maryland bridge before a dental implant

I’m trying to figure out what to do. My daughter has a congenitally missing lateral incisor. We did orthodontics to open the space. Now we’re working on the temporary tooth replacement. Our dentist decided on a Maryland Bridge. We did non-metal wings because I wanted them to be as natural-looking as possible. The problem we’ve had is the bridge has fallen off twice in just a couple of weeks. After the first time, she (our dentist) tried a different bonding cement, but that didn’t make it any stronger. Now she wants to try doing it with metal wings. Here’s the thing. My daughter is 14. She’s going to have to wear these for a few years. I don’t want her to feel self-conscious. I have two questions:
1. Will these stay on better? 2. Will the metal be a better choice?


Dear Karyn,

I’m a little concerned about some things I’m hearing here. First, I would not consider a Maryland Bridge a temporary replacement. This requires tooth preparation, which means you’re reducing tooth structure. If you’re doing that, you might as well stick with a dental bridge and not get a dental implant.

Another thing is the bonding issue. It doesn’t sound like your dentist understands bonding principles. She placed the bridge with a cement and it fell off. Then, she gets (I’m assuming) a stronger cement and it still falls off. Her next thought is to switch to metal wings.

Maryland Bridge Preparation

That’s not likely to work out any better for her. The non-metal (zirconia) wings are usually easier to bond than the metal ones. My guess is the problem is with her tooth preparation. If you look at this image on the left. You can see that a groove should be cut into the tooth to support the wings. Without this, she’s likely to have trouble no matter what type of bonding she uses.

While she could go back and make the correct grooves, I am going to recommend a completely different direction. While you can go ahead with the bridge, once she gets her dental implant, you’re going to need another procedure to have these grooves filled in. Why do that when you can instead get a temporary tooth which will not require any modification to her adjacent teeth?

I’m not trying to discourage you from your future plans of getting her a dental implant. It is the best tooth replacement around. It will be a great solution for her when her jaw is fully developed.

I am trying to discourage you from the dental bridge. Instead, I’m going to recommend something else.

Removable Partial Flipper

A removable partial flipper will be perfect for her situation. When well cared for it can last long enough for her to get her dental implant. Even if something happens, it is significantly less expensive than any other tooth-replacement option. You could replace several of them for the cost of a single Maryland Bridge.

They can be made to look beautiful too, so your daughter won’t look self-conscious.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.