Dental TipsDentistry |3 min read

CMS in Everyday Dentistry: How to Create a Strong Temporary Bridge

Looking to up your temporary bridge game? 

Chris Catalano Headshot NewestThe true value of a Dental CE course is most apparent in how it meshes with the real world. What would be the point of learning endlessly if it didn’t translate to real results?

In this spirit, Dr. Catalano has created a comprehensive explanation of a solid temporary bridge technique. We hope you’ll master it and make it work in your everyday dentistry!

by Dr. Chris Catalano, CMS Clinical Faculty

When Failure Is Not an Option

A temporary bridge needs to be as stable as the Golden Gate. Living in the Bay Area, I cross three bridges weekly. The most famous is the Golden Gate. It is an architectural and style masterpiece. It was built by an amazing generation of Americans in just over four years. It is strong and beautiful. When I think of my dental bridges that is what I want.

What about our temporary bridges? Holding the space for our permanent restoration is a must. Failure is not an option. We need the same qualities with these temporary materials but unfortunately they cannot do the job alone. The BisGMA temporary materials lack tensile strength. That is where we can use something borrowed from our construction friends to increase its strength: a material called Rebar.

Rebar You Can Find in Any Dental Office

A paper clip can be used as rebar for a temporary bridge.Rebar is short for reinforcing bar. It is a steel reinforcing bar that is laid in concrete to increase the tensile strength. They lay it into a mesh-like arrangement and pour concrete around it. This steel reinforcing bar holds the concrete from breaking when it undergoes tension. Luckily we have a simple miniature version of rebar in all our dental offices: the paper clip. It is a steel wire that can mimic rebar and provide the strength for any temporary bridge. Just don’t call it a paper clip. Call it the steel wire or whatever you want.

Temporary Bridge Technique: Using Rebar to Your Advantage

temporary bridge techniqueMake your temporary bridge out of your favorite BisGMA temporary product. Once you have finished fitting the bridge, unfold the paper clip, turn your bridge upside down or for anterior bridges, look at the lingual aspect.

Now measure the length by placing the tip of the paper clip from abutment to abutment. I usually score the spot with my handpiece where I am going to section it. You can also mark it with a pen. I use my handpiece to cut the wire. I essentially just cut it halfway and then I break it with my fingers by bending it at the cut mark. I use a diamond prep bur to do the trimming. When you break it the wire will have a rough edge. Round it with your bur.

Now that you have your wire, use that same prep bur and create a trough big enough to fit the wire. I go from prep to prep careful not to touch the margins of my temporary. Check to make sure your wire fits.

temporary bridge techniqueClean and dry the trough of the temporary. Squirt a little flowable composite into the bottom of the trough. While the flowable is wet, lay your wire into the trough. I use a small condenser to push it to the bottom.

Next, go ahead and fill up the trough with the flowable and before curing it, seat it on the patient’s teeth. Make sure it is fully seated, then light cure the pontic area from occlusal, buccal, and lingual. Take the bridge off and light cure from the gingival. What you will see is any excess flowable will be adapted to the edentulous ridge. Trim any excess flash, sharp, or rough spots.

You are done! Your bridge is now a steel reinforced beauty.

Once you’ve used Dr. Catalano’s technique in your practice, let us know how it went in the comments! 

Have your read Dr. Nosti’s series on ceramic porcelain fracture or Dr. Olitsky’s guide to the seven violations of smile design? These posts will help you incorporate Clinical Mastery into your everyday dentistry,

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19 comments on “CMS in Everyday Dentistry: How to Create a Strong Temporary Bridge”
  1. Avatar
    David

    Can you do the same from the occlusal side for double tensile support?

    Reply
    1. Avatar
      Chris Catalano

      Hi David,
      This technique works well. I have been doing it for over 15 years and it is a slam dunk. Usually 1 piece does the job but if it is a longer span 2 pieces may help. I have used 2 pieces when I cantilever an anterior tooth on my temporary and it held up great.

      Reply
  2. Avatar
    Don Boatman

    A paper clip? Seriously? So what does the metal contain? My paper clips are not FDA approved for medical or dental use. I do have some stainless steel ortho wire that would do the job. You might want to edit your article, as I’m sure your insurance carrier would not want to defend your use of a paper clip of unknown materials on that case accusing you of causing fibromyalgia in that sweet lady. It’s a nice article with good information, minus the paper clip. Thanks

    Reply
    1. Avatar
      Chris Catalano

      Hey Don, I know it sounds a little MacGyverish but it works! Your ortho wire would also work great as well as Ribbond. I have used all of these. My main goal was to bring up a solution for BisGMA bridge fractures with a simple cheap technique. I should have recommended all three! As far as FDA approval, I do not believe temporary materials fall into the scope of needing it. Never the less I understand your patients concern. I practice in Marin County so I understand those patients very well. That is where the Ribbond would be a better solution. By the way the paper clip is a galvanized steel. I do wipe it down with Birex, rinse it and dry it very well. It is also completely embedded in the temporary with light cured flowable composite so it is not exposed. Thanks for reading it!

      Reply
      1. Avatar
        Cinder Jones

        Not gonna lie. I love how smoothly you answered this. No better way to say “up yours” to a smug know it all than to be classy and informative. I applaud the way you handled this. I’m sure I’d have used one emoji. No need to explain I’m sure.

        Reply
  3. Avatar
    Michael

    The Pontic area is not normally the fracture point, but the thin edge and wall of the retainers , so unless you have sufficient occlusal reduction to extend the “rebar” over the occlusal aspect of each prep, the temp restoration is not effectively stronger.

    Reply
    1. Avatar
      Chris Catalano

      Hey Michael, this hasn’t been my experience when using this technique. I do not overlay it onto the occlusal and it still works. However I do make sure that my connectors have adequate thickness buccal to lingual and occlusal to gingival. I use flowable composite in these areas to increase thickness if the connectors are too thin. My thought is that the wire gives it enough strength and flexibilty to prevent this type of fracture. Thanks for the comment and give it a try!

      Reply
  4. Avatar
    Nishanth reddy Puchalapalli

    Dr Catalano was my instructor in University of Pacific.
    I remember him very well being there for 1 night clinic in my group. He was very friendly and approachable I remember speaking to him about lasers this was almost 5 years ago and though I am blessed with excellent memory can’t recall what I learnt specifically from him in our brief student instructor time.

    Thanks for sharing your technique. Most of my failures with temp bridges occur at connector region , does this technique help prvevent that

    Reply
    1. Avatar
      Chris Catalano

      Hi Nishanth,

      Great to see you on here! Thanks for the comment. This technique works well. I have been using it for many years and have had great success. Even though the wire ends at the connector it prevents the temporary from breaking. Try it out on your next bridge!

      Reply
  5. Avatar

    From a physics and engineering perspective, this technique does not seem that it would really help, and probably even hurt.

    First of all, steel is not steel is not steel. The variations in steel are almost infinite. Paper clips are made of Galvanized steel, whereas rebar is “structural steel”. Nearly opposite ends of the spectrum.

    Various types of steel are assigned numbers. They inherently have different hardness, brittleness/flexibility, resistance to deformation (this is critical here) and capabilities of what is called “hardening” after manufacture (typically using intense heat). It’s all about the makeup of the molecules themselves, and also how the molecules are arranged.

    I wouldn’t say that paper clips are dead-soft, but they are far closer to being dead-soft than they are to being considered “structural steel”.

    The important term is “stiffness”. It describes the rigidity of the steel, which relates to how much force the steel can take before it “deforms” (or permanently bends). This is critical here.

    You can see in your photo that you’ve “unbent” the paperclip. You probably did that with your hands. Paperclips deform very, very easily. They have very poor “stiffness”. And as we dentists know, you will exert many, many times more force with biting forces than you ever could with your fingers.

    The other concern is that there is no fusion (what we dentists might call “bonding”) between the Galvanized steel paperclip and the plastic or resin material the bridge is made of. So by drilling the slot in the bridge, you’re actually weakening the bridge, because the paperclip will not bond or fuse with the resin of the temporary bridge.

    The perfect analogy is what we dentists have learned from the science regarding inserting posts into endo canals. 50 years ago dentists placed posts into canals to accomplish two things:
    1) To hold the core buildup securely in place
    2) To “strengthen” the root.

    Well, of course many years ago the science informed us that yes, posts will help stabilize (retain) the buildup, but NO, drilling a hole for a post will not strengthen the root. Quite the opposite in fact – drilling away more internal root structure to insert a post will do nothing but weaken the root.

    Of course we’ve now gained the ability to bond various posts to dentin, so things have changed at least a little in that respect.

    What is needed is to employ the principles of physics and mechanical engineering when selecting your technique and materials. What we need is:

    1) A material that resists flexing very well, yet when forced to flex, will not break and will rebound with no “deformation” under the anticipated maximum loads to be encountered.
    2) A material that will fuse with the resin of the temporary bridge itself

    In my opinion, that material is fiber reinforcement. The fiber strip or tube can be filled or saturated with resin and placed into the impression (or whatever matrix we have made to form the temporary bridge) along with the resin before even placing in the mouth to create the temporary.

    Given the microscopic penetration of the resin into and within the fibers, the result is a very strong physical “bond” of the resin to the fibers.

    If this is applied in a way that the fiber reinforcement extends fully from the mesial to distal, this also reinforces the strength of the interproximal joints between abutments and pontics. And when extending over the occlusals of the abutments, even reinforces the strength of the abutment portion of the bridge also.

    Dentistry is bio-engineering. We need to treat our patients with not only evidence based clinical treatment, but evidenced based engineering principles.

    Thanks,

    Rod Kurthy

    Reply
    1. Avatar
      Chris Catalano

      Hi Rod,

      Thanks so much for your response. This technique definitely works and has been successful in my hands for more than 15 years. You could definitely use Ribbond. I have been using Ribbond since 1998 and love it. In fact, my first resin bonded posts were homemade lab fabricated Targis/vectris posts with Ribbond stuffed into the canal. This was before many commercially produced resin reinforced post were available. I haven’t used a metal post since then. This “paper clip” technique is quick, cheap and very effective. By burying it into the flowable resin it stays put and does its job. What drew me to this technique was its simplicity and ease. You can easily measure and cut the length which is critical to this technique. You really want the paper clip to extend from abutment to abutment with out interfering with the prep. As far as the physics of the steel of the paper clip and how it works is beyond me…..It just works.

      Reply
  6. Avatar
    Michael Engel

    I tried your reinforcement some 10-15 years ago with acrylic and Bisacryl . I found this to actually be the weak spot of the temps. I feel it doesn’t matter what you do because there is no bond to the wire, roughing up the wire or cutting grooves.

    Reply
    1. Avatar
      Chris Catalano

      Yes it certainly is not a new concept, just one that has gotten me great results. 15 years and counting with great success. The bond to the wire doesn’t seem to matter. I used to air abrade and place a metal primer All Bond 2 back in the day or now something like Z prime and bury it in the flowable resin. It worked great as well. Now I just place it in the slot and bury it in the resin and I haven’t had any problems. You could definitely use this technique with Ribbond, treat it with a resin and then bury it with flowable composite to get a great bond. I just found the paper clip to be super easy, cheap and effective. I can whip out a metal reinforced temporary in minutes. The patient’s appreciate the bridge not breaking too! Thanks for your read!”

      Reply
  7. Avatar
    Paul Hansen

    Neither resin or composite will bond to a metal wire. The wire will actually make the provisional restoration weaker. If you use a bondable mesh such as ribbond, you can make the provisional stronger. The use of the wire has been proposed for at least 50 years and is nothing new.

    Reply
  8. Avatar

    I love all the comments that have been posted so far! Thank you all for your participation! All of the engineering responses, and chemical bonding responses are great, but guys I think we are over thinking things here. This is a temporary bridge, 2-3 weeks in the mouth, not a post and core or long term restoration.
    I understand the concerns about “FDA” approval but I have two comments about this. 1) the paper clip isn’t being placed into a tooth or touching a tooth, it is embedded within the acrylic. Which I think the chemicals in the acrylic probably are more harmful than the paperclip. 2) There was also a picture of a old metal post that one can use if the paper clip idea is something you don’t like. We all know the old metal posts that are still sitting in your dental draw somewhere because you stopped using them when fiber posts came out, but refuse to throw them away every time your dental assistant asks “what do you want me to do with these things?”. Now you have an option!
    One thing I think we are not taking into account is the cost of materials. Ribbond is probably the most expensive fiber re-inforcement on the market. A piece large enough to strengthen this temporary bridge would most likely cost around $50 minimum. Ask a dentist to increase his lab fee by $50 and the thought makes them want to jump ship to a cheaper lab. I think to use Ribbond on a temporary bridge isn’t worth the investment personally. Honestly you could purchase enough paper clips to reinforce every temporary bridge for your career for that same cost, or just use the free metal posts in your draw.
    Unfortunately I don’t feel cheaper versions of “splint grid” work as well as wire does. Maybe that is just my opinion from seeing and treating many reconstruction cases with patients who can recruit/generate higher occlusal forces than the average patient. I have treated several “destroyers” where if long span temporary bridges were being utilized they required either lab fabricated metal reinforced temporaries, or thick braided wire chair side for reinforcement. I am currently working on one of these patients now who’s treatment requires telescoping copings, long span bridges and implants.
    Let’s talk strength and actual “bonding” for a second. I think we are overthinking things here folks. Are we looking for the paper clip to bond to the temporary or is it being used just like “rebar”? The rebar, to my knowledge (from reading it on Wikipedia 🙂 ), doesn’t bond to the concrete, it’s job is to help resist fracture of the concrete during tension. The metal reinforcement was placed into the bridge with flowable composite. The flowable bonds to the acrylic while the metal is embedded in it, just like rebar in concrete. That is why this procedure works! Rather plain and simple.
    Stainless steal ortho wire works great! Love that option– just don’t use the nickel titanium wire from your Six Month Smiles kit… that won’t work.
    Keep up the great comments!

    Reply
  9. Avatar
    Lee Ann Brady

    One of the great things about dentistry is there is never just ONE way to solve a technical challenge, and we get to choose our preferred approach based on our professional preferences, the clinical situation and the specifics of the individual patient. I have used both RibBond and other brands of fiber reinforcement and a paper clip over the years. There are risks and benefits to each method as well as different technique concerns. I’m guessing there are also other ways to solve the challenge of reinforcing a bridge provisional, or minimizing the risk that it breaks. What other ideas are out there? What else have you tried?

    Reply
  10. Avatar

    After close to 40 years in clinical dentistry, I can attest to something that Dr. Catalano said above, when he said, “It just works”. Having come from a mechanical engineering and physics background, I tend to drive myself (and others) nuts sometimes. But absolutely, I don’t think that any of us can deny doing things that maybe shouldn’t work…but they simply do.

    There are some very important things to think about that have been brought up here through this collective brain trust. It really is pretty amazing for us to have the ability to toss things around like this with the likes of Dr.s Catalano, Nosti and Brady.

    Anyhoo – from my experience, a couple things that both Dr. Nosti and Catalano said are not only extremely important, but simply a fact of life. And that is that we humans (including dentists) often are influenced by how easy or fast we can do something, and how inexpensively. Dr. Nosti brought up the cost of materials – Ribbond, etc., and Dr. Catalano alluded to cost and ease of use. Points well taken.

    And the term “FDA” (which I deal with on a nearly daily basis) has also been thrown around a bit here. Keep in mind that the FDA really has a grip on manufacturing companies, but not so much on practitioners. And given that a temporary bridge is…well…temporary, Dr. Nosti made a great point that the paper clip is not being used within any tissues or tooth structure on a permanent basis, and more importantly, it is encased in other (FDA approved) materials.

    With that in mind, I’d like to throw something out there that may or may not be of interest to anyone here – that maybe none of you have thought about. I think that everyone here has mentioned the superiority of fiber reinforcement, but of course it can take more chairtime and is a LOT more expensive.

    The key is that the fibers in fiber reinforcement, when encased in resin, develop phenomenal physical strength regarding increasing compressive strength, tensile (tension) strength, flexural strength, etc. And of course, pretty much everyone here has said we love the durable results.

    So you may consider this: Chopped fiberglass. Super cheap. Easy to find on Ebay. Most dentists don’t know this stuff even exists. You’ll find it in three main appearances. One is rather thick chopped pieces of rather dense fiberglass (not my favorite). The next is very thin strands. And the third type looks almost wispy – almost like expanded cotton.

    The amount of this stuff that you’d use for something small like a temporary bridge would be a couple pennies worth. So the cost is negligible.

    It’s also encased in the temporary resin, and only in the mouth temporarily, so I personally have no concern using it in this capacity.

    And compared to using something like Ribbond it’s extremely easy and fast to use. For example, if you were to use a length of Ribbond, and you were going to put it in the impression/matrix along with the temporary resin material, when you actually put that in the mouth and seat it, the resin will flow and the teeth will push on the Ribbond ribbon, and who knows where it will go? So often we use the Ribbond on a model and cure it first.

    But with this chopped fiber glass, you can run some temporary resin along the occlusals, take your cotton pliers and place these strands of chopped fiber glass over the entire length, use an instrument to push the fibers into the resin that you’ve already placed – and then add the rest of the resin over the fibers and insert in the mouth. It takes maybe 20 seconds more time.

    Then you insert it in the mouth. Since these fibers are not tied together like a braided ribbon, they stay spread out and overlapping throughout the entire temporary bridge, including over and around the abutments.

    You get 90% of the additional strength that you would have accomplished with Ribbond. It’s really simple, really fast, and REALLY cheap.

    Just thought I’d mention it in case anyone would like to give it a go.

    This stuff is really inexpensive, ranging from $2 – $10 per pound. LOL!!

    Here are a couple examples:
    https://www.ebay.com/itm/231949295230
    https://www.ebay.com/itm/201597507116

    Like I said, most dentists are not aware that this stuff even exists. I’d love to hear what Dr.s Catalano, Brady and Nosti think.

    Anyway, to Dr.s Catalano, Brady and Nosti – thanks for everything you give and do for dentistry – and the ability for dentists to have such great and informative discussions with you.

    Rod

    Reply
    1. Avatar
      Chris Catalano

      Thanks Rod, I feel the same about you and appreciate all your contributions to dentistry. Thanks for sharing about that bulk fiberglass material on Ebay. That looks very cool. Imagine submerging that into a deep large composite. I know the Biomimetic guys do this with Ribbond. I want to give it a try.

      Reply
  11. Avatar
    Lane Ochi

    We’ve been using silaneated fiberglass in acrylic provisionals since the late 70’s. I can tell you it works better than wire reinforcement. Studies have shown the addition of these fibers will not affect the transverse strength of the acrylic in any way, and may not always yield an increase in strength but when it does it is significant.

    Reply
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