Q U I N T E S S E N C E I N T E R N AT I O N A L
PROSTHODONTICS
Single-retainer resin-bonded fixed
dental prostheses as an alternative to orthodontic
space closure (and to single-tooth implants)
Matthias Kern, Prof Dr med dent1
This article describes single-retainer resin-bonded fixed dental
prostheses (RBFDPs) as an excellent alternative to orthodontic
space closure or tooth replacement with implants or conven-
tional fixed dental prostheses for congenitally and traumatical-
ly missing anterior teeth. Although the treatment with RBFDPs
is technique sensitive, it is extremely reliable given a correct
Key words: children, resin-bonded fixed dental prostheses (RBFDPs), single tooth replacement
The most common congenitally missing teeth are the
maxillary lateral incisors and the mandibular second
premolars. Females are significantly more often
affected by congenitally missing teeth than males. On
an average, 1.5% to 1.8% of the population is missing
the maxillary lateral incisors.2 This means that in Ger-
many alone, tens of thousands of young patients are
affected by missing lateral incisors (Fig 1).
Accident-related injuries of the maxillary incisors are
very common. By the age of 14 years, 18% of female
and 26% of male teenagers are already affected by an-
1 Professor and Chairman, Department of Prosthodontics, Propaedeutics and
Dental Materials, Christian-Albrechts University at Kiel, Kiel, Germany.
Correspondence: Dr Matthias Kern, Department of Prosthodontics, Pro-
paedeutics and Dental Materials, Christian-Albrechts University at Kiel,
Arnold-Heller-Straße 16, 24105 Kiel, Germany.
Email: mkern@proth.uni-kiel.de
VOLUME 49 • NUMBER 10 • NOVEMBER/DECEMBER 2018
Matthias Kern
indication and adequate adhesive procedures. (Quintessence
Int 2018;49:789–798; doi: 10.3290/j.qi.a41158; Originally pub-
lished in German in Kieferorthopaedie 2018;32:123–134, with
illustrations from “RBFDPs. Resin-bonded fixed dental prosthe-
ses: Minimally invasive – esthetic – reliable”1)
terior tooth injuries.3 These injuries result in about 7%
of instances in loss of anterior teeth.4 Therefore,
approximately 1.3% of female and 1.8% of male teen-
agers exhibit tooth loss caused by trauma (Fig 2).
Hence it can be assumed that about 3% to 3.5% of all
teenagers have missing anterior teeth. These should be
replaced at an early age, as missing anterior teeth affect
the quality of life considerably and might also affect the
healthy psychologic development of adolescents.5-7
Therapeutic alternatives
Orthodontists often favor orthodontic space closure
and are proud to achieve a closed dentition without
restoration.8 Unfortunately, there are no randomized
prospective clinical trials showing whether orthodontic
space closure or prosthetic tooth replacement is the
better therapy for symmetrically missing lateral inci-
sors.9,10 Therefore, no clear therapeutic recommenda-
tions can be derived from the scientific literature.
789
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Fig 1a Extraoral view of a 16-year-old

woman with congenitally missing maxil-
lary incisors [Courtesy of Birka Dimaczek,
formerly University of Kiel, currently
Private Practice, Flensburg, Germany].
Fig 1b Labial view with retracted lips
[Courtesy of Birka Dimaczek].

a b

Fig 2a Extraoral view of a 10-year-old boy

with a traumatically lost central incisor.
Fig 2b Labial view with retracted lips.

a b

Fig 3 A young patient with bilaterally

congenitally missing maxillary lateral inci-
sors after orthodontic space closure. Clear-
ly recognizable are the darker shade of the
canines and that their shape does not
match that of the lateral incisors [Courtesy
of Helge Fischer-Brandies, University of
Kiel].

Orthodontic closure of edentulous spaces is a treat-
ment alternative in cases of symmetrically congenitally
missing maxillary lateral incisors.11 However, it has cer-
tain esthetic and functional disadvantages when the
canines are moved to the position of the missing lateral
incisors (Fig 3). This case of a successful orthodontic
space closure demonstrates that the darker shade of
the canines at the position of the lateral incisors is
rather dominant and that the incorrect shape of the
canines stands out quite strikingly. When teeth in the
maxillary anterior area are congenitally or traumatically
missing unilaterally, orthodontic space closure is espe-
cially critical as it will result in a strongly asymmetric
esthetic appearance (Fig 4).
In general, implant-retained restorations in the
esthetic zone are contraindicated in children and ado-
lescents. After finalization of the transversal growth of
the dental arches with odontogenesis of the permanent
canines, clinically relevant vertical growth of the alveo-
lar process must be still expected.12,13 By the age of 17
to 18 years, this vertical growth still has a magnitude of
0.1 to 0.2 mm per year. Therefore, implant restorations
inserted in adolescents may result in a vertically
retained implant with infraposition of the implant-re-
tained crown, creating different levels of the incisal
edges (Figs 5a and 5b). This is also known to happen
with ankylosed natural teeth.14,15 Patients with a high lip
line are then permanently esthetically compromised. A
repositioning of the vertically malpositioned implant is
possible only to a very limited extent.16 Clinically relevant
vertical growth of the alveolar process has been revealed
even in adults above the age of 20 years.12,13,15,17,18 Often
this results in even more severe esthetic problems in
later years (Figs 5c and 5d).
Therefore, it seems meaningful to apply single-
tooth implant-supported crowns in the esthetic zone

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Fig 4a Extraoral view of a 15-year-old

female patient with unilateral anodontia
of the maxillary right lateral incisor. The
maxillary right canine is located in its
place, with the primary canine being
retained distally.
Fig 4b View with retracted lips and teeth
in maximum intercuspation. Canine guid-
ance is missing on both sides. a b

Fig 5a Traumatically lost maxillary right

central incisor in a 16-year-old patient,
with an implant crown placed in 1993
[Courtesy of photo archive, Dental School,
University of Kiel].
Fig 5b View at 23 years old, in 2000. The
implant at the maxillary right central inci-
sor has been vertically retained, while the
adjacent teeth and the alveolar process
a b
developed vertically [Courtesy of Photo
archive, Dental School, University of Kiel].
Fig 5c View at 41 years old, in 2018. The
elevation of the implant at the maxillary
right central incisor has increased even
further [Courtesy of Norman Hanske, Uni-
versity of Kiel].
Fig 5d The length of the newly fabricat-
ed metal-ceramic crown reveals the verti-
cal position changes of the adjacent teeth
during the past 25 years [Courtesy of
c d
Norman Hanske, University of Kiel].

only in older patients (25 years and older).11 Such
growth-related complications are minimized and
accordingly delayed to a higher age, when the aging
related changing lip line will result in a reduced visibil-
ity of the gingival areas.19 Lengthening of the implant-
retained crown for adaptation to changes of the natural
teeth is less likely to be required if the gingival areas are
exposed to a lesser degree in the higher age group or if
they are not visible at all. When planning implants, it
should also be borne in mind that every fifth patient
develops peri-implantitis within 5 to 10 years after
implant placement,20 which can cause serious esthetic
problems, especially in the esthetic zone.
Resin-bonded fixed dental prostheses (RBFDPs),
also known worldwide as Maryland bridges, represent
an alternative for single tooth replacement in the
esthetic zone. Unfortunately, RBFDPs are used relatively
seldom, and usually only as a provisional restoration
with the aim of replacing the RBFDP later with suppos-
edly better and more stable implants. This is in contra-
diction to the fact that RBFDPs for the replacement of
single incisors provide excellent long-term clinical out-
comes,21,22 and therefore should be considered perma-
nent restorations.
In general, single-retainer all-ceramic RBFDPs can be
used to replace missing incisors when at least one adja-
cent tooth is sound and provides an adequate bonding
surface within its enamel. In addition, there must be
sufficient space for the retainer wing and the proximal
connector between retainer wing and pontic. One of the
most frequent and dreaded complications with two-
retainer RBFDPs with a metal framework was the unilat-
eral debonding of one retainer wing, which was often
not noticed by the patient, or even ignored. Such unilat-
eral debondings in multiple-retainer RBFDPs almost inev-
itably resulted in caries (Fig 6), and discredited RBFDPs.

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a b
Since the mid-1990s, it has been routinely recom-
mended to attach RBFDPs unilaterally. The single-retainer
wing reduces peeling and shear forces resulting from
the differential loading forces, preventing the complica-
tions caused by unilateral debondings experienced
with two-retainer RBFDPs.23,24 In the meantime, the con-
cept of metal-based single-retainer RBFDPs with superior
longevity compared to multiple-retainer RBFDPs was
confirmed in various clinical studies.21,25-29 The risk of
caries development under a unilaterally debonded
retainer wing that exists with two-retainer RBFDPs is not
present when using single-retainer RBFDPs.
In a recently published randomized clinical long-
term trial with metal-ceramic RBFDPs replacing maxil-
lary incisors over a mean observation time of 18 years,
the outcomes between single-retainer and two-retainer
RBFDPs differed significantly.29 While all single-retainer
RBFDPs survived, only 10% of the two-retainer survived
without complications. The overall survival rate of
two-retainer RBFDPs was 50% when survival with com-
plications was considered, compared to a 100% survival
rate without complications of the single-retainer
RBFDPs. Based on these results, the application of
two-retainer anterior maxillary RBFDPs can no longer
be recommended.
Advantages of the single-retainer design are a hard
tissue-preserving tooth preparation, a more rational
fabrication technique, and the immediate realization of
retention loss.30 In addition, the single-retainer design
simplifies oral hygiene as dental floss can be intro-
duced at the open proximal contact area. Also, in cases
of edentulous spaces that are too wide for anatomically
well-proportioned pontics, it is possible to create a
diastema, if esthetically desired. Only occasionally, and
792
Fig 6a Unilaterally debonded two-re-
tainer metal-ceramic RBFDP, replacing the
maxillary left central incisor.
Fig 6b Clearly visible caries at the
debonded abutment tooth (maxillary right
central incisor) after removal of the RBFDP.
in special situations, are two-retainer RBFDPs consid-
ered still appropriate. The splinting of adjacent retain-
ers of two cantilever RBFDPs quite often makes sense,
especially as a long-term retentive device after ortho-
dontic closure of a midline diastema in order to prevent
a recurrence.
Starting in the mid-1990s, all-ceramic single-retainer
RBFDPs have been used,31 which also proved much
better than the two-retainer variant.32 Single-retainer
RBFDPs made from alumina ceramics had a 10-year
survival rate of 95.4%, that decreased to 81.8% after
15 years.33 Single-retainer RBFDPs for incisor replace-
ment made of zirconia ceramic (twice as strong as
alumina ceramic) achieved a 10-year survival rate of
98.2% in a recent study with 108 RBFDPs.22 Interest-
ingly, in this 2017 study it did not make any difference
whether traumatically lost teeth (mostly maxillary
central incisors) or congenitally missing teeth (mostly
maxillary lateral incisors) were replaced.
Application of single-retainer RBFDPs in
children and adolescents
Single-retainer RBFDPs already offer (for children and
for adolescents) an almost optimal treatment modality
to replace missing incisors in the long term. As single-
retainer RBFDPs do not interfere with the growth of the
dental arches, they can be used before the transversal
jaw growth is completed. They can even be used
despite an eventually necessary orthodontic therapy, as
they do not hinder this approach (Figs 7a to 7j). The
required treatment time is relatively short, and all exist-
ing restorative treatment alternatives, eg, implants or
conventional fixed prostheses in higher ages, remain
possible. In the case shown, an all-ceramic RBFDP was
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b c

a d e

f g
Fig 7a Seven-year-old boy with traumatic loss of the maxillary left central incisor that occurred approximately 6 months earlier.
Fig 7b Labial view of the early mixed dentition.
Fig 7c Occlusal view.
Fig 7d Digital design of the zirconia ceramic framework [Courtesy of Reinhard Busch, University of Kiel].
Fig 7e Digital design of the labial veneering to be milled from lithium disilicate ceramic [Courtesy of Reinhard Busch, University of Kiel].
Fig 7f Milled zirconia ceramic RBFDP framework (IPS e.max ZirCAD) and milled lithium disilicate ceramic veneer (IPS e.max CAD).
The veneering is connected to the zirconia ceramic framework with sintering ceramic (IPS e.max CAD Crystall/Connect) and simultane-
ously crystallized (so-called CAD-on technique).
Fig 7g Finalized single-retainer RBFDP. If necessary, the veneer could be replaced with a new veneer made from lithium disilicate
ceramics, to allow later adaptation to age-related changes.

h i
Fig 7h Labial view of the inserted single-retainer RBFDP that would not impede later-
required orthodontic therapy.
Fig 7i Occlusal view of the inserted RBFDP.
Fig 7j The happy patient.

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a b c
Fig 8a A 0.1-mm-thick tinfoil was adapted on the prospective abutment tooth (maxillary right central incisor) in the extension of the
planned retainer wing. The incisal and proximal extension corresponds to what is esthetically and functionally possible without impairment.
Fig 8b After the outline of the tinfoil was transferred to millimeter paper with a pencil, the millimeter squares could be counted and
the area of adhesion determined in mm2. In the present case it was more than 40 mm2.
Fig 8c A slight vertical overbite allows an unproblematic expansion of the retainer wing below the antagonistic contact point.

made with a framework of high-strength zirconia and
with a labial veneer of medium-strength lithium disili-
cate ceramic, since this veneering is four times as
strong as a conventional feldspathic veneering. In addi-
tion, the veneering can later be simply adjusted to
growth-related changes in the patient by replacing it
with a new veneer.
In the initial assessment and indication setting for
the therapy with RBFDPs, particular attention should be
paid to the following points:
• Adequate bonding surface of at least 30 mm2
within the enamel of a periodontally healthy abut-
ment tooth. If an adequate enamel bonding sur-
face is not present, the use of RBFDPs cannot be
recommended. The size of the prospective adhe-
sive surface can be easily measured by adapting a
0.1-mm-thick tinfoil to the intended abutment
tooth. This can be done intraorally, or more easily
on the diagnostic cast. The foil is cut according to
the intended bonding surface and then rolled out
onto millimeter paper. Then the bonding surface
in mm2 can be determined simply by counting the
millimeter squares (Figs 8a and 8b).
• Adequate maxillomandibular space for a 0.7-mm-
thick retainer wing in the area of the required
enamel bonding surface. In patients with an over-
bite of up to about 4 mm, a sufficiently large
retainer wing can generally be applied to the max-
illary incisors below the occlusal contact areas so
that no interferences of the retainer wing with the
occlusion are produced (Fig 8c). If there is not
enough space for an adequate retainer wing in a
deep-bite situation, an orthodontic adjustment of
the required space should be considered. In no
case should it be attempted to countersink the
retainer wing in the enamel using an aggressively
deep preparation. That would weaken the tooth
structure substantially and there would be a high
risk of exposing dentin. In deep-bite cases of the
Angle Class II/1 with protruding maxillary central
incisors and occlusal contacts in the area of the
lingual tubercles, the retainer wing might be
applied above the occlusal contact area without
changing the centric contact in any way. Of course,
the slightly modified anterior guidance is then on
the retainer wings (Figs 9a and 9b).
• Sufficient maxillomandibular space for a proximal
connector height of 3 mm. When antagonists are
extruded into the edentulous area of the missing
tooth, reducing them in height within the incisal
enamel (enamel sculpturing) should be considered
in order to obtain sufficient maxillomandibular
space. At the same time, an existing esthetic dishar-
mony in the opposing dental arch is eliminated
(compare to Fig 8c).
• Existing or restorable incisor-canine guidance on
the abutment or other teeth so that the pontic of
the intended RBFDP does not have any guidance.

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a b
Fig 9a Lingual view of an inserted RBFDP. The retainer wings were mesially splinted to Fig 10 Lingual view of two single-retain-
permanently retain the orthodontic diastema closure. The occlusal contacts of the man- er RBFDPs. Due to too small edentulous
dibular incisors are on the lingual tubercles of the two maxillary incisors. Therefore, the spaces the pontics of the lateral incisors
retainer wings of the RBFDP have been recessed in the occlusal contact area. were designed with a small overlap at the
Fig 9b Extraoral view of the patient with ovate pontic rests, which give the impression central incisors to achieve an adequate
that the pontic “grows out” from the gingiva. The so-called roll flap technique was used pontic width.
for soft tissue optimization prior to insertion of the RBFDPs.

• Adequate esthetics and morphology of the abut- Orthodontic pretreatment

ment teeth. If esthetic impairments are present, it is
important to consider whether the deficiencies can
be remedied by means of adhesive techniques with
composite resins or a ceramic veneer in combina-
tion with a RBFDP, or whether a conventional
crown-retained FDP is preferred.
• Adequate edentulous space for the pontic. If the
edentulous area is too wide, orthodontic adjust-
ment of the space width should be weighed against
a broadening of the adjacent teeth with composite
resin. If the tooth space is too narrow, an orthodon-
tic space opening should be discussed against a
slight overlap of the pontic in front of the abutment
tooth (Fig 10).
• Adequate soft tissue conditions in the edentulous
area to allow a convex (ovate) design of the pontic
gingival contact zone with the correct tooth length. In
the case of tissue excesses in the coronal direction as
well as in the case of ridge defects, an esthetic design
with the correct length of the pontic is not possible. In
such cases, improving the edentulous area should be
considered using minor oral surgery such as the
application of a roll flap or a subepithelial connective
tissue graft. The aim is a pontic contact zone from
which the pontic emerges in a way that creates the
illusion that it “grows out” directly from the gingiva
like a natural tooth (compare to Fig 9b).
Ideally, the orthodontic adjustment of the pontic space
is performed in close consultation with the dentist pro-
viding the prosthetic therapy. The orthodontic treat-
ment should only be completed and the multiband
appliance removed if the restorative dentist has
checked whether the corrected spaces can be ade-
quately restored with RBFDPs. The space width should
correspond to the normal width of the missing tooth
and there must be sufficient maxillomandibular space
for the retainer wing.
In the case of an overbite not exceeding 3 to 4 mm,
the adhesive preparation and the retainer wing in the
maxilla can be placed below the occlusal contacts, so
that the ceramic framework does not interfere with the
occlusion. In the case of a deeper vertical overbite of 4
to 5 mm, it should be critically checked whether there is
a sufficiently large enamel surface of 30 mm2 cervical to
the occlusal contacts and whether a sufficient connec-
tor height and thickness of 3 × 2 mm can be achieved.
If this is not the case, as in deeper bite situations
with retroclined maxillary incisors, an adequate ortho-
dontic erection of the incisors is a necessary prerequisite
for the use of RBFDPs, in spite of the deep bite. A sagittal
clearance of 0.6 to 0.7 mm should be established ortho-
dontically between the mandibular and maxillary inci-
sors, so that – after the adhesive preparation – a zirconia
ceramic retainer wing with a minimum thickness of

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a b c

d e f

Fig 11a A 13-year-old female patient with bilateral anodontia of the lateral incisors and
a wide midline diastema. [Courtesy of Bärbel Kahl-Nieke, University of Hamburg, Germany].
Fig 11b View with retracted lips and teeth in maximum intercuspation. Without ortho-
dontic adjustment of the correct space widths and closure of the midline diastema,
therapy with RBFDPs would not be possible.
Fig 11c Extraoral view after closure of the midline diastema and space opening in the
area of the missing lateral incisors [orthodontic treatment by Bärbel Kahl-Nieke].
Fig 11d View with retracted lips and teeth in maximum intercuspation. The adjusted
overbite of approximately 2 mm enables the application of the retainer wings below the
occlusal contact points.
Fig 11e Lingual view of the splinted RBFDPs. The midline splinting secures the closure
of the midline diastema. The risk of unilateral debonding is much lower when splinting
two central incisors compared to splinting a central incisor with a canine as in case of
two-retainer RBFDPs.
Fig 11f Extraoral view at the completion of treatment.
Fig 11g The satisfied patient [Courtesy of Bärbel Kahl-Nieke].

0.7 mm can be bonded. The occlusal contacts of the
mandibular incisors will then be on the polished zirco-
nia ceramic that will also provide the anterior guidance.
In cases with bilateral agenesis of the lateral incisors
with a midline diastema, this should be orthodontically
closed preferably by axial mesialization of the central
incisors (Fig 11). The edentulous spaces of the missing
lateral incisors should be symmetrical with simultane-
ous adjustment of the midline. The edentulous spaces
of the lateral incisors should have a width correspond-
ing to about 50% to 74% of the width of the existing
central incisors in order to achieve the best esthetics.34

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In the case of a unilateral agenesis of maxillary lat-
eral incisor, a pontic space should normally be created
on the side of the agenesis and the canine should not
be moved into the place of the missing incisor to cause
an unesthetic asymmetric condition. If an optimal
space cannot be achieved in the individual case, sym-
metry should be achieved in the center of the arch.
Necessary esthetic compromises, such as additional
tooth broadening, should be applied more distally into
less discrete areas, eg, by an additional mesial broaden-
ing of the canines.
DISCUSSION AND CONCLUSION
Single-retainer RBFDPs for the replacement of missing
incisors, with the correct indication and use of ade-
quate procedures, represent a treatment method that
is extremely reliable.35 The clinical outcome is compara-
ble if not better than the survival rates of conventional
fixed dental prostheses (FDPs) or single-tooth
implants.36,37 Substantial factors for the long-term clin-
ical success with metal or all-ceramic RBFDPs are appro-
priate abutment preparations, adequate dimensions of
the retainer wings and connectors for the pontic, the
use of hydrolytically durable bonding systems, and the
avoidance of errors during the adhesive bonding pro-
cedures.1
Irrespective of whether RBFDPs are already part of
one’s own treatment repertoire, all patients eligible for
this method should be informed about this treatment
alternative today. According to the author’s experience,
however, this is far from current practice, and young
patients with missing anterior teeth are often offered
only orthodontic space closure and single-tooth
implants as permanent minimally invasive treatment
alternatives, while RBFDPs are classed as (long-term)
provisionals. However, due to the excellent data
described above on the long-term survival of RBFDPs in
the incisor area, a therapist would thus fail to provide
adequate information. According to ethical principles
in health care, patients should be comprehensively
informed before the start of treatment about every-
thing that is important for their treatment, especially
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about risks and treatment alternatives. Only then can a
patient exercise his/her right to self-determination
(patient autonomy) and give consent to the proposed
therapy, or even refuse. Since single-retainer RBFDPs
are today in many cases an excellent treatment alterna-
tive for orthodontic space closure and single-tooth
implants, they should also be given due consideration
in the educational discussion on the treatment of miss-
ing anterior teeth.
ACKNOWLEDGMENT
Some parts of the text and figures are based on excerpts of the book
RBFDPs. Resin-Bonded Fixed Dental Prostheses: Minimally Invasive
– Esthetic – Reliable.1 The author thanks cand med dent Katrin Otto,
University of Kiel, for her support in the treatment of the 7-year-old
patient shown in Figs 7a to 7j. In addition, the author thanks the
colleagues who provided photographs of patients (see figure legends).
REFERENCES
1. Kern M. RBFDPs. Resin-bonded fixed dental prostheses: Minimally invasive –
esthetic – reliable. 1st ed. London: Quintessence Publishing, 2017:1–256.
2. Polder BJ, Van’t Hof MA, Van der Linden FP, Kuijpers-Jagtman AM. A
meta-analysis of the prevalence of dental agenesis of permanent teeth.
Community Dent Oral Epidemiol 2004;32:217–226.
3. Kirschner H, Burkard W, Pfütz E, Pohl Y, Obijou C. Anterior tooth trauma. The
preservation and treatment of the injured tooth [in German]. Schweiz
Monatsschr Zahnmed 1992;102:209–214.
4. Tuli T, Hächl O, Rasse M, Kloss F, Gassner R. Dentoalveolar trauma. Analysis of
4763 patients with 6237 injuries in 10 years [in German]. Mund Kiefer
Gesichtschir 2005;9:324–329.
5. Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and
oral health-related quality of life: a systematic review and meta-analysis.
Health Qual Life Outcomes 2010;8:126.
6. Chen P, Yu S, Zhu G. The psychosocial impacts of implantation on the dental
aesthetics of missing anterior teeth patients. Br Dent J 2012;213:E20.
7. Yu SJ, Chen P, Zhu GX. Relationship between implantation of missing anterior
teeth and oral health-related quality of life. Qual Life Res 2013;22:1613–1620.
8. Kokich VO Jr, Kinzer GA. Managing congenitally missing lateral incisors. Part I:
Canine substitution. J Esthet Restor Dent 2005;17:5–10.
9. Kiliaridis S, Sidira M, Kirmanidou Y, Michalakis K. Treatment options for con-
genitally missing lateral incisors. Eur J Oral Implantol 2016;9(Suppl 1):S5–S24.
10. Silveira GS, de Almeida NV, Pereira DM, Mattos CT, Mucha JN. Prosthetic
replacement vs space closure for maxillary lateral incisor agenesis: a system-
atic review. Am J Orthod Dentofacial Orthop 2016;150:228–237.
11. Zitzmann NU, Özcan M, Scherrer SS, Bühler JM, Weiger R, Krastl G. Resin-
bonded restorations: a strategy for managing anterior tooth loss in adoles-
cence. J Prosthet Dent 2015;113:270–276.
12. Thilander B, Odman J, Jemt T. Single implants in the upper incisor region and
their relationship to the adjacent teeth. An 8-year follow-up study. Clin Oral
Implants Res 1999;10:346–355.
797
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Kern
13. Thilander B. Dentoalveolar development in subjects with normal occlusion. A
longitudinal study between the ages of 5 and 31 years. Eur J Orthod
2009;31:109–120.
14. Kawanami M, Andreasen JO, Borum MK, Schou S, Hjorting-Hansen E, Kato H.
Infraposition of ankylosed permanent maxillary incisors after replantation
related to age and sex. Endod Dent Traumatol 1999;15:50–56.
15. Daftary F, Mahallati R, Bahat O, Sullivan RM. Lifelong craniofacial growth and
the implications for osseointegrated implants. Int J Oral Maxillofac Implants
2013;28:163–169.
16. Zitzmann NU, Arnold D, Ball J, Brusco D, Triaca A, Verna C. Treatment strat-
egies for infraoccluded dental implants. J Prosthet Dent 2015;113:169–174.
17. Bernard JP, Schatz JP, Christou P, Belser U, Kiliaridis S. Long-term vertical chang-
es of the anterior maxillary teeth adjacent to single implants in young and
mature adults. A retrospective study. J Clin Periodontol 2004;31:1024–1028.
18. Huanca Ghislanzoni L, Jonasson G, Kiliaridis S. Continuous eruption of maxil-
lary teeth and changes in clinical crown length: a 10-year longitudinal study
in adult women. Clin Implant Dent Relat Res 2017;19:1082–1089.
19. Vig RG, Brundo GC. The kinetics of anterior tooth display. J Prosthet Dent
1978;39:502–504.
20. Mombelli A, Muller N, Cionca N. The epidemiology of peri-implantitis. Clin
Oral Implants Res 2012;23(Suppl 6):67–76.
21. Botelho MG, Ma X, Cheung GJ, Law RK, Tai MT, Lam WY. Long-term clinical
evaluation of 211 two-unit cantilevered resin-bonded fixed partial dentures. J
Dent 2014;42:778–784.
22. 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. J Dent 2017;65:51–55.
23. Briggs P, Dunne S, Bishop K. The single unit, single retainer, cantilever res-
in-bonded bridge. Br Dent J 1996;181:371–379.
24. Hussey DL, Linden GJ. The clinical performance of cantilevered resin-bonded
bridgework. J Dent 1996;24:251–256.
25. Djemal S, Setchell D, King P, Wickens J. Long-term survival characteristics of
832 resin-retained bridges and splints provided in a post-graduate teaching
hospital between 1978 and 1993. J Oral Rehabil 1999;26:302–320.
798
26. van Dalen A, Feilzer AJ, Kleverlaan J. A literature review of two-unit canti-
levered FPDs. Int J Prosthodont 2004;17:281–284.
27. Saker S, El-Fallal A, Abo-Madina M, Ghazy M, Özcan M. Clinical survival of an-
terior metal-ceramic and all-ceramic cantilever resin-bonded fixed dental
prostheses over a period of 60 months. Int J Prosthodont 2014;27:422–424.
28. King PA, Foster LV, Yates RJ, Newcombe RG, Garrett MJ. Survival characteris-
tics of 771 resin-retained bridges provided at a UK dental teaching hospital.
Br Dent J 2015;218:423–428.
29. Botelho MG, Chan AW, Leung NC, Lam WY. Long-term evaluation of canti-
levered versus fixed-fixed resin-bonded fixed partial dentures for missing
maxillary incisors. J Dent 2016;45:59–66.
30. Botelho M, Nor LC, Kwong HW, Kuen BS. Two-unit cantilevered resin-bonded
fixed partial dentures: a retrospective, preliminary clinical investigation. Int J
Prosthodont 2000;13:25–28.
31. Kern M, Gläser R. Cantilevered all-ceramic, resin-bonded fixed partial den-
tures. A new treatment modality. J Esthet Dent 1997;9:255–264.
32. Kern M, Sasse M. Ten-year survival of anterior all-ceramic resin-bonded fixed
dental prostheses. J Adhes Dent 2011;13:407–410.
33. Kern M. Fifteen-year survival of anterior all-ceramic cantilever resin-bonded
fixed dental prostheses. J Dent 2017;56:133–135.
34. Wolfart S, Thormann H, Freitag S, Kern M. Assessment of dental appearance
following changes in incisor proportions. Eur J Oral Sci 2005;113:159–165.
35. Mourshed B, Samran A, Alfagih A, Samran A, Abdulrab S, Kern M. Anterior
cantilever resin-bonded fixed dental prostheses: a review of the literature.
J Prosthodont 2018;27:266–275.
36. Pjetursson BE, Sailer I, Makarov NA, Zwahlen M, Thoma DS. All-ceramic or
metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic
review of the survival and complication rates. Part II: Multiple-unit FDPs. Dent
Mater 2015;31:624–639.
37. Pjetursson BE, Asgeirsson AG, Zwahlen M, Sailer I. Improvements in implant
dentistry over the last decade: comparison of survival and complication rates
in older and newer publications. Int J Oral Maxillofac Implants 2014;29
(Suppl):308–324.
38. Law to improve the rights of patients [in German]. Bundesgesetzblatt
2013;1(9):277–282.
VOLUME 49 • NUMBER 10 • NOVEMBER/DECEMBER 2018