Maryland Bridges as long term temporary solutions
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.
I got a chance to see this last weekend in Charlotte at Level 3. Having the ability to use two ways to design the connectors is fantastic, and I'm looking forward to letting my referring GPs know about this choice.
Great Cases Kris,
Just did one these this morning. Patient is 19, and after having the conversation with ortho, mom, and patient, they decided that implant option was not on the table at this time. We decided to pursue a Maryland Bridge option as the occlusion was favorable. It is great to know this is an option and can always be removed and implant placed if they so choose.
Tom
Great cases Kris and Tom. Hey Tom, what was the obstacle to doing an implant? Cost? Did you do a lingual prep of the central? I'm wondering if a small Valplast flipper with two little wings might have been considered, occlusion and smile line permitting.
On 11/15/2018 at 12:40 pm, Eric Prouty said...Great cases Kris and Tom. Hey Tom, what was the obstacle to doing an implant? Cost? Did you do a lingual prep of the central? I'm wondering if a small Valplast flipper with two little wings might have been considered, occlusion and smile line permitting.
Patient and mom went to OS for consult. With grafting/healing/placement they didn't want to invest time or money at this time. So we talked about a more "permanent" option of a 1 wing maryland bridge. They decided this was good for them at this time. Told mom that if she decided to do ortho we can always cut off the wing. I actually just rough prepped #11, not 9. She had a generous amount of clearance there since her occlusion was near the cusp, as the bite was not a deep bite. She also had a staple behind 8/9 acting as a permanent retainer. We could have done a flipper if she was still considering implant therapy, but I'm assuming after cost of ortho they weren't ready? 
so who knows.
Great case and execution Kris! But I don't like how Tom has the hijack your thread although his case is nice too! =)
On 11/15/2018 at 1:20 pm, John Yu said...Great case and execution Kris! But I don't like how Tom has the hijack your thread although his case is nice too! =)
Kris and I worked it out :)
she told me to post it here. We thought we would try and dethrone Dan from being the king of Maryland Bridges. 
Great result Kris and great mention of the Flem technique for those who havent used the neat little trick.
Tom, nice contours as always.
The Anatomical connector trick is a great one that we were teaching in the old Level 5 inlab course many years ago. We now can start teaching this again in V4.6. Makes design a breeze!
Really great stuff Tom and Kris...I forgot to give Tom some love about his amazing dentistry.
So Tom and Kris want me to post a few cases so we have some examples of Maryland Bridges. None of these are perfect, but provided a nice, conservative solution for each patient. As an adjunct, if I do this as a long term temporary, I bill as a two unit bridge.
For the newer users, Sam, Mike and Flem do a great job training you on how to do this at the Workshops
