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Most Conservative Bridge Lower Premolar — ORE Part 1 MCQ

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EasyRestorative DentistryMost Conservative Bridge Lower PremolarORE Part 1

A patient requires a fixed bridge to replace a missing lower left first premolar. The second premolar and canine are available as abutments. Both are vital with minimal restorations. The patient is keen to preserve as much tooth structure as possible. What is the most conservative bridge design?

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Correct answer: D — Cantilever resin-bonded (Maryland) bridge with a single retainer on the second premolar

The answer is **A: Cantilever resin-bonded (Maryland) bridge with a single retainer on the second premolar**. This is the most conservative design because it requires minimal or no tooth preparation, involves only one abutment, and is fully reversible. When both abutments are vital with minimal existing restorations and the patient prioritises conservation, a single-wing resin-bonded bridge maximises enamel preservation whilst delivering proven long-term success in lower premolar sites. Option A (fixed-fixed conventional) and D (cantilever conventional) require extensive tooth preparation and full crowns—contrary to the patient's wishes. Option E (fixed-fixed resin-bonded), whilst more conservative than B, still requires bilateral abutment coverage and is more invasive than A. Option B (spring cantilever) is outdated; modern resin-bonded designs are preferred.

Reference: Survival characteristics of 771 resin-retained bridges provided at a UK dental teaching hospital. Journal of Oral Rehabilitation, 2015. https://pubmed.ncbi.nlm.nih.gov/25858740/