Cast anterior bridges utilizing composite resin.

J. he loss of a permanent anterior tooth on a young patient poses unique problems in replacement for the pedodontic practitioner. Full crown coverage of the abutment teeth necessary for conventional fixed bridgework is often contraindicated due to the large size of the pulp chamber and the potential for pulpal damage. Even if possible, this reduction violates the current concepts of good conservative dentistry, since these teeth rarely have caries or restorations. The care necessary for proper maintenance of a full coverage fixed bridge may often be neglected by a young patient, and dislodgement or damage is more possible during the accident prone years. As the patient ages, increased exposure of the clinical crowns of teeth also occurs, decreasing the esthetics of the gingival margins of anterior full coverage crowns. Most young patients therefore, have missing anterior teeth replaced by a removable appliance, often of the "flipper" type. Although these appliances are conservative, they are often damaging to the supporting tissues of the teeth and an inconvenience to the patient. The new composite resin systems, in combination with the acid-etch procedure, have offered the practitioner a wide range of esthetic techniques for the solution of anterior teeth problems. One of these is a conservative, relatively inexpensive, and permanent method of replacing missing anterior teeth with little or no tooth structure removal.The technique involves bonding a thin cast metal framework with porcelain pontic to the lingual surface of the anterior abutment teeth utilizing the acid-etch technique with composite resin as the bonding agent. The use of acid-etch retained cast appliances has also been expanded to include applications other than anterior tooth replacement. These include posterior tooth replacement, postorthodontic stabilization, periodontal splinting, and tooth recontouring.