Single-unit cantilevered resin-bonded bridge: an alternative for maxillary lateral incisor replacement

Abstract

Fixed partial denture (FPD) prostheses restore esthetics and function by connecting and fixing to adjacent teeth. Conventional FPDs require, for better retention and resistance, extensive preparations. Those preparations include buccal, palatal or lingual coverage, proximal guide planes, chamfers and /or grooves to optimize retention.1–4 The removing of such large amount of tooth structure increases the risk of periodontal complications and pulp exposure.1,3 In 1973, Rochette introduced resin bonded FPDs as a less invasive therapeutic option. He pioneered the use of lingual perforated cast alloy framework with acid etch composite for periodontal splinting of the anterior region.5 However, early Rochette bridges presented high failure rates. Since then, resin bonded FPDs have evolved with different framework materials and designs. Even though metal frameworks are highly resistant, they do have esthetical and mechanical limits such as the greyish appearance of the abutment teeth and dislodgment by the early loss of retention.2–4,7 This led to introducing metal free FPDs, also widely developed thanks to adhesive dentistry. The preparation designs for RBFPDs were strictly limited to the enamel. Studies revealed a survival rate of 86% after 3 years without retentive preparation.6 All Ceramic RBFPDs have been introduced in the early nineties of the last century as a treatment option for missing incisors. Adhesive dentistry has undergone major transformations in current concepts. It has launched new resin bonded FPD designs that allowed to be more conservative such as single unit cantilevered ceramic bridges which become the most commonly used design when replacing lateral incisor especially when implant supported crowns cannot be indicated.8 Placing an implant is not always possible in cases where there is an insufficient bone height or width or for patients with general pathologies that may limit implant indications. That is why in some cases it is compulsory to indicate an FPD. Anterior ceramic RBFPDs showed promising results and high survival rates. They have proved to be viable and reliable alternative.8