The esthetic stainless steel crown bridge: report of two cases.

Pediatric Dentistry – 21:2, 1999 The loss or congenital absence of permanent anterior teeth in young patients has significant psychological ramifications. 2 Typically, adolescent patients are acutely aware of their appearance and its importance in selfimage and social acceptance. Although a variety of treatment approaches are available to provide esthetic replacement of missing anterior permanent teeth in young patients, there are numerous restorative and financial considerations. The continued eruption of teeth adjacent to the edentulous space, changing gingival contours and large pulp chambers generally contraindicate permanent restorative approaches. Transitional restorative approaches that optimize esthetics are frequently necessary until the patient is in late adolescence or early adulthood when definitive treatment can be performed (e.g., fixed appliances, implants). Despite these restorative challenges, the dentist plays a crucial role in helping maintain optimal esthetics in this young patient population during a critical psychological and psychosocial period of development. During the mixed or early permanent dentitions, transitional treatment often consists of removable tissue born partial dentures. This approach can provide excellent esthetics at a relatively low cost. While removable appliances are generally easy to fabricate and adjust, they also are easily broken and lost. Alternatively, a variety of fixed prostheses can be used in young adolescents having all their permanent anterior teeth. Over the past several decades, bonded prostheses have added substantially to our list of tooth replacement alternatives. Bonded prostheses include the Rochette bridge, Maryland bridge, ceramic-resin bridge, and direct bonding of pontics or natural tooth crowns lost from trauma. 5 Clinical studies have shown the success of bonded appliances to be variable and design dependent. Clearly, all prostheses retained by bonding are predicated on having abutment teeth with adequate structure and sound enamel for bonding. Clinicians can be faced with young patients requiring replacement of anterior permanent teeth where neither removable or bonded appliances are appropriate leaving few restorative options. For example, patients unable to maintain removable appliances or having soft tissue pathology may be poor candidates for removable partial dentures. Likewise, individuals with severe enamel hypoplasia or enamel hypomineralization may not be candidates for bonded prostheses. Because of our ongoing investigations and treatment of individuals with epidermolysis bullosa(EB); we have The esthetic stainless steel crown bridge: report of two cases