Frequently Asked Questions

This section of our website is currently being formulated and will frequently be revised and expanded. We welcome suggestions for questions/answers to be included.

My son/daughter has missing teeth and is currently wearing braces. When is the best time for him/her to see a restorative dentist or prosthodontist?

The earlier the better and certainly before the braces are removed. Ideally, the prosthodontist should be involved from the outset even before the orthodontic therapy is begun. It is important that the prosthodontist is involved in the decisions regarding optimal space for implants or for the replacement teeth. In other situations, the prosthodontist may have preferences as to where the supporting teeth are to be positioned or where excess space or reduced spaces are to be located in the arch. If the braces are removed without evaluation by the restorative dentist or prosthodontist, there is the possibility that the braces may have to be re-applied to fulfill the requirements of the prosthodontist’s treatment plan.

What is the Maryland Bridge Technique (Etched metal resin-bonded prosthesis)?

The Maryland Bridge Technique (MBT) (technical term cast metal resin-bonded bridge) is an alternative conservative bridge technique for the replacement of missing teeth and other applications.  The procedure avoids the preparation of teeth (tooth reduction) for full crowns required to provide support for the replacement of the missing teeth.  Bonding to enamel was introduced by Buonocore in the 1950’s allowing dentists to bond composite (resin) to enamel and fundamentally changing restorative dentistry.  Bonding to enamel consists of the development of micro-mechanical retention on the enamel surface using a mild acid to create an etched retentive surface.

Twenty-five years later (1980) Livaditis and Thompson introduced a process that enabled the development of a comparable micromechanical retentive surface on the restoration allowing the bonding of the restoration (prosthesis or bridge) to the etched enamel surface.  From there on, crowns, bridges, inlays, onlays and other restorations could be bonded to teeth while maintaining the enamels surfaces intact.  Prior to the introduction of the MBT,  fixed prosthodontic restorations relied on frictional retention and cements to attach restorations to teeth requiring more tooth reduction and complex designs in tooth preparation (near-parallel walls, retentive grooves, box preparations, pins and pin holes) to obtain the necessary attachment to the teeth.

Shortly after the introduction of the MDT, efforts were undertaken and continue to be pursued to develop similar micromechanical surfaces on other materials to enable bonding to tooth surfaces.  Etching of porcelain was one of the first successful efforts to follow the MDT, leading to the development of bonded ceramic veneers, inlays,onlays and crowns.

The term “adhesive” restorations or bridges is sometimes applied to MDT procedures – incorrectly.  MDT restorations rely on micromechanical retention while the term adhesive may indicate a chemical adhesion of the restoration.  The micromechanical retention provided by the etching of metal provides (according to Livaditis) retention and long-term success comparable to the bonding to enamel.  Bonding to enamel has been successful for over half a century.

What is Pulp Therapy or Vital Pulp Therapy?

See Pulp Therapy under Dental Procedures.