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Resin Bonded Bridges: From Crust to the Core – A Review Article

Shraddha Ramteke1, Seema Sathe2, S.R. Godbole3, Ankita Rawat1

retainer to enamel using adhesive resin. His application was

ABSTRACT to splint periodontally involved mandibular anterior teeth us-
For more than 30 years resin bonded bridges have proved to ing a cast gold bar bonded to the lingual surfaces of the teeth.
be one of the best treatment option for restoration of anterior The cast metal splint described had perforations to provide
teeth in most of the cases. During this period there has been mechanical interlocking between the cement and the met-
a lot of research, modifications and advancement in this field al. His introductory article made reference to modifying the
to increase the success rate of resin bonded prosthesis and de- technique for application as an RBFPD.
crease its failure rate. The dentists are turning towards more Howe and Denehy modified this application to introduce the
cost and time effective management of cases and resin bonded
first form of RBFPD. Their design recommendation was:
bridges considerably satisfy these needs. This review article
therefore includes the history and evolution of the resin bond-
1) extending framework to cover maximum area of lingual
ed fixed dental prosthesis (RBFDP), the type of RBFDP, and surface,
the design variations in the resin bonded bridges. 2) little or no tooth preparation, and
3) limitation to mandibular teeth or teeth with minimal oc-
Keyword: Resin bonded prosthesis clusal contact.2
Livaditis proposed abutment preparation, including reduc-
tion of proximal and lingual surfaces to create a path of
INTRODUCTION insertion, along with occlusal rest seat preparation to resist
tissueward displacement of the retainer. These modifications
There are several treatment dilemmas where convention-
enhanced the retention and resistance forms of the metal re-
al fixed or removable prosthesis do not appear completely
tainer to the tooth.
satisfactory. In the adolescent, many factors influence the
prosthetic therapy, tooth development, occlusal development Virginia Bridge
and esthetics. It should preserve tooth structure and should It was first developed at Virginia Commonwealth University,
not limit the future treatment options in adulthood. Tissue School of Dentistry by Moon and Hudgins in 1984. It has a
supported acrylic removable partial dentures have some dis- macroscopic mechanical means of retention.
advantages, particularly soft tissue and periodontal inflam- Fabrication: It is fabricated with the help of a Lost salt crys-
mation. Fixed prosthesis also has a certain amount of failure tal technique. In this technique specialized salt crystals 150
rate due to insufficient crown length, also in young teeth that – 250 u, are sprinkled within the outlines of the retainer leav-
possess large pulp chambers tooth preparation becomes dif- ing a 0.5mm border without crysatals on the periphery on a
ficult. Therefore, a resin bonded fixed dental prosthesis is a working cast, over which the pattern ia adapted. During its
suitable treatment option. fabrication, the salt is dissolved from the pattern giving a
Resin bonded or resin retained bridges are minimally inva- rough surface for resin tag formation.
sive fixed dental prosthesis which rely on composite resin
cements for retention. First described in 1970s, the resin Maryland Bridge
bonded bridges have evolved significantly. This article re- Maryland bridges are resin bonded bridge using electrolytic
views the types of resin bonded bridges, their applications, etching of metal to retain the metal framework. Thompson
and clinical considerations. and Livaditis in 1983 developed a technique of electrolytic
etching of Ni-Cr and Co-Cr alloy.3
EVOLUTIONARY CHANGES IN RESIN Advantages of etched cast retainers over cast perforated re-
BONDED BRIDGES tainers:
1) Improved retention; resin to etched metal bond is strong-
Bonded pontic
These are the earliest resin bonded prosthesis, introduced by
Ibsen and Portnoy in 1973. Extracted/ natural or acrylic teeth
1
Student, 2Professor, 3Professor and Head, Department of Prostho-
were used as pontics. These are bonded directly to the etched dontics, Sharad Pawar Dental College, Sawangi(Meghe), Wardha,
enamel. Composite resin connectors are used reinforced with Maharashtra, India
wire or stainless steel mesh framework. These are limited to Corresponding author: Dr. Shraddha Ramteke, "Pratibha", 52,
short anterior spans.1 Jansewa Housing Society, New Subhedar Layout, Hudkeshwar
The drawback of this type of prosthesis is degradation of Road, Nagpur, 440024, India
composite resin bond and subsequent fracture. Hence should
be given as short term or provisional replacement. How to cite this article: Shraddha Ramteke, Seema Sathe, S.R.
Godbole, Ankita Rawat. Resin bonded bridges: from crust to the
Rochette bridge core – a review article. International Journal of Contemporary Med-
Rochette in 1973, introduced the concept of bonding a metal ical Research 2016;3(2):503-506.

International Journal of Contemporary Medical Research 503

ISSN (Online): 2393-915X; (Print): 2454-7379 Volume 3 | Issue 2 | February 2016
Ramteke et al. Resin Bonded Bridges: From Crust to the Core

er than resin to etched enamel. The resin to alloy ten- of the wings, the Drake Precision Laboratory has developed
sile bond strength was determined to be greater than 20 a proprietary process for coating them with porcelain, etch-
MPa (2900 psi), while the accepted resin to acid etched ing the porcelain, and bonding the porcelain surface to the
enamel bond is approximately 8-10 MPa (1160-1450 teeth with composite, veneer cement, or a composite-based
psi). luting system.5
2) Oral surface of cast retainers is highly polished which Carolina Bridge6: Developed at university of North Caroli-
resists plaque accumulation. na, it is also a tooth colored version of maryland bridge. It
But etching is alloy specific. Only non-precious alloy which is an all-pocelain bonded pontic that is used as an interim
can be etched is used. Precious alloys cannot be etched. Mi- prosthesis. Uses little or no tooth preparation at all.
cromechanical retention in noble alloys is achieved by elec-
trolytic tin plating. Adhesive Bridge
Other means of micromechanical etching are Sand blast- As a result of extensive research chemically active adhesive
ing 50-250 u Aluminium oxide. Chemical etching can cements were developed for direct bonding to metal. Devel-
be achieved by Hydrofluoric Acid gel and Aqua Regia oped in early 1990s, these cements rely on chemical adhe-
Gel.3 sion to the metal and not on microretention in the surface of
Electrolytic etching: The procedure can be outlined as fol- the metal for bond strength. Etching was no longer neces-
lows: the polished bridge is mounted on an electrode (the sary. Adhesive bridge shows chemical bonding between the
metal and the resin luting agent.
electrode to the lingual of the retainers), electrical conti-
Metabond is first of these resin systems.1 It is based on for-
nuity is assured by use of a conductive paint at the contact
mulation of Methylmetha acrylate (MMA) polymer powder
point, and all areas not to be etched land the electrode are
and MMA liquid modified with adhesion promoter 4- META
then masked with sticky wax. The electrode and bridge are
(4-methacryloxyethyl trimellitate anhydride). Unique tribu-
mounted opposite a stainless steel electrode and immersed in
tyl borane catalyst is added to liquid. Superbond has highest
an appropriate acid. The bridge is made anodic and current
initial bond strengths of any adhesive resin systems. But,
passed at a given density for a prescribed time. The etching
it gives weak bond with high gold alloys. Introduction of
acid, its concentration, the current density, and etching time
Metabond was followed by Panavia which can be used both
must be carefully determined for a given alloy in order to get
with high gold and base metal alloy.1
maximum resin to alloy bond strengths. Use of the wrong
Design and tooth preparation: Based upon the work of
acid can result in electropolishing rather than etching. The
Livaditis the elements of design that are essential for suc-
conditions for etching a commonly used Ni-Cr alloy are:
cessful restorations have evolved. The following design ele-
10% sulfuric acid at a current density of 300 ments should be included in any posterior bridge.3
milliamperes per square centimeter of surface to be etched 1. Path of insertion: A distinct path of insertion must be cre-
for a period of 3 minutes followed by cleaning with 18% ated in an occlusogingival direction. This is accomplished by
hydrochloric acid in an ultrasonic bath for 15 minutes.3 parallel modification of proximal and lingual surfaces.
A stress-relieved resin bonded fixed partial denture: A mod- of the abutment teeth. The height of contour is lowered to
ification of the Maryland bridge is given by Sanford Plain- within one millimeter of the gingival margin where possible,
field, Vincent Wood and Ralph Podesta4, for stress relieving provided that such modification
that has been proved effective in preventing debonding of will not penetrate the enamel. Thus in some proximal areas,
the prosthesis during function. Their observation of failures due to the concavity created by the coronal narrowing in a
of resin bonded bridges indicated that there was a problem gingival direction, the height of
often with the mobility of the abutment teeth during function contour may only be lowered sufficient to provide occlu-
and not due to the bonding of the prosthesis. sogingival depth for the connector — generally a minimum
The design they proposed included the matrix(female) por- of 2 mm.3
tion of stress reliever within the pontic section of the pros- 2. Proximal resistance form: The alloy framework must ex-
thesis. The patrix(male) was attached to the abutment section tend buccally beyond the distobuccal and mesiobuccal line
to be bonded to the abutment tooth. They came up with the angles of the respective
term “The Golden Gate Bridge.”4 abutments. If esthetics are compromised by the buccal extent
The Procera Maryland Bridge5: The Procera Maryland of the alloy, then judicious modification of the buccal enamel
Bridge represents a further evolution of Livaditis’s initial allows the proximobuccal line
concept. The one-piece zirconia framework incorporates an angle to be moved lingually. The alloy only needs to extend
all-ceramic incisor just buccal to this line angle to establish the resistance form
pontic connecting two wings that are bonded (or cemented) and is easily hidden with proper contour of the buccal por-
to the lingual of the adjacent teeth. Preparation is restricted celain.3
to the lingual surfaces and the lingual 3. Occlusal rest: The rest should be small but well defined
aspect of the interproximal and is minimal, limited to 0.5 and not a broad
mm or less of the enamel layer. The framework is precision spoon shape similar to classic removable partial denture oc-
milled from a solid piece of zirconia. Zirconia cannot be ac- clusal rests. Usually a number 5 or 6 round bur is employed
id-etched. To further increase the bond strength capability and the rest created is 1-1.5 mm in the buccolingual direc-

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Volume 3 | Issue 2 | February 2016 ISSN (Online): 2393-915X; (Print): 2454-7379
Ramteke et al. Resin Bonded Bridges: From Crust to the Core

tion, 1-1.5 mm in the mesiodistal direction and 1 mm deep. where along the marginal ridge to remove it from an area of
The location of the rest is not critical and can be placed any- occlusal contact. When a distinct Cusp of Carabelli is pres-
ent, this can be modified to function as a rest.
Replacement of single missing tooth 4. Margins of the preparation: Enamel is removed gingival-
Young patients with large pulp chamber ly only to the extent
Periodontally compromised teeth that a knife-edge supragingival margin results. Thus the gin-
Sound or minimally restored abutments gival contour of the restoration should duplicate the enamel
Table-1: Indications for resin bonded bridges9,10 removed during preparation.
These fine margins are aided by the 0.3 mm minimum thick-
Long edentulous spans ness commonly employed for the lingual portion of the re-
Unfavourable occlusal scheme/ parafunctional habits tainer.3 There is no attempt made to create a chamfer margin
Heavily restored abutment teeth at the gingival; this only removes enamel unnecessarily.
Significant pontic width discrepancy The other features of tooth preparation as described by Vimal
Abnormal quality and quantity of enamel Arora, M.C. Sharma, Ravi Dwivedi7; in their study Compar-
Nickel sensitivity ative evaluation of retentive properties of acid etched resin
Table-2: Contraindications for resin bonded bridges9,10 bonded fixed partial dentures include:

Reduced cost
Supragingival margins
Minimal tooth preparation
Table-3: Advantages of resin bonded bridges10

Uncertain longevity
No space correction Figure-6: The Procera Maryland Bridge
No alignment correction
Difficult temporization
Table-4: Disadvantages of resin bonded bridges10

Figure-7: Carolina bridge

Figure-1: Bonded pontic; Figure-2: Rochette bridge

Figure-3: Virginia bridge; Figure-4: Maryland Bridge

Figure-8: Standard tooth preparation with wings and occlusal
rest; Tooth preparation with proximal slice; Tooth preparation with
wings, proximal slice and grooves; Tooth preparation with wings,
proximal slice,grooves and occlusal coverages

Figure-5: Three-piece “Golden Gate Bridge” Figure-9: Mary – lever prosthesis

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Ramteke et al. Resin Bonded Bridges: From Crust to the Core

Mary- lever Posthesis or hybrid resin bonded prosthesis

It was described by Venkat Aditya Sunki et al8 in 2013, in
this kind of prosthesis a combination of conventional fixed
dental prosthesis and resin bonded prosthesis.
It is given in cases where the edentulous span is long where
an ideal resin bonded prosthesis cannot be given.8

SUMMARY
The RBB requires less clinical time and, in most cases, is
less demanding to fit than all other forms of tooth replace-
ment. Failure is generally far less catastrophic than with
conventional bridges or implant retained prostheses. RBBs
can now be considered to be a minimally invasive, relatively
reversible, aesthetic and predictable restoration for prescrip-
tion in general dental practice.11

REFERENCES
1. Dr Sakshi Madhok, Dr Saksham Madhok; Evolutionary
changes in bridge designs; IOSR Journal of dental and
medical sciences.2014;13.
2. Rosenstiel, Land, Fujimoto; Contemporary fixed Prost-
hodontics; 4th Edition.
3. Van P.Thompson, Gus J. Livaditis; Etched castind acid
etch composite bonded posterior bridges; journal of
Pediatric dentistry. 1982;4:38-43.
4. Sanford Plainfield, Vincent wood, Ralph Podesta; A
stress relieved resin – bonded fixed partial denture;
Journal of Prosthetic dentistry. 1989;6661;291-293.
5. Larry R Holt, Billy Drake; The Procera Maryland
Bridge: A case Report; Journal of Esthetic Dentistry Re-
storative Dentistry. 2008;20;165-173.
6. Heymann HO; The Carolina Bridge: a novel interim
all-porcelain bonded prosthesis; J Esthet Restor Dent.
2006;18;81-92.
7. Lt Gen Vimal Arora, Col M.C. Sharma, Ravi Dwivedi;
Comparative evaluation of retentive properties of acid
etched resin bonded fixed partial dentures; Medical
Journal Armed Forces India. 70;2014;53-57.
8. Venkat Aditya sunki, Krishna mohan Reddy, CH Vamsi
Krishna, Nidhi Gupta; Esthetic replacement of maxil-
lary lateral incisor with mary-lever prosthesis: A novel
conservative approach; Journal of Orofacial Research
2013.
9. Dr Una Lally; Resin – bonded fixed partial dentures past
and present – an overview; Journal of the Irish Dental
association. 2012;58;294-300.
10. Alok Kumar, Deshraj Jain, Ravi Madan, Laxman Sin-
gh; Resin bonded Maryland Bridge; Journal of dental
sciences and oral rehabilation, Bareilly, 201;63-65.
11. Dr Mahesh Verma, Dr Pooja Kumari, Dr. Ankur Gup-
ta, Dr. Charu Gupta; Resin Bonded bridges – An Over-
view; International Journal of Research in dentistry.
2014;4:26-31.

Source of Support: Nil; Conflict of Interest: None

Submitted: 30-12-2015; Published online: 20-01-2016

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International Journal of Contemporary Medical Research
Volume 3 | Issue 2 | February 2016 ISSN (Online): 2393-915X; (Print): 2454-7379