bdj_2011resin bonded bridges techniques for success

7/30/2019 Bdj_2011Resin Bonded Bridges Techniques for Success

1/6

Resin bonded bridges:techniques or successK. A. Durey,1 P. J. Nixon,2 S. Robinson3 and M. F. W.-Y. Chan4

VERIFIABLE CPD PAPER

By using a RBB it is possible to provide a

xed replacement or missing teeth which

is essentially reversible and does not com-

promise the abutment tooth. This is espe-

cially important or young patients who

may be more likely to experience endo-

dontic complications as a result o exten-

sive tooth preparation.

Despite this recognised advantage, the

role o RBBs as denitive restorations

remains somewhat controversial due to a

lack o long term prospective data regard-

ing success. The majority o inormation

is based on the results o longitudinal

studies, many o which have been poorly

controlled, used a variety o cements and

preparation techniques making it dicult

to isolate actors aecting outcome.4

Recent systematic reviews have esti-

mated the ve-year survival rates or

bridgework as 87.7% or resin bonded

prostheses4 and just over 90% or con-

ventional bridges depending on design.5

Although these rates are lower than the

94.5% success6 reported or implant

retained single crowns over the same ve

year ollow up, resin bonded bridgework

has the advantages o being less invasive,

requiring a shorter total treatment time

and less nancial commitment.

In contrast to these avourable esti-

mations o RBB success, Hussey et al.7

reported high ailure rates when they usedthe number o recement ees claimed to

gauge the success o RBBs in NHS gen-

eral practice. Additionally, a recent study

o RBB designs employed by dentists in

INTRODUCTION

Resin bonded or resin retained bridges

(RBBs/RRBs) are minimally invasive xed

prostheses which rely on composite resin

cements or retention. These restorations

were rst described in the 1970s and since

this time they have evolved signicantly.

The rst type o RBB was the Rochette

Bridge, which relied on the retention

generated by resin cement tags through

a characteristic perorated metal retainer.1

However, longevity o this type o restora-

tion was limited and in an eort to address

this, methods o altering the surace o

the metal retainer to enhance microme-

chanical retention were developed.2 The

term Maryland Bridge resulted rom the

development o a type o electrochemi-

cal etching at the University o Maryland.

More recently bridge retention has been

enhanced by the development o resin

cements which bond chemically to both

the tooth surace and the metal alloy.

From a clinicians perspective, the main

advantage o RBBs is that, in compari-

son to conventional bridge preparations,

they are conservative o tooth structure.3

Resin bonded bridges are a minimally invasive option or replacing missing teeth. Although they were rst described over

30 years ago, evidence regarding their longevity remains limited and these restorations have developed an undeserved

reputation or ailure. This article provides a brie review o the literature regarding bridge success and continues to high-

light aspects o case selection, bridge design and clinical procedure which may improve outcome.

both general practice and hospital settings

reported that a high proportion o prac-

titioners used unavourable techniques.8

It seems reasonable to assume that with

improved education and careul planning,

outcome could be improved.

The aim o this article is to re-evaluate

the role o RBBs in xed prosthodontics

and provide a guide or practitioners with

regard to case selection, bridge design and

clinical techniques in order that successul

outcomes may be achieved.

FACTORS AFFECTING SUCCESS

Case selection

i) Patient factors

Restoration o missing teeth aims to

improve oral unction, aesthetics and

restore occlusal stability. However, inter-

vention should be considered careully as

in some cases it may be detrimental to the

remaining dentition.9-11

General actors such as the health, age o

the patient, their expectations, local actors

related to dental health and the missing

tooth itsel need to be taken into account.

For example in older patients with reduced

manual dexterity it may be appropriate to

accept a shortened dental arch rather than

replacing a lost posterior unit. I a tooth

must be replaced, a RBB may be preerable

to a removable partial denture (RPD) espe-cially where there is a history o signi-

cant periodontal disease or dental caries.9

As they are minimally invasive, RBBs can

also provide a temporary option or young

1*Specialist Registrar in Restorative Dentistry, 2,4Con-sultant in Restorative Dentistry, Leeds Dental Institute,Clarendon Way, Leeds, LS2 9PU; 3Senior Lecturer inClinical Dentistry, University o Queensland, Universityo Queensland, Turbot Street, Brisbane, Australia

*Correspondence to: Dr Kathryn DureyEmail: [email protected]

Refereed PaperAccepted 16 June 2011DOI: 10.1038/sj.bdj.2011.619British Dental Journal 2011; 211: 113-118

Gain a contemporary understandingo the role o resin bonded bridges inreplacing missing teeth.

Learn how to improve survival andaesthetics o resin bonded bridges.

A quick reerence summary o thingsto consider clinically and technically, toimprove outcome.

I N BR I E F

PRACTIC

E

BRITISH DENTAL JOURNAL VOLUME 211 NO. 3 AUG 13 2011 113


2/6

PRACTICE

patients who have suered the early loss

o an anterior tooth. This situation would

otherwise condemn the patient to years

o denture wear until growth has ceased

and an implant or denitive bridge can

be considered.

RBBs have the advantages o taking

minimal clinical time12 and rarely requiring

anaesthetic, thereore they may be appro-

priate or patients who are apprehensive o

dental treatment or unable to commit to

more involved treatment involving mul-

tiple appointments. However, the patient

should still be dentally motivated and

caries and periodontal disease should be

under control beore embarking on xed

prosthodontics. In addition, managing

expectations with regard to aesthetic out-come and longevity should be considered

an important part o treatment planning.13

I expectations are unrealistic, patient sat-

isaction with the nal result is likely to

be low.

ii) Abutment tooth selection

When selecting abutment teeth, investi-

gations should be carried out to ensure

endodontic and periodontal health.

Periodontal support should be assessed

considering bone levels and root congu-

ration. Although a history o periodontal

disease and reduced bone support does

not exclude bridgework (Fig. 1), the use

o abutments with active periodontal dis-

ease should be avoided as increased unc-

tional loading may increase the rate o

periodontal destruction.14

Coronally, there should be sucient

enamel available or bonding. The denti-

tions o hypodontia patients are requently

associated with a degree o microdontia

reducing the amount o tooth structure

available. Surace area may also be com-

promised i teeth are restored or where

there has been signicant tooth wear.

Additionally, the alignment or angulation

o teeth may aect the degree to which a

retainer can be extended. Crowding may

reduce access and rotations may mean that

ull wraparound is dicult to achieve. An

unconventional approach may be neces-

sary, or example in Figure 1, where a

buccal retaining wing has been used on a

lingually tilted molar in an eort to avoid

the undercut lingual area that proved di-

cult to access.

I periodontal support and coronal con-

dition are avourable, any teeth, including

retained deciduous teeth,15 can act as abut-

ments over an appropriate span. Deciduous

molars can make particularly good abut-

ments as they are multirooted and have a

large coronal surace area which allows

ull extension o the retainer wing. The

roots o retained deciduous teeth are likely

to have undergone some resorption and

have reduced length however, they may

also be ankylosed and so are well placed

to act as abutments.

iii) Occlusal features

When planning or RBBs, a detailed assess-

ment o both static and dynamic occlusal

relationships is crucial to optimise success.

A wax up on articulated casts gives a valu-

able view rom the palatal aspect aiding

the assessment o the amount o interoc-

clusal space available or the retainer

wings and pontics.13 It is important that

the pontic is not involved in guidance dur-

ing mandibular excursive movements.16 I

this is unachievable, guidance should be

shared with other natural teeth.

I there is insucient space or an aes-

thetic pontic, adjustment o opposing teeth

could be considered. Alternatively space

Fig. 1 a) Older patient with a history o successully treated periodontal disease anddissatisaction with partial denture. b) Remaining teeth lingually tilted with increasedmobility. c) Provision o multiple (5) cantilever RBBs mimicking root exposure and staining onatural teeth. d) Note novel bucco-occlusal retaining wing used on lingually tilted molar tooth

Fig. 2 Hypodontia case demonstrating two cantilever RBBs to replace UL 3 and ULE. Note the extent o coverage o metal retainers,characterisation o porcelain work and ovate style pontic to achieve good aesthetics

a

c d

b

114 BRITISH DENTAL JOURNAL VOLUME 211 NO. 3 AUG 13 2011


3/6

PRACTICE

be maintained separately to restorative

treatment, either with removable ortho-

dontic retainers or orthodontic bonded

wire retainers. I a xed-xed design is

required, contact in excursive movements

and intercuspation should be on the

retainer only.19

i) Retainer wing coverage

The surace area covered by an RBB retainer

has been shown to aect retention. It is

accepted that 180 wraparound retainers

constitute the ideal design, but this must

be balanced with the demand or aesthet-

ics. Retainers on posterior teeth may be

extended to include coverage o the palatal

and lingual cusps and a proportion o the

occlusal surace (Fig. 2) to increase the sur-ace area and improve retention. I neces-

sary, the surace area or bonding can be

maximised by crown lengthening, either

with conventional periodontal faps or with

electrosurgery (Fig. 3). Electrosurgery is par-

ticularly relevant or young patients who

have short clinical crown heights, a substan-

tial proportion o whom present ollowing

orthodontics wearing retainers which can be

associated with gingival hyperplasia. I teeth

are restored, llings should be replaced with

resh composite restorations, which will

bond more avourably to the resin cement

enhancing retention o the bridge.26

ii) Technical features

Any fexing o the metal bridge retainer

exerts stress on the cement lute that

eventually leads to atigue ailure.27 Base

metal alloys are highly rigid and thereore

can be used in thin section without risk

o fexing, making them ideally suited or

use in RBB retainers. In vitro research hasshown that base metal retainers o less

than 0.7 mm thickness have less resistance

to dislodgement28 and thereore 0.7 mm

as a minimum dimension should be stipu-

lated in the technical prescription. Where

there is insucient interocclusal space to

accommodate a retainer o this thickness,

teeth can be reduced to create space or the

bridge can be cemented high as previously

described.17,18 Clinicians should veriy

adequate thickness o the metal retainer

beore cementation to ensure sucient

rigidity, or example using an Iwansson

crown gauge (UnoDent Ltd, Witham,

Essex, UK).

A locating tag or seating lug should be

extended over the incisal edge o anterior

teeth (Fig. 4) to help to locate the retainer

may be gained with localised anterior

composite build ups to adjust guidance

patterns or by cementing the restoration

at an increased OVD on the retainer.17

With both o these options the occlusion

would then be allowed to re-establish over

a period o months through passive erup-

tion.18 Cementing restorations high does

not appear to increase the risk o abut-

ment teeth proclining or the restoration

debonding,19 however, the authors suggest

that this technique should be used to make

only modest and controlled changes to

the occlusion.

Paraunctional orces increase the likeli-

hood o restoration ailure, especially where

the occlusion has not been accounted or.

Any habits should be identied during theassessment phase and the patient should

be counselled to avoid habits like nail and

pen biting. Where bruxism is suspected the

prescription o a night guard or occlusal

splint should be considered.2

Bridge design

It has been widely reported that RBBs

are more successul as cantilevers than

as xed-xed restorations.20-23 Despite

this evidence a high number o dentists

continue to use xed-xed designs and

double abutments.8

Resin bonded bridges with multiple abut-

ments are more likely to debond due to the

dierential movement o abutment teeth,

especially where occlusal contact involves

the natural tooth surace. In these cases

occlusal orce leads to the tooth and the

retainer being driven apart causing ailure

o the cement lute.19 Where two abutment

teeth have been used it is unlikely that

both retainers will debond simultaneously.

When only one retainer ails, the bridge

is likely to remain in situ promoting the

development o caries beneath the ailed

retainer.20,21,24

There are, however, some situations in

which a xed-xed design may be the

most appropriate. These include large

pontic spans and where abutment teeth

are small and sucient surace area or

retention can only be gained by using one

abutment at either end o the span. It has

also been suggested that xed-xed RBBscan provide a orm o orthodontic reten-

tion, particularly where teeth have been

de-rotated.25 However, it is the view o the

authors that orthodontic retention should

Fig. 3 Upper central incisor ollowinglengthening o clinical crown height usingelectrosurgery

Fig. 4 Extension o retainer wing into existing palatal access cavity to improve resistanceand retention orm. Also note incisal seating lug



4/6

PRACTICE

correctly and resist cervical displacement

o the retainer during cementation. It can

be removed with a bur ater cementation

and the metal polished as needed.

iii) Aesthetics

The aesthetics o a RBB are determined by

the retainer wing, the porcelain work and

how the sot tissues are managed. Metal

connectors may shine-through translucent

incisors causing them to appear grey and

in act Djemal et al.19 reported that the

metal o the retainer was the most com-

mon reason or patient dissatisaction with

their RBB.

Greying can be reduced to a degree

by the use o opaque cement and careul

retainer design, avoiding extending themetal to within 2 mm o the incisal edge,

where the enamel becomes relatively more

translucent. In cases where the retainer

cannot be disguised by opaque cements, it

may be necessary to reconsider the choice

o abutment tooth or place composite labi-

ally as a veneer.

The shade o the porcelain should be

conveyed to the technician by means o

a shade map, which can include details

o characterisation eatures i appropriate

(Fig. 2). The shade should be taken in natu-

ral light at the beginning o the appoint-

ment when the teeth are hydrated. A good

quality digital photograph with the chosen

shade tab in situ can be a valuable aid or

the technician.

iv) Pontic design

Several alternatives or pontic design have

been described based on the pontic-ridge

relationship. The most commonly used

o these is the modied ridge lap pontic,

which allows reasonable aesthetics and

acilitates hygiene. In aesthetically criti-

cal areas, the authors preerred alterna-

tive to this is the ovate pontic, which has

a convex prole to the sot tissue tting

surace helping to create a good emergence

prole (Fig. 2). When designing the pontic,

it is important to relate the gingival level

to that o the adjacent natural teeth.

Clinical techniques

i) Need for tooth preparation

The need or tooth preparation or RBBs is

a subject o debate. Previous research used

more extensive preparations to enhance

retention,29 however, most authorities now

advocate minimal preparation, within

enamel,30 or no preparation at all.17,19

Vertical grooves are the particular ea-

ture which has been identied as reducing

stresses on the cement bond31 and increas-

ing resistance to debonding orces.29,32

However, preparation involves irrevers-

ible damage to abutment teeth or what

is reported to be only a limited benet,19

and even when minimal preparation is

intended, dentine exposure is likely during

preparation.24 Bond strength to dentine is

lower than that that can be achieved to

enamel which may aect bridge retention.

Additionally dentine exposure increases

the chance o sensitivity between appoint-

ments and the risk o caries i the area is

not sealed adequately at cementation.

A situation in which more extensive

preparation can be justied is when teeth

are restored. Preparation may be devel-

oped into restorations to produce longi-

tudinal grooves, occlusal rests and boxes

on posterior teeth, and into access cavity

restoration on anterior teeth. This helps to

promote axial loading and creates resist-

ance orm (Fig. 4).

ii) Cementation

Developments in resin cements have

helped to increase restoration longevity.

Early composite resin materials exhibited

degradation and reduced bond strength

with time. In contrast, Panavia (Karrary

Co. Ltd, Osaka, Japan) demonstrates pro-

longed high bond strengths. This is due

to ormation o a chemical bond between

the phosphate group o the cement mon-

omer and the oxide layer o the metal

retainer. Sandblasting to create micro-

mechanical interlocking should be car-

ried out beore cementation to urther

enhance retention.

RBB cementation requires an uncontam-

inated, etched and primed enamel or den-

tine surace to generate maximum bond

strengths. In vitro research has shown

that achieving uniorm and ideal etching

o enamel suraces is variable, especially

on lingual suraces o lower posterior

teeth where moisture control is dicult.33

Audenino et al.34 ound that the use o rub-

ber dam during cementation reduced the

risk o the restoration debonding; however,

in contrast, Marinello et al.35 reported the

isolation method used had no signicant

eect on bridge outcome. It is the experi-

ence o the authors that, i patients are

compliant, adequate moisture control can

be achieved in the upper anterior region

using the cotton wool rolls and saliva ejec-tors. Elsewhere in the mouth rubber dam

is advisable and a split dam technique

can be utilised to acilitate seating o

the restoration.

Fig. 5 a) Young patient presenting with developmentally missing lateral incisors. Note thecentral incisors are barrel shaped and the canines diminutive. b) Ridge preparation at thepontic site, note the central incisors and canines have been built up using composite resinto improve dimensions. c) Resin bonded bridges in situ replacing the lateral incisors. d) Theemergence profle created ollowing ridge preparation and use o an ovate pontic gives apleasing aesthetic result

a

c

b

d



5/6

PRACTICE

I a bridge debonds there are two

options: remake or recement. I a one

o event such as trauma has resulted in

decementation, recementing the restora-

tion may well be appropriate. However,

studies have shown that once a bridge has

debonded it is more likely to ail again39

and recementing or a second time is gen-

erally ill advised as replacing the bridge

has been ound to have a higher success

rate.35,39 This is probably because in the

majority o ailed cases, there is an inher-

ent problem with bridge design which mayhave been present at initial cementation

and/or developed since. With this in mind,

the restoration itsel should be examined

and the patient should be reassessed rom

iii) Ridge preparation

A disadvantage o all bridgework is its

inability to replace sot tissue. In cases

with vertical ridge deects, pink porce-

lain36 or composite may be used to rep-

licate the gingival margins. However, the

amount o sot tissue this can replace is

limited as the restoration becomes bulky

and compromises oral hygiene. Matching

gingival shade and characterisation is

also challenging.

When there is adequate ridge height,

sot tissue management aims to create a

realistic emergence prole and interden-

tal papilla. This can be done clinically by

dening the pontic site with a high speed

bur or electrosurgery37 immediately beore

impression taking (Fig. 5). Alternatively,the master cast may be relieved in the lab

and the sot tissues adjusted at t. I the

clinician is unable to alter the cast them-

selves, the depth o relie required (taking

in to account the compressibility o the

tissues clinically at the pontic site), should

be conveyed to the technician.

Where electrosurgery has been carried

out and the patient is wearing a RPD, this

can be relined to help to maintain the gin-

gival contour between appointments. I

there is any relapse, electrosurgery can be

repeated or the pontic modied at bridge t.

DEALING WITH FAILURE

Biological reasons or ailure include car-

ies and periodontal disease but these occur

relatively rarely.4 To prevent complications

oral health education, encompassing oral

hygiene instruction and advice regard-

ing diet and the use o fuoride, should be

provided at the treatment planning stage

and nalised ollowing bridge cementa-

tion. Where a xed-xed design has been

used, patients should be warned o the risk

o one retainer debonding and to report

this immediately i they eel that the bridge

is loose.

The most common technical reason

or RBB ailure is debonding.5 Although

authors have reported that debonding does

not appear to aect patient satisaction19,38

and there is usually limited damage to

abutment teeth, it is an inconvenience.

Other technical problems which maynecessitate remake o the bridge include

structural damage and shade match dete-

rioration which can be a result o natural

tooth discoloration or porcelain changes.

an occlusal perspective: have they devel-

oped a new paraunctional habit or has the

occlusion changed in ICP or lateral excur-

sion as a result o restoration or tooth wear

o adjacent or opposing teeth?

I the decision is made to recement

a RBB, the metal retainer should be air

abraded and any cement residue removed

careully rom the tooth beore attempting

this. Where the restoration is cantilevered,

recementation is usually straightorward.

Where there is a xed-xed design and

only one side is loose, attempts can bemade to remove the retainer that is still

in place with the help o an ultrasonic

scaler. Alternatively, depending on the

length o span, the debonded retainer can

Table 1 Factors related to success o resin bonded bridges

Case selection

Patient selection: are they motivated/compliant?

Does the space need to be restored? What options are there or restoration? Abutment tooth quality: is the tooth periapically and periodontally healthy? Is there periodontal

support adequate? Is there sufcient enamel surace area or bonding and how translucent is

the enamel?

Tooth position: is spacing and alignment o natural teeth avourable? How large is the pontic

span and will the abutment(s) support this span length?

Occlusal assessment: is there sufcient space or a pontic o the right shape and size and the

retainer, or does this need to be created?

Paraunctional habits: are there any habits that can be eliminated or do they need to be

managed as part o the treatment plan?

Expectations: has enough inormation been provided? Are the patients expectations realistic

with regard to aesthetics and longevity?

Bridge design

Retainer o 0.7 mm thickness

Full retainer extension as allowed by aesthetic demands

Minimal ICP contact

Careul management o excursive contacts to avoid undue orces on pontic

Use o an ovate pontic were aesthetics are important

Clinical techniques

Replace existing restorations with composite

Ensure adequate clinical crown height or crown lengthen to increase bonding area i necessary

Create space or the restoration: opposing tooth adjustment, preparation of abutment tooth orcement at increased OVD

Preparation: for unrestored teeth use minimal preparation, on restored teeth, extend preparations

into restorations to increase resistance form

Assess shade accounting or opaque cement and possible grey shine through o retainer wing

Prepare the pontic site to improve gingival profle when needed or aesthetics

Excellent moisture control during cementation and use o a resin cement with a phosphate

monomer eg Panavia

Protect the fnal result: provide a night guard or orthodontic retention if required



6/6

PRACTICE

be sectioned and the bridge let in situ as

a cantilever.2

CONCLUSION

Resin bonded bridges can be highly eec-

tive in replacing missing teeth, restoring

oral unction and aesthetics and result in

high levels o patient satisaction. They

represent a minimally invasive, cost eec-

tive and long lasting treatment modality.

Given thorough patient assessment and the

use o careul clinical techniques (Table 1),

the authors suggest that RBBs should be

considered more requently as the restora-

tion o choice or short spans.

The authors are very grateful for the excellentstandard of technical support provided byMr Kevin Wilson, Senior Dental Technician,

Leeds Dental Institute

1. Howe D F, Denehy G E. Anterior xed partial den-tures utilizing the acid-etch technique and a castmetal ramework. J Prosthet Dent1977; 37: 2831.

2. St George G, Hemmings K, Patel K. Resin-retainedbridges re-visited. Part 1. History and indications.Prim Dent Care2002; 9: 8791.

3. Edelho D, Sorensen J A. Tooth structure removalassociated with various preparation designs oranterior teeth. J Prosthet Dent2002; 87: 503509.

4. Pjetursson B E, Tan W C, Tan K, Bragger U, ZwahlenM, Lang N P. A systematic review o the survivaland complication rates o resin-bonded bridgesater an observation period o at least 5 years. ClinOral Implants Res2008; 19: 131141.

5. Pjetursson B E, Bragger U, Lang N P, Zwahlen M.Comparison o survival and complication rates otooth-supported xed dental prostheses (FDPs) andimplant-supported FDPs and single crowns (SCs).Clin Oral Implants Res2007; 18 Suppl 3: 97113.

6. Jung R E, Pjetursson B E, Glauser R, Zembic A,Zwahlen M, Lang N P. A systematic review o the5-year survival and complication rates o implant-supported single crowns. Clin Oral Implants Res2008; 19: 119130.

7. Hussey D L, Wilson N H. The provision o resin-bonded bridgework within the General DentalServices 19871997. Prim Dent Care1999; 6: 2124.

8. Patsiatzi E, Grey N J. An investigation o aspects o

design o resin-bonded bridges in general dentalpractice and hospital services. Prim Dent Care2004;11: 8789.

9. Jepson N J, Moynihan P J, Kelly P J, Watson G W,Thomason J M. Caries incidence ollowing restorationo shortened lower dental arches in a randomizedcontrolled trial. Br Dent J2001; 191: 140144.

10. Knoernschild K L, Campbell S D. Periodontal tissue

responses ater insertion o articial crowns andxed partial dentures. J Prosthet Dent2000;84: 492498.

11. Rashid S A, Al-Wahadni A M, Hussey D L. Theperiodontal response to cantilevered resin-bondedbridgework. J Oral Rehabil1999; 26: 912917.

12. Verzijden C W, Creugers N H, vant Ho M A.Treatment times or posterior resin-bonded bridges.Community Dent Oral Epidemiol1990; 18: 304308.

13. Tredwin C J, Setchell D J, George G S, Weisbloom M.Resin-retained bridges as predictable and success-ul restorations. Alpha Omegan 2007; 100: 8996.

14. Lindhe J, Svanberg G. Infuence o trauma romocclusion on progression o experimental peri-odontitis in the beagle dog. J Clin Periodontol1974;1: 314.

15. Robinson S, Chan M F. New teeth rom old: treat-ment options or retained primary teeth. Br Dent J

2009; 207: 31520.16. Briggs P, Dunne S, Bishop K. The single unit, single

retainer, cantilever resin-bonded bridge. Br Dent J1996; 181: 373379.

17. Ibbetson R. Clinical considerations or adhesivebridgework. Dent Update2004; 31: 254256, 258,260 passim.

18. Poyser N J, Porter R W, Briggs P F, Chana H S,Kelleher M G. The Dahl Concept: past, present anduture. Br Dent J2005; 198: 669676.

19. Djemal S, Setchell D, King P, Wickens J. Long-termsurvival characteristics o 832 resin-retainedbridges and splints provided in a post-graduateteaching hospital between 1978 and 1993. J OralRehabil1999; 26: 302320.

20. Chan A W, Barnes I E. A prospective study o can-tilever resin-bonded bridges: an initial report. AustDent J2000; 45: 3136.

21. Olin P S, Hill E M, Donahue J L. Clinical evaluationo resin-bonded bridges: a retrospective study.Quintessence Int1991; 22: 873877.

22. van Dalen A, Feilzer A J, Kleverlaan C J. A literaturereview o two-unit cantilevered FPDs. Int JProsthodont2004; 17: 281284.

23. Kern M. Clinical long-term survival o two-retainerand single-retainer all-ceramic resin-bonded xedpartial dentures. Quintessence Int2005; 36: 141147.

24. Bassi G S, Youngson C C. An in vitro study o dentinexposure during resin-bonded xed partial denturepreparation. Quintessence Int2004; 35: 541548.

25. Garnett M J, Wassell R W, Jepson N J, Nohl F S.Survival o resin-bonded bridgework providedor post-orthodontic hypodontia patients withmissing maxillary lateral incisors. Br Dent J2006;201: 527534.

26. Walls A W, Nohl F S, Wassell R W. Crowns and otherextra-coronal restorations: resin-bonded metal res-torations. Br Dent J2002; 193: 135-135, 141142.

27. Northeast S E, van Noort R, Shaglou A S. Tensilepeel ailure o resin-bonded Ni/Cr beams: an experi-mental and nite element study. J Dent1994;22: 252256.

28. Ibrahim A A, Byrne D, Hussey D L, Claey N. Bondstrengths o maxillary anterior base metal resin-bonded retainers with dierent thicknesses.J Prosthet Dent1997; 78: 281285.

29. De Kanter R J, Creugers N H, Verzijden C W, VantHo M A. A ve-year multipractice clinical study onposterior resin-bonded bridges. J Dent Res1998;77: 609614.

30. Botelho M. Design principles or cantilevered resin-bonded xed partial dentures. Quintessence Int2000; 31: 613619.

31. Ziada H M, Orr J F, Benington I C. Photoelastic stressanalysis in perorated (Rochette) resin bondedbridge design. J Oral Rehabil2000; 27: 387393.

32. Creugers N H, de Kanter R J, Verzijden C W, vantHo M A. [Five year survival o posterior adhesivebridges. Infuence o bonding systems and toothpreparation]. Ned Tijdschr Tandheelkd1999;106: 250253.

33. Hobson R S, Crotty T, Thomason J M, Jepson N J. Aquantitative study o enamel acid etch patterns onsuraces used or retention o resin-bonded xedprostheses. Eur J Prosthodont Restor Dent2005;13: 123128.

34. Audenino G, Giannella G, Morello G M, CeccarelliM, Carossa S, Bassi F. Resin-bonded xed partialdentures: ten-year ollow-up. Int J Prosthodont2006; 19: 2223.

35. Marinello C P, Kerschbaum T, Heinenberg Bet al.Experiences with resin-bonded bridges and splints -a retrospective study. J Oral Rehabil1987;

14: 251260.36. Alani A, Maglad A, Nohl F. The prosthetic manage-ment o gingival aesthetics. Br Dent J2011;210: 6369.

37. Elder A R, Djemal S. Electrosurgery: a techniqueor achieving aesthetic and retentive resin-bondedbridges. Dent Update2008; 35: 371-374, 376.

38. Creugers N H, De Kanter R J. Patients satisactionin two long-term clinical studies on resin-bondedbridges. J Oral Rehabil2000; 27: 602607.

39. Creugers N H, Kayser A F. An analysis o multipleailures o resin-bonded bridges. J Dent1992;20: 348351.


bdj_2011resin bonded bridges techniques for success

Documents