Dr Priyanka Gubrellay et al. / IJRID Volume 4 Issue 3 May.-June.

2014

Available online at www.ordoneardentistrylibrary.org ISSN 2249-488X

Review- article

INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY

Andrews Bridge System A literature Review

Dr Priyanka Gubrellay1, Dr Prateek Gubrellay2, Dr. Richa Vyas3
1
Department of Prosthodontics, R.R. Dental College and Hospital, Udaipur, India.
2
Private Practitioner, Jhansi, India.
3
Private Practitioner, Jhansi, India.
Received: 3 Apr. 2014; Revised: 6May 2014; Accepted: 11June. 2014; Available online: 5 July 2014

ABSTRACT
Treatment of anterior edentulous space requires complex treatment procedures particularly when associated with ridge defects. Such
conditions require hard and soft tissue augmentation procedures prior to the prosthetic rehabilitation. In these cases, unconventional
treatment options like Andrews bridge system can be used to provide an esthetic and functional prosthesis, without the need of soft or hard
tissue augmentation. The purpose of this article is to review the various indications, advantages and disadvantages of this system.
Key Words: Ridge defect, Abutments, Fixed dental prosthesis, Edentulous.

INTRODUCTION

Prosthodontics is branch of dentistry which deals with diagnosis, treatment planning, rehabilitation and
maintenance of oral function, comfort and appearance of patients with missing / deficient tooth and
maxillofacial tissues using biocompatible substitutes. Restoration of missing teeth and lost alveolar contour
presents a challenging task for dentist, in patients who have suffered from traumatic injury, congenital defects
or other deformities those results in loss of anterior dentition along with the soft and hard tissue loss. In such
cases, patient often desires a fixed prosthesis. But in cases of ridge defects, a tooth supported or implant
supported fixed prostheses has several limitations: unaesthetic long pontics, lack of proper lip support, need of
soft and hard tissue augmentation and difficulty in maintenance. A fixed removable partial denture (Andrews
Bridge System) can provide a viable treatment option in such cases.
History: 1, 2
The use of such treatment modality has been presented since 1900s. A round bar attached to abutment crowns
supporting a suprastructure by Fossume appears to one of the first attempts. Other variations employing bar and
clip concept were presented by Dolder, Baker and Hader and by Andrews. The first use of precision or
semiprecision bar and sleeve assembly that provided for rotational stability gained directly through the
substructure bar and the abutment teeth was the approach by Bennett, called as Bennett Blade. The Andrews
bridge system was first introduced by Dr. James A. Andrews (Covington, La).

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In recent years many other variations of this concept have been developed.
Indications: 2, 3, 5
1. Ridge defects as a result of trauma, congenital defects or in other defects where fixed dental prosthesis would
not adequately restore the missing teeth and supporting structures.
2. Periodontally compromised adjacent abutments.
3. Patients whose residual ridge has a relationship to the opposing dentition that would prohibit the esthetic
placement of the pontics of a fixed partial denture.
4. Patients requiring diastema to harmonize the natural dentition.
5. Often fixed partial denture failure with badly damaged, cracked or weakened teeth by fillings and
disproportionate teeth.
Advantages: According to Prieskel,
1. Reduced denture bulk, occupying minimal vertical and horizontal space.
2. Four different curvatures of the bar follow the ridge and permit use of the bar anteriorly.
3. Various lengths replace one to four teeth.
4. The denture provides good retention with little wear.
5. It provides high tensile and yield strengths.
6. It permits replacement of missing alveolar structure for esthetic reasons.
7. Special transfer sleeves for each bar are provided so that a duplicate removable prosthesis can be made
quickly.
Other Advantages:
1. More stable because it is totally tooth-borne and the occlusal forces are directed more along the long axes of
the abutment teeth.
2. Compared to a conventional fixed partial denture, the pontic teeth are arranged during the esthetic try-in
appointment.
3. The flange of the pontic assembly is contoured to improve comfort, esthetics, and phonetics, and to resist
possible torque during function.
4. In contrast to conventional fixed partial dentures, the pontic assembly is removed to facilitate hygiene
procedures and may be relined as the ridge resorbs.
5. Economical.
Disadvantages:
1. Failure as a result of inadequate soldering.
2. It should not be used for patients having occupations, where the restoration may become jarred loose and
swallowed or aspirated.
3. Technique sensitive procedures.
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4. Food and plaque trap in the flange area leads to tissue proliferation in the region of contact of bar and ridge.
Limitations:
1. Derive their entire support from the abutment teeth, the abutments desirability is same that for the fixed
partial denture.
2. Path of placement and removal of the retentive elements of the abutment preparations must be parallel to
each other.
3. Length of edentulous span and curvature of the pontic from axial alignment of the abutment teeth.
4. Minimum 3 4 mm occlusogingival height is necessary for proper functioning.
Discussion:
Various treatment options available for the restoration of anterior edentulous space includes removable partial
denture, fixed dental prosthesis and implant supported fixed prosthesis. Although Removable partial dentures
provide the missing contour and means of positioning the replacement teeth in their natural relationship, they
must incorporate coverage of large soft tissue area and several teeth as abutments for stabilization. The tooth
and implant supported fixed prosthesis has the above mentioned disadvantages. A fixed removable prosthesis
provides a combination of advantages of both fixed and removable partial dentures. Fixed removable partial
dentures are particularly indicated for patients with extensive supportive tissue loss and when the alignment of
the opposing arches and/or esthetic arch position of the replacement teeth creates difficulties. Such an assembly
provides maximum aesthetics and phonetics in Class III ridge defect cases, when other traditional treatment
options prove to be futile. It utilizes fixed retainers that are connected by a bar that follows the curve of ridge
under it. The prosthesis consists of teeth set in a patient removable flange of gingival colored acrylic resin that
clips over and is stabilized by the rectangular bar. The length and curvature of the bar is decided based upon the
length of the edentulous span, ridge form and interocclusal space available. The bar is soldered to the retainers
at a slight mesiodistal angulation. The irregularly arcuate contour provides exceptional retention and resistance
to rotational forces for the superstructure. A minimum of 2 mm vertical bar height is required for sufficient
strength to support the removable portion of the restoration, but tissue contact is not desirable. If the inferior
surface of the bar contacts the tissue and particularly if the patient has a casual approach to oral hygiene, tissue
proliferation can result.
Patient selection is critical and problems that develop are essentially the result of diagnostic errors during
treatment planning. The decision depends on specific clinical factors and the desires of the patient. In 12-year
period, more than 25 fixed-removable partial dentures were made and found to be as durable as conventional
fixed partial dentures2. The only failures in the bar were due to inadequate soldering, and these failures were
eliminated by casting the retainers directly to the bar. The wear and fracture incidence seen in the pontic
assemblies were similar to those found with conventional removable partial dentures and were easily repaired.
During this time, only a few adjustments with three-prong pliers were needed.
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Conclusion:
When treating patients with congenital or acquired defects, the Andrews Bridge permits rehabilitation with a
fixed-removable partial denture when conventional methods are contraindicated. This system permits the
replacement of the lost teeth as well as supportive structures necessary for proper esthetics. This type of denture
has qualities of both the fixed partial denture and the removable partial denture and is indicated where the
abutments would support a fixed partial denture but a severe defect is present in the edentulous space.
References:
1) John E. Rhoads et al. Dental Laboratory Procedures: Fixed Partial Dentures, 2nd Ed. St. Louis: Mosby;
1986. p. 367-380.
2) Leonard A. Mueninghoff, Mark H. Johnson. Fixed-removable partial denture. J Prosthet Dent
1982;48:547-550.
3) Robert J. Everhart, Edmund Cavazos. Evaluation of a fixed removable partial denture: Andrews Bridge
System. J Prosthet Dent 1983;50:180-184.
4) Walid M. Sadig, Bone anchored Andrew's Bar System a prosthetic alternative. Cairo Dental Journal
1995;11:11-15.
5) Ravi Shankar Y., A. V. Rama Raju, D. Srinivasa Raju, P. Jitendra Babu, D.R.V. Kumar, D.
Bheemalingeswara Rao, A fixed removable partial denture treatment for severe ridge defect. Int J Dent
Case Reports 2011; 1(2):112-118.
Fig 1: Diagrammatic representation of Andrews Bridge system.

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