Maryland Bridge | What Is It and Is It Right for You?

A normal bridge crowns the teeth either side of the gap and hangs the false tooth between them. That means shaping those teeth down, even when they're perfectly healthy. A Maryland bridge takes a different approach. The false tooth has thin wings, made of metal or ceramic, which are bonded onto the back surfaces of the neighbouring teeth.

Think of a shelf on brackets rather than a shelf built into the wall. The brackets sit behind, out of sight, and the wall barely knows they're there.

Because the wings are glued on rather than cemented over a shaped tooth, preparation is minimal. Often it's confined to the outer enamel on the back of the tooth, and many people don't need an injection at all. That's why I like it for young, healthy teeth: you're not trading away good tooth to fill a gap.

These days many are made with a single wing on one side only. That's a type of cantilever bridge, and I'll come back to why that's often a good thing.

The textbook candidate looks like this:

• one missing tooth, usually at the front
• healthy, unfilled or lightly filled teeth either side
• teeth that aren't wobbly
• a fairly gentle bite, where the top front teeth don't overlap the bottom ones very deeply

It's often used for younger people who are missing a front tooth, because it protects the neighbouring teeth for the future. The Oral Health Foundation describes adhesive bridges as needing minimal drilling and typically being used for front teeth. If you're weighing up your choices for one gap, my guide to which bridge suits a single tooth sets them side by side.

I'll be straight with you: it's not for everyone. It relies on glue holding on to enamel, so anything that puts big forces on those wings, or leaves less enamel to stick to, counts against it. The main ones are:

• Grinding or clenching. A jaw doing a night shift nobody asked for will test any glue.
• A deep bite, where the lower teeth hit the back of the upper teeth hard.
• Heavily filled or weak neighbouring teeth. There's less good enamel to bond to.
• Long gaps. Several missing teeth in a row is usually a job for something sturdier.
• Back teeth. They can work, but the evidence is better for front teeth.

If any of those sound like you, it doesn't mean you're out of options. It means a conventional bridge, a denture or dental implants may suit you better. You can't work that out from the bathroom mirror, and neither can Google. I can, usually in one visit.

The research varies, so here are the two main reviews. A 2017 systematic review by Thoma and colleagues found about 91% of resin-bonded bridges were still in place at five years. Another 2017 review in the British Dental Journal estimated about 84% at five years and 65% at ten years. That review also found front bridges tended to hold on better than back ones.

Thoma's review concluded that front bridges with a zirconia framework and a single wing seemed to perform best. The one-winged version makes sense when you think about it. Two neighbouring teeth move very slightly and independently when you bite, so a bridge glued to both is being gently pulled in two directions. Glue it to one and there's no tug of war.

Your own mileage depends on your bite, your habits and how well you clean around it. The Oral Health Foundation recommends cleaning under the false tooth with special floss or cleaning aids every day, as well as brushing.

The most common problem is exactly that: the bond lets go. In the British Dental Journal review, coming unstuck accounted for most failures. The good news is that when a Maryland bridge comes off in one piece, it can often be cleaned up and re-bonded.

So if yours falls out, keep it somewhere safe, don't try to glue it back yourself, and ring us. My guide to a bridge that's loose or has fallen out covers what to do in the meantime.

Wondering about cost? A Maryland bridge is a bridge, so on the NHS it's Band 3. Private fees vary with materials and are confirmed in writing before treatment; my guide to dental bridge costs in the UK has more.

If you're considering one, book a normal consultation. A gap isn't urgent, but getting advice early gives you the most choice.

Call us today if:

• your Maryland bridge has come off or feels loose
• a tooth holding the bridge aches, throbs or is tender to bite on
• your gum around the bridge is swollen or there's a bad taste
• a wing or the false tooth has chipped or broken

Call 999 or go to A&E, not a dentist, if: you're finding it hard to breathe, swallow or speak, or swelling is spreading towards your eye or down into your neck.

If you're near Harlow or Enfield, I'd much rather take a look at your gap and your bite than have you guess from photos online. Ring your nearest Minti practice and ask about a bridge consultation. If your bridge has come off or something hurts, say it's urgent and we'll do our best to see you the same day. Anywhere else, or out of hours, call NHS 111.

This article is general information, not a diagnosis. Whether a Maryland bridge suits you depends on an examination in person.