Resin-bonded (Maryland) bridge — a minimally invasive way to replace a missing tooth

A twenty-four-year-old patient attends with a missing lateral incisor — the tooth never developed. She asks whether two healthy adjacent teeth really have to be prepared in order to close the space. Not always. The resin-bonded bridge, also known as the Maryland bridge, was developed precisely to replace a single missing tooth without destroying healthy tissue. Its design and materials have changed and, above all, data on its real-world durability are now available. Below you will find the indications, a comparison with an implant, and the questions patients tend to ask only after treatment: how to clean such a restoration, what not to bite into and what should give cause for concern.

What a resin-bonded bridge is and how it works

A resin-bonded bridge is a fixed restoration made up of two components: the pontic (the artificial tooth filling the gap) and the retainer wing (a thin plate bonded to the lingual or palatal surface of the adjacent tooth). The wing remains invisible when the patient smiles, and the restoration is held in place by a layer of resin cement rather than by mechanical encirclement of the tooth with a crown.

That is where the difference lies. A conventional bridge requires the teeth on either side of the gap to be prepared — a layer of enamel, and usually dentine as well, must be removed from each of them to accommodate a crown. This loss is irreversible — a prepared tooth cannot be restored to its original state, and the deeper the preparation, the greater the risk of irritating the pulp (the living tissue inside the tooth) and of root canal treatment in the future. The resin-bonded variant most often requires no more than smoothing of the enamel or the preparation of a shallow guide groove, and it is sometimes cemented with no preparation at all.

The name “Maryland bridge” comes from the University of Maryland, where the technique of electrolytically etching the metal wing was developed in 1982. Earlier designs, with a perforated wing, had already been described in the 1970s. Today, all that connects that early work with contemporary restorations is the underlying concept — the materials and the design have been thoroughly reworked.

One wing or two — the change that improved safety

The classic design relied on two wings, one on each side of the gap. This seemed logical — clinical practice showed otherwise. Every tooth has its own slight mobility within bone. When a rigid restoration joins two teeth that move independently, stress builds up within the cement: one wing debonds earlier than the other, and the patient does not notice. A gap forms beneath the loose wing, dental plaque penetrates it, and decay develops out of sight.

This is why the single-retainer design, also known as the cantilever design, is now the standard — the pontic is supported by a single abutment tooth. The restoration moves together with that tooth, and any debonding is immediately apparent to the patient. Here, paradoxically, less support means greater safety.

How long a resin-bonded bridge lasts — what the research shows

Two ceramic materials are used above all today. Zirconia has very high flexural strength and fracture resistance, which makes it suitable wherever chewing forces are high or the wing has to be exceptionally thin. Lithium disilicate is markedly less strong mechanically — its flexural strength is roughly two to three times lower than that of zirconia — but it transmits light far better. The division of roles does not, however, follow a simple front–back line: in the posterior region zirconia is the obvious choice because of the chewing forces involved, but it also has the best long-term documentation in the anterior region [6]. Lithium disilicate is sometimes chosen where translucency is the priority and the occlusal conditions are favourable.

In the anterior region. A retrospective multicentre study assessed 108 single-retainer lithium disilicate restorations replacing a missing maxillary incisor. The mean follow-up was just under three years, with individual restorations observed for periods ranging from a fortnight to more than nine years. None of them fractured, debonded or developed decay underneath — the authors stress, however, that these conclusions relate to a short-term perspective. The problems that did occur concerned aesthetics and the soft tissues: discolouration at the restoration margin and inflammation of the gingiva around the pontic — matters requiring correction rather than loss of the restoration [2].

In the posterior region. Here the chewing forces are several times greater. A three-year prospective study assessed 40 single-retainer zirconia restorations replacing missing premolars and molars. After three years close to 9 in 10 of them were still in function, and around 3 in 4 met all the criteria for complete success, with no intervention of any kind required. Oral health-related quality of life improved so clearly that the change is difficult to put down to chance [1]. The authors noted that such a result depends on a rigorous wing design — its thickness, the extent of coverage of the abutment tooth and the dimensions of the connector.

The conclusion for the patient: a resin-bonded bridge is not an inferior solution, but one with a different risk profile. The most common complication is debonding rather than destruction of the tooth — and it can usually be re-cemented.

Resin-bonded bridge vs conventional bridge vs implant

The durability row is easily read too optimistically. The data on implant-supported restorations are very good: among 644 monolithic zirconia crowns and bridges on implants followed for up to five years, a single failure of the restoration itself was recorded [3]. Another analysis, covering close to 1,300 monolithic ceramic restorations on implants, found prosthetic failures and complications in around 2 in 100 single crowns overall, with the most frequent — screw loosening, debonding and minor chipping — being repairable [5].

The median follow-up there was, however, two years, and the figures describe the durability of a crown on an implant, not the success of implant treatment as a whole. By way of comparison: monolithic zirconia crowns on natural teeth — that is, single restorations rather than bridges — achieved survival rates of between 91% and 100%, with a mean follow-up of a little over a year [4]. We are therefore comparing different things over different time horizons — a decision cannot be based on the figures alone.

A more detailed comparison of the two most popular options can be found in the article “Dental implant or bridge — which is better?”. The differences between a restoration supported by an implant and one supported by a natural tooth are described in “A crown on an implant vs a crown on your own tooth”.

What a resin-bonded bridge does not do: bone and gingiva beneath the pontic

This is information patients are not usually given, yet it genuinely affects the decision. Once a tooth is lost, the alveolar bone no longer receives loading and gradually shrinks — most rapidly during the first three months, in which around two-thirds of the loss of ridge width observed over the first year takes place [9]. The pontic rests on the gingiva and does not halt this process. Of the options discussed here, only an implant transmits chewing loads to the bone and thereby limits its resorption — though it does not stop it altogether.

There are two consequences. After several years a gap may appear between the pontic and the gingiva, visible in a broad smile — this risk decreases markedly with an ovate pontic, which supports the gingiva from the edentulous side; with this configuration, preservation of the soft tissues has been described even after more than twenty years [7]. And if an implant is planned for the future, the bone conditions will by then be poorer than they are today and augmentation (bone reconstruction) may be required. None of this is an argument against the method. In a patient who has not yet finished growing, the choice is limited in any case — the alternatives are orthodontic space closure with the canine positioned in place of the missing incisor, a temporary denture, or autotransplantation of a tooth germ. It is, however, worth knowing this before making a decision.

Who it suits best

A resin-bonded bridge is a precisely targeted rather than a universal solution. The necessary conditions, which must all be met together:

• A single tooth is missing, most often a maxillary lateral incisor, in a space of natural width.
• The adjacent teeth are healthy and unprepared, with no extensive fillings and no root canal treatment.

In addition, the following situations argue particularly strongly in favour of this method:

• The patient has not finished skeletal growth. An implant placed earlier does not move with the growing bone and over time comes to sit out of line with the adjacent teeth. In adolescents this is often the treatment of choice for the several years of waiting involved.
• There is congenital absence of a tooth germ (agenesis). Setting wisdom teeth aside, the most commonly missing permanent tooth is the mandibular second premolar [10], yet it is absence of the maxillary lateral incisor that tends to be the typical indication for this method — usually following an orthodontic phase that sets up the space.
• The tooth has been lost through trauma — in adolescents following avulsion or fracture of an incisor, when implant placement is not yet possible.
• The patient does not accept surgery or has general medical contraindications to implant placement.
• An interim solution is needed — for the period of bone healing before planned implant placement.

If the space has been opened orthodontically, the restoration does not take the place of retention. Teeth tend to return to their former positions, which is why a retainer is still required — a bonded palatal wire or a night-time removable retainer. Omitting this stage is sometimes the cause of premature debonding.

When it is not a good choice

The limits of the method matter just as much as its advantages. Caution is warranted where:

• The patient clenches or grinds their teeth (bruxism) — repetitive loading predisposes to debonding and to fracture of the ceramic.
• The bite is deep and the space between the teeth minimal — without room, the wing will either be too thin or will start to interfere with the opposing teeth.
• The abutment tooth is weakened — it has extensive fillings or significant loss of enamel. Resin cement bonds to enamel far more strongly than to dentine.
• More than one tooth is missing or the gap is wide — the forces acting on the bond increase with the length of the pontic.
• Hygiene is inadequate or there is active gingival inflammation.
• The missing tooth is a molar — this is possible (the posterior study cited above showed that close to 9 in 10 restorations were still in function after three years [1]), but it requires a rigorous wing design and the patient must be advised of the higher risk compared with the anterior region.

How treatment proceeds and what to expect afterwards

The procedure is shorter than for an implant and involves no surgical stage. It begins with assessment: of the abutment teeth, the occlusal conditions, the state of the gingiva and the amount of available space, together with a radiograph and an intraoral scan. The material and the abutment are then decided upon. Preparation is minimal — in some patients it amounts to no more than smoothing the enamel. The restoration is designed digitally, on the basis of the scan.

The stage that determines durability is cementation — carried out in isolation from saliva, most often with a rubber dam (a rubber sheet isolating the operating field), after etching of the enamel and preparation of the ceramic. Contamination of the field with saliva or blood weakens the bond and predisposes to later debonding — as do a wing that is too thin and an unfavourable distribution of occlusal forces. Finally, the occlusion is checked — the wing must not take up contact either in intercuspation or during lateral movements of the mandible.

During the first few days the following are normal: a sense of something foreign and of “bulk” on the palatal side, transient sensitivity of the abutment to cold, and minor stumbling over sibilant sounds. This usually passes within a week as the tongue becomes accustomed to the new shape. Pain that increases rather than subsides is a signal to contact the practice.

Living with a resin-bonded bridge: hygiene, habits and warning signs

Durability is largely determined by what happens between appointments.

Hygiene. Dental floss will not pass between the pontic and the abutment, because they are joined. Beneath the pontic, cleaning is done horizontally — with superfloss (floss with a stiffened end and a spongy section) or a floss threader, once a day, ideally in the evening. A water flosser is a good adjunct, but it does not replace floss: a jet of water will not remove mature dental plaque. Fluoride toothpaste is of particular importance here — the enamel around the margin of the wing is an area of raised caries risk.

In our practice in Wola, Warsaw, we pay particular attention to teaching patients how to clean the area around the pontic before cementation takes place — a habit established at the outset proves more durable than a correction made a year later.

Habits. An anterior restoration is not designed for biting into hard foods. Apples and crusty bread are better cut up and chewed with the back teeth. We advise against opening packaging with the teeth and against biting ice, nuts in their shells and pens. A mouthguard is needed for contact sports.

When to contact the practice — warning signs by urgency:

Check-ups are scheduled every six months, together with a professional cleaning — the clinician then checks the integrity of the bond, the condition of the gingiva around the pontic and the distribution of occlusal forces, catching problems before they become noticeable. More on planning restorative work can be found on the page devoted to prosthodontics in Warsaw.

Frequently asked questions

Do healthy teeth have to be prepared? 

In most cases not in the sense familiar from a conventional bridge. Preparation is usually confined to enamel — smoothing the surface or creating a shallow guide groove. There are situations requiring more extensive intervention, but it is never a matter of reducing the tooth for a crown. The precise extent is determined by the clinician after assessing the occlusion and the thickness of the enamel on the abutment.

How long does a resin-bonded bridge last? 

In the anterior region ten-year data are available: in a series of 108 single-retainer zirconia restorations, survival after 10 years was 98.2% and complete success 92.0% [6]. A meta- analysis covering periods of between 3 and 10 years confirms success rates above 80% [8]. A separate study of lithium disilicate restorations, with a mean follow-up of just under three years, recorded no loss of any restoration [2]. In the posterior region there are fewer data — after three years close to 9 in 10 restorations were still in function [1].

Does the procedure hurt? 

Fitting the restoration itself does not involve pain — there is no incision of the gingiva and no intervention in bone. With minimal enamel preparation, anaesthesia is often unnecessary. Discomfort is usually limited to the pressure of the rubber dam and to the time spent with the mouth open. The appointment itself normally lasts about an hour and requires no recovery period.

How much does a resin-bonded bridge cost? 

The cost depends on the material, the number of appointments and the extent of any preparatory work, and is therefore determined after examination. In comparative terms it is usually a less expensive solution than either implant treatment or a conventional bridge involving two crowns. Follow-up appointments and possible replacement of the restoration after several years of use are worth including in the estimate.

What should I do if the restoration debonds? 

Keep it and arrange an appointment — in most cases it can be re-cemented during a single visit, provided the ceramic is intact and the abutment healthy. Do not attempt to re-attach it with anything available at home: a contaminated surface makes proper bonding more difficult later. Until your appointment, avoid biting on that side and watch out for sharp edges of exposed enamel. It is worth knowing that every re-cementation or replacement of the restoration carries a risk of minor enamel loss on the abutment tooth.

Does food collect beneath the pontic? 

Yes, which is why daily cleaning with superfloss is obligatory rather than optional. Plaque accumulating in this area leads to gingival inflammation — the most common reason for dissatisfaction with the restoration, though it does not amount to failure and usually resolves once hygiene improves. A water flosser can also help, used as an adjunct rather than a substitute for floss.

Can I bite into an apple? 

Biting into hard foods with restored front teeth is not advisable. Apples and carrots need only be cut up and chewed with the back teeth. This is a small change of habit that clearly reduces the risk of debonding and of fracture of the ceramic. The same principle applies to crusty bread, ribs, hard nuts and opening packaging with the teeth.

Can I switch to an implant later? 

Yes, and this is one of the main advantages of the method — the adjacent teeth are preserved, so once skeletal growth is complete the choice remains open. The only significant limitation is the condition of the bone: it diminishes at the site of the missing tooth during that time, and augmentation may be required before implant placement.

Summary

A resin-bonded bridge is neither inferior to an implant nor a substitute for one — it answers a different problem. It makes sense where a single tooth is missing, the adjacent teeth are healthy, and the alternative would be to prepare intact enamel or to wait several years for growth to be completed. Modern single-retainer zirconia designs have documented ten-year survival above 98% in the anterior region, and the most common complication — debonding — can usually be repaired without loss of the tooth. The limitations are equally real: bruxism, lack of space in the occlusion, a weakened abutment, a wide gap and progressive bone resorption beneath the pontic. Daily hygiene and regular check-ups affect durability to a comparable degree to the technique of placement itself. 

For the patient described at the outset — with growth complete and a single congenitally missing tooth — a resin-bonded bridge and an implant are both realistic alternatives; they differ in the extent of intervention, the effect on bone and the cost, rather than in one method being “better” than the other. The final decision depends on individual diagnosis.

Read more:

• Prosthodontics — Warsaw
• Dental implant vs bridge — which is better?
• Crown on an Implant vs a Crown on a Natural Tooth — What's the Difference?
• Dental implants — a comprehensive guide
• How much does a tooth implant cost in Poland in 2026?

Content and liability disclaimer

This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.

Sources

Source 1 Links https://doi.org/10.1016/j.jdent.2024.105140 │ https://pubmed.ncbi.nlm.nih.gov/38901823/ Description Lam WYH, Lim TW, Yu Yon MJ, Chau JMH, Lai GCH, Wang DCP, Botelho MG. „Posterior two-unit cantilevered zirconia resin-bonded fixed partial dentures: A 3-year prospective single-arm clinical trial.” Journal of Dentistry. 2024;147:105140.

Source 2 Links https://doi.org/10.1016/j.prosdent.2023.07.040 │ https://pubmed.ncbi.nlm.nih.gov/37718177/ Description Jonker JA, Tirlet G, Dagba A, Marniquet S, Ouwerkerk M, Cune MS, Gresnigt MMM. „A 32-month evaluation of lithium disilicate cantilever resin-bonded fixed dental prostheses to replace a missing maxillary incisor.” The Journal of Prosthetic Dentistry. 2024;132(5):956-963.

Source 3 Links https://doi.org/10.1111/jopr.13575 │ https://pubmed.ncbi.nlm.nih.gov/35929416/ Description Kim W, Li XC, Bidra AS. „Clinical outcomes of implant-supported monolithic zirconia crowns and fixed partial dentures: A systematic review.” Journal of Prosthodontics. 2023;32(2):102-107.

Source 4 Links https://doi.org/10.2186/jpr.JPR_D_21_00081 │ https://pubmed.ncbi.nlm.nih.gov/34615842/ Description Leitão CIMB, Fernandes GVO, Azevedo LPP, Araújo FM, Donato H, Correia ARM. „Clinical performance of monolithic CAD/CAM tooth-supported zirconia restorations: systematic review and meta-analysis.” Journal of Prosthodontic Research. 2022;66(3):374-384.

Source 5 Links https://doi.org/10.1016/j.prosdent.2022.11.013 │ https://pubmed.ncbi.nlm.nih.gov/36564291/ Description Lemos CAA, Verri FR, de Luna Gomes JM, Santiago Junior JF, Miyashita E, Mendonça G, Pellizzer EP. „Survival and prosthetic complications of monolithic ceramic implant-supported single crowns and fixed partial dentures: A systematic review with meta-analysis.” The Journal of Prosthetic Dentistry. 2024;132(6):1237-1249.

Source 6 Links https://doi.org/10.1016/j.jdent.2017.07.003 │ https://pubmed.ncbi.nlm.nih.gov/28688950/ Description Kern M, Passia N, Sasse M, Yazigi C. „Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors.” Journal of Dentistry. 2017;65:51-55.

Source 7 Links https://doi.org/10.1111/jerd.13001 │ https://pubmed.ncbi.nlm.nih.gov/36579757/ Description Kern M, Gläser R. „Single-retainer all-ceramic resin-bonded fixed dental prostheses: Long-term outcomes in the esthetic zone.” Journal of Esthetic and Restorative Dentistry. 2023;35(1):64-73.

Source 8 Links https://doi.org/10.1016/j.prosdent.2021.10.015 │ https://pubmed.ncbi.nlm.nih.gov/34893319/ Description Al-Bermani ASA, Quigley NP, Ha WN. „Do zirconia single-retainer resin-bonded fixed dental prostheses present a viable treatment option for the replacement of missing anterior teeth? A systematic review and meta-analysis.” The Journal of Prosthetic Dentistry. 2023;130(4):533-542.

Source 9 Links https://pmc.ncbi.nlm.nih.gov/articles/PMC4040934/ Description Horváth A, Mardas N, Mezzomo LA, Needleman IG, Donos N. „Alveolar ridge preservation. A systematic review.” Clinical Oral Investigations. 2013;17(2):341-363 — omówienie danych Schroppa dotyczących dynamiki zaniku wyrostka zębodołowego.

Source 10 Link: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0528.2004.00158.x  Description Polder BJ, Van’t Hof MA, Van der Linden FPGM, Kuijpers-Jagtman AM. „A meta-analysis of the prevalence of dental agenesis of permanent teeth.” Community Dentistry and Oral Epidemiology. 2004;32(3):217-226.