Maryland bridges consist of a porcelain or ceramic false tooth (pontic), which is bonded to a metal backing. This metal backing aside from the false tooth has (usually) two flanges, which are known as wings. These wings fit closely to the back of the abutment teeth that are adjacent to the gap, either the palatal or lingual surface depending in whether it is an upper or lower restoration. They are mostly used to fill the gap of one tooth as they rely entirely on bond strength to keep them in place.
Maryland bridges have the advantage of needing very little preparation of the abutment teeth. The only preparation done, in fact, is at the fitting stage of the procedure and this is purely to create good bond strength for the material which will hold the bridge in place, even then the tooth is not permanently damaged in anyway, therefore if the patient changes their mind about the restoration over time the procedure is reversible. These bridges are most commonly used on anterior teeth. Their biggest disadvantage is their lack of retention; therefore they are unsuitable for posterior teeth where the occlusal forces are great.
At a patients’ first appointment the dentist will ensure that teeth involved are clean and calculus free. They take impressions as they would when providing a crown, involving recording of teeth to be replaced, opposing teeth and the patients bite, where necessary a tooth shade is taken and noted. The impressions are then disinfected, appropriately bagged and are sent to a dental technician with a written prescription of work to be carried out.
Before the bridge is permanently fitted the dentist checks the fit and appearance of it, they also check that the patients occlusion is unaffected by the bridge with use of articulating paper, and make adjustments if necessary. To permanently fit a Maryland bridge the abutment teeth are prepared with acid etch (like when composite fillings are placed), and are sometimes sandblasted. A specific adhesive resin, such as Rely X, or Panavia Ex, is then placed on to the wings. Most of these adhesive resins are light cured. The bridge is then placed and the adhesive resin is set. The patients bite is then re-checked and adjusted if necessary. Dentists then provide oral hygiene instruction for care of the bridge and underlying gingiva.