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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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 Posted: Tue Feb 26, 2008 2:20 pm Post subject: Maryland Bridge failures |
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"Attempting" to replace congenitally missing #7 with conventional Maryland Bridge from 6 to 8. Original lasted about 20 years (or so I was informed.
Have recommended implant, but finances a problem for awhile; she elected to re-do bridge for now. Recommended an NTI. Divorce, changed jobs, little kids....the usual distractions.
Recemented the original 4 times with Surpass & Anchor. Sandblasted metal with 50 micron, tooth with 27 micron.
Have made new Md Br twice. Cemented as above.
Failed again. No NTI yet, but that's my fault. Actually a review of my records tells me that I have not made one....thought I had already. 
So, first step will be protection from parafunction, but is there a chance that there is a better cement?
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Dennis M Murphy, DDS
Cincinnati, Ohio
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john kanca
Joined: 14 May 2005
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| Posted: Tue Feb 26, 2008 2:34 pm Post subject: |
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Why did it fail in the first place?
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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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| Posted: Tue Feb 26, 2008 4:38 pm Post subject: |
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| john kanca wrote: | | Why did it fail in the first place? |
Not really a good question, huh?  I cannot get her to contact it any lateral excursion that she'll do for me, but I don't think the situation lends it self to good retention. I don't like the Ortho result, but I didn't get a say-so in it in the first place.
I know it's parafunction.....getting her to wear the NTI will be the trick
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Dennis M Murphy, DDS
Cincinnati, Ohio
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Ekrause
Joined: 11 May 2005
Posts: 782
Location: I'm here now.
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| Posted: Tue Feb 26, 2008 4:55 pm Post subject: |
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Maryland bridges usually fail because one of the abutments is more mobile than the other one (and it need not be a huge difference either). In this case, I'd bet the central is a little more mobile than the canine, and it will fail just from function, let alone parafunction.
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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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| Posted: Tue Feb 26, 2008 5:08 pm Post subject: |
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My intention is to get her into an implant.....she's not ready. What's a mother to do without removing more tooth structure??
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Dennis M Murphy, DDS
Cincinnati, Ohio
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Swifty
Joined: 04 Jan 2007
Posts: 57
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| Posted: Tue Feb 26, 2008 5:52 pm Post subject: |
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Maryland bridges can work well if just bonded to the central incisor OR the canine (not both). The pontic can then move with the abutment in function (or parafunction) and so there is less stress on the bond. Flossing is much easier also.
However, if the central and canine are joined, the bridge will often debond from one of the abutments due to the differential movement. |
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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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| Posted: Tue Feb 26, 2008 7:45 pm Post subject: |
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So, why did the first one last 20 years?
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Dennis M Murphy, DDS
Cincinnati, Ohio
d2thdr@gmail.com |
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john kanca
Joined: 14 May 2005
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| Posted: Tue Feb 26, 2008 8:19 pm Post subject: |
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| d2thdr wrote: | | So, why did the first one last 20 years? |
The same reason my first knee replacement is likely to last longer than the second.
The same reason that the second amalgam won't last as long as the first.
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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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| Posted: Tue Feb 26, 2008 9:13 pm Post subject: |
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| john kanca wrote: | | d2thdr wrote: | | So, why did the first one last 20 years? |
The same reason my first knee replacement is likely to last longer than the second.
The same reason that the second amalgam won't last as long as the first. |
So basically I'm screwed, right?
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Dennis M Murphy, DDS
Cincinnati, Ohio
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john kanca
Joined: 14 May 2005
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| Posted: Wed Feb 27, 2008 9:16 am Post subject: |
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Murf
The teeth have 20 years more fatigue on them. The occlusion is not the same.
You'd need to prep again and re-make, likely covering a larger area.
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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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| Posted: Wed Feb 27, 2008 12:16 pm Post subject: |
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Have actually already done that (reprepped and covered larger area). I know her parafunction is not helping.
One issue I see is that because she's post-ortho from 20+ years ago, the anteriors are flared labially. The result is that there is less vertical tooth to prep and retain to, than there is tooth surface in the horozontal plane.
I'm appreciating the discussion, even though when bringing the thought process of teeth having "20 years more fatigue on them" and "The occlusion is not the same" means diddly-squat to the patient. 
Thanks for humoring and not hammering me. 
How was the Tattinger??
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Dennis M Murphy, DDS
Cincinnati, Ohio
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Ekrause
Joined: 11 May 2005
Posts: 782
Location: I'm here now.
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| Posted: Wed Feb 27, 2008 12:36 pm Post subject: |
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Pin ledges, anti-rotation slots etc. Your prep needs to be like a lingual veneer.
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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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| Posted: Wed Feb 27, 2008 12:46 pm Post subject: |
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Thanks, E. Appreciate the visuals.
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Dennis M Murphy, DDS
Cincinnati, Ohio
d2thdr@gmail.com |
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john kanca
Joined: 14 May 2005
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| Posted: Wed Feb 27, 2008 1:16 pm Post subject: |
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| d2thdr wrote: | Have actually already done that (reprepped and covered larger area). I know her parafunction is not helping.
One issue I see is that because she's post-ortho from 20+ years ago, the anteriors are flared labially. The result is that there is less vertical tooth to prep and retain to, than there is tooth surface in the horozontal plane.
I'm appreciating the discussion, even though when bringing the thought process of teeth having "20 years more fatigue on them" and "The occlusion is not the same" means diddly-squat to the patient.
Thanks for humoring and not hammering me.
How was the Tattinger?? |
It was fabulous. Thanks!
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d2thdr
Joined: 16 Oct 2005
Posts: 402
Location: Cincinnati, Ohio
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| Posted: Mon Mar 03, 2008 7:03 am Post subject: |
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| john kanca wrote: | Murf
The teeth have 20 years more fatigue on them. The occlusion is not the same.
You'd need to prep again and re-make, likely covering a larger area. |
My brain just clicked on....
1. Is there literature to support the issue of fatigue issues?? I understand the occlusion issue.
2. Will it work better if retained to the Central only? I think that the cuspid is the occlussion problem.
3. Will the retention be increased that much if I use a prep design similar to what Eric is showing? And, should I then jsut stick to one abuttment?
Thanks for your help. I wish she could have just afforded the implant. 
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Dennis M Murphy, DDS
Cincinnati, Ohio
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