Before and After 2020: Missing Tooth Replacement on Lateral Incisors (Part 2)
A Caucasian male patient in his youth was introduced to me upon a failure of the previous Maryland-Bridges on 13-11, 21-23.
The restorations only lasted for a few months (done by another technician), and I couldn’t identify its cause or never given a specific reason by the treating clinician.
In part 1 of the ‘missing tooth replacement’ (click here to read), I presented implant restorations in Zirconia with Ti interface abutment to replace the lateral incisors.
For this case, I present more of a conservative and cost-effective option – Maryland-Bridges in lithium disilicate (e.max) for optimum bonding strength.
Figs 1-2 show the pre-op condition.
Fig 3 shows my standard protocol in shade taking. I make sure to use three different shade guides to identify the correct value and chroma.
Fig 4 shows the use of the eLAB technique – an aid to assessing the colour matching of restorations before sending the case out to the treating clinician. The method allows us to perform a virtual try-in to visually and numerically ensure the accuracy of reproduction in colour (https://emulation.me).
The debate over 1-wing vs 2-wings for Maryland-Bridge remains provocative. However, it is the treating clinician who has to decide its design based on his clinical philosophy. For this case, I was requested to have two wings each, as the prep indicates. The patient has an edge-to-edge bite, so obtaining enough thickness for the connectors wasn’t an issue.
Please also refer to another Maryland-Bridge case presenting an innovative technique in Zirconia, which is suitable where the bridge’s connector dimensions are limiting – click here to read.
Figs 7-8 show the post-op condition. The patient was, of course, thrilled with the natural aesthetics – reproduction of ‘nature’ is achieved, which is perfectly blending in with his surrounding natural dentition.
Acknowledgement:
I’d like to thank Dr Malcolm Cooke from Smile Doctor in Mona Vale NSW, Australia, for his clinical excellence.
https://www.smiledoctor.com.au/
This case was issued in March 2020 with no remakes.
