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Single Wing Maryland Bridge with IPS e.max

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CEREC gives us a ton of options and allows us to do treatment for patients without the frustration to us as clinicians or frustration to our patients.  For me one of those treatments is Maryland Bridges.  As we all know, if we attempt to do this with a lab, provisionalization is challenging and we are at the mercy of the lab for getting the shade and fit correct.  CADCAM has made this a very efficient and predictable option for us chairside.

 This patient has a lot of compromises but really wanted something fixed versus her removable partial to replace #23.  As you can see from the radiograph, tooth #24 is not doing well.  I had her get a consultation from an endodontist and took a CBCT.   He thinks it looks fine and would be a candidate for an abutment but I still think the tooth is toast.  I really wanted to avoid potentially opening a bag of worms with #24 and didn't want to prep #22 for full coverage to act as an abutment for a conventional 3 unit FPD.

So after some discussion, I felt a Maryland bridge was the best option.  In this case, I did prep a little into the canine a little bit.  

Here's the proposal: 

Restoration at try-in: 

I used a C14 block A2 LT.  I did have to re-fire this case a second time for color. 

Nothing earth shattering for this case, but I'm still amazed how we can do this in less than a two hour appointment and be ultra conservative and get a great result.  I don't know how long this will last (I've been searching on PubMed for articles that Skramy refers to but couldn't find them), but with total etch and enamel bond, I think it will do well for quite some time.

Well executed sir!! very well done.

Nicely done and great documentation

Love the Maryland Bridge option....

Nice job, and well presented Dan..... thumbs up


Love it, Dan. Such a cool feature. 

Nice work Dan

Boom...that is nice

Lookin good.

Nice work Dan!

Beautiful Dan

Nicely done Dan-love the creative options we have available!

Great case! I love the characterization you put in on the pontic. It looks fantastic (and not just because I am biased or hoping you will cook dinner big grin)

Wait, if we complement him he will cook dinner?

It works for me a whole lot of days!! :)

No problem Ponzio! I need some mileage runs. Dinner won't be cheap but if you tell me sweet nothings I'll make every dime worth it!

Thank you Skramy for the following: 

For those of you that have come to Scottsdale, you have heard Mike and Sam talk about single wing Maryland bridges.  Here is the literature supporting that.  Matthias Kern and Martin Sasse are referenced quite a bit and from what I could find, their article discussing 10 year survival rates is the longest study that has been reported.   Interesting to note that Kern and Sasse have done quite a bit of research with Zirconia as their material choice for the Maryland bridges.  A few of these are just abstracts and there are a couple full articles

Here are a few publications as references: 

Article #1

Article #2

Article #3

Article #4

Article #5-Interesting article because it talks about material selection and the stresses on abutment tooth, restoration itself, cement interface, etc... and what materials are more favorable in this author's eyes

Article #6