Technical Discussion: Maryland/Rochette Bridge
Proper Preparation for a Maryland/Rochette Bridge
Tooth preparation for a Maryland Bridge is minimal, requiring only 1mm reduction on the lingual surface of the adjacent anterior teeth. Even this small amount is necessary only if there is inadequate clearance for the restoration in centric or lateral relationships.
Regardless of the restoration design, Maryland or Rochette, proper tooth preparation is necessary for a successful result. A definite cingulium rest should be prepared to act as a positive stop in seating the restoration and help translate the stress of the restoration along the long axis of the tooth. The interproximal areas of the abutment teeth, mesial and distal, should be slightly shaved to produce a vertical path of
insertion and allow for a "wrap around" of the abutment tooth. Since the Maryland is cemented using the acid-etch technique, the enamel can not be penetrated.
Posterior Maryland preparation requires a broad shallow rest preparation on the teeth adjacent to the pontic. The abutment teeth should also have a guide plane prepared in the interproximal area. The buccal line angles adjacent to the pontic area (mesio-buccal or disto-buccal) should be shaved to allow for a "wrap-around" of the abutment teeth and produce a vertical path of insertion. The enamel can not be penetrated. These areas should be shaved as opposed to heavy-cut.
An indication of future success or failure of the restoration is its retention. When you try in the bridge, it should have retention of its own. If it doesn't, you could be asking too much of the composite bonding material and greatly increase the chance of failure.
After the bridge is cemented, minor adjustments can be made on the opposing arch as necessary to eliminate undue stress on the pontics. Pontic stress in ex-centric movements will cause the bridge to dislodge.
Note: Light activated composites can not be used since the light will not penetrate the metal.
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