Resin-retained Bridges Research Articles

Long-term complications and management of dental trauma in the adult patient - Part 2: discoloured, displaced and missing teeth.

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.

Soft Tissue Management Around the Dental Implant: A Comprehensive Review.

In the modern world, there is an increasing concern among people regarding dental esthetics. Edentulism can impact one's appearance, affect the regular bite, and can even affect mental well-being. There are variousoptions to replace the missing teeth, such as removabledentures, fixed crown and bridge prostheses, and resin-retained bridges. Various factors are evaluated before giving a suitable prosthesis for missing teeth. Implant installation is highly desired by patients as it has a high success and long-term survival rate when used to replace lost teeth. However, several difficulties relating to errors in treatment planning, surgery, soft tissue, and hard tissue care, and infections may compromise the efficacy of implant therapy. An increasing body of research indicates that long-term clinical stability and esthetics may be significantly impacted by the stability of the soft tissues around osseointegrated dental implants. Consequently, when implant therapy is planned, the dental surgeon has to have the necessary expertise to appropriately handle any possible causes of difficulties in addition to being able to carry out the necessary actions to maintain or develop stable soft tissue. Various augmentation procedures can be done for the correction of any deformity or inadequacy of soft tissues. Osseointegration is a fundamental part of the success of the implant treatment. It is the formation of a biological and functional connection between the bone and the implant increasing the stability of implant prosthesis. After the treatment, the patient should be counseled for regular and proper oral hygiene practices suitable for the implant. A proper follow-up has to be done after implant treatment in regular intervals. Any postoperative soft tissue complications, such as peri-implantitis or peri-implant mucositis, should be addressed immediately, and appropriate treatment has to be given. This article reviews about theprocedures before and after the implant placement to prevent or treat soft tissue complications, ultimately leading to the success of the implant.

387 A Multidisciplinary Approach to the Sequelae of Dental Trauma in a Child: A Radicular Cyst

Abstract Background A radicular cyst is an inflammatory cyst of odontogenic nature, formed by cells of Malassez in the periodontal ligament, which are stimulated and proliferate, following insults such as dental trauma. First stage treatment is commonly orthograde root canal treatment (RCT), followed by apicectomy or extraction and enucleation of the lesion +/- bone grafting and replacement tooth. Presenting problem This case illustrates the sequelae of a repeated dental trauma to a LR1 in a child, which was endodontically treated and obturated with Mineral Trioxide Aggregate (MTA). After a second dental trauma, a painful intra-oral swelling developed with mobility and tenderness of adjacent teeth. The swelling increased after extraction of the LR1, leading to enucleation by the Oral and Maxillofacial Surgery Surgeon (OMFS). Investigations Plain radiographic films, cone beam CT (CBCT) imaging revealing a radiolucent area extending from LR3 to LL3, 2 x 1.1 x 1.9cm, with buccal perforation and thinning of the lingual cortex. Clinical management Across a 6-year period restoration and orthograde RCT was completed LR1. A second dental trauma 4 years later necessitated extraction of LR1. Subsequent acute swelling and pain lead to further radiological assessment which was consistent with a giant cell lesion. Following enucleation, histopathology confirmed a radicular cyst, with pulse granuloma and reactive changes. Bony infill was noted and the LR1 was replaced with a resin-retained bridge. Discussion This case aims to raise awareness of the sequelae of dental trauma in children and the multidisciplinary approach to their care.

Resin-retained bridges: considerations to maximize enamel bonding and aesthetics for abutment teeth with compromised contour

The provision of resin-retained bridges (RRBs) on abutment teeth that require composite resin build-ups often proves challenging. This article presents a technique, represented through two clinical cases, that aims to reduce some of the issues associated with such scenarios. It describes the simultaneous cementation of the RRB while also undertaking composite resin additions. It showcases the advantages of such a technique – particularly in terms of maximizing enamel surface area available for bonding to the retainer, and thereby potentially improving the longevity of the prosthesis. CPD/Clinical Relevance: Careful design and execution is required when providing resin-retained bridgework.

Evaluation of Bond Strength of Cantilever Resin-retained Bridge Designs: An In Vitro Study

The aim of the study was to compare the bond strength of three cantilever resin-bonded bridge (RBB) designs cemented with resin cements. Twenty-four extracted human mandibular canines with eight teeth per group were used in this study to evaluate the bond strength of cantilever resin-retained bridge designs of the mesh, perforated, and combination of mesh and perforated luted to the prepared lingual surface of canine teeth using resin cement. Debonding was done using Instron universal testing machine by applying load on the mid-buccal region of the pontic and the obtained values were evaluated. The data was analyzed statistically. The mean shear bond strengths of mesh, perforated, and combination of mesh and perforated are 0.88 ± 0.31 MPa, 0.81 ± 0.31 MPa, and 0.93 ± 0.32 MPa. However, there is no significant differences in the statistical analysis that were performed using a one-factor analysis of variant (ANOVA) test (p = 0.744). Within the limitation of this study for cantilever resin-retained bridge designs, the combination of mesh and perforated design showed greater mean shear bond values when compared with the mesh design and perforated designs. This shows equal in vitro performance to the gold standard designs (group A is mesh design and group B is perforated design). The new design which is the combination of mesh and perforated shows equal in vitro performance to the gold standard designs. Thus, their use in clinical situation can bring better result in concern to cantilever resin-retained prosthesis.

The Post-Cementation Periodontal Response to Resin Retained Bridge

Objective: To compare the mean periodontal health of resin retained abutment tooth with its baseline score.Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Prosthodontics, Armed Forces Institute of Dentistry Rawalpindi Pakistan, from Oct 2019 to Mar 2020.
 Methodology: Before starting abutment preparation, the baseline scores for gingival index, plaque index and periodontal pocket depth of the abutment teeth were calculated. The gingival index was calculated using a blunt probe, whereas the periodontal pocket depth of the teeth in both groups was calculated using a calibrated periodontal probe.
 Results: According to the results recorded there was a significant difference seen in the mean periodontal health of abutment teeth before and after the cementation of the resin-bonded bridge. Our calculated p-value (0.001) indicated definitive significance associated with both the groups i.e., before and after the score of gingival indices and before and after the score of periodontal pocket depth, after 30 days of provision of the resin-bonded bridge.
 Conclusion: There was a significant association found in the mean periodontal health of abutment teeth before and after the cementation of the resin-bonded bridge.

Debonding of cast metal-based cantilever and fixed-fixed resin-retained bridgework: A review of the literature.

Cast metal-based resin-retained bridgework (RRB) offers a practical, conservative approach when restoring edentulous spaces. This review examines the debonding of cast metal-based RRB, comparing cantilever resin-retained bridgework (CRRB) and fixed-fixed resin-retained bridgework (FRRB) designs taking into context developments in RRB design, construction, and cementation over time. An electronic search was conducted through Medline and Embase with the aid of Boolean operators to combine the following key words: "adhesive bridges", "resin-bonded bridges", "resin-retained bridges", "resin-bonded fixed partial dentures", "cantilever", "debond", "fixed-fixed", "decementation", "failure", "success", "outcome", "longevity" and "survival". The search was limited to peer-reviewed articles written in English and published from 1995 through to 2019. Thirty-one studies were included. Five studies compared the longevity of CRRB versus FRRB, five assessed the clinical performance of CRRBs alone, and 21 studies assessed the clinical performance of FRRBs. There was great variability in study design and the reporting of clinical outcomes, and an analysis and critique of the included papers is provided. Overall, CRRB tend to debond less and hence provide longer-term and more reliable clinical service when compared to FRRB. More high-level, long-term, prospective and clinical controlled trials are required to further analyse and evaluate the long-term outcomes of cast metal-based RRB.

Resin-retained bridges: ten tips for success and an update on all-ceramic designs

Resin-retained bridges RRBs are a conservative and minimally invasive means of tooth replacement. The complex nature of planning for RRBs can be overlooked and may subsequently lead to poor outcomes. With ceramic RRBs gaining popularity, discussion surrounding how their preparation differs from that of conventional RRBs is imperative. This article provides an update on ceramic RRBs and highlights some tips for the general practitioner to improve the aesthetics and longevity of their bridges. CPD/Clinical Relevance: Tips to improve the aesthetics and longevity of bridges carried out in general practice are provided.

Resin Luting Materials

Luting materials are a central component of indirect dentistry, with the most recently introduced types being resin-based materials. These may be classified into conventional resin luting materials, self-adhesive resin luting materials and ‘smart’ resin luting materials. Their physical properties have been found to be good, with no risk of dissolution in the dilute organic acids found in plaque, such as occurs with phosphate and glass ionomer cements. Uses of resin luting materials include the luting of any indirect restoration, but these materials have facilitated the development of the resin-retained bridge and aesthetic ceramic or composite restorations, notwithstanding the fact that they may provide, for the first time, truly adhesive luting of crowns and inlays. CPD/Clinical Relevance: Resin luting materials are appropriate for placement of all indirect restorations: the self-adhesive variants have simplified the use of such materials.

Textbook and Color Atlas of Traumatic Injuries to the Teeth

Wound healing subsequent to injury response of oral tissues to trauma mediators of hard tissue resorption classification, aetiology and epidemiology child abuse examination and diagnosis of dental injuries crown fractures crown-root fractures root fractures luxation injuries avulsions injuries to the supporting bone injuries to developing teeth soft tissue injuries endodontic management of traumatized teeth orthodontic management of the traumatized dentition restoration of traumatized teeth with composites resin-retained bridges in the anterior region conventional bridges in the anterior region antotransplantation of the teeth to the anterior region implants in the anterior region prevention of dental and oral injuries prognosis of traumatic dental injuries.

Upper Lateral Incisor Replacement With Socket Preservation and An Implant After A Failed Resin-Retained Bridge (RRB): A Case Report and Literature Review

Upper Lateral Incisor Replacement With Socket Preservation and An Implant After A Failed Resin-Retained Bridge (RRB): A Case Report and Literature Review

Contemporary teaching of bridges (fixed partial dentures) in Ireland and United Kingdom dental schools.

Aim The aim of this study was to investigate and describe the current teaching of bridges (fixed partial dentures) within dental schools in Ireland and the United Kingdom. The authors previously surveyed this teaching in 2009. Method Following receipt of positive ethical approval, an online survey was distributed to the 18 dental schools in Ireland and the United Kingdom with primary dental degree programmes in 2017. This questionnaire sought information about the current nature and extent of dental school teaching of bridges, including clinical techniques taught. Information was also sought on current and future challenges to teaching in this area. Results Responses were received from all 18 schools invited to participate (response rate = 100%). There was diversity in the range of exercises completed in preclinical courses for bridgework: the greatest commonality was seen in relation to preparation exercises for fixed-fixed posterior conventional bridges (n = 14 schools) and cantilever anterior resin-retained bridges (n = 13 schools). Fourteen schools required students to complete a preclinical assessment before they were permitted to provide bridgework in a clinical setting. Anterior cantilevered resin retained bridges were the most common clinical treatment provided (average = 1.67 bridges per student per respondent school; range = 0–3), representing a two-fold increase since the 2009 survey, which indicated that the equivalent mean was 0.83 per student. Two schools permitted their students to provide all-ceramic anterior bridges clinically. Five schools reported that their teaching of bridges had reduced over the past 5 years. Within the respondent schools, the most common challenges cited to teaching bridges was a lack of suitable patients (13 schools) and lack of time within the primary dental degree programme (7 schools). Conclusions This study found increased student experience in the clinical provision of bridgework, in particular the provision of anterior cantilever resin-retained bridges, compared to the time of the last survey in 2009. Aspects of the teaching of removable partial dentures and implant dentistry should be surveyed to identify how these areas of teaching are adapting to changing patterns of oral healthcare and the further refinement of developing technologies in these areas.

Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report

Abstract This case report describes the multidisciplinary management of a young male who presented with a Class I incisor relationship and bi-maxillary dento-alveolar protrusion on a Class I skeletal base. The occlusion was complicated by an ankylosed and moderately infra-positioned upper left permanent central incisor, an anterior crossbite, crowding, a reduced overbite and centreline discrepancy. The incisor was traumatised and avulsed when the root was immature and the tooth was reimplanted with delay. On referral for orthodontic treatment at age 11.5 years, the upper left central incisor was experiencing ankylosis-related (osseous replacement) resorption and external root resorption simultaneously. Aside from the orthodontic aims, it was important to address the disrupted alveolar development to facilitate later prosthodontic replacement of the upper left permanent central incisor by idealising the inter-coronal and inter-radicular spaces. Treatment consisted of fixed orthodontic appliances in conjunction with the extraction of all second premolars and the upper left permanent central incisor with episodic surgical curettage. An upper Hawlix retainer was provided immediately at debond and a cantilevered resin-retained bridge was placed four months later.

Resin-retained bridges

Resin-retained bridges

Survival characteristics of 771 resin-retained bridges provided at a UK dental teaching hospital.

To analyse the factors affecting the clinical performance and those influencing the survival of resin-retained bridgework provided at a UK dental teaching hospital between 1994 and 2001. A prospective analysis of restorations provided at a single centre using case notes with all patients invited for review to corroborate findings. Department of Restorative Dentistry, University of Bristol Dental Hospital and School, Bristol, United Kingdom. Between January 1994 and December 2001, data regarding 1,000 consecutive resin-retained bridges provided at Bristol Dental Hospital and School were recorded. Data was available for 805 patients at the time of the study. Following invitation, 621 patients attended for a review appointment. Life table and Kaplan-Meir survival analysis were carried out for all restorations provided. The five-year and ten-year survival rates estimated by the life-table method are 80.8% (95% confidence interval 78.0-83.6%) and 80.4% (95% confidence interval 77.6-83.2%) respectively. The median survival cannot be estimated for this study as the survival probability remains above 80% even at the longest follow-up. Analysis of clinical variables influencing survival revealed that design of the restoration and experience of the operator providing the restoration were significant factors. Resin-retained bridges made with minimal tooth preparation are shown to be superior in terms of longevity than those for which other types of tooth preparation is made. Patient satisfaction with their treatment was high.

Ten year survival of bridges placed in the General Dental Services in England And Wales

AimIt is the aim of this paper to consider the factors associated with the need for re-intervention on a conventional or resin-retained bridge, excluding recementation. MethodsA data set was established consisting of patients, 18 years or older, whose birthdays were included within a set of randomly selected dates, one of which was chosen in each possible year of birth and whose restoration records contained the placement of one or more indirect restorations on courses of treatment with last date on the claim form after 31st December 1990, and with date of acceptance after September 1990 and before January 2002. For each patient treated with a bridge, the subsequent history of intervention on each tooth used as a bridge abutment was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. Thus a data set was created of bridge abutments which have been placed, with their dates of placement and their dates, if any, of re-intervention. ResultsData for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 7874 abutments (6800 conventional and 1074 resin-retained) were obtained from the data over a period of eleven years.Factors which were found to reduce outcome of bridges included type of bridge, patient payment exemption status, patient attendance pattern and position of the bridge in the patient's mouth. ConclusionsSurvival of conventional bridge abutments has been shown to be 72% at 10 years, this being similar survival time to crowns. Various patient factors and bridge type were also found to influence survival.

Interim Restorative Approach for the Management of Congenitally Missing Permanent Mandibular Incisors: Presentation of Three Cases

Congenital missing of mandibular permanent incisors with retained primary incisors may jeopardize the esthetic appearance and psychological development of children, especially during the years of transition into adolescence. The retained primary teeth are necessary for the maintenance and normal development of alveolar bone, which in turn is essential for future definitive rehabilitation. In such situations, an interim restoration may be provided before any definitive treatment is given to comfort the young patient during this transition period. Interim restorations may include resin-modified additions to the existing teeth as well as more sophisticated restorations such as resin-retained bridge and removable partial dentures. However, this restoration differs for different clinical situations based on various factors such as age and patient compliance, and also consideration has to be given for the growth changes of the child. The aim of this present paper is to discuss the esthetic management of three cases with bilateral agenesis of permanent mandibular incisors and retained primary incisors with composite interim restoration.

Considerations for the Selection of a Luting Cement

Selection of a luting material for optimal cementation of indirect restorations requires the consideration of several factors relating to the properties of both the cement and of the restoration. Contemporary restorations (for example, dentine-bonded crowns or resin-retained bridges) often rely on bonding, and advances in dental materials science have resulted in simplified resin systems. Their ease of use and other favourable properties also offer advantages when used for more conventional restorations. Traditional luting cements remain commonplace and their benefits and shortcomings are discussed in terms of handling and clinical performance. Developments and trends in adhesive dentistry are explored. Luting cement selection and application is integral to the optimal performance of indirect restorations.

Resin-Retained Bridges: Fibre-Reinforced versus Metal

Resin-retained bridges (RRBs) have become an accepted part of the restorative dentist's armamentarium. Despite disadvantages, such as more frequent rates of debonding than conventionally-luted bridges, RRBs hold advantages such as their minimally invasive preparation and reduced cost, along with good patient acceptance. RRBs have traditionally been formed of a metal framework with porcelain coverage: most recently, fibre-reinforced RRBs (FRRRBs) have become available, using fibres to reinforce a laboratory composite material. They may also be formed intra-orally. This paper discusses the current status of indirectly-placed FRRRBs, their principal advantages being their improved aesthetics because they are tooth-coloured, and a principal disadvantage being a lack of long-term clinical research. In cases where the visibility of metal may compromise the appearance of a metal-based RRB, a fibre-reinforced, resin-retained bridge may provide a clinical solution.

Developmentally absent maxillary lateral incisors

Objective To investigate the orthodontic management of patients with developmentally absent maxillary lateral incisors. Materials and methods A questionnaire was mailed to all orthodontists on the specialist list held by the British Orthodontic Society. Results The questionnaires (57.3% response) were analysed in two groups: Group 1 consisted of orthodontists who worked only in an orthodontic practice environment; Group 2 consisted of orthodontists who worked full-time or part-time in an environment where there were restorative dentists available for advice. Group 1 orthodontists were significantly more likely to recommend (p = 0.006) space closure in the management of developmentally absent maxillary lateral incisors. Group 2 orthodontists were significantly more likely to recommend (p = 0.004) minimal preparation bridges. Group 2 orthodontists also saw significantly more patients with hypodontia (p ≤0.001) and were significantly more likely to routinely obtain a restorative dentistry opinion before orthodontic treatment commenced (p = 0.001). Group 1 orthodontists were significantly more likely to assess the space required for implants by measurement between the crowns of adjacent teeth (p = 0.001). Group 2 orthodontists were significantly more likely to assess the space by use of intraoral radiographs (p = 0.019) or by measurement between teeth at the gingival margin (p = 0.029). Conclusions The management of developmentally absent maxillary lateral incisors by orthodontists in the UK appeared to be influenced by their practice environment, their experience and the availability of restorative dentistry advice. The influence of these factors was greater for the treatment options of space closure or replacement via resin-retained bridges but less so for implant treatment. This reinforces the need for multidisciplinary involvement.