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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 (


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.




I’d like to thank Dr Malcolm Cooke from Smile Doctor in Mona Vale NSW, Australia, for his clinical excellence.


This case was issued in March 2020 with no remakes.




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