Kristine Aadland I love to use Maryland bridges as long term temporary solutions. Especially when kids are getting out of ortho and not quite ready for implants. The most difficult part is typically the connector for these types of cases. A great tip I just got at CERECdoctors.com to help with this is to design the Maryland Bridge with the connector as an intersection, get the connector to about a 3, and then go back to admin phase and switch it to anatomic. This will help bump up the connector automatically to the needed size without the ridges that anatomic normally gives (I believe it is called the Fleming technique ;)). It was a great tip that helped speed up design. That is just one more reason why I love this group. Even coming to the courses to mentor, we can always get great tips!
Here are a few examples of some fun Maryland Bridge cases with kiddos. These can be done with the wing on the facial or the lingual and there are examples of both. This is dependant on the bite. What material I use is dependant on the amount of time and the amount of characterization that is needed. If the restoration needs to last less than a year, and I don't need to prep anything, then I love using GC Cerasmart. If the restoration needs to last several years, I have personally found that e.max tends to last longer. I do warn my patients and parents that these can fall off. It doesn't happen very often, but when it does it is only at the most in-opportune times. The good news, it's very easy to recement it and typically there is no damage done. They still love this solution much more than a flipper.
1. This is an interdisciplinary case with my orthodontist and periodontist. Her centrals were hopeless due to trauma but placing two implants next to each other can be really difficult to restore. We extracted #9, moved #10 into the #9 space and are holding on to #8 as long as we can until she is ready for implants (hopefully). She is 15 yrs old at this point.
2. Post ortho, a young man missing #9 due to trauma. He is 16yr old and still growing and could not stand having a flipper.
3. A young man congenitally missing #10 and also too young for an implant.
