Dear Dr. Hall,
My name is Rachel. I have had a Maryland Bridge (upper left premolar) for over 30 years. During the past 2 years it fell off a few times and was glued by our general dentist. These re-attachments were short lived and required a new attempt to reattach the fake tooth. The original Maryland Bridge was made and placed by UF faculty dentists when we were in Florida. Actually, my husband underwent the same procedure in two teeth and does not have any problem with his Maryland Bridges.
I am looking for an expert that will work with my current bridge, which looks to be in excellent condition, to attach it permanently in place. How can I find a dentist who will be able to do this?
– Rachel from Fort Worth, Texas
(See Dr. Hall’s answer below.)
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Rachel,
There is a tendency for some dentists to think that a Maryland bridge is a simple, easy way to replace a missing tooth. But I have had several emails from patients where the dentist simply couldn’t get the Maryland bridge to stay in. The teeth it rests on have to be prepared and the bridge has to be designed so that it will resist being dislodged. After that, there is a special bonding protocol that has to be followed. I wouldn’t call this bonding protocol “gluing.” It is much more sophisticated than that. If it is a Maryland bridge with metal wings, the metal has to be etched in order for it to hold, and there are special metal bonding agents, not normally used in composite bonding, that will help insure a strong bond.
In your case, the tooth preparation and design of the bridge must have been fine, because it stayed on for over 30 years. The problem in your case is an ignorance of the proper bonding protocol. Once it comes off, the wings should be thoroughly cleaned and re-etched. Then an appropriate bonding agent needs to be applied. Assuming that this is a true Maryland bridge with metal wings, for best results, I wouldn’t use ordinary composite bonding resins but a resin that is particularly made for bonding to metal, such as some of the products made by Panavia.
While metal bonding isn’t a requirement for being an accredited cosmetic dentist, an accredited dentist generally will have a better understanding of this bonding technology. So I would start by looking for a dentist accredited by the American Academy of Cosmetic Dentistry. Another option would be to check the doctor bio to see if the doctor has a strong history of continuing education, way beyond the minimum requirements of the dental board. Fellowship in the Academy of General Dentistry is granted to dentists who diligently pursue extensive post-graduate education.
Whether you find an accredited cosmetic dentist or not, I would start by asking if the dentist is familiar with Panavia metal-bonding resin. The staff person answering the phone will have to ask the dentist this. Don’t take a wishy-washy answer from a receptionist—insist that they get an answer from the dentist. Hopefully you will then have a dentist who knows the proper metal-bonding techniques.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
It can be made without clasps, as shown in this picture, or with a couple of metal clips over back teeth. Yes, I suppose the child could lose it, but you could buy several of these flippers for the cost of a Maryland bridge. And there is a strong motivation for the child not to want to be seen without their tooth.
Shaving the canines and even bonding to them or doing porcelain veneers would not look normal. Yes, it looks better than missing teeth, but as a cosmetic dentist, if a patient comes to me looking like this and wants the ideal solution, I would have them put in braces to move the canines back to their normal position and then use one of several methods to replace the lateral incisors.
teeth attached. It fits up on the palate and there are two wire clips, one on each side, that snap over the back teeth to hold it in. The cost should be pretty reasonable – maybe a couple hundred dollars, more or less. Here’s a photo of what that appliance would look like.