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Content

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by

Hatem Abo Ria

on 24 March 2015

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Transcript of Content


Concept











Resin Bonded Bridge
Cast Perforated RBBs
Etched Cast RBBs
Micro-Mechanical Retention
Lost Salt Crystal
Macroscopic Mechanical Retention
Chemical Bonding RBBS
Chemical Bonding
Resin Bonded Bridges without metal framework
Zirconium or Fiber Reinforced Composite
Thanks

Definition:

A fixed dental prosthesis that is luted to tooth structures, primarily
enamel, which has been etched to provide mechanical retention for
the
resin cement*
.
Or
It’s a dental prosthesis replacing missing tooth by pontics with
retainers (wings), fixed to the
minimally prepared
lingual &
proximal surfaces of the surrounding abutments that relies on it’s
retention on
composite resin cement.


*Glossary of Prosthodontic Terms
Development of Resin Bonded Bridges
Rochette Bridge
Mechanical Retention
Maryland Bridge
Virginia Bridge
Adhesive Bridge
Due to advances in the types of resin cements
1-Superbond:
Use of 4-META as Adhesion Promoter.
2-Panavia 21
: bis-GMA Based composite with
10-MPD as Adhesion Promoter.
3-Panavia F 2.0
: dual cure with fluoride release.
4-
Improve bonding by air abrasion, silica-carbon
layer & silanation and
Rocatec system
(silica
with alumina)
Case Selection
Bridge Design
Clinical Technique
Success
Factors related to success of RBBs


Case Selection
1-Patient Factor:






a-Age:
1-Young Patient with large Pulp
2-Old Patient: a-Short Chair Time & Minimal Appointment
b-Shortening dental arch
b-Patient Expectation:
Longevity of RBBs lower than conventional FBDs
c-Fear of Anesthesia:
No need for anesthesia
Little discomfort near DEJ



Case Selection
2-Abutment tooth selection:







a- Periodontal Health:
-Any active periodontal disease should be stoped.
-RBBs used for splinting of teeth with periodontal disease.

b-Enamel Condition
c-Alignment of teeth


Case Selection
2-Abutment teeth selection:








a-Periodontal Health
b-Enamel Condition:
-Quality: Enamel Hypoplasia, Amelogenesis Imperfecta.
-Quantity: Short Clinical crown




c-Alignment of teeth


Case Selection
2-Abutment tooth selection:







a-Periodontal Health
b-Enamel Condition
c-Alignment of tooth
-Crowding: Reduced Access & Small pontic.(bad esthetic)
-Spacing: Excessive force on large pontic.
-Rotation: Full wrap around is difficult.
-Diastema: Difficult with RBBs but may be with spring cantilever.
-Mesial & Mesiolingual Inclination: Need modification in design

Clinical Case











Case Selection
3-Occlusal Assessment:









-Sufficient space for a pontic of the right shape and size.
-Parafunctional Habits: bruxism
-Pontic involvment in guidance during mandibular excursive movements.
-Deep vertical bite.


Bridge design
1-Retainer wing coverage










-Increase surface area for retention:
180° wraparound balanced with esthetic


Bridge design

1-Retainer wing coverage











Electrosurgery
is particularly relevant for young patients who have short clinical crown heights.


Bridge design
2-Technical features













-Base metal alloys are highly rigid so,used in thin section.
-Retainer of 0.7 mm thickness.
-Maryland bridge retainer used in thin section in comparison to Virginia.
-Seating lug locate the retainer & resist cervical displacement.


Bridge design

3-Aesthetics












1-Translucency of enamel lead to metal display cause graying of abutment.
To over come:
a-Opaque cement
b-Avoid metal in incisal 2mm of lingual surface.
2-Proper shade matching in natural light with hydrated teeth.
3-Preparation of pontic site to stimulate natural contour.


Clinical techniques













a-Existing restorations
1-Anterior
a-Class III is not contraindicated
b-Class IV is contraindicated
2-Posterior
incorporation of amalgam restoration
b-Extend preparations with grooves for retention.
c-Excellent moisture control during cementation


Regarding the past, The Indication & Contraindication
of Resin Bonded Bridges.............................

Indications







1-1.Replacement of missing anterior teeth in children & adolescent.
2-Short span, unrestored or minimally restored abutments.
3. Splinting of the periodontally compromised teeth.
4-Single posterior tooth replacement.
5-Post-orthodontic splinting

Indications









6-Immediate replacement of teeth after extraction.
7-Implant temporization.
8-As an interim bridge following periodontal surgery.

Contraindications










-Insufficient Enamel for bonding. "Hypoplasia,short clinical crown,etc..."
-Parafunctional habits.
-Thin translucent anterior teeth.
-Long edentulous spans.
-Tooth Malalignment. "large or small pontic space"
-Deep vertical bite.
-Nickel Allergy.




Advantages










1-Minimal removal of tooth structure.
2-Minimal potential for pulpal trauma
3-Tissue tolerant
4-Easy impression making.
5-Anesthesia not usually required.
6-Interim restoration not usually required.
7-Reduced chair time.
8. Reduced patient expense.
9. Rebonding is possible.


Disadvantages









1-Less longevity than conventional bridge.
2-Can't be used in broken teeth.
3-Thin abutment cause grayness problem.
4-Esthetics is compromised on Posterior teeth.
5-Space correction is diffcult.
6-Restricted to single teeth replacment.
7-Proper Isolation is critical for bonding.


How we reach to success in RBBs???????????














Clinical Cases

Patient with congenitally missed Max. lateral Incisor and partially impacted canine.
Case 1







Case 1







*Compendium of Continuing Education in Dentistry
June 2011, Volume 32, Issue 5
Published by AEGIS Communications

Case 2













Mr E was 55 years old, asked if he could have a ‘screw-in tooth to replace his denture,he smoke 15 cigarettes per day,So Implant is not option.
*Dental Update – November 2001
Dent Update 2001; 28: 442–448
CLIVE J. GIBSON
A fit and well 25 year-old male patient suffered the loss of Mand. Central & Lateral Incisors treated with fiber-reinforced RBBs

Case 3











*RestorativeDentistry
Dent Update 2008; 35: 521-526
FJ Trevor Burke

Case 4










Having lost lower 5 as a result of repeated periapical infection, a 55 year-old female patient requested replacement of this tooth.
*RestorativeDentistry
Dent Update 2008; 35: 521-526
FJ Trevor Burke

Advantage of FRRBBs:











1-Improved aesthetics, since framework is tooth-coloured.
2-Bond of the composite retainers to etched enamel via resin
lute may be more reliable than that to metal retainers.
3-Strength, in the form of fibres, may be placed where needed.
4-May cost less than cast-metal frameworks.
5-Can be fabricated by direct or indirect methods.


As Conclusion, due to controversial longevity of RBBs as
compared to conventional Fixed Fixed bridges,it's better
to consider RBBs as
long term provisional
restoration or
limited to
selected cases


Content
Definition
Types of RBBs
Factors Affecting success
Advantages & Disadvantages
Clinical Cases
Full transcript