When Implants Aren’t an Option: The Case for Fiber-Reinforced Bridges

If you ask me, dental implants feel a very, very good solution. I will say that mostly the best solution if you don't want to touch or prepare the neighbor teeth. But there are cases when the patient doesn't have enough bone, for example, even though they have money. Welcome to the Phil Klein Dental Podcast. While traditional fixed bridges and implants have long been the gold standard for replacing missing teeth, they're not always feasible. Whether due to insufficient bone, medical contraindications, financial constraints, or patient preferences, single-tooth implants aren't the solution for every case. That's where fiber-reinforced bridges come in. These innovative restorations provide a minimally invasive, cost-effective, and highly aesthetic alternative for replacing missing teeth. Unlike conventional metal or zirconia frameworks, fiber reinforced bridges offer a more flexible, shock-absorbing structure that mimics the natural properties of dentition. And what's great about them is that they can be fabricated chair-side, reducing treatment time while maintaining durability and strength. Beyond single -tooth replacement, fiber reinforced bridges have a broad range of clinical applications. from interim prostheses to long-term solutions in select cases. With proper case selection and technique, they allow us to provide conservative, patient-friendly solutions without compromising function or aesthetics. So why should you consider integrating fiber-reinforced bridges into your practice? What are the clinical advantages, limitations, and best practices for success? To help us answer these questions is our guest, Dr. Marvin Chacon. Based on his preference, we'll be addressing him, Dr. Marvin. He practices in Costa Rica with over 15 years of experience in conservative cosmetic and reconstructive dentistry. Dr. Marvin obtained his master's in aesthetic dentistry from King's College, London in 2022. As a clinical trainer and speaker, he focuses on modern dental materials and innovative techniques under the minimum intervention approach. Dr. Marvin, it's a pleasure to have you on the show. Hey, doctor. How are you? We're going to be calling the doctor, Dr. Marvin. He's in Costa Rica now, which is very cool. And interesting enough, the time zone is exactly the same. I asked him what time it was before we started the show, and he said 2.30 p.m. And I say that's- Same continent. Same, yeah, exactly. So if I flew to visit him, I wouldn't have to adjust my watch, which is awesome. Awesome. Okay, so I got to tell the audience that I had the pleasure and opportunity to listen to your webinar on Viva Learning. And it was really fascinating. You did some- Thank you. Yeah, you did some miraculous stuff with some of these patients. And then your follow-up, some of the follow -up was eight years. And it seems to me that- someone watches this webinar, they would think that the techniques that you're using would not last that long. And it's just amazing that you have gone down that route to utilize these types of solutions because there's a lot of applications, clinical applications, financial restrictions for patients. And you're just... some amazing stuff, even things like agenesis or hypodontia, which you talked about. Exactly. Yeah. So anyway, for the audience, if you want to see this, which I really recommend, it's called Fiber Reinforced Direct Bridges. Fiber Reinforced Direct Bridges, New Techniques for Success. It's on vivalearning.com. And just look up. Last name is Chacon, C-H-A-C-O-N. Is that correct? Exactly. Okay, good. So I've done enough talking here. You're the superstar here because you're the one that's fabricating these fiber reinforced bridges. Let's start the conversation by you telling us what is a fiber reinforced bridge and why should dentists consider offering this service to their patients? Sure, doctor. Well, fiber reinforced bridges are fixed prosthesis composed of two parts. The first one is the framework. made from the fiber chosen by the dentist. And the second part is the veneering material, which is used to fabricate the pontic. The choice of veneering material depends on how long the dentist wants the bridge to remain at the patient's mouth. If they're looking, for example, for a long-term provisional solution, let's say one, one and a half years, they can use a last-generation bicycle. If they want a definitive restoration, they should use resin composite. Okay, so when you, your accent, I'm just going to say bisacryl is what is, bisacryl is bisacryl. Bisacryl, exactly. Okay, bisacryl. So, regarding the reasons, let me share a few with you. The materials used to fabricate these bridges have... a more favorable mechanic behavior due to their flexibility. Their behavior is more biomimetic, let's say, compared to a rigid conventional prosthesis, which is particularly important in cases where the abutment teeth lack of ideal biological support, for example, in post-perio patients. These ridges have a lower biological cost. than conventional bridges. The retention relies on adhesion. The necessary preparations are highly conservative, highly aesthetic as well, because modern dental materials such as composite resins allow dentists to layer different shades and effects. All the materials used in their fabrication are biocompatible. This is very, very important. There is no metal involved. And one of the most significant advantages, doctor, in my opinion, is their retrievability. What does this mean? These bridges can be repaired without having to replace the entire prosthesis. Actually, you mentioned that during my Viva Learning webinar, I showcased a fascinating case with eight-year follow-up. It involves bridges I made for a patient with agenesis of the upper lateral incisors. The photographs illustrated how, over time, I was able to modify the bridges and even change their shape. This, Dr. Klein, is precisely what modern dentistry aims for, treatments that can be evolved with the patient. How did you get into... getting excited about doing this because a lot of dentists when they get out of dental school they can't wait to do implants uh maybe just do crown and bridge where they prepare the abutments and do these beautiful zirconia bridges so tell us what ignited your excitement about fiber reinforced bridges you've got to a point now where they're very beautiful and they last quite a long time well it started uh when i just finished my dental school that was 17 years ago and suddenly i was in a need of a of a treatment to replace missing teeth what i had in 17 years ago is the same treatments that we have today implants removable prosthesis and the normal bridges that we'll know. So I started to investigate a little bit about different dental materials and found these reinforced fibers. And yeah, it has been a long trip to be in this point, but very exciting. Did you expect the lifespan of these chair-side bridges that you actually fabricate right there in the office to last as long as they are lasting? Or were you looking to have a solution for a patient as an interim or something to carry them over until either finances allowed something more, quote unquote, permanent? Something to say nothing's permanent. Nothing's definitive. Like you said, it's evolving. So when I say definitive or permanent, you know, it's semantics. Because your bridges might... well in their lifespan and function last longer than some bridges that are put in correctly right with uh the old porcelain fuse to gold or whatever bridges you know zirconia bridges i mean yeah so tell us were you surprised at how long these lasted undergoing normal forces of mastication and everything else because i mean these patients are chewing on this stuff i always shoot for a permanent or definitive solution as you said Of course, dental treatments are costly, not as in the USA, but I always look for dental treatment that can provide teeth for mostly every person. It doesn't matter if the person has money or has a little bit of money. These particular treatments are very affordable. So Dr. Marvin, we talked offline about this. There wasn't a whole lot of information about fiber reinforced bridges. So you kind of took it upon yourself to experiment in some ways. Tell us about that. At the beginning, when I discovered these materials, the fibers, because I doesn't have any clinical protocol, I started to... to play let's say with these materials for example i remember one of my first cases was my security card of the place i used to live and i did it for free security security guard exactly and the i i made him i i if i don't remember wrong like four bridges in the upper arch and it lasts almost five years using the wrong fiber by the way but since the very first beginning I knew that the materials will work I just need to perfect the technique actually yeah and the technique that you perfected is clearly shown in that webinar the one that i mentioned earlier that's on viva learning.com you show several different techniques and you show them for different clinical applications so with your experience dr marvin what kind of case should a dentist take on in the beginning when they're first experimenting first starting to use a fiber reinforced bridge that's a very very good question uh the best Starting point will be an anterior case, definitely. As you may know, the anterior bridges, anterior prosthesis tend to last longer than posterior bridges. So that will be a very good starting point, an anterior case. So if a patient comes in with a vertical root fracture, clearly unsavable lateral incisor, upper lateral incisor, a single tooth implant is not feasible for whatever reason, you're suggesting that would be a good start. to do a fiber reinforced bridge to replace that upper lateral incisor that would be a very good case for example two weeks ago i did a case for my wasn't an adult woman that had an accident and one of her upper centrals with root root canal just completely broke, a catastrophic fracture, what we called. And she didn't have the money for dental implant at the moment. And she was, if I don't remember wrong, 32 years old. So if you think about making a removal prosthesis for a 30 something years old person, it's terrible. So I did an immediate bridge after bone grafting. and this will sound crazy doctor but i doesn't have any anterior bridge failure in my life just posterior failures it is a very good starting point for you to mostly because you have to learn how to manipulate the fibers are kind of tricky this is an engineering creation yeah it's an engineering feat what you do right you're reinforcing the composite by a huge factor a huge multiple And that's what struck me when I watched the webinar, Dr. Marvin, is that the technique in manipulating the fibers is very important, which of course is difficult to get from a podcast episode, but the webinar makes it much clearer and easier to understand. And at the end of this podcast, we'll get some information from you about how people can get in touch with you if they have more questions. So when it comes to the fibers that we're talking about, what is the material that you use to reinforce the composite bridge? Our Grand Tech from Volco are unidirectional glass fibers. Those fibers are the only ones that the literature mentioned are capable to sustain over time for definitive bridges. These fibers in the anterior bridges need to have... a little bit of curvature as well um this as i mentioned this part is kind of tricky the manipulation part uh so i i design a i design a dental instrument that was developed during those 15 years in in making these bridges and that instrument you're talking about dr marvin i know you're getting some prototypes and that helps curve the grand tech glass fiber material yeah the the thing is each strand of fibers comes with almost 4500 fibers and these fibers will behave very good if they work together so you as a dentist when you manipulate it manipulate them you have to keep it keep it uh as a group you you can't spread it because they will start to absorb the forces individually. And that's how failures appear. A key point is try to keep it in a group. You have the longitudinal fibers that go across in the direction of the arch. It follows the arch, but then you have a short one that goes 90 degrees to it. Am I correct? Yeah, this is the oblique wall. the obliquial one. And this fibrous literature mentioned or showed that helps to absorb lateral forces and avoid the fracture of the veneering materials in posterior bridges. How long does it take you to make one of these bridges? And I know it's evolving because you're very much into playing with the materials. You stain it and it looks amazing. It looks like a lab. fabricated bridge when you're done with it. It's almost hard to believe. You're going to be impressed, but the thing that consumes the most time is to remove the old restorations. So after you remove the old restorations from the abutments or there's no restoration there, how long does it typically take you to do the bridge? It will take less than 30 minutes to fabricate one. one one posterior bridge anterior bridges tend to take a little bit more time because you you have to layer different shades of right but posteriors are more straightforward just a little bit of tints in the fissures, a little bit of tints of this cervical area. I don't polish it either. I don't polish it. I use a glaze. So yeah, almost 30-something minutes. So for the anterior ones, you showed a case. The patient, I think, may have been 12 years old when she came in. She's now 20 years old. She's going to architecture school. And it's amazing how this looks. You have a one-year follow -up, then you go to two, and then you go to three. And you put this together with a fiber strip and some composite, right? I mean, that's the way this thing is built. And she's been chewing on... She was missing, what, two laterals? yeah a genetia of two of the two laterals incisors right so she just never got those teeth agenesis on those teeth agenesis yeah so or a hypodontia we should probably call it as well yeah so those two laterals those upper laterals were missing and eight years later from 12 to 20 years old she's been living every day like a teenager and chewing on everything and exactly and they look beautiful and you even make them so that they could keep oral hygiene really well tell us about that making sure that they could because people are going to say well how do you floss how do you clean you have techniques for making it so that the patient could take care of this and prevent periodontal disease in case of anterior bridges it's all about how to manipulate the soft tissues by making the oval pontic eye candy I want to invite all the doctors who are listening to see the Viva Learning webinar so you can see how I managed to fabricate the oval pontic but by applying pressure to the soft tissues you can shape it and the anterior bridges when you have the oval pontic shaped it's actually very easy for the patient to floss uh because it will naturally create the space between the pontic and the gum right uh in case of posterior bridges is a little bit a little bit more tricky because you actually don't want space between the rich surface of the pontic that is the surface that is in intimate contact with the mucosa, you don't want space between the ridge surface and the mucosa. You just want a little bit of space between the interproximal area of the abutment and the pontics. And this space, it's made by the invagination of the rubber dam. And once you remove the rubber dam, you will obtain... semi like a semi-circular shape along the interproximal area of the of the abutment teeth that is where the the the patients can floss but on the other hand i actually recommend my patients to use uh water flosser more than or what about interproximal brushes a brush would go through you mean tps yeah in tps yeah they can work Most on the posterior area, I have found that in the anterior areas, sometimes patients use tipis that are too thick and they tend to stimulate the gingiva and the gingiva go up a little bit to create spades. So I will prefer it in the anterior area, just water pick or water flosser or the regular floss. So when a dentist gets into this and they start fabricating a fiber reinforced bridge, typically what should they expect as a lifespan? Average lifespan for a posterior bridge will be between four to five years. Although there are documented cases of bridges lasting more than 22 years. And in case of anterior bridges, we're looking an average lifespan between seven to eight years. Wow. And then when you have a failure, what does the failure look like and awesome and then how do you deal with the failure one of the most frequent failures will be the bonding of the wind or fracture of the wings and that is because the dentist don't don't respect the minimal thing the minimal depth of the preparation that will be two and a half millimeters there is one millimeter for the fibers and one and a half millimeters for the veneering material and when you say veneer material dr marvin you're talking about the material that you're flowing over the grand tech glass fibers that's embedded in the tooth on each side and also that's spanning across the two abutments that veneer of composite is is the veneer material on the abutment areas always resin composite always resin composite the only materials you can change is the one in the in the pontic for the pontic bisacryl or resin composite okay so bisacryl as the pontic or composite resin but what you flow into the abutment teeth to hold that fiber in place and to flow over the fiber is uh composite resin yeah and and you your favorite on that do you have a favorite product that you like to use definitely uh grandioso heavy flow it's what i called the the invincible marriage i can't think in fiber reinforced bridges without thinking in grand tech and i can't think in grand tech without thinking in grandioso heavy flow uh you just apply a a little bit of a grandioso flow on the preparations just put your position in your your fibers like you're and on top of this just a bold field composite. Assuming you have two abutments, two virgin abutments, and you are ready to prep those two to accommodate the grand tech, what's the preparation design look like on those teeth? In my investigation work, I analyzed six different teeth preparation. And from those six preparations, The one that shows the best numbers were one called box shape design. And it's almost a regular class too, but it has an additional preparation that it's called isthmus in the proximal areas. And that is must just bring that extra reinforcement for the connector area. There is a very critical area for this. for these bridges the connector area it's my personal perspective if you're looking for a long-term provisional just a regular class 2 preparation will behave very good but in addition to this one complication additional complication will be secondary decay so that's why you have to choose your your patient wisely A patient who likes to clean, right? But... Where do you see the areas of the secondary decay? Under the connector. Yeah, because patients don't like to floss. Okay, so it's right in the interproximal area in that box. Exactly. And as far as adhesion? Sure, yeah. Just your regular bonding protocol, total etch or selective etching. And after... rinse apply your of course futura bond you is the best bonding agent in the world and after that you're ready to go tell us about how you manage the occlusion over time as you evaluate these fiber reinforced bridges a very tricky part in mostly in the posterior areas is to manage occlusion okay and that is not only for these treatments but for every dental treatment and i have noticed that that that if you're not if you not carefully calibrate the occlusion you will find that uh some of the cuspids showed some chippings you as a dentist have to choose if you want to repair it by adding a little bit more composite or just polishing because the body is telling you that they don't want more material in that area and Do you just polish a little bit and that's it? I think many dentists would agree, Dr. Marvin, that the ideal treatment plan for a single missing tooth where they don't have to touch the adjacent teeth would be a single tooth implant. But if that's not feasible for whatever reason, as I mentioned earlier, you would prefer to go with a fiber-reinforced bridge from the standpoint of minimally invasive dentistry. I, of course, won't prepare. an abutment for full crown and make this bridge it doesn't make sense i would prefer to maintain the residual tooth structure or remnant tooth structure and make my bridge without removing the the the remnant teeth tooth structure but i will i will say that it will depend on the case Yes, no doubt. Every case we have to treat individually. And you actually had an interesting case about a woman who wanted to have a single tooth implant, but you had to go with a fiber reinforced bridge. Tell us about that. Very nice case. 60 something years old woman that. Had a first open molar missing for more than 20 years. And they came to my office. She came to my office asking for an implant, but she was taken by phosphonates. Even though she has all the money in the world, as you said, well, you can't touch a patient surgically. She had osteoporosis? Yeah, she had. She was taking biphosphonate because of osteoporosis. So in that particular case, I provide her with a long-term provisional until her doctor, I'm sorry, say that she was okay to place an implant. But if you ask me, dentin implants still a very, very good solution. I will say that mostly... Mostly the best solution if you don't want to touch or prepare the neighbor teeth. But there are cases when the patient doesn't have enough bone, for example, even though they have money. And another consideration, Dr. Marvin, which we talked about offline, regarding your decision to use a fiber reinforced bridge rather than putting an implant in, has to do with age. Now, you don't feel particularly comfortable. putting an implant in a younger person, a young adult. And this is a very good alternative treatment plan. Well, from my perspective, as a personal point of view, I don't want to put an implant on a 20 -something years old patient in the anterior area. I want to wait a little bit more. You know, the gums evolve along the years. things could happen aesthetically i would prefer to place an implant once she's actually an adult so but if the patient is an adult for example if if you come to my office Probably I will analyze an implant for a first option. And if it doesn't work for you, I don't think you can have it for any reason. I will provide with a provisional or let's say a definitive solution. And for sure, this solution will have to be the one that has the least biological cost possible. What do you charge for typically in American dollars? What would that be equivalent to in Costa Rica for your work to do a... Let's talk about replacing number 19. I don't know what is 19. A lower molar. A lower molar, okay. A lower first molar. Okay. How do you guys number the teeth over there? Starting from one, finishing, and the last is 32. Yeah. but but that's what we do coming across from right maxilla all the way across to the left oh yeah yeah no that's what you guys do oh i asked you what you guys do four quadrants and in each quadrant we have from one to eight okay all right that's that okay i wasn't asking what we do i know what we do over here i'm asking what these dennis in costa rica do okay yeah yeah so what i charge is uh The same as I charge for a zirconia crown in the anterior and the posterior area. So typically, what would a fiber reinforced bridge be to replace a, let's say, a first molar, a lower right first molar? What would you charge for that? Almost $900. Almost $900. And it takes you 30 minutes? It takes me 30-something minutes, just one appointment. With no lab costs. No lab fees. And you almost have all the materials you need to make it in your office, right? You just need to be sure to choose the correct fibers. And of course, you will have resin composites. Yeah. And you also have more flexibility on the price for those patients that are younger, like that 12-year-old. If the family doesn't have that much money, you have more flexibility because your overhead is lower. So it's up to you to do that as a favor to the patient if you want to help them out. But you have that flexibility without having that lab fee. Yeah, and one of the most important points in this aspect will be that you're not preparing necessary. You're not removing necessary tooth structure that will let those abutments to have shorter lifespan. No, it's an amazing service. But the key thing is, and again, it goes back to the webinar, and even after the webinar, hopefully somebody could reach out to you, Dr. Marvin in Costa Rica, and maybe you can direct them. In fact, my last question as we wrap up this podcast is, what recommendations would you give to dentists who want to... applying this treatment to their patients because they it's more than just taking the fiber and laying it into the to you know like you show in the webinar you're right there's a there's more to this because your success rate is too high yeah okay that led me first and foremost the doctor needs to enjoy playing with dental materials i like the the the word playing with dental materials as dentists the dentist should have fun while working if they don't something is wrong uh i think they should educate themselves Nowadays, there is no reason to perform treatments based on trial and error. The best thing they can do is learn from other dentists who have already made many mistakes like me. I don't hold back when it comes to sharing information. As you know, I love it. On my website and social media, I share in-depth techniques that will ensure this bridges meet clinical requirements successful. If they are truly interested in the topic, it will be fantastic if they have the opportunity to take my two-day course, which is a master class where I teach how to create these bridges from A to Z. And where is that? In person or online? It's in person. So they need to take a vacation in Costa Rica, which is beautiful. Yeah, it's beautiful. You can come and surf. We can surf together if you like. wow yeah and actually i lived in california for 16 years and right off right off the ocean but i didn't surf yeah i was a tennis player so uh well it's cold water right yes oh yeah oh we have warm water here yeah so it's like there's more like hawaii where you are yeah yeah yeah all right well listen um great stuff dr marvin and uh very much doctor yeah if somebody wants to look you up what is your uh website address dr marvin Chacon is C-H-A-C-O-N, drmarvinchacon.com. Speaking to the audience, feel free to take a look at that webinar. Get yourself familiar with the whole concept. He talks about the hugging mylar band technique. He's got a whole lot of different things he does there, and it's really quite extensive. what he covers in that 50-minute webinar. And then if you're interested in more information, again, you heard his website. Thank you very much for joining us. Thank you, doctor. It was an honor. Thank you very much. See you. Bye-bye.