Composite Prosthesis Research Articles

Fixed partial dentures in an up to 8-year follow-up

Information on the longevity of fiber-reinforced composite fixed partial dentures (inlay FPDs) should be considered in the selection of materials, operative techniques and patient instructions related to prognosis and long-term cost-effectiveness.ObjectiveThis study evaluated the long-term survival of fiber-reinforced, adhesively-bonded composite prostheses placed in posterior teeth.Material and Methods Twenty-one patients that received adhesively bonded polyethylene inlay FPDs in posterior teeth were selected from a private practice dental office and invited to evaluation. Of the eligible 21 patients, 13 (mean age 50.3 ±11.5 years) agreed to be enrolled as participants, providing 22 restorations, as several subjects presented more than one inlay FPD. One dentist placed all inlay FPDs using Ribbond as reinforcement and Tetric Ceram/Durafil or Charisma/Renamel composite combinations, according to manufacturer’s instructions. Two independent calibrated operators performed the evaluation, using modified USPHS criteria. Survival functions of restorations were analyzed with Kaplan-Meier and Log Rank test (α = 0.05).ResultsThe majority of restorations received A or B scores. Four (18.2%) inlay FPDs fractured among the 22 evaluated. The mean estimate survival rate was 7 years (95% CI: 5.9 to 8.1), and the overall percentage of survival was 81.8%. There were no significant differences (p>0.05) between composite combinations or tooth location considering all clinical aspects evaluated and survival functions.ConclusionPosterior fiber-reinforced fixed partial dentures exhibited acceptable clinical performance after a period up to 8 years.

Optimal design of customised hip prosthesis using fiber reinforced polymer composites

The need for new materials in orthopaedic surgery arises from the recognition of the stress-shielding effect of bone by high-modulus implants presently made of engineering alloys. A lower modulus implant material will result in the construction of a more biomechanically compatible prosthesis. In this respect, composite materials are gaining importance because they offer the potential for implants with tailor-made stiffness in contrast to metals. In the present study, the bending stiffness of composite prosthesis is matched with that of bone in both the longitudinal and radial directions by choosing optimal carbon fiber reinforced polyether ether ketone (PEEK) matrix lay-up. A numerical optimization algorithm is developed to deduce the optimal composite femoral prosthesis lay-up that matches the stiffness properties of the femoral bone in both the transverse and longitudinal directions. Effective bending moments and compressive forces acting on the hip joint are considered in the design of the optimal length and diameter of the prosthesis. The optimization algorithm was implemented, by using MATLAB(R)™ for designing the composite prosthesis to a patient’s specific requirement. Finally the efficiency of the composite stem is compared with that of metallic alloy stems in terms of stress shielding using a finite element program.

A fiber-reinforced composite prosthesis restoring a lateral midfacial defect: A clinical report

This clinical report describes the use of a glass fiber-reinforced composite (FRC) substructure to reinforce the silicone elastomer of a large facial prosthesis. The FRC substructure was shaped into a framework and embedded into the silicone elastomer to form a reinforced facial prosthesis. The prosthesis is designed to overcome the disadvantages associated with traditionally fabricated prostheses; namely, delamination of the silicone of the acrylic base, poor marginal adaptation over time, and poor simulation of facial expressions.

PERFORMANCE CHARACTERIZATION AND MODELING OF A COMPOSITE HIP PROSTHESIS

Summary Hip prostheses made from thick laminated composite material were cyclically tested under biaxial compressive loading. Fatigue damage was studied using X-ray radiography, a surface replication, and sectioning of the specimens. It has been shown that damage in the neck region occurred predominantly in form of matrix cracking along fiber directions in the major load-carrying plies. These matrix cracks initiated from the surface of the medial-posterior corner, as a result of local high compressive stress, extended to the lateral side, and distributed toward the anterior side, with an increase of applied cycles. We also briefly outlined a life-prediction model for predicting the remaining life and strength of the composite prosthesis based on a “critical element” concept, as well as how laboratory test results can be used in the model.

Repair of bone segment defects with surface porous fiber‐reinforced polymethyl methacrylate (PMMA) composite prosthesis: Histomorphometric incorporation model and characterization by SEM

Background and purpose Polymer technology has provided solutions for filling of bone defects in situations where there may be technical or biological complications with autografts, allografts, and metal prostheses. We present an experimental study on segmental bone defect reconstruction using a polymethylmethacrylate‐(PMMA‐) based bulk polymer implant prosthesis. We concentrated on osteoconductivity and surface characteristics.Material and methods A critical size segment defect of the rabbit tibia in 19 animals aged 18–24 weeks was reconstructed with a surface porous glass fiber‐reinforced (SPF) prosthesis made of polymethylmethacrylate (PMMA). The biomechanical properties of SPF implant material were previously adjusted technically to mimic the properties of normal cortical bone. A plain PMMA implant with no porosity or fiber reinforcement was used as a control. Radiology, histomorphometry, and scanning electron microscopy (SEM) were used for analysis of bone growth into the prosthesis during incorporation.Results The radiographic and histological incorporation model showed good host bone contact, and strong formation of new bone as double cortex. Histomorphometric evaluation showed that the bone contact index (BCI) at the posterior surface interface was higher with the SPF implant than for the control. The total appositional bone growth over the posterior surface (area %) was also stronger for the SPF implant than for controls.Both bone growth into the porous surface and the BCI results were related to the quality, coverage, and regularity of the microstructure of the porous surface.Interpretation Porous surface structure enhanced appositional bone growth onto the SPF implant. Under load‐bearing conditions the implant appears to function like an osteoconductive prosthesis, which enables direct mobilization and rapid return to full weight bearing.

Fiber-Reinforced Composite for Chairside Replacement of Anterior Teeth: A Case Report

A variety of therapeutic modalities, from implant to conventional Maryland prosthesis, can be used for the replacement of a missing anterior tooth. Whenever a minimal tooth reduction is preferred, a fiber reinforced composite (FRC) prosthesis could be a good alternative to conventional prosthetic techniques, chiefly as temporary restoration before making a final decision on the treatment. The purpose of this case report is to describe the clinical procedure of fabricating anterior chairside FRC prosthesis with pre-impregnated unidirectional E-glass fibers and veneered particulate filler composite. Fiber-reinforced composite in combination with adhesive technology appears to be a promising treatment option for replacing missing teeth. However, further and long-term clinical investigation will be required to provide additional information on the survival of directly-bonded anterior fixed prosthesis made with FRC systems.

Seguimiento del comportamiento peritoneal de diferentes biomateriales empleando laparoscopia secuencial. Aplicabilidad en la reparación de hernias ventrales

Despite the advantages offered by meshes, their use in abdominal wall repair can promote adhesions and damage the intra-abdominal viscera. This study was designed to assess the behavior at the peritoneal interface of several composite prostheses using sequential laparoscopy to monitor the real-time adhesion formation process. Three composite prostheses, Parietex Composite (n=8), Sepramesh (n=8) and PL-PU 99 (n=8), were used to repair 7 x 5 cm defects created in the abdominal wall of 24 New Zealand white rabbits. The area occupied by adhesions at 3, 7 and 14 days after prosthesis placement was established by tracing the adhesions onto a polyethylene template, using images obtained from sequential laparoscopy, and subjecting it to image analysis. At 14 days, the animals were sacrificed and specimens of the prostheses plus adjacent host tissue were obtained for histological and morphometric tests. Adhesion formation was laparoscopically observed to stabilize between 7 and 14 days post-implant, with no increase in adhesions produced at 14 days. The Parietex and PL-PU99 meshes showed significantly lower proportions of adhesions (0.55 +/- 0.06% and 0.27 +/- 0.20% respectively) than Sepramesh (18.55 +/- 1.96%). All three composites induced similar host tissue ingrowth and mesothelialization of the peritoneal prosthetic surface. a) The three prostheses tested showed optimal behavior at the peritoneal interface; b) the critical period when most adhesions form is the first week after implant; c) these biomaterials are suitable for use in laparoscopic ventral hernia repair.

Evaluation of a new composite prosthesis for the repair of abdominal wall defects

The degree of integration of biomaterials used in the repair of abdominal wall defects seems to depend upon the structure of the prosthesis. The present investigation evaluates the behaviour in terms of adhesion formation and integration of a new composite prosthesis that could be employed in this clinical application. Full-thickness abdominal wall defects (7 x 5 cm) were created in 16 anaesthetized New Zealand white rabbits and the prosthesis were placed in direct contact with the visceral peritoneum during the experiment. The defects were repaired with a composite prosthesis or pure polypropylene mesh to establish two study groups (n = 8 each). The composite device was constituted by a polypropylene mesh physically attached to a poly(ether)urethane-polydimethylsiloxane laminar sheet. Animals were sacrificed 7, 14, 21 and 30 days after implant and prosthesis/surrounding tissue specimens subjected to light and electron microscopy. Firm adhesions were detected in the polypropylene implants, while they were not present in the composite implants. The excellent behaviour of the composite prosthesis shown in this study warrants further investigation on its use for the repair of abdominal wall defects when a prosthetic device needs to be placed in contact with the intestinal loops.

Peritoneal Effects of Prosthetic Meshes Used to Repair Abdominal Wall Defects: Monitoring Adhesions by Sequential Laparoscopy

The prosthetic materials currently used to repair abdominal wall defects sometimes have to be placed in contact with the visceral peritoneum. This interface is often a site of complications such as intestinal obstruction or fistulas due to adhesions. The aim of this study was to follow the process of adhesion formation in several prosthetic materials by sequential laparoscopy. Defects (7 x 5 cm) were created in the abdominal wall of 30 New Zealand White rabbits and repaired using Surgipro polypropylene mesh (PP), Ultrapro monocryl-prolene mesh (UP), Dual Mesh expanded polytetrafluoroethylene (ePTFE), Composix (PP-ePTFE), Parietex Composite (polyester with collagen-polyethylene glycol-glycerol coating [PO-gl]), or PL-PU99 (PP-polyurethane) patches fixed to the edges of the defect by running polypropylene suture. Adhesions to the implants were laparoscopically determined at 3, 7, and 14 days after surgery. Percentage adhesion scores were significantly lower for ePTFE, PP-ePTFE, PO-gl, and PP-PU, compared to PP or UP. No differences were observed in adhesion scores recorded at 3, 7, and 14 days postimplant. Reticular prostheses were infiltrated by disorganized scar tissue with fibers concentric to the mesh filaments. In contrast, ePTFE implants were encapsulated by organized tissue, with fibers running parallel to the surface of biomaterial. All three composites achieved good recipient tissue integration and a homogeneous, organized, and well-vascularized neoperitoneum. At 14 days postimplant, laminar prostheses and composites showed similar results in terms of adhesion formation and integration within host tissue. Our findings suggest that both the composite prostheses and the laminar ePTFE performed very well in terms of reduced adhesion formation at the peritoneal interface.

Histological evaluation of novel ossicular chain replacement prostheses: an animal study in rabbits

Conclusion. The improved biocompatibility of Bioverit® II coated with a nanostructured surface shows promising qualities for use in human reconstructive middle ear surgery. In the case of chitosan-hydroxyapatite composite prostheses, further investigations regarding composition of the material, degree of purity and design are necessary before clinical application. Objective. The selection of optimal materials for reconstructive middle ear surgery continues to be a problem. In the present study novel materials were tested as total ossicular replacement prostheses (TORPs) in an animal model. Materials and methods. Bioverit® II coated with a nanostructured surface and chitosan-hydroxyapatite composites were placed in the middle ear of 40 rabbits. Uncoated Bioverit® II was used as control. After an implantation period of 28, 84 or 300 days petrous bones were extracted, embedded in epoxy resin and examined by light microscopy. Results. Uncoated and coated Bioverit® prostheses revealed a mucosal coverage and a little osseogenic response after 28 days. The results of the coated Bioverit® prostheses slightly surpassed those of the plain prostheses. Chitosan-hydroxyapatite composite prostheses were mostly found to be dislocated after 28 days. Formations of granulation tissue and fibrotic capsules were observed around these implants. This reaction could be caused by the instability of the composite material or may be due to impurities present in the chitosan.

Use of fibrin glue (Tissucol®) in laparoscopic repair of abdominal wall defects: preliminary experience

The aim of this study was to establish the efficacy and tolerability of human fibrin glue (Tissucol) for the nontraumatic fixation of a composite prosthesis (Parietex) in the laparoscopic repair of small to medium-sized incisional hernias and primary defects of the abdominal wall. From October 2003 to October 2005, 40 patients underwent laparoscopic repair at the hands of one surgeon with expertise in laparoscopic surgery; all meshes were implanted in an intraperitoneal position. Follow-up visits were scheduled for 7 days and 1, 6, and 12 months. These included assessments for pain and postoperative complications. Forty patients (24 females, 16 males) with a mean age of 50 years (range, 26-65 years) and a mean Body Mass Index (BMI) of 27 (range 25 to 30) were included in the study. Sixteen patients had incisional hernias, and 24 had primary defects. The size of the defects varied from 2 to 7 cm. Adhesiolysis was necessary in 92.5% of cases (25/40). There were no intraoperative complications or conversions. After a mean follow-up of 16 months (range, 3-24 months), no postoperative complications were observed. The mean surgical intervention time was 36 min (range, 12-40 min), with an average hospitalization time of 1 day. The use of fibrin glue in the present study provided stable and uniform fixation of the prosthesis and minimized intraoperative and postoperative complications. Consequently, laparoscopic treatment of small to medium-sized abdominal defects using this approach is our therapeutic option of choice.

Long-term results of modified Bentall procedure using flanged composite aortic prosthesis and separately interposed coronary graft technique

We have selected the flanged composite aortic prosthesis and separately interposed coronary graft technique for the aortic root replacement over seven years. We sought to evaluate the long-term results of aortic root replacement with this technique. Between April 1996 and September 2003, 71 patients (mean age 46.1+/-12.9 years, 67.6% males) underwent aortic root replacement with this technique. Sixty-two patients had annuloaortic ectasia, and seven patients acute type A aortic dissection. Marfan syndrome was recognized in 35 patients. Two separate 8-10 mm knitted Dacron grafts were interposed between a valved composite graft and both coronary ostia to avoid kinking of coronary arteries. The early mortality rate was 4.2%. The actuarial survival rate was 93.9+/-3.0% at 5 years. The freedom from operation related complications was 86.7+/-4.1% at 5 years. No patients had anticoagulant-related hemorrhage, valve thrombosis, reoperation, graft thrombosis, or coronary pseudoaneurysm. The separately interposed coronary graft and the flanged composite graft technique is predictable and safe. Coronary pseudoaneurysm and graft thrombosis have been eliminated.

Oklahoma Prosthesis: Resection of Tumor of Clavicle and Chest Wall Reconstructed With a Custom Composite Graft

Tumors involving the clavicle by primary or metastatic growth may require clavicular resection often with rib resection. The resulting cosmetic and functional impairment of clavicular resection may be significant with a sloped appearing shoulder girdle and chronically impaired movement of the upper extremity. We report a 48-year-old woman presenting with a bulky metastatic renal cell mass of her left clavicle extending to the chest wall. We report en-bloc clavilculectomy and chest wall resection with a novel method of reconstruction using a single methyl methacrylate and prolene composite prosthesis in a configuration resembling the state of Oklahoma.

Prospective clinical study of laparoscopic treatment of incisional and ventral hernia using a composite mesh: indications, complications and results

The aim of this study is to establish the indications, safety, efficacy, feasibility and reproducibility of the laparoscopic technique in treating defects in the abdominal wall, including those of large dimensions, to standardise the surgical technique and to confirm the performance of the composite prosthesis used (Parietex, Sofradim). The study encompassed the period from January 2001 to December 2004 and included 178 nonselected patients (108 women and 70 men), with an average age of 56 years (range: 26-77 years) and an average body mass index (BMI) of 30 (range: 26-40). These patients were treated for either abdominal hernia (156 patients; 89.7%) or a primary defect (22 patients; 10.3%). The dimensions of the abdominal hernias treated varied from 4 to 26 cm (average: 12.1 cm). All patients were treated using the laparoscopic technique, and all meshes were placed in the intraperitoneal position. Eleven (7%) postoperative complications arose after an average follow-up period of 29 months (range: 1-48 months): seven seromas (4.4%) lasting for 4 weeks, with one becoming infected after being punctured repeatedly; we removed the infected prosthesis by laparoscopy; three (1.9%) patients with persistent neuralgia, which were resolved after 2 months with a prescription for FANS; one patient with a haematoma at the trocar site. There were also four recurrences (2.5%), all of which occurred between 1 and 3 months postsurgery: one in the 'small' group of abdominal hernias (less than 9 cm) and three in the 'large' group of abdominal hernias. With the exclusion of any primary defects, an adhesiolysis was carried out in 99.3% of the patients. In seven cases (4.4%) we carried out a raphe for speritonealisations of loops in the small intestine; in four patients (2.5%), following tenacious adhesion (one patient) and loops fixed to the previous scar by stitches (three patients), we carried out an intestinal perforation (ileus) which was sutured by laparoscopy. The average operating time was 65.6 min (range: 28-130 min), with an average postoperative period in the hospital of 2.1 days (range: 1-5 days). No conversion was observed, and mortality was zero. The results obtained during the clinical trial demonstrate the safety and efficacy of the laparoscopic technique and of the mesh used as well as the reproducibility of the technique in the intraperitoneal treatment of congenital and postincision defects in the abdominal wall, including those of large dimensions.

Desmoid tumour involving the abdominal rectus muscle: report of a case

The desmoid tumour (DT) is a quite rare soft tissues neoplasm that lacks metastatic potential. Though it is characterized by a local infiltrating growth that involves frequent relapses after surgical excision. The presented case report refers to a young female in her childbearing age, who underwent the radical excision of a large DT infiltrating the left rectus muscle of the abdomen. The only radical treatment of this tumour is still the surgical resection carried out far from the tumour borders into the healthy tissues. Nevertheless, when these tumours arise in the abdominal wall, their resection causes wide muscle-fascial defects involving the whole thickness wall and determining serious reconstructive problems. These problems are connected to the use of wide prosthesis that are exposed both to the possible development of visceral adhesions and to the abdominal wall rigidity due to the inclusion in the fibrosis of high quantities of totally non-absorbable material. These remarks induced to employ a new composite prosthesis presenting the double advantage of having a non-adherent visceral surface and part of its network made of absorbable material. Its application in filling the wide abdominal muscle-fascial gap gave very satisfying mechanical and esthetical results.

Composite prostheses for the repair of abdominal wall defects: effect of the structure of the adhesion barrier component

The component of a composite prosthesis, which makes contact with the visceral peritoneum, can be reabsorbable or non-reabsorbable, and laminar or reticular. This study was designed to determine whether the composition of this second, barrier component could improve its behavior at this interface. Abdominal wall defects in rabbits were repaired using a polypropylene prosthesis (PP), or the composites Sepramesh (PP + h) or Vicryl (PP + v). Fourteen days after surgery, the implants were evaluated by light and scanning electron microscopy, and immunohistochemistry. Prosthetic areas occupied by adhesions (PP: 71.08 +/- 5.09, PP + h: 18.55 +/- 4.96, P + v: 69.69 +/- 16.81%), neoperitoneal thickness (PP: 256.17 +/- 21.68, PP + h: 83.11 +/- 19.63, PP + v:213.72 +/- 35.90 microm) and macrophage counts (PP: 8.73 +/- 1.16, PP + h: 27.33 +/- 4.13, PP + v: 31.24 +/- 3.08%) showed significant differences (P < 0.05). The tested biomaterials induced an optimal recipient tissue infiltration. Least adhesion formation was observed on the PP + h implants. This suggests that the second component, although reabsorbable, should be smooth in structure.

Composite prostheses used to repair abdominal wall defects: Physical or chemical adhesion barriers?

In a composite prosthesis, the component placed at the peritoneal interface takes the form of a physical or chemical barrier. In this experimental study performed on the white New Zealand rabbit, several composites were examined to establish the effectiveness of these barriers at impeding adhesion formation. The biomaterials tested were two polypropylene prostheses (PP) with the physical barriers of expanded polytetrafluoroethylene or polyurethane (PP + ePTFE and PP + PU) and two prostheses (one polyester and the other PP) with the absorbable chemical barriers of polyethylene glycol/glycerol and hyaluronate, respectively (PO + gl and PP + hy). The composites were used to repair 7 x 5 cm defects created in the abdominal wall of the animals by placing the implant in contact with the visceral peritoneum and the subcutaneous tissue and fixing it to recipient tissue by 4/0 polypropylene running suture. Fourteen days after surgery the animals were sacrificed and specimens were taken for light microscopy and scanning electron microscopy. Adhesions developing at the prosthesis/visceral peritoneal interface were quantified. All the prostheses induced optimal mesothelialization. Composites with physical barriers behaved similarly in terms of provoking adhesions. However, the prostheses with chemical barriers differed in their effectiveness at preventing adhesions. Overall, the best results were obtained with the PP + PU composite.

Prótesis compuestas en las reparaciones de defectos de pared abdominal. Estudio comparativo del empleo de barreras físicas y/o químicas

Composite biomaterials designed for the repair of abdominal wall defects are usually composed of a reticular component and a second component, or barrier, which is laminar (absorbable or non-reabsorbable) and which is placed in contact with the visceral peritoneum. This study was designed to evaluate how the composition of this second component affects the biological behavior of the biomaterial and the formation of adhesions. Defects (7 x 5 cm) comprising all the tissue planes except the skin were created in the anterior abdominal wall of white, New Zealand rabbits. In group A (n = 12) the defects were then repaired with composite prostheses with a non-reabsorbable physical barrier, polypropylene + ePTFE (PL + ePTFE) and PL + polyurethane (PL + PU). In group B (n = 12) the defects were repaired with a reabsorbable chemical barrier, polyester + a polyethyleneglycol/glycerol film (PO + gl) and PL + hyaluronate (PL + hy). Fourteen days after surgery, the animals were sacrificed and specimens were taken for light and scanning electron microscopy and immunohistochemical labeling for macrophages (RAM-11). Adhesions forming at the prostheses/visceral peritoneum interface were quantified. All the materials showed optimal tissue infiltration and mesothelialization. Adhesion formation was similar in prostheses with a physical barrier (PL + ePTFE, 0.49 +/- 0.14%; PL-PU, 0.29 +/- 0.2%). In contrast, those with a chemical barrier showed a significant difference in adhesion formation (PO + gl, 0.55 +/- 0.06%; PL + hy, 18.55 +/- 4.96%; p < 0.05). Physical barriers seem to induce similar adhesions, while adhesions formed to prostheses with chemical barriers can vary considerably, possibly depending on the chemical composition of the barrier.

Tumeurs malignes osseuses du genou : exérèse et reconstruction

Both the distal femur and the proximal tibia are the preferential site of primitive malignant bone tumours, particularly adolescents' osteosarcomas. Total knee replacement is the gold standard when the tumour spreads to the epiphysis, when it is aggressive and extracompartimental. The prosthesis used in such case is the cemented press-fit of which the long centromedullar stems rest onto the healthy side of the isthmus. The joint is a hinge which may be rotational or not. In femoral lesions without joint invasion, in case of subtotal excision of the quadriceps, an extensor mechanism must be reconstructed, by transfer of the ischii and leg muscles. Surgery by antero-medial access allows controlling the vasculonervous pedicle. In tibial tumours, special attention must be paid to soft tissues, for the front prosthesis coverage (made using a medial gastrocnemius flap) and the extensor kinematization as well. If a part of the patellar ligament has been preserved, it is sutured on the biceps tendon after transferring both the osteotomized fibula and the medial gastrocnemius. If full excision of the patellar ligament has been performed, a combined composite prosthesis is used, that permits re-inserting the patient's extensor mechanism on the extensor mechanism of the allograft. In case of joint invasion, arthrectomy is necessary, using a total composite prosthesis with extensor allografting. After two decades of such reconstructive prostheses use, their long-lasting and satisfactory functional results following extensor reconstruction are confirmed and allow considering this therapeutic procedure even in young and active subjects. Biological reconstruction is recommended in patients with preserved epiphysis and joint (chondrosarcomas, metaphysis limited osteosarcomas). In femoral tumours, medial vascularized fibulas are used for reconstruction, with complementary lateral allografting. Plating is used for osteosynthesis. In tibial tumours, maintaining the allograft by a fixed nail may be effective. Arthrodeses are limited to some rare cases such as athletes, hard-working subjects, or major infectious risk. Today, prostheses are far more frequently used than arthrodeses. Owing to long-lasting effects, biological therapy is recommended provided it is compatible with satisfactory carcinologic excision. Such exeresis and reconstruction surgical procedures showed good oncologic and functional results, but interventions were complex, necessitating frequent resumptions. This surgery can be undertaken only by trained surgical teams, familiar with this type of prostheses, flap use, and vascularized bone transfers.

Indirect resin-bonded fibre-reinforced composite anterior bridge: A case report

In recent years fibre-reinforced resin composites (FRCs) have gained increasing acceptance in mainstream prosthodontics as viable alternatives to alloy-based restorations. A combination of good aesthetics and fracture toughness validates their use in a diverse range of clinical applications. In this case report an indirect resin-bonded fibre-reinforced composite anterior bridge incorporating a novel design is described. At 24-months recall the prosthesis was problem free and the patient was very happy with the treatment outcome. While definitive long-term data about their clinical performance is scarce, fibre-reinforced resin composite prostheses appear to have a worthwhile role in the conservative treatment of short edentulous spaces.