UNCONVENTIONAL BRIDGES: INNOVATIVE APPROACH IN MODERN PROSTHODONTICS.pptx

Unconventional bridges in Prosthodontics refer to non-traditional approaches to bridge design and placement that deviate from standard fixed partial dentures. These might include resin-bonded bridges, cantilever bridges, or implant-supported bridges, which are tailored to specific clinical situations. Resin-bonded bridges, for example, rely on minimal tooth preparation and are often used in cases where preserving tooth structure is crucial. Cantilever bridges involve abutment teeth on only one side of the missing tooth, making them suitable for areas with low occlusal forces. Implant-supported bridges, on the other hand, provide a robust alternative by anchoring directly into the jawbone, offering enhanced stability and longevity compared to traditional methods. These unconventional options are often selected based on the patient’s specific needs, anatomical considerations, and the desire to minimize invasive procedures. Understanding the principles, advantages, and limitations of these alternatives is crucial for prosthodontists seeking to provide optimal, patient-centered care.

1. UNCONVENTIONAL BRIDGES DR. SATVIKA PRASAD MDS DEPARTMENT OF PROSTHODONTICS

2. CONTENTS Introduction Classification Conventional bridge design Resin retained bridges Combination bridges Design variations for special situations Implant retained fixed prosthesis Tooth implant supported fixed prosthesis Conclusion References

3. INTRODUCTION In the realm of prosthodontics, the restoration of edentulous spaces has traditionally been dominated by conventional fixed and removable prostheses. However, advancements in dental materials and innovative techniques have paved the way for unconventional bridges, offering unique solutions to complex clinical scenarios. These unconventional bridges, provide versatile options that cater to specific patient needs where traditional approaches may fall short. By expanding the prosthodontist's toolkit, these innovative bridges enhance esthetic outcomes, improve functionality, and increase patient satisfaction, ultimately pushing the boundaries of restorative dentistry.

4. Fixed dental prosthesis :- A ny prosthesis that is fixed to a natural tooth or teeth, or to one or more dental implants/ implant abutments and that which cannot be removed by the patient -GPT 9

5. Classification of various bridges design

6. Conventional bridge design Based on the type of support provided at each ends of the pontic Fixed- fixed Cantilever bridge Spring cantilever bridge

7. Fixed – fixed bridge Rigid connector on both ends of the pontic This design provides desirable strength and stability to the prosthesis Abutment teeth should be parallel to each other, so as to have single path of insertion

8. Cantilever bridge It is used when support can be obtained from one side of the edentulous space. These have compromised support The abutment teeth should be strong enough to withstand additional torsional forces. Support can be obtained from more than one tooth on the same side of the edentulous space.

9. Spring cantilever bridge It is a tooth and tissue supported bridge. This is a special cantilever bridge exclusively designed for maxillary incisors but these can support only a single pontic . Support is obtained from posterior abutments (usually a single molar or a pair of splinted premolars) This is attached to the end of a long metal arm running high into the palate and then sweeping down to a rigid connector on the palatal side of a single retainer or pair of splinted retainers The arm is so long and thin so that it is springy, but not so thin that it would deform permanently under normal occlusal forces

10. Resin retained bridges These are minimal preparation bridges for resin retention luted to tooth structure, primarily enamel which has been etched to provide micromechanical retention for the resin cement. INDICATIONS Short edentulous span areas Patient unwilling or unsuitable for surgical treatment Adolescents with single missing tooth (traumatic or congenital) Needle phobic patients Post orthodontic fixed retention In periodontally compromised- as splinting CONTRAINDICATIONS Heavily restored abutments Small sized abutments- peg laterals Extensive caries Parafunctional habits Deep bite Mal- aligned abutments Mobile abutments Long span edentulous area Allergy to base metal alloys

11. Madhok S, Madhok S. Evolutionary Changes in Bridges Designs. IOSR J. Dent. Med. Sci. 2014;13:50-6.

12. Objective – cover as much enamel as possible without compromising occlusion, esthetics and periodontal health Weakest Link – bond between the framework and resin Mechanical retention, micromechanical retention, macroscopic mechanical and chemical retention

13. ROCHETTE BRIDGE (macro - mechanical retention) Developed in 1973 by Rochette He used the technique principally for periodontal splinting mandibular anterior teeth and also used pontic in his design Use of wing like retainers with funnel shaped perforations through them to enhance resin retention Rochette AL. Attachment of a splint to enamel of lower anterior teeth. The Journal of prosthetic dentistry. 1973 Oct 1;30(4):418-23. Can be made of zirconia as well

14. The perforation technique presents following limitations:- Weakening of the metal retainer by the perforations. Exposure to wear of the composite resin at the perforations Limited adhesion of the metal provided by the perforations. DISADVANTAGES Weakening of the metal retainer by perforations Limited adhesion Wear of composite resin Thick lingual retainers Plaque accumulation

15. In 1980, Livaditis modified the rochette bridge to be used for posterior teeth Livaditis GJ. Cast metal resin-bonded retainers for posterior teeth. Journal of the American Dental Association (1939). 1980 Dec 1;101(6):926-9.

16. Prevents displacement of the restoration in a gingival direction during trial insertion and final bonding. Assists in transferring the occlusal forces to the abutment tooth Approx. 1mm in diameter and 0.5mm deep. The framework should extend well beyond the contact area toward the proximo-facial line angle. This slight “wrap around” design will provide considerable stability in a facio-loingual direction. The proximal segment should provide an adequate connector area for pontics without impinging on the soft tissues. The margin of the framework is located supra-gingivally When it is necessary to terminate the framework near the gingiva, the margin of the retainer must be well adapted with a knife edge finish line The general objective is to obtain maximum coverage for a greater bond. OCCLUSAL REST LINGUAL SEGMENT PROXIMAL SEGMENT

17. Virginia bridge (medium mechanical retention) In 1983, Moon & Knap developed a roughened metal surface by using salt crystals to create voids in self curing acrylic resin patterns In 1985, Hudgins used the lost salt technique for the fabrication of resin bonded metal retainers giving the framework macroscopic mechanical means of retention with the resin cement Roughened surface of the retainer itself provides for retention Achieved by lost salt technique Air abrasion with aluminum oxide

18. Technique

19. Another method involves the use of a mesh pattern with a design similar to woven screen wire Another example of void containing framework is the technique involving cast mesh given by Shen in 1984 Example of net-like wire mesh used in cast mesh bridge is Kett - O- Bond. This technique gives moderate to good retention but the framework is bulky.

20. ADVANTAGES Can be used with any alloy esp. gold alloys and those with a high palladium content, which have no etchants. Elimination of the etching process. Therefore, reduced cost, time and health hazards The grey discoloration commonly transmitted through the enamel when cast etched retainers are used was not apparent with the mesh system

21. Maryland bridges These are resin bonded bridge using electrolytic etching of metal to retain the metal framework using micromechanical retention Thompson & Livaditis in 1983 developed a technique of electrolytic etching of Ni-Cr and Co-Cr alloy

22. Electrolytic etching The polished bridge is mounted on an electrode (the electrode to the lingual of the retainers). Electrical continuity is assured by use of a conductive paint at the contact point, and all areas not to be etched (and the electrode) are then masked with sticky wax. The electrode and bridge are mounted opposite a stainless steel electrode and immersed in an appropriate acid. The bridge is made anodic and current passed at a given density for a prescribed time. The etching acid, its concentration, the current density, and etching time must be carefully determined for a given alloy in order to get maximum resin to alloy bond strengths. Use of the wrong acid can result in electropolishing rather than etching

23. The conditions for etching a commonly used Ni-Cr-Mo-Al-Be alloy are: 10% sulfuric acid at a current density of 300 milliamperes per square centimeter of surface to be etched for a period of 3 minutes . The etched surface will be occluded with a black debris layer following etching and must be cleaned in 18% hydrochloric acid in an ultrasonic bath for 15 minutes. The etched surface will then have a matt grey appearance and care should be exercised to avoid contamination of the surface. BONDING:- Upon seating the patient, the bridge is solvent rinsed with acetone or chloroform , the abutment teeth are isolated and thoroughly cleaned with flour of pumice -- with particular attention to the lingual and proximal surfaces -- and then rinsed. 37% phosphoric acid is used for etching, for 90 seconds Following thorough rinsing and drying a bonding resin is applied to the etched abutments and then to the etched surfaces of the bridge, & cured for 90 seconds . The low film thickness composite is then immediately applied to the bridge and the bridge seated before the bonding agent sets. The bridge is then held under pressure until the composite sets.

24. ADVANTAGES Better retention: resin – etched metal bond is stronger than resin to etched tooth Retainers are highly polished and resists plaque accumulation DISADVANTAGES Etch is alloy specific requiring special apparatus Only non- precious alloy which can be etched is used Precious alloys cannot be etched. E.g.- Au, Ag, Pt, Pd

25. Two techniques of etching Two step etching Use a 3.5% solution of nitric acid with a current of 250mA/sq-cm followed by immersion in an 18% hydrochloric acid solution in an ultrasonic cleaner for 10 minutes One step etching Combined solution of sulfuric acid and hydrochloric acids placed in an activated ultrasonic cleaner with electric current passed for 95 seconds ( McLaughling )

26. Chair side etching The bridge is clipped to the anode of etching unit and touched with an absorbent point soaked in the etching solution and connected to cathode

27. Reverse Maryland Bridges Utilizing the Maryland bridge applied from the labial and buccal aspect

28. Bonding The intaglio surfaces were etched with 5% hydrofluoric acid for 20 seconds. After rinsing and drying, an MDP-containing ceramic primer was applied and then dried. An MDP-containing dentin adhesive was then applied to the intaglio surfaces, air-thinned, and followed with an application of a highly-filled, flowable resin composite. Both restorations were then isolated from any light sources.  The teeth were isolated, etched with 37% phosphoric acid, rinsed, and dried. An application of the same MDP-containing dentin adhesive was then applied to all of the prepared tooth surfaces and air-thinned to remove the solvent. The adhesive layer was not light-cured at this time. Both of the bridges that were preloaded with flowable resin composite were then inserted, and the excess cement was removed with cotton rolls and micro-brushes. While holding the restorations in place, the facial and lingual surfaces of the abutments were light-cured. Gregg A. Helvey : Facially-Retained Maryland Bridges-An alternative approach to the resin-bonded, fixed partial; Inside Dentistry October 2018 Volume 14, Issue 10

29. Procera Maryland Bridge Further evolution of Livaditis ’ initial concept. The one piece zirconia framework incorporates an all ceramic pontic connecting two wings that are bonded (or cemented) to the lingual surface of the adjacent teeth. The preparation is limited to 0.5mm or less of the enamel layer. The framework is precision milled from a solid piece of zirconia. Zirconia cannot be acid-etched, so to increase the bond strength a proprietary process for coating them with porcelain, etching the porcelain, and bonding the porcelain surface to the teeth with composite

30. The Procera Maryland Bridge: A Case Report The patient was an 18-year-old female who presented with an undersized right lateral incisor and a congenitally missing left lateral incisor. However, consecutive cephalometric radiographs indicated that she had not reached full physical maturity and thus, was not yet a candidate for single implant placement. After a review of her options, she elected to receive a Procera Maryland Bridge as an interim solution. Holt LR, Drake B. The procera Maryland bridge: A case report. Journal of Esthetic and Restorative Dentistry. 2008 Jun;20(3):165-71.

31. Zirconium framework on die model without porcelain on pontic . Central and lateral tooth preparation

32. ADHESIVE BRIDGES Chemically active adhesive cements were developed for direct bonding to metal

33. Adhesive systems Chairside systems Laboratory systems Metabond – 1 st adhesive resin system MMA polymer & monomer Catalyst- tributyl borate Adhesive- 4-META Superbond Highest initial bond strengths Weak bond with gold alloys Bond shows hydrolytic instability Silicoater classical Immediate layer containing silica as this provides sufficient bonding of the resin via a silane bonding agent Rocatec System A tribochemical silica coating is sandblasted onto the metal surface to provide ultrafine mechanical retention

34. Fiber reinforced composite resin Consists of a fiber reinforced substructure Translucent Veneered with composite material Increased flexural strength, fracture resistance, tensile strength

35. Classification

36. INDICATIONS- Esthetics The need to decrease wear of the opposing dentition The use of conservative abutment tooth preparations The desire for a metal free, non porcelain prosthesis CONTRINDICATIONS- Inability to maintain good fluid control Long span (two or more pontics ) Patients with parafunctional habits Patients with unglazed porcelain or RPD frameworks that would oppose the restoration

37. Anterior Fiber-reinforced Composite Resin Bridge: A Case Report A 16-year-old boy was referred to the Department of Pediatric Dentistry who has lost maxillary right permanent central incisor. The removable acrylic splint appliance had been repaired several times, mainly in the middle anterior region. As implant procedure cannot be done until boy turned 18 as he had not reached full physical maturity so he opted this procedure. Chafaie A, Portier R. Anterior fiber-reinforced composite resin bridge: a case report. Pediatric dentistry. 2004 Nov 1;26(6):530-4.

38. Thin foil was closely adapted to the working cast (Figure 2). The foil extended to the middle thirds of each abutment and crossed the pontic area directly under the incisal edge. The foil was flattened and used as a pattern, against which the exact length of the ribbon needed was measured. One should avoid touching the ribbon until after it is wetted with bonding resin via the fingers, because any contact can contaminate its reactive surface layer

39. Case report A 21 year patient reported to the department of prosthodontics, MM College of Dental Sciences & Research, Mullana . She had a chief complaint of missing teeth in maxillary anterior region due to trauma. She had sufficient bone height and width for implant placement and she opted for it also. After implant placement, we had to provide her with the provisional restoration, but she was reluctant to have removable prosthesis due to peer pressure. So we splinted acrylic tooth with fiber splint and kept it out of occlusion in all mandibular movements. We can give provisional prosthesis also with this unconventional bridges

40. DR. SATVIKA PRASAD DR. SATVIKA PRASAD DR. SATVIKA PRASAD DR. SATVIKA PRASAD

41. Combination bridges COMPOUND BRIDGE A combination of any two or more of the conventional bridges design is referred to as compound bridge. The fixed-fixed & cantilever design The fixed-fixed & fixed movable design A bridge with a removable buccal flange that replaces lost alveolar tissue ADVANTAGES Simplifies the construction of the prosthesis Complex bridge to be broken down into several parts Unfavorable angulation of abutment can be corrected resulting in same line of insertion Precision retainers- permits the separation of two or more components

42. Hybrid bridges Fixed movable connectors are employed in case of hybrid bridges Resin bonded + conventional retainers = Hybrid bridge MAJOR RETAINER So that debonding does not require replacement of conventional retainer Hybrid means the combination of two varieties of prostheses. On the one hand, it is a fixed prosthesis, since the patient cannot remove the prosthesis from the mouth; it is fixed, and constructed of two or more different materials. The goal was to give patients an option that was not removable, but that was removable by the clinician to clean and tighten or replace screws periodically.

43. Design variations for special situations Andrew’s bridge Telescopic prosthesis Non – rigid connectors

44. Andrews bridge Dr. James Andrews introduced the fixed removable Andrews bridge system. Improve or achieve comfort, hygiene, normal phonetics and aesthetics Abutment tooth stabilization is combined with a removable partial denture to resolve challenging aesthetic problems Pontic assembly that is removed by the patient for preventive maintenance

45. These prefabricated units were made of precision machined stainless steel rather than gold alloy Very high tensile and yield strengths were claimed for the material so that the bar could be made thin and also occupy minimal vertical space

46. INDICATIONS- Excessive residual ridge defect either due to trauma or surgical ablation Cleft palate patients with congenital or acquired defects ADVANTAGES- Has all the advantages of both fixed and removable i.e. better aesthetics, hygiene along with better adaptability and phonetics Comfortable and economical to patient No plate as in RPD No soft tissue impingement and the surrounding structures System acts as stress breaker while transmitting unwanted leverage forces Flexibility in placing denture teeth DISADVANTAGES- Complex laboratory steps

47. TELESCOPIC PROSTHESIS Used in non- parallel abutments It enables the mesial and distal surfaces to be prepared for single path of insertion ADVANTAGES – Easy access for oral hygiene Better retention Can include teeth with questionable long term prognosis

48. Non – rigid connectors INDICATIONS- Pier abutment Mal-aligned abutment Mobile teeth Long span FPDs

49. Tenon – mortise connectors Cross pin and wing connectors Split pontic connector Loop connectors Moulding MB, Holland GA, Sulik WD. An alternative orientation of nonrigid connectors in fixed partial dentures. The Journal of Prosthetic Dentistry. 1992 Aug 1;68(2):236-8.

50. Tenon mortise connector KEY & KEYWAY an interlock using a matrix and patrix between the units of a fixed dental prosthesis. It may serve two functions: to hold the pontic in the proper relationship to the edentulous ridge and the opposing teeth during occlusal adjustment on the working cast (during application of any veneering material) and 2) to reinforce the connector after soldering

51. Banerjee S, Khongshei A, Gupta T, Banerjee A. Non-rigid connector: The wand to allay the stresses on abutment. Contemporary Clinical Dentistry. 2011 Oct 1;2(4):351-4.

52. Reverse key and keyway

53. If non rigid connector is placed on distal side of the middle abutment, any mesial movement seats the key into keyway If connector is located on mesial side of the middle abutment, mesial movement of the teeth tends to unseat key

54. Split pontic This is an attachment that is placed entirely within the pontic It is particularly useful in tilted abutment cases Casting of mesial half is done Wax is poured into it Casting of distal half

55. O'Connor RP, Caughman WF, Bemis C. Use of the split pontic nonrigid connector with the tilted molar abutment. The Journal of prosthetic dentistry. 1986 Aug 1;56(2):249-51.

56. The cross pin and wing are the working elements of a two piece pontic system that allows the two segments to be rigidly fixed after the retainers have been cemented on their respective abutment preparations The design is used primarily in teeth with disparate long axes. The path of insertion of each tooth preparation is made parallel to the long axis of that tooth. Specifications of wing:- Parallel to path of Insertion of mesial abutment Extend 3mm mesially 1mm faciolingually thickness 1mm short of occlusal surface Cross pin & wing

57. Loop connector Loop connectors are required when an existing diastema is to be maintained in a planned fixed prosthesis. The connector consists of a loop on the lingual aspect of the prosthesis that connects adjacent retainers and/or pontics . The loop may be cast from sprue wax or Pt-Au-Pd alloy wire Meticulous design is important so that plaque control will not be impeded

58. CASE REPORT A 23 year old patient visited to the Department of Prosthodontics, MM college of Dental Sciences & Research, Mullana . He had a chief complaint of missing teeth in upper anterior region due to trauma. Both lateral incisors were congenitally missing. Due to loss of bone, implants cannot be placed. He was presented with various options in FPD, but he opted for loop connectors, as earlier patient had diastema so he wanted to maintain it.

59. DR. SATVIKA PRASAD DR. SATVIKA PRASAD DR. SATVIKA PRASAD DR. SATVIKA PRASAD DR. SATVIKA PRASAD

60. Implant retained fixed prosthesis Porcelain metal restoration Ceramic layer bonded to a cast metal framework Increased bulk of metal used in the substructure to keep porcelain to its ideal 2mm thickness Prosthetic options in fixed full arch restorations Hybrid prosthesis Metal framework + acrylic resin + artificial denture teeth The impact force during dynamic occlusal loading also is reduced

61. Tooth implant supported fixed prosthesis Anatomical limitations of space for implants or failure of an implant to osseointegrate may create a situation in which it would be desirable to connect the implants to teeth. It was 1 st introduced by Ericcson et al.

62. Whether or not it is acceptable to connect an implant to a tooth, or teeth, in a restoration is one of the most misunderstood areas of implant dentistry. The reason so much confusion exists is simple: there isn’t one correct answer.  To understand why, we must look at the mechanics of connecting an implant and a tooth; recognizing that the implant is essentially ankylosed, with effectively no mobility, the tooth has a PDL and may have minimal to significant levels of mobility. Under occlusal loading, the implant, being less mobile, will always be at greater risk of receiving increased load. The tooth will never be at risk of being over-loaded, as it is more mobile and would move under the load compared to the implant. If connecting a single implant to single tooth which has no mobility, the risk of significantly increasing the load on the implant is very low, even in the case of an FPD where there may be pontics between the implant and tooth.

63. He was referred to the dentist in 1986 after fracturing porcelain and solder joints on his fourth reconstruction in only 10 years, he has a history of severe bruxism. After removing the old reconstruction he was left with a maxillary right canine that had endo and a post core, and on the left side a lateral, canine and both premolars. All five remaining teeth had a Grade 2 mobility. in the mid 1980s it was rarely considered sacrificing a natural tooth to place an implant. So the surgeon placed two implants, one in the right lateral position, and one in the right second premolar position. Then placed gold copings on all the natural teeth. In addition a one-piece superstructure was temporarily cemented over the teeth and implants. The problem is that the one-piece restoration is effectively cantilevered off of the two implants due to the Grade 2 mobility of the natural teeth. It took three years, but ultimately he lost the integration of the second premolar implant and it came out when the dentist went to remove the temporarily cemented superstructure. Connecting Teeth and Implants: Yes, No, Maybe? By Frank Spear on May 7, 2018

64. He then put the lateral incisor implant to sleep, and used composite to turn the lateral and second premolar, where the implants had been, into pontics . It is interesting when all the teeth are equally mobile, and you use a one-piece restoration, to see how well they do. He went seven years before finally the right canine root fractured. We then removed all the teeth and went to a completely implant supported restoration using eight implants to support his high levels of muscle activity.   Having focused on the risk for the implant when connecting them to a natural tooth, there is one concern for the natural teeth, intrusion, the tooth moving apically out from under the prosthesis. This is an issue that has occurred for decades, not just with teeth and implants. In the old days of periodontal prosthesis, where each tooth received a gold coping that was permanently cemented with a full arch restoration temporarily cemented over the top, it was not unusual to see an isolated tooth or teeth intrude out from under the prosthesis, sometimes by as much as 1 to 1.5mm

65. Most of the implant companies back then did not have any type of anti-rotational implant abutments, so it was necessary to connect the single tooth implant restorations to the adjacent tooth with a non-rigid connection so that the implant restoration didn’t rotate and come loose. In addition, because of how weak the screw was connecting the restoration to the abutment, it was necessary to place the female portion of the non-rigid attachment on the natural tooth, and the male on the implant. This allowed for removal and retrieval of broken or loose screws after the restorations were placed. But it also created a situation where the natural tooth could intrude relative to the implant, and on occasion they did. The classic coping and one-piece superstructure design used in the 1980s and 1990s  is also susceptible to natural tooth intrusion if the temporary cement washes out between a coping and the superstructure, it now allowed the natural tooth to move independently of the restoration, and intrusion was a possibility. Several theories have been postulated as to why intrusion occurs. With the risks of overloading of the implant, and intrusion of the teeth, it would seem reasonable to ask WHY you would want to connect an implant and a tooth, but there are times where it may be necessary, and sometimes even desirable. The most common reason would be because you HAVE to, an example might be a patient missing a lower first and second molar. A surgeon places two implants, one for each missing molar, but what if the first molar implant doesn’t integrate? A new implant is placed for the first molar, but it also doesn’t integrate. The patient says NO MORE, they want the restorations, your only choice is to connect the second molar implant to the second premolar and do a 3-unit FPD. Connecting Teeth and Implants: Yes, No, Maybe? By Frank Spear on May 7, 2018

66. CONCLUSION A common axiom in conventional prosthodontics for partial edentulism is a fixed partial denture. Fewer the natural teeth missing better the indication for fixed partial denture. Unfortunately every case is different in relation to anatomical variations, patient's desires and medical condition, therefore subtle modifications in designing are required to suit a given particular case. Over the period of time many types of bridges have come up ranging from the traditional to resin retained to the implant retained bridges. With the treatment options available today the primary goal of a prosthodontist should be "meticulous replacement with maximum preservation."

67. References Misch, C.E., 2004.  Dental implant prosthetics-E-book . Elsevier Health Sciences. Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of fixed prosthodontics. Hanover Park, IL: Quintessence Publishing Company; 2012. Rosenstiel SF, Land MF, editors. Contemporary Fixed Prosthodontics-E-Book: Contemporary Fixed Prosthodontics-E-Book. Elsevier Health Sciences; 2015 Jul 28. Madhok S, Madhok S. Evolutionary Changes in Bridges Designs. IOSR J. Dent. Med. Sci. 2014;13:50-6. Rochette AL. Attachment of a splint to enamel of lower anterior teeth. The Journal of prosthetic dentistry. 1973 Oct 1;30(4):418-23. Livaditis GJ. Cast metal resin-bonded retainers for posterior teeth. Journal of the American Dental Association (1939). 1980 Dec 1;101(6):926-9. Taleghani M, Leinfelder KF, Taleghani AM. An alternative to cast etched retainers. The Journal of Prosthetic Dentistry. 1987 Oct 1;58(4):424-8. Livaditis GJ, Thompson VP. Etched castings: an improved retentive mechanism for resin-bonded retainers. The Journal of prosthetic dentistry. 1982 Jan 1;47(1):52-8. Badwaik PV, Pakhan AJ. Non-rigid connectors in fixed prosthodontics: Current concepts with a case report. The Journal of Indian Prosthodontic Society. 2005 Apr 1;5(2):99-102.

68. Miller TE. Reverse Maryland bridges: clinical applications. Journal of Esthetic and Restorative Dentistry. 1989 Sep;1(5):155-63. Holt LR, Drake B. The procera Maryland bridge: A case report. Journal of Esthetic and Restorative Dentistry. 2008 Jun;20(3):165-71. Langer Y, Langer A. Tooth-supported telescopic prostheses in compromised dentitions: A clinical report. Journal of prosthetic dentistry. 2000 Aug 1;84(2):129-32. Moulding MB, Holland GA, Sulik WD. An alternative orientation of nonrigid connectors in fixed partial dentures. The Journal of Prosthetic Dentistry. 1992 Aug 1;68(2):236-8. Banerjee S, Khongshei A, Gupta T, Banerjee A. Non-rigid connector: The wand to allay the stresses on abutment. Contemporary Clinical Dentistry. 2011 Oct 1;2(4):351-4. Gopi A, Sahoo NK. Andrews Bridge: A fixed removable prosthesis, J Pierre Fauchard Acad (India Sect). (2016) O'Connor RP, Caughman WF, Bemis C. Use of the split pontic nonrigid connector with the tilted molar abutment. The Journal of prosthetic dentistry. 1986 Aug 1;56(2):249-51. Connecting Teeth and Implants: Yes, No, Maybe? By Frank Spear on May 7, 2018 Chafaie A, Portier R. Anterior fiber-reinforced composite resin bridge: a case report. Pediatric dentistry. 2004 Nov 1;26(6):530-4. Gregg A. Helvey : Facially-Retained Maryland Bridges-An alternative approach to the resin-bonded, fixed partial; Inside Dentistry October 2018 Volume 14, Issue 10 Academy of Denture Prosthetics. Nomenclature Committee. Glossary of prosthodontic terms. Journal of Prosthetic Dentistry, CV Mosby; 1987.