What is a Maryland bridge, and can it take the place of an implant?

In a conventional bridge, the teeth on either side of the gap are reduced on every surface and crowns are fitted over them. In a resin-bonded bridge, by contrast, the false tooth is attached to a thin wing that sits on the tongue or palate side of the neighbouring tooth, and this wing is fixed to the enamel with a resin-based adhesive. According to a practical guide published in the British Dental Journal in 2023, these bridges are a conservative method that needs little or no tooth preparation, and bonding-based techniques have been in use for more than fifty years.

The retention comes not from a mechanical lock but from the bond the adhesive forms with the enamel. The same guide states that this bond is strongest to enamel and much weaker to surfaces such as amalgam, dentine and glass ionomer. That is why a large neighbouring tooth with no fillings and sound enamel makes the best support, while a heavily filled tooth is a poor candidate. According to the guide, extensive tooth preparation shortens the life of the bridge; today it is accepted that bonding to unprepared enamel can also be successful.

There are two basic designs. A two-wing bridge is bonded to the teeth on both sides of the gap at once. A single-wing bridge is attached to only one neighbouring tooth, and its free end sits in the gap. According to the British guide, the most successful results come from the single-wing design, and bridges at the front of the mouth are more successful than those at the back. With a two-wing design, one of the wings can come away while the bridge stays in place, held by the other; in that case there is a risk of decay progressing under the wing that has come away.

Long-term results vary markedly with the material and the design. In a study by Kern and colleagues at Kiel University that followed 108 single-wing zirconia bridges at the front of the mouth, 10-year survival was 98.2% and problem-free success 92.0%; all six bridges whose wing came away were bonded back on. In a study the same team published in 2025, in which 310 bridges were followed for an average of about seven years, 15-year survival was calculated at 97.3%; the wing came away on 17 bridges, and 16 of these were bonded back on and remained in use without problems.

There are more pessimistic figures too, and it is important to know why. A 2017 systematic review in the British Dental Journal, which combined studies from different periods and designs, estimated the rate of remaining problem-free at 83.6% at 5 years and 64.9% at 10 years; it did not count bridges that had been bonded back on as successes. In the same review, bridges at the front of the mouth and in the upper jaw tended to stay on better. In short, how long a bridge lasts is determined as much by the design, the location and the choice of supporting tooth as by the bonding method.

The most natural use for this bridge is congenitally missing teeth. The 2023 British guide notes that these patients are mostly young, that their neighbouring teeth have no fillings and that their teeth have been aligned with braces, which is why a minimally invasive resin-bonded bridge has an advantage over other methods. A 2021 review by Mendes and colleagues likewise describes all-ceramic single-wing bridges as a suitable solution for teenagers and young adults who may still be growing.

This is where the limitation of implants in young people becomes clear. A 2024 review by Khalil and colleagues reports that an implant stays fixed in place like a tooth fused to the bone, that as the neighbouring natural teeth continue to erupt, the tooth on the implant can come to look shorter than its neighbours over time, and that this can continue even into early adulthood. A resin-bonded bridge, on the other hand, is attached to a natural tooth and, because it needs no surgery, allows the decision about an implant to be put off until growth is complete.

The distinction below rests on the condition of the tooth that will act as the support and on where the gap is. Single missing teeth are not our area; for this decision, see your own dentist or, if needed, a prosthodontist. The lists are there to help you go into that appointment prepared.

There is no surgery, and the process usually spreads over a few appointments between taking impressions and bonding. The steps below follow the clinical sequence in the practical guide published in the British Dental Journal in 2023.

1. 1

   Assessing suitability

   The size of the supporting tooth, its fillings, its tilt, the condition of the gum and how it meets the teeth of the opposite jaw are examined. If needed, planning is done on models, along with a wax-up showing the expected appearance.

2. 2

   Oral hygiene and preparing the gums

   If the gums are inflamed, they are cleaned first. If gum that has overgrown from long-term wear of a retainer narrows the enamel surface to be bonded, it can be reshaped.

3. 3

   Limited tooth preparation, if needed

   The enamel may be reshaped slightly to open up the path along which the wing seats, to make room for the connection, or to replace an unsuitable old filling; often no cutting is needed at all.

4. 4

   Impressions and choosing the shade

   The shade is chosen at the start of the appointment, before the teeth dry out. The impression is sent to the laboratory, and the wing is designed to cover as wide an area of enamel as possible.

5. 5

   Try-in and bonding

   The bridge is first tried for fit on the model and in the mouth. Moisture control is critical during bonding; a surface contaminated with saliva weakens the bond. After bonding, the bite is checked; the false tooth should not take any load during side-to-side movements.

6. 6

   A new retainer and cleaning instructions

   For a patient who has had braces, a new retainer is made, because the old one will no longer fit. You are shown how to clean with an interdental brush or a special floss that passes under the bridge.

Which one is right for you depends on your age, the condition of the neighbouring teeth and where the gap is. Asking your dentist the following makes the comparison easier: Will the bridge have one wing or two, and why? Will the wing be metal or zirconia? Will my tooth be cut, and if so, will the cutting stay within the enamel? What should I do if the bridge comes off, and can it be bonded back on?

The risks of a resin-bonded bridge are mostly technical; those that harm the supporting tooth can often be prevented by noticing them early.

Because there is no surgery, there is no healing period. What determines how long the bridge lasts is the habits formed in the first weeks and regular check-ups.

1. The first day

   Bonding and the bite check are completed at the same appointment. Because the supporting teeth dry out during bonding, they may look a slightly different colour for a short while; this is temporary.

2. The first few days

   If you have had braces, your new retainer is made. The British guide recommends that it be fitted as quickly as possible, ideally within 48 hours.

3. Every day

   Clean under the false tooth and along the edge of the wing with an interdental brush or special floss. Avoid biting on hard things with your front teeth.

4. At check-ups

   The edge of the wing, the enamel of the supporting tooth and the gum are checked. Keep wearing your retainer regularly.

A Maryland bridge is a single-tooth solution, and it is planned by your own dentist; we do not give figures here. The main items that determine the scope are these:

The material of the wing and false tooth

Metal-backed porcelain bridges and all-ceramic or zirconia bridges require different laboratory work.

One wing or two, one tooth or two

Where both lateral incisors are missing, two separate bridges or a design attached to the two central incisors may be planned.

Preparation beforehand

Reshaping the gum, replacing an old filling or creating space with braces may be added to the plan.

The retainer

A patient who has had braces needs a new retainer that fits with the bridge.

The long-term view

The chance of needing the bridge bonded back on should be weighed together with the surgery and waiting time an implant involves; your age changes this calculation.