2017).

Had the bridge been cemented on the distal retainer with a definitive cement, the removal of the bridge might have proved very difficult, or even impossible, without damage to the bridge or retainer but, because the retainer had been cemented with Temp-Bond™, it was possible to remove the bridge undamaged. There was a small area of caries under the mesial adhesive retainer and this was dealt with and the adhesive wing and bridge was replaced, as previously (Figures 3–6).

Figure 3. Mesial adhesive retainer recemented.
Figure 4. Duralay jig used to ensure adhesive wing is replaced in the same position as it was previously.
Figure 5. Occlusal view of recemented bridge.
Figure 6. Buccal view of bridge in place.

Forward planning and consideration of how fixed bridgework might fail saved what would otherwise have been a disaster.