Intracoronally implanted bridges fixed by glassionomers and composites. The fifteen years of experiences Martin Tvrdo ň Clinical consultant for dentistry Teaching Hospital and Policlinic Of Academician L.Derer, Bratislava, Slovakia
The methods of fixation of bridges by classic ret a iners /e.g. crowns/ used so far have been accompanied by certain disadvantages such as:
1.drastic reduction of tooth tisue by grinding off the whole surface of the abutments,
2.psychological stress and suffering of the patient,
4.destruction of the original natural shape of the tooth,
5. d irect contact of the crowns with cervical margins of gingiva.
Known s aving methods
The conventional methods are even more serious if only one tooth is missing and it is required to drill off /sacrifice???/ sound intact neighbouring teeth. There exist traditional ways to maintain and save the tooth tissue:
Metal inlays positioned on one side of the bridge only / this may cause aesthetic drawbacks as the inlays are usually made of gold
3.1. shorth longevity – the time of adhesion to the tooth surface /average-two and half years , 1982, at present the results of the retention are better aboat 6 years, adequate with the development of composites
3.2. the contact surface under metal plates is often affected by carious erosion
3.3. indication limited by unafavorable occlusion of anterior teeth
3.4. the indication is suitable only for intact - caries and filling-free
3.5 Maryland bridges / microchemical adhesion/ are more effective than
Rochette desing with the perforations (macromecanical adhesion)
Nevertheless, in our work we suggest a completely new solution ...
Materials and procedure
The proposed type of the bridge is suitable for small edentulous spaces after the loss one tooth. For this type of the bridge, light curing glassionomers and composites as adherents and chrome-cobalt alloys as basic materials have been used. The procedure suggested consist s of the following steps:
The fillings are removed from the abutments adjacent to the edentulous space.
In case of intact teeth,
it is not necessary to drill strict by
J..V.Black I. forms, but so called open central cavities to the gap, nevertheless, sufficient depth is required.
1. The linning glassionomer is placed on the base of cavity in thin layer . It should cover all basic surface and should not extend onto the enamel.
2. The impression of the prepared by silicone materials is taken together with occlusal registration and the impression of the opposing teeth
Metal framework of intracoronally anchored fixed-fixed bridge. It consits of the p ontic and thin plates with finger-like irregular margins /occlusal view/ for intracoronal fixation by glassionomers and composites.
The framework of the bridge is constructed on a stone model incorporating the cavities of the abutments
The definitive bridge completed with C +B resin, ceramic or ADORO material on master cast.
Note opaque resin applicated on the surface
Suitable case of
42-year-old female patient with fillings and missing 15.
... and fixed bridge in situ after...
Schematic design of intracoronally anchored fixed-fixed bridge
Occlusal view of intracoronally anchored fixed-fixed bridge
The aim of the present study
The aim of the present study is to evaluate
the effectiveness of intracoronally anchored fixed bridges in the period of the past fifteen years.
- The number of the manufactured fixed bridges / 15 years - 120
In average : 8 bridges / year
- The number of the followed patients: 80
- The rest of the patients – 40, lost from our evidence /change of residence, travel abroad, death etc./
- Failure rate : f rom 80 cases / 6 bridges were removed = 7,6%.
- The reason of the failure: 3 bridges with two pontics /fracture of the wall of cavities of abutments,
3 bridges – pulpitis acuta
These 6 bridges were reconstructed into bridges with conventional crowns
The advantages of the method are as follows:
the method is simple, technically not complicated
the bridges are esthetically far more satisfactory than conventional ones
the drastic reduction of tooth tissue necessary for the construction of most conventional retainers is avoided
a problem of contact with the cervical margin
of gingiva is none thus removing liability of gingival irritation
natural anatomical shape of the tooth crowns is maintained
6. the procedure is much more comfortable for both the patient and the dentist as well
bridges can utilize good fillings fillings which were placed into the teeth prior to our treatment
contrary to any conventional retainers of bridges, all metal or facet crowns, it is always possible to check on the state of the abutments
9. in case of any complication, it is far easier to remove the bridge.
Utilization of the bridges in anterior area of dental arch is possible but more delicate Larger, two pontics fixed bridge is not recommended
Carious anterior teeth
with missing 12
Anterior view of
framework of intracoronally anchored fixed bridge
on working cast
Palatal view of restored anterior teeth.
The patient was a wearer of the bridge
from 1992 until 2002
Detailed view of the situation on the master cast: