TechniqueTips
Supported by
Technique Tips – Management of a De-bonded, Fixed-
fixed, Resin-bonded Bridge
Figure 1. Clinical photograph of the failed 3-unit
fixed-fixed RBB replacing a missing maxillary first
premolar.
Resin-bonded Bridges (RBBs) have been used
for the last 40 years with different success rates.
The use of RBBs is a conservative approach for
replacing missing teeth and gives the patient
the advantages of using the fixed prosthesis.
Since their introduction, a great deal of effort
has been put into their development in order
to increase their longevity and clinical use.
When a RBB is used, ideally the abutment
tooth should be decay- and/or restorationfree. The preparation should be conservative
and confined within the enamel.1,2 Maximum
surface coverage and wraparound are required
to obtain a maximum surface area of the
abutment tooth for bonding.3,4
In this clinical tip, a missing
maxillary left first premolar was replaced with
a fixed-fixed RBB using the canine and the
second premolar teeth as abutment (Figures
1 and 2). The bridge failed as the retainer
on the maxillary left canine was de-bonded.
The patient was made aware of different
treatment options and their advantages and
disadvantages. The patient chose to have the
bridge converted into a cantilever type without
removing and re-cementing the bridge. The
connecter between the pontic and the canine
retainer was cut using a coarse diamond bur
and the metal retainer was removed. The
remaining resin cement left on the palatal
surface of the canine tooth was smoothed
down and the palatal surface was coated
with fluoride varnish (Duraphat® 22,600 ppm
fluoride) (Figure 3). The bridge now works as a
cantilever RBB (Figure 4).
Figure 2. Occlusal view of the failed RBB. The
distal retainer covers the palatal cusp. Note
the space between the fitting surface of the
retainer and the canine abutment tooth. A
cupping defect in the incisal edge of the canine
abutment is obvious. This cupping is treated with
a composite resin restoration (not seen). TSL can
also be seen in the second premolar abutment at
the margin of the retainer.
Figure 3. Post-operative clinical photograph.
The resin cement can be seen covering almost
all palatal surface of the abutment. This indicates
that the failure is adhesive in nature and occurs
between the fitting surface of the retainer and
the cement and not between the abutment
surface and the cement. Note the gingival
inflammation around the abutment canine and
the cupped defect on the incisal edge of the
abutment canine.
References
1.
2.
3.
St George G, Hemmings K, Patel K. Resinretained bridges re-visited. Part 1. History
and indications. Prim Dent Care (Journal
of the Faculty of the General Dental
Practitioners (UK)) 2002; 9: 87–91.
St George G, Hemmings K, Patel K. Resinretained bridges re-visited Part 2. Clinical
considerations. Prim Dent Care (Journal
of the Faculty of the General Dental
Practitioners (UK)) 2002; 9: 139–144.
Saad AA, Claffey N, Byrne D, Hussey D.
Effects of groove placement on retention/
resistance of maxillary anterior resinbonded retainers. J Prosthet Dent 1995;
Figure 4. The intra-oral clinical photograph taken
in the recall visit at three months. The remaining
lutting cement can be seen. The cupping is
treated with a composite resin restoration.
4.
74: 133–139.
Ibrahim AA, Byrne D, Hussey DL, Claffey N.
Bond strengths of maxillary anterior
base metal resin-bonded retainers with
different thicknesses. J Prosthet Dent 1997;
78: 281–285.
Aslam Fadel Alkadhimi, Third-year Dental Science Student, Mohammad Ashkanani, Third-year Dental Science Student, Ahmed Sultan,
Fourth-year Dental Science Student and Abdulhadi Warreth, BDS, MDentSci, PhD, Clinical Supervisor in Restorative and Periodontology
Division, Dublin Dental University Hospital, Dublin, Ireland.
520 DentalUpdate
September 2012
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