Reverse Maryland bridges: clinical applications

The "Maryland Bridge" or the etched metal-composite bonded retainer has experienced a variety of clinical applications since its inception as the etched enamel plastic-bonded Rochette periodontal splint. Through the evolutionary stages of different metals and framework preparation for composite bonding by electrolytic, chemical, and air-abrasive procedures and the improvements in bonding composites, the bridge has been in clinical use for approximately 9 to 10 years. Certain clinical and radiographic criteria must be satisfied prior to using the conventional Maryland bridge, but with the unique application of the basic bridge design modified and placed from the labial or buccal position some previously contraindicated uses of the bridge can be reversed by using a unique, if not provocative, application of the bridge design principles. This article presents two clinical case reports utilizing the Maryland bridge applied from the labial and buccal aspect. Both fixed partial dentures presented have been in place clinically for over 18 months, whereas others of this type have been successfully in place for over 6 years.