Maryland Bridges in 2026: Zirconia Cantilevers, Metal Wings and What the Evidence Says

A teenager with a congenitally missing lateral incisor is too young for an implant, and nobody wants to cut two healthy, unrestored teeth for a conventional bridge. A Maryland bridge is the obvious answer, yet many dentists still remember metal wings that came off every few years.

The design has changed: the best-documented version today has one wing, not two, and is usually zirconia. Here is the evidence and the protocol.

Quick Answer

For a single missing incisor, the best-documented Maryland bridge in 2026 is a single-wing cantilever in high-strength (3Y) zirconia, bonded to an enamel-only prep after air abrasion and an MDP primer or cement. In the largest series, 97.3% survived 15 years. Two-wing designs fail more often, metal wings still perform, lithium disilicate is outside Ivoclar's indications, and a debonded bridge can usually be rebonded.

Where Does the Name "Maryland Bridge" Come From?

The idea predates Maryland. In 1973, Rochette bonded a perforated metal splint to the enamel of lower anterior teeth. In 1977, Howe and Denehy used that design to replace a missing anterior tooth, and "Rochette bridge" entered the literature. The perforated wings often debonded early.

In 1982, Livaditis and Thompson of the University of Maryland published "etched castings": the inner surface of non-noble alloy retainers was etched electrochemically to give the resin micromechanical retention. The name "Maryland bridge" stuck; the neutral term today is resin-bonded fixed dental prosthesis (RBFDP).

One Wing or Two: Which Design Works Better?

The classic Maryland bridge had a wing on each abutment. In Kern and Sasse's glass-infiltrated alumina series, several two-retainer bridges fractured at one connector; 10-year survival was 73.9% for two-retainer and 94.4% for single-retainer designs. A 2017 review of 2,300 bridges also found higher survival and less debonding with one retainer. (For metal-ceramic bridges alone, a 2016 meta-analysis found no difference.) And one wing of a two-wing bridge can debond unnoticed, letting caries progress under it. Two wings still make sense when the bridge must also hold teeth likely to relapse after orthodontics.

Metal, zirconia or lithium disilicate?

In a review of all-ceramic RBFDPs, zirconia failed less often than glass-ceramic but debonded more often, a trade that favors zirconia: a debond can be rebonded, a fractured wing cannot. Lithium disilicate did well short term (108 cantilevers, no failures at a mean of 32 months), but a 2026 study of 66 single-wing bridges recorded nine catastrophic fractures and one debond. More on the materials in Zirconia vs. E.max.

Grade matters too. The Kiel reports describe 3Y zirconia, and Kuraray Noritake calls its more translucent KATANA STML and UTML unsuitable for a cantilevered pontic bridge. See 3Y, 4Y and 5Y zirconia explained.

What Does the Evidence Say About Survival and Debonding?

Two cautions. "Survival" counts rebonded bridges; the 2025 zirconia series had a retention rate of 82.3%. And, as Blatz and colleagues note, the long-term zirconia studies selected patients carefully (caries-free abutments, no periodontitis, yearly recalls). A 2026 systematic review called the single-retainer evidence limited but favorable.

Who Is a Good Candidate?

• Good fit: a single missing incisor, congenital or traumatic (the reason did not affect 10-year longevity); adolescents who cannot have an implant yet because growth is ongoing; gaps under about 7 mm; a caries-free or minimally restored abutment with enough enamel, no periodontitis and good hygiene.
• Bruxism: Ivoclar lists untreated bruxism among the limitations of use for both IPS e.max CAD and IPS e.max ZirCAD and calls for a splint after placement. A no-prep zirconia series that included bruxers had 100% survival at 3 years, but only 16 bridges.
• Occlusion: the pontic should have at most a light contact in intercuspation and no role in guidance.

How Should You Prepare the Abutment?

Unlike our crown preps, this prep stays in enamel. The Kiel protocol uses a lingual veneer preparation, a groove on the cingulum and a small proximal box: a definite seat, not mechanical retention.

• Lingual veneer area: cover as much enamel as possible, wrapping toward the interproximals; stop about 2 mm from the incisal edge, as translucency allows; light chamfer at the gingival crest.
• Proximal box: small, on the pontic side.
• Cingulum rest: a shallow groove or round-bur depression so the wing seats in one position; posterior designs use an occlusal rest.
• Wing thickness: at least 0.7 mm for zirconia and for non-precious metal.
• Connector: zirconia, 3 mm high and 2 mm wide in a 2026 published case, though Ivoclar's IPS e.max ZirCAD LT/MO table lists 12 mm² (4 by 3 mm) for one-pontic cantilevers, so follow the disc's instructions; metal, 3 mm; e.max, no manufacturer value.

How Do You Bond a Maryland Bridge?

Debonding is the main complication, and protocol is where you control it: Kern's review of clinical studies found that air abrasion at moderate pressure plus phosphate monomer primers or resins bonds durably to zirconia. Crown steps are in How to Cement Zirconia and Bond E.max.

• Zirconia: air-abrade the wing (Ivoclar lists 25 to 70 µm alumina at 1 bar), then an MDP primer such as Monobond Plus for 60 seconds or an MDP resin cement. In a Kiel trial, Panavia 21 and Multilink with Metal/Zirconia Primer each had one debond over a mean of 64.2 months.
• Lithium disilicate: Ivoclar's protocol is IPS Ceramic Etching Gel for 20 seconds and Monobond Plus for 60 seconds, or the one-step Monobond Etch & Prime.
• Metal: air-abrade with 30 to 50 µm alumina (3M lists 2 bar; Kuraray 1 to 4 bar). MDP bonds to metal; Monobond Plus adds a sulfide methacrylate for precious alloys.
• Enamel and isolation: etch with phosphoric acid (Kuraray lists 10 seconds for adhesion bridges with PANAVIA SA Cement Universal) under a rubber dam, as its instructions say. In a 10-year study, a dam reduced debonding risk. If the wings reach the gingival margin, a dam may not fit.

What Should You Do When a Maryland Bridge Debonds?

Usually, rebond it. In the 2025 series, 16 of 17 debonded bridges were rebonded with no further complications; in the 10-year study, all six (three from trauma) were. Among 211 two-unit metal cantilevers, 28 debonded; with rebonding, 90.0% were functioning at review, against 86.7% retention.

A Dutch report on two large trials found rebonded bridges less successful than the originals; it still advised rebonding but read repeated debonds as a sign of the wrong indication. Find the cause (trauma, an interference, contamination), remove old cement from tooth and wing, and repeat the full protocol.

Maryland Bridge vs. Implant vs. Conventional Bridge

On typodont teeth, veneer and resin-bonded retainer preps removed about 3% to 30% of coronal tooth structure, against 63% to 72% for crown preps. In a 2026 study, implant crowns outlived single-wing lithium disilicate bridges at 5 years (96.7% vs. 87.9%), yet white esthetic scores favored the bridges. The table mixes different reviews; read it as ranges.

Prep and Rx Checklist

• Abutment: sound, enough enamel, no mobility, no untreated bruxism.
• Design and material: single wing; 3Y zirconia or non-precious metal, with the grade on the Rx.
• Prep: enamel-only lingual veneer, small proximal box on the pontic side, cingulum groove or rest.
• Space: 0.7 mm for the wing in all excursions and room for a connector about 3 mm high.
• Pontic: light contact at most, no guidance. Records: full-arch and bite scans, shade photos.
• Bonding: rubber dam if possible, phosphoric acid on enamel only; then a retainer after orthodontics and yearly recalls.

Zirconia, E.max and PFM at Elegant Dental Laboratory

• Zirconia: solid, 9-layer, solid with buccal porcelain, and zirconia copings with layered porcelain. See our zirconia options.
• IPS e.max: full-contour crowns, veneers, layered crowns, and inlays and onlays. PFM: base and precious alloys.
• Every case is made in house by more than 35 technicians at our 7,000 sq. ft. facility at 2308 McDonald Ave, Brooklyn, NY, and digital scans are reviewed before production.
• 5 business day standard turnaround on most restorative cases, rush options available, and up to a 7-year warranty on final restorations. Submit a digital case or call 877-335-5221.

Related Guides

• Implant Abutments Explained: Stock vs. Custom vs. Ti-Base vs. Multi-Unit
• E.max Press vs. E.max CAD: Which Lithium Disilicate Should You Prescribe?
• Screw-Retained vs. Cement-Retained Implant Crowns: How to Choose

FAQ

How long does a Maryland bridge last?

Pooled survival is 91.4% at 5 years and 82.9% at 10; single-wing zirconia incisor bridges reached 97.3% at 15.

Can a Maryland bridge be made from e.max?

Ivoclar lists Maryland bridges among the limitations of use for IPS e.max CAD, outside its indications. In a 2026 study, 5-year survival was 87.9%, with nine catastrophic fractures among 66 bridges.

What if the bridge comes off?

Most zirconia and metal bridges can be rebonded with the full protocol. If the same bridge keeps debonding, reconsider the indication.

Can I use a Maryland bridge on a premolar or molar?

Sometimes, with an occlusal rest, but the evidence is thinner: a 2026 review estimated 82.8% survival at 5 years and 68.5% at 10 for posterior RBFDPs.

How is a Maryland bridge coded?

The retainer is D6545 (cast metal) or D6548 (porcelain/ceramic), and the pontic is coded separately. New York Medicaid's 2026 manual approves them only for members under 21, or when pulp anatomy rules out crown preps, and only for certain anterior gaps. See our CDT cheat sheet.

Reviewed by Gary Fingerman, founder and CEO of Elegant Dental Laboratory, Brooklyn, New York (founded 2007). Last reviewed: September 28, 2026. Material values are manufacturer data or published studies; always follow the current instructions for use of the material you choose.