the most common complication is debonding of the maryland bridge. The rate of debonding depends on the number of pontic. The debond rate of maryland bridges with more than 1 pontic is double that for frameworks supporting one single pontic. however, the survival rate for 5 years is about 80%. you have to make attention on the preparation of the teeth, occlusion and bonding. if you use a traditional metal framework you have to use Panavia or RelyX Unicem after the necessary treatment of the framework. If you use Cubic zirconia as framework you must use Panavia V5.

If you are using a traditional acid etched metal framework you can use any of the lower filled nano-filled (re: microfils) with a forth generation bonding resin for the enamel and any inadvertently exposed dentin.  We used anterior microfils for years before I switched to Kuraray Clearfil Majesty Esthetic.  Light curing is through the tooth and is very effective.  In my practice I followed these type of bridges for more than 15 years without debonding, the longest was followed at the U. of CT for more than 20 years without debonding.  You can easily bond through a maxillary cuspid and for the bicuspids or molars you bond through the buccal cusp and between the teeth from the lingual.  I produced several papers in the mid 80's on the bonding procedures for Maryland Bridge (acid etched fixed partial denture) and lingual 6X6 retainers.  For the Zirconia Bridges, you can used Panavia and bond again with a lighter filled nano composite although both Kuraray and Bisco make other good bonding resin systems for Zirconia or Lithium Disilicate bridges/veneers.  The life expectancy in my practice has been greater than 7 years as those types of bridges since they are much "newer" for "Maryland Bridges" . Lithium Disilicate bridges seem to last longer and are in my mind just as strong as zirconia and much easier to bond.  Light curing through the tooth is best for all these bridges...staying away from self or dual curing materials generally since light cured materials have been generally stronger over a longer term.

Dr Serpil Djemal published a paper about 10 years on the statistics associated with Maryland bridges.

I have experience (10 years) with esthetic maryland bridges: framework in glass fiber and composite and veneer in empress or E-max. Otherwise, bridges totaly builded in lithium dislicate with only one wing.... both of solutions are very nice estehetics and biomechanical proprieties close to the tooth structure. It also easy cement them with standard adhesive procedures...Good work!

In addition to acid-etch bonding (Panavia), I have added a TMS stainless steel retention pin in each tooth into the dentin, which project loosely through the metal framework and are inserted before bonding.  This insures that the enamel bonding is mechanical as well as chemical.  Multiple retention holes in the framework also allow escape of excess cement and easier removal if de-bonding occurs.  I have placed many 8-12-unit resin-bonded FPDs this way at much less cost (keep the terminal casting sprues in place until bonded to stabilize the casting).

Gettleman, L., Haik, P.L., Jr., Lapeze, J.P., and Matthews, R.J.: Acid-Etched Splints for Mobile Teeth. J. Louisiana Dent. Assoc. 40:3:8-12, 1982.

Adhesive Prosthodontics. L. Gettleman, M.M.A. Vrijhoef, and Y. Uchiyama, editors. Proceedings of a Symposium, June 24, 1986, Amsterdam, The Netherlands. Chicago: Academy of Dental Materials, 1987.

This makes sense, added retention features is good. The most important features are maximum area of attachment and careful assess any para-functional activity. If there is then choose another method ie: indirect retainer.

We had a very thorough education by Dr. John Townsend (he retired this year) at the University of Washington on Maryland bridges. This was his primary focus throughout his career.  He was very careful with the electroplating process on the non-precious metal and, of course, the bonding protocol was meticulous, avoiding moisture contamination with rubber dam and following manufacturers directions carefully on chosen luting agent.  I have only done a handful over my career of 20+ years and they were mostly successful.  I remember one that did fall off regularly on a young patient with tricky occlusion.  Mandibular single incisor without adjacent tooth mobility is, of course, ideal.  I also used them a few times when I planned an implant later (younger patient) or as the interim prosthesis during healing.  I used the rochette design (holes in the retainers) so that I could "easily" take it off and on for my impression procedure.  Be careful to follow the path of draw during removal with the spring loaded tool!

Good luck,

Lisa

Adhesive bridges can be classified into several groups according to the: material (metal and non-metal), type (conventional, hybrid, modified hybrid, two-piece and El-Mowafy modified), the form of wings (perforated and complete), the number of wings (three-unit-fixed-fixed, two-unit-cantilever and fixed-moving), the method of construction (intermediate and immediate), placement in the oral area (front and posterior), the size of the framework (one-unit, two-unit and more-unit), overlapping (complete or extracoronary, partial or intracoronary and combined or extracoronary and intracoronary) and the type of retention used (mechanically and chemically).

Each group adhesive bridges has its indications and contraindications, as well as its advantages and disadvantages.