We have reopened for regular dental appointments. In light of Covid-19 public health concerns, there will be some changes to our usual protocols. Click here to learn more.


Case report: Maryland bridges, or “is this really the best way to get to Delaware?”

The allure was strong: place a dental bridge without having to shave down a substantial amount of tooth structure like a conventional bridge. Bond that thing in and you have a tooth where there was none before!  This type of bridge was developed at the University of Maryland in the early 1980’s (although provenance is disputed)  and was quickly adopted into mainstream dentistry.  A false tooth with a thin wing of metal bonded to the adjacent teeth.  What could go wrong?  This post describes a real-life-Maryland-bridge-gone-wrong and how we were able to correct it.

What is a Maryland Bridge?

When you see enough of these things you quickly see the problems that arise over and over again: darkening of the front teeth from the metal wings, and even more frustrating, debonding of one of the wings without any loosening of the other. You can’t take it off easily and you can’t rebond the loose part.

Here’s an example of just such a case from our office.  A patient who was missing both her lateral incisors (the teeth next to the front teeth) had a long-span Maryland bridge placed at an early age (not by us, so don’t ask us why two smaller bridges weren’t done instead). Immediately after insertion of the bridge, the aesthetic drawbacks were obvious- the front teeth looked dark due to the metal wings.  She hated it, but her parents had paid for it and it was already cemented into her mouth.  Here’s another look, and that’s how it was for the next twelve years.

Pre-operative view of old Maryland bridge. Note the greyness of the front teeth and canine teeth (third from the front) due to the metal wings of the Maryland bridge bonded to the back.  The prosthetic teeth are the second from the front on both sides.


Retracted view of old Maryland bridge. Very noticeable is the greyness of the patients upper left front tooth.  Also nasty?  The prosthetic teeth are longer than the front teeth, when they would normally be about 1mm shorter.


Right retracted view of teeth showing the old Maryland bridge. Note the greyness of the upper front and third teeth, as well as the mis-angled prosthetic fake tooth, second from the front.


Left retracted view of mouth. Again, the greyness of the upper left front tooth is evident.


View of the old Maryland bridge from the biting surface. The metal backings were cemented to the teeth on either side of the prosthetic teeth.

Not long ago, this patient returned to report that one of the wings had actually detached from the tooth.  Not good, because it was still attached to 3 other teeth and that would have made removing and recementing very difficult.   Incidentally, it is thought to be the movement of the supporting teeth in different directions when chewing that causes loss of bond strength.

The Solution

So what to do?  We sectioned the bridge in the midline to see if we could just remove the bridge on that side and recement it, but still no luck. We were now forced to look at the replacement of the entire Maryland bridge.

This, as it turns out, was the patient’s opportunity: she could now i) whiten her teeth, and ii) replace that unsightly bridge with a solution that is more aesthetic and allows her to floss!

Although dental implants in the two spots would have been ideal, the root angulations of the adjacent teeth as well as the insufficient volume of bone made that impossible.  After some discussion, we decided that the replacement of the bridge with two separate cantilever all-ceramic bridges was the best option.

Our patient wore a cheap-o acrylic partial denture to temporarily replace the missing teeth while she whitened and while the prostheses were being made by the lab. Surprise surprise, she hated it, but luckily it was only needed for a short time.

Retracted front view of the completed Maryland bridges!

Here’s a picture of the big day!  We finally got rid of the denture and bonded the two glass ceramic bridges onto her canine teeth (the third ones from the middle).  We hope you’ll agree that the appearance is much better than the previous Maryland bridge, and she could actually floss her teeth as well without using a floss threader!

For the dental nerds: bilateral IPS e.Max bridges replacing lateral incisors, cantilevered off the canines.  Teeth were air abraded with Danville PrepStart, acid-etched with Bisco’s phosphoric acid with Benzalkonium Chloride, and the prostheses were cemented with Calibra esthetic resin cement as per manufacturer’s instructions.

Right retracted view of the completed Maryland bridge. Note that not only are the surrounding teeth not dark, the angulation of the fake tooth is much better.


Retracted left side view of the new Maryland bridge. The greyness of the original bridge is gone!


Front view of the completed Maryland bridges, replacing the upper later incisors, second from the middle on both sides. Note that there is no longer any greyness to the surrounding teeth!
View of the completed new Maryland bridges from the biting surface. These bridges were bonded only to the canine teeth, third from the front, which allowed easy flossing under the bridge by passing floss between the first and second teeth on each side.  The undersides of the front teeth were filled with bonded composite resin.

A final note: this is not a solution that can be used anywhere. Cantilever Maryland bridges have pretty poor survival in all other areas of the mouth except for upper lateral incisors, and it just so happened that not only did this patient have missing lateral incisors, the bite against them was very light. Being able to minimize the forces against these bridges means that we have a better expectation of long-term success.  By bonding the prosthetic teeth to just one adjacent tooth instead of both, we avoid the twisting forces that likely led to the original debonding.

Hopefully, this gives some insight into the real-life issues with Maryland bridges, and how we need to troubleshoot them.  If you have some concerns with your mouth, or would just like an overall exam, please contact us!  We’d love to be your Barrie dentist.

Dr. Elston Wong Portrait

About Dr. Elston Wong

Dr. Elston Wong completed his dental degree at The University of Toronto in 1999 before arriving in Barrie in 2002. After graduating, he continued to learn everything he could about dentistry. Now he has taken the time to share important information for anyone to read.

Meet The Whole Team

Ready to bring your smile back to glory?

Our Team is Ready to Guide You to Long-Lasting Oral Health