Abstract:
A dental bridge and a dental device. The dental device may include a structural portion extending along an axis and connectable to at least one tooth. A truss portion may depend from the structural portion and be operable to support a pontic, the truss portion may define a plurality of slots extending from a peripheral surface. The structural portion may have a first surface oriented toward the occlusal surface and an opposite second surface, the structural portion defining a plurality of openings, the plurality of openings extending transverse to the axis and between the first surface and the second surface. The structural portion may define an angled surface leading into at least one of the plurality of openings. A plurality of projections may be formed on a first surface of the structural portion, each of the projections having a projection surface spaced beyond the first surface toward the occlusal surface.

Description:
RELATED APPLICATION DATA 
       [0001]    The present application is a continuation-in-part of pending U.S. patent application Ser. No. 11/582,038, filed Apr. 11, 2007, which is the national application of International Application No. PCT/US2004/041981, filed Dec. 15, 2004, which claims priority to prior-filed provisional patent U.S. Application Ser. No. 60/529,475, filed Dec. 15, 2003, the entire contents of all of which are considered as being part of the present application and are hereby incorporated by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This invention relates generally to a dental bridge, insert or other dental device and, more particularly, to framework for use in producing tooth-replacement bridges, reconstructing one or more teeth or splinting one or more unstable teeth. 
       SUMMARY 
       [0003]    In some independent aspects and in some constructions, an adjustable system for bonded composites may generally include a ladder supporting a truss in one of multiple relative positions therewith. The ladder generally includes opposing rails connected by a plurality of rungs. The plurality of rungs are spaced along the rails to define a plurality of openings between adjacent rungs. The truss generally includes a strip, which may be formed of metal or another material, having a plurality of upstanding projections. The projections are correspondingly spaced with the openings defined in the ladder to allow the truss to engage the ladder in a plurality of relative configurations. The combination of the ladder and truss may also provide a torsionally rigid and substantially stiff assembly with which to support one or more pontics and/or unstable teeth. 
         [0004]    In some independent aspects and in some constructions, a system for bonded composites may generally include a reinforced substructure for supporting a pontic. The reinforced substructure, which may be formed of metal or another material, may be substantially webbed or generally include a plurality of apertures or perforations therethrough to allow the flow or seepage of resin through and around the substructure for increased bonding strength of the resin between the pontic and the substructure. The substructure also generally includes reinforcing structure or framework in a direction along the ladder and truss, to which the substructure is coupled, and in a direction substantially normal to the ladder and truss. 
         [0005]    In some independent aspects and in some constructions, a system for bonded composites may generally include the ladder and truss structure having a sufficient length to extend substantially through one or more teeth and a plurality of apertures or perforations therein to allow the flow or seepage of resin through and around the ladder and truss for increased bonding strength of the resin between the supporting one or more teeth and the ladder and truss. 
         [0006]    In some independent aspects and in some constructions, a system for bonded composites may generally include provisions for occlusal stops. One or more projections on the truss may be configured to extend sufficiently far through the ladder such that the one or more projections serve to slow or halt the occlusal wear of the pontic and/or of adjacent teeth. 
         [0007]    In some independent aspects and in some constructions, a system for bonded composites may generally include a bendable ladder structure configured to go through a quadrant of teeth, a half-arch of teeth, or a full arch of teeth. The ladder structure may also be configured with an anterior segment for full or partial arch splinting. The anterior segment may include a single rail connecting ladder structures at opposite ends thereof, in addition to a plurality of apertures or perforations therethrough to allow the flow or seepage of resin through and around the ladder and truss for increased bonding strength of the resin between the supporting one or more teeth and the anterior segment. In addition, the bendable ladder structure may support a relatively long span of teeth or other attachments (e.g., arch wires). 
         [0008]    In some independent aspects and in some constructions, a system for bonded composites may generally include a ladder and truss structure adaptable by the dentist and/or oral surgeon while sitting chair side with their patients. The adjustability built into the ladder and truss structure allows the dentist and/or oral surgeon to make adjustments to the composite without having to send it off-site to a laboratory. 
         [0009]    In some independent aspects and in some constructions, a dental device may include a structural portion extending along an axis and connectable to at least one tooth. A truss portion may depend from the structural portion and be operable to support a pontic, the truss portion having a peripheral surface, the truss portion defining a plurality of slots, each of the slots extending from the peripheral surface. Each of the slots may extend parallel to the axis. The structural portion may have a first surface oriented toward the occlusal surface and an opposite second surface, the structural portion defining a plurality of openings, the plurality of openings extending transverse to the axis and between the first surface and the second surface. The structural portion may define an angled surface leading into at least one of the plurality of openings. A plurality of projections may be formed on a first surface of the structural portion, each of the projections having a projection surface spaced beyond the first surface toward the occlusal surface. 
         [0010]    In some constructions, the dental device includes a dental bridge. In some constructions, the dental device includes an insert for one or more teeth. 
         [0011]    Independent features and independent advantages of the present invention will become apparent to those skilled in the art upon review of the following detailed description, claims and drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]      FIG. 1  is a perspective view of a ladder structure. 
           [0013]      FIG. 2  is a perspective view of a truss structure that is engageable with the ladder structure shown in  FIG. 1 . 
           [0014]      FIG. 3  is a perspective view of the truss structure shown in  FIG. 2  with a reinforcing structure for supporting a pontic. 
           [0015]      FIG. 4  is an exploded view of the ladder structure shown in  FIG. 1  and the truss structure shown in  FIG. 2  and the reinforcing structure shown in  FIG. 3 . 
           [0016]      FIG. 5  is a top perspective view of the ladder structure shown in  FIG. 1 , and the truss structure shown in  FIG. 2 , connected to form a bridge, with the reinforcing structure shown in  FIG. 3  coupled to the bridge for supporting a pontic in preparation for bonding to prepared teeth. 
           [0017]      FIG. 6  is a perspective view of an anterior perforated segment. 
           [0018]      FIG. 7  is a perspective view of the ladder structure shown in  FIG. 1  connected to the anterior perforated segment shown in  FIG. 6 . 
           [0019]      FIG. 8  is a perspective view of two ladder structures shown in  FIG. 1  connected to the anterior perforated segment shown in  FIG. 6 . 
           [0020]      FIG. 9  is a perspective view of a combination of the bridge and reinforcing structure shown in  FIG. 5 , coupled to the anterior perforated segment shown in  FIG. 6 . 
           [0021]      FIG. 10  is a rear perspective view of a shield for supporting an anterior pontic. 
           [0022]      FIG. 11  is another perspective view of the shield in  FIG. 10  for supporting an anterior pontic. 
           [0023]      FIG. 12  is a perspective view of the bridge and reinforcing structure of  FIG. 5  for supporting a pontic connected to the anterior perforated segment of  FIG. 6  with the shield of  FIG. 10  connected to the anterior perforated segment for supporting an anterior pontic. 
           [0024]      FIG. 13  is a perspective view of an anterior arch wire. 
           [0025]      FIG. 13   a  is an enlarged perspective view illustrating the connection between the anterior arch wire shown in  FIG. 13  and the ladder structure shown in  FIG. 1 . 
           [0026]      FIG. 13   b  is a perspective view of the combination of the anterior arch wire shown in  FIG. 13  connected to the bridge and reinforcing structure shown in  FIG. 5 . 
           [0027]      FIG. 14  is a perspective view of two reinforcing structures supported by the bridge shown in  FIG. 5 . 
           [0028]      FIG. 14   a  is an exploded view of the assembly shown in  FIG. 14 . 
           [0029]      FIG. 14   b  is a perspective view of the assembly of  FIG. 14  attached to two surrounding teeth. 
           [0030]      FIG. 15  is a perspective view of another construction of the bridge shown in  FIG. 5  with one reinforcing structure for supporting a pontic with the bridge inserted into an adjacent tooth and an internal view of the bridge inserted into a tooth on the right. 
           [0031]      FIG. 15   a  is a perspective view of the assembly shown in  FIG. 15  with the external view of the bridge inserted into the tooth on the right. 
           [0032]      FIG. 15   b  is a perspective view of the assembly shown in  FIG. 15  with the middle and right teeth filled with composite resin to enclose the bridge. 
           [0033]      FIG. 16  is a perspective view of an assembled bridge and reinforcing structure shown in  FIG. 5  during the process of inserting a pontic onto the reinforcing structure. 
           [0034]      FIG. 16   a  is a perspective view of the assembly shown in  FIG. 16  with the pontic completely inserted onto the reinforcing structure. 
           [0035]      FIG. 17  is a perspective view of another arrangement of a bridge and reinforcing structure inserted in an edentulous space between two teeth with the tooth on the left filled with composite resin. 
           [0036]      FIG. 17   a  is a perspective view of another arrangement of a bridge with two reinforcing structures adjacent to one another, the middle reinforcing structure coupled to a pontic partially filled with composite resin and adjacent to a tooth. 
           [0037]      FIG. 18  is a perspective view of a temporary or permanent bridge abutment lingual finger reinforcement. 
           [0038]      FIG. 19  is a perspective view of multiple permanent bridge abutment lingual finger reinforcements adjacent to a reinforcing structure coupled to the bridge as shown in  FIG. 5 . 
           [0039]      FIG. 20  is a perspective view of a bridge with a reinforcing structure as shown in  FIG. 5 . 
           [0040]      FIG. 20   a  is an exploded view of the assembly shown in  FIG. 20 . 
           [0041]      FIG. 20   b  is an exploded view of another construction of the reinforcing structure, with a substructure coupled to a bridge. 
           [0042]      FIG. 20   c  is an assembled view of the construction shown in  FIG. 20   b  before the bridge has been formed, for example, by casting. 
           [0043]      FIG. 20   d  is an assembled view of the construction shown in  FIG. 20   b  of the bridge and reinforcing structure. 
           [0044]      FIG. 21  is a perspective view of a truss for an insert for use in individual single composite restorations. 
           [0045]      FIG. 22  is a perspective view of the truss shown in  FIG. 21  connected to a ladder to form a bridge for an insert for use in individual single composite restorations. 
           [0046]      FIG. 23  is a side view of the combination shown in  FIG. 22  inserted into a single tooth. 
           [0047]      FIG. 24  is a perspective view of the combination shown in  FIG. 22  inserted into a single tooth. 
           [0048]      FIG. 25  is a perspective view of another construction of an insert for use in individual single composite restorations, with a bridge. 
           [0049]      FIGS. 25   a - 25   c  are views of the insert shown in  FIG. 25  for use in individual single composite restorations. 
           [0050]      FIG. 26  is a perspective view of the insert shown in  FIG. 25  inserted into a tooth that to which composite resin has been added for bonding to the tooth. 
           [0051]      FIG. 26   a  is a perspective view of the insert shown in  FIG. 25  with composite resin bonding a quarter of a pontic to the insert. 
           [0052]      FIG. 26   b  is a perspective view of the insert bonded to a quarter of a pontic shown in  FIG. 26   a  being inserted into a damaged tooth for bonding thereto. 
           [0053]      FIG. 26   c  is a perspective view of the insert bonded to a quarter of a pontic shown in  FIG. 26   a  inserted into a damaged for bonding thereto. 
           [0054]      FIG. 27  is a perspective view of a bridge and reinforcing structure of  FIG. 5  with connections for fitting into the jaw. 
           [0055]      FIG. 28  is an exploded view of the assembly of  FIG. 27 . 
           [0056]      FIGS. 29 and 29   a  are views of a bridge with a reinforcing structure of  FIG. 5  inserted into the lower set of teeth, with the reinforcing structure fitting into an edentulous space. 
           [0057]      FIG. 30  is a top perspective view of another construction of a dental device, such as a truss structure or bridge framework. 
           [0058]      FIG. 31  is a bottom perspective view of the truss structure shown in  FIG. 30 . 
           [0059]      FIG. 32  is a top view of the truss structure shown in  FIG. 30 . 
           [0060]      FIG. 33  is a front view of the truss structure shown in  FIG. 30 . 
           [0061]      FIG. 34  is a right side view of the truss structure shown in  FIG. 30 . 
           [0062]      FIG. 35  is a partial cross-sectional view of a portion of the truss structure taken generally along line  35 - 35  in  FIG. 33 . 
           [0063]      FIG. 36A  is a top perspective view of another construction of a dental device, such as a truss structure or bridge framework. 
           [0064]      FIG. 36B  is a bottom perspective view of the truss structure shown in  FIG. 36A   
           [0065]      FIG. 37  is a top view of the truss structure shown in  FIG. 36A . 
           [0066]      FIG. 38  is a front view of the truss structure shown in  FIG. 36A . 
           [0067]      FIG. 39  is a right side view of the truss structure shown in  FIG. 36A . 
           [0068]      FIG. 40  is a partial cross-sectional view of a portion of the truss structure taken generally along line  40 - 40  in  FIG. 38 . 
           [0069]      FIG. 41  is a top perspective view of another construction of a dental device, such as a truss structure or bridge framework. 
           [0070]      FIG. 42  is a top view of the truss structure shown in  FIG. 41 . 
           [0071]      FIG. 43  is a front view of the truss structure shown in  FIG. 41 . 
           [0072]      FIG. 44  is a right side view of the truss structure shown in  FIG. 41 . 
           [0073]      FIG. 45  is a perspective view of another construction of an insert for use in individual single composite restorations. 
           [0074]      FIG. 46  is a top view of the insert shown in  FIG. 45 . 
           [0075]      FIG. 47  is a front view of the insert shown in  FIG. 45 . 
           [0076]      FIG. 48  is a partial cross-sectional view of a portion of the insert taken generally along line  48 - 48  in  FIG. 47 . 
           [0077]      FIG. 49  is a right side view of the insert shown in  FIG. 45 . 
           [0078]      FIG. 50  is a perspective view of another construction of an insert for use in individual single composite restorations. 
           [0079]      FIG. 51  is a top view of the insert shown in  FIG. 50 . 
           [0080]      FIG. 52  is a front view of the insert shown in  FIG. 50 . 
           [0081]      FIG. 53  is a partial cross-sectional view of a portion of the insert taken generally along line  53 - 53  in  FIG. 52 . 
           [0082]      FIG. 54  is a right side view of the insert shown in  FIG. 50 . 
       
    
    
       [0083]    Before any independent features and at least one construction of the invention are explained in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangements of the components set forth in the following description or illustrated in the drawings. The invention is capable of other constructions and of being practiced or being carried out in various ways. Also, it is understood that the phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting. The use of “including”, “having” and “comprising” and variations thereof herein is meant to encompass the items listed thereafter and equivalents thereof as well as additional items. 
         [0084]    Although references may be made below to directions, such as upper, lower, downward, upward, rearward, bottom, front, rear, etc., in describing the drawings, these references are made relative to the drawings (as normally viewed) for convenience. These directions are not intended to be taken literally or limit the present invention in any form. In addition, terms such as “first” and “second” are used herein for purposes of description and are not intended to indicate or imply relative importance or significance. 
       DETAILED DESCRIPTION 
       [0085]    In some independent aspects and in some constructions, an adjustable system for bonded composite dentistry may be provided. The system for bonded composites generally includes multiple parts that can be altered and used alone or in combination to perform a plurality of operations such as, for example, splinting one or more unstable teeth, reconstructing one or more teeth, supporting pontics, bridging gaps between teeth, preventing additional wear on new or existing teeth, etc. 
         [0086]    As shown in  FIG. 1 , a first member, a ladder structure, or a ladder  10 , includes opposing rails  12  connected by a plurality of rungs  14 . The length of the ladder  10  can be adjusted and may vary greatly. In the illustrated construction and in some aspects, the configuration of the ladder  10  provides the ladder  10  with an increased torsional rigidity and stiffness not found in conventional bridge framework and/or connecting assemblies. 
         [0087]    In the illustrated construction, the rails  12  each include a plurality of apertures or perforations  16  therethrough. The apertures  16  can be round and are distributed along the ladder  10  to, for example, allow for the flow of composite resin. In the illustrated construction, the rails  12  are configured such that they are separable from one another so a segment comprising a singular rail may be formed, if desired, as part of the overall framework of the ladder  10 . 
         [0088]    The plurality of rungs  14  are spaced along the rails  12  to define a plurality of openings  18  between adjacent rungs  14 . The rungs  14  may be hollow or solid. The rungs  14  may have various cross-sectional shapes such as, for example, round, oval or square. 
         [0089]    With reference to  FIG. 2 , a second member, a truss structure, or a truss  20 , is shown. In the illustrated construction and in some aspects, the combination of the ladder  10  and truss  20  also provides a torsionally rigid and substantially stiff bridge with which to support one or more pontics and/or unstable teeth. 
         [0090]    In the illustrated construction, the truss  20  includes a strip  22  having a plurality of upstanding projections  24 . The projections  24  may act as occlusal stops and to protect the biting portion of bonded teeth from the wear that occurs through mastication and contact with the opposite set of teeth. The projections  24  of the truss  20  are correspondingly spaced with the openings  18  defined in the ladder  10  to allow the truss  20  to engage the ladder  10  in a plurality of relative configurations to yield a bridge. One or more apertures  26  may also be formed through the truss  20  in a location between the projections  24 . 
         [0091]    The projections  24  may be arranged on the truss  20  to engage in the opening  18  between every, every other, every third or every fourth rung  14  in the ladder  10 . As a result, the truss  20  may fit precisely between the two rails  12 , and the projections  24  may fit precisely in the opening  18  between every, every other, every third, or every fourth rung  14  in the ladder  10  to interlock the truss  20  and ladder  10 . In addition, the projections  24  may act as occlusal stops by extending above the ladder  10  (e.g., ending 1-1.5 mm above the height of the top portion of the rails  12  and rungs  14 ). The truss  20 , after interlocking with the ladder  10 , reinforces and/or bridges the openings or open span between the rungs  14  on the ladder  10 . 
         [0092]      FIG. 4  shows the ladder  10 , truss  20 , and a reinforced substructure  28  coupled to the truss  20 . In the illustrated construction, the substructure  28  is substantially webbed, and includes a plurality of apertures or perforations  30  therethrough to, for example, allow the flow or seepage of resin through and around the substructure  28  for increased bonding strength of the resin between a pontic and the substructure  28 . The apertures or perforations  30  through the substructure  28  provide an increased surface area on which the resin is to bond. 
         [0093]    The substructure  28  can be connected to a cross truss  32 , as shown in  FIG. 4 . With the substructure  28  positioned along the truss  20 , the reinforcing structure  32  can be positioned in a direction substantially normal to the truss  20 , creating a reinforcing structure  34 . A pontic formed around the reinforcing structure  34  may have an increased torsional rigidity as a result of the resin bonding with the reinforcing structure  34 . 
         [0094]    One or more portions of the truss  20  (e.g., the strip  22 , the projections  24 , the substructure  28 , the cross truss  32 , etc.) may be formed of metal. In the illustrated construction, the structures of the truss  20  are formed of metal. In other constructions, one or more of the structures of the truss  20  may be formed of another material, such as, for example, a composite material. 
         [0095]      FIG. 5  shows a joined ladder  10  and truss  20 , hereinafter referred to as a bridge  35 . The projections  24  of the truss  20  are shown engaging every other rung  14  of the ladder  10 . The rungs  14  of the ladder  10  are shown as being square in this construction.  FIGS. 29 and 29   a  are views of a bridge  35  with a reinforcing structure  34  inserted into the lower set of teeth, with the reinforcing structure  34  fitting into an edentulous space. 
         [0096]    With reference to  FIG. 6 , an anterior perforated segment  36  is shown. The segment  36  can be formed independently or by removing the rungs  14  and one rail  12  of the ladder  10  used on the sides of the mouth. The segment  36  has a connection portion or piece  38  that can be coupled to the ladder  10  used on the side of the mouth to form a single component. The piece  38  includes a first recess or slot which extends transverse to the axis and a second recess which extends along the axis. The segment  36  includes a plurality of perforations  40  that, for example, allows resin bonding material to seep through. 
         [0097]    As illustrated in  FIG. 7  and  FIG. 8 , the segment  36  can be locked to a ladder  10  on both sides. Connecting the segment  36  on both sides to two individual ladders  10  would require two connection pieces  38  rather than a single connection piece  38  as shown in  FIG. 6 . The segment  36 , bridge  35 , and reinforcing structure  34  can be used in combination for supporting a pontic and stabilizing loose teeth, as illustrated in  FIG. 9 . 
         [0098]    With reference to  FIG. 10  and  FIG. 1 , alternate sides of a shield  42  are shown. The shield  42  has projections  44  positioned to engage the perforations  40  of the anterior perforated segment  36 . In the illustrated construction, the shield  42  is also substantially webbed and includes a plurality of apertures or perforations  46  therethrough to, for example, allow the flow or seepage of resin through and around the segment  36  for increased bonding strength of the resin between an anterior pontic and the segment  36 . In the illustrated construction, the shield  42  and the projections  44  are formed of metal but, in other constructions, may be formed of another material. 
         [0099]    Adding a shield  42  to the combination of the segment  36 , bridge  35 , and reinforcing structure  34  of  FIG. 9 ,  FIG. 12  shows the framework for supporting an anterior pontic. The shield  42  is connected to the segment  36  in a manner similar to the reinforcing structure  34  being connected to the bridge  35  for supporting respective pontics. This arrangement of  FIG. 12  allows for the bonding of an anterior pontic in the anterior portion of the mouth and the bonding of an additional pontic on a first side of the mouth. 
         [0100]      FIG. 13  shows an anterior arch wire  48  to be connected or locked into the bridge  35 , and  FIG. 13   b  shows the arch wire  48  locked into the bridge  35 . The arch wire  48  is an alternate to the segment  36  for anterior support used alone or in combination with the side ladders  10 .  FIG. 13   a  shows the detail of the arch wire  48  locking into the ladder  10 . The anterior arch wire  48  is connectable to the bridge  35  in the same manner as the segment  36  by using connection piece  38 . The slot of the connection piece  38  receives a first rung  14  in a direction transverse to the axis, and the second recess receives a second rung  14  in a direction parallel to the axis. Also, a portion of the connection piece  38  may engage an end portion of the truss  20 . 
         [0101]    In the illustrated construction, the arch wire  48  is a solid wire as opposed to the segment  36  with perforations  40 . The arch wire  48  can have a variety of applications including, for example, supporting anterior teeth that may be loose or maintaining alignment of anterior teeth. The arch wire  48  can be bonded to the back of a row of teeth, as understood in the art. 
         [0102]      FIGS. 14 ,  14   a  and  14   b  show two reinforcing structures  34  supported by bridge  35 . Two or more reinforcing structures  34  (arranged side by side or otherwise) may be used in this system because of the reinforcing nature of the bridge  35  provided by the truss  20  interlocking with the ladder  10 . In the illustrated construction and in some aspects, this combination increases the compressive strength and resistance to torquing of the pontic provided by the substructure  28 , which may be formed of metal or another material. The strength of the bridge  35  may also be increased by splinting as many teeth as possible to stabilize the pontic. In other words, the more abutments incorporated on either side of the reinforcing structure  34 , the stronger the bridge  35 . 
         [0103]      FIGS. 15 ,  15   a  and  15   b  illustrate the bridge  35  with one reinforcing structure  34   a  for supporting a pontic with the bridge  35  inserted into an adjacent tooth  52  and an internal view of the bridge  35  inserted into a tooth  52  on the right. Referring to the tooth  52  in the middle, composite resin has been partially added near the bridge  35  with a goal of bonding the bridge  35  to the middle tooth  52 . This is, in effect, a prefabricated, performed composite bridge  52 , which can be manufactured and supplied to dentists before a patient actually needs this bridge  35 . In other words, this preformed bridge  35  could be kept in storage until the appropriate time. This preformed bridge  35  could be bonded wherever a bicuspid or molar is missing. With reference to the reinforcing structure  34  on the left side, additional ladder inserts  54  with perforations  16  are shown running parallel to the ladder  10  to provide, for example, increased bonding surface area, increased strength, etc. 
         [0104]      FIGS. 16 and 16   a  show the bridge  35  and the reinforcing structure  34  during the process of inserting a pontic  64  onto the reinforcing structure  34 . Pontics  64  used with the illustrated constructions of the bridge  35  can have various sizes. The pontic  64  illustrated in  FIG. 16  is of an average size.  FIG. 17  shows the bridge  35  and the reinforcing structure  34  inserted in an edentulous space  65  between two teeth  52  with the tooth  52  on the left filled with composite resin  58 .  FIG. 17  also shows, on the tooth  52  on the left, projections  24  showing through the composite resin  58 . The projections  24  may be formed of metal or another material. 
         [0105]    With reference to  FIG. 18 , lingual fingers  66 , such as those illustrated, can be adapted to bridge  35 . The lingual fingers  66  are attached to a plate  68  to form a lingual finger reinforcement  70 , the combination adapted to be coupled to the bridge  35 . As shown, the reinforcement  70  slides into the side apertures or perforations  16  in the rails  12 . However, many alternate methods of attaching the reinforcements  70  to the bridge  35  are possible. The reinforcements  70  sit lingual to the prepared teeth (e.g., molar, bicuspid, cuspid, lateral, and central).  FIG. 19  shows lingual fingers  66  that can be adapted around three teeth. Lingual fingers  66  can be used in a variety of situations, including but not limited to, adjacent to a reinforcing structure  34 , adjacent teeth  52 , adjacent to two reinforcing structures  34 , etc. 
         [0106]      FIGS. 20 and 20   a - 20   d  show a bridge  72  with reinforcing structure  34 . The ladder  10  and truss  20  are merged into a one piece flat plane bridge  72 . The bridge  72  may be made, for example, by casting or another method, of an appropriate material, such as, for example, gold, titanium, laboratory processed composite, etc. The bridge  72  is imbedded into unpolymerized composite resin, and then the resin is tamped over and light-polymerized or cured. Thus, the bridge  72  will form the contact points, the marginal ridges, and the occlusal stops of a bonded, composite restoration. 
         [0107]      FIGS. 21-25  are an adaptation of one or more features of the present invention for use with individual single composite restorations.  FIG. 21  illustrates a truss structure  120  similar to the truss structure  20  in  FIGS. 1-20  for insertion into a single tooth. The truss structure  120  has a plurality of apertures  126  or perforations therethrough. The apertures  126  in the truss  120  can be round and are distributed to, for example, allow for the flow of composite resin. The truss  120  also has projections  124  to, for example, act as occlusal stops. 
         [0108]    As shown in  FIG. 22 , the projections  124  on the truss  120  may also be used for engagement through rungs  114  of a ladder  110 . The ladder  110  is similar to the ladder  10  in  FIGS. 1-20 . In the illustrated construction, the projections  124  of the truss  120  in  FIG. 22  fit through every rung  114  of the ladder  110 , which is a preferred construction for a single insert composite restoration  108 . However, depending on the size of the tooth and the size of the ladder  110 , the projections  124  of the truss  120  may engage the ladder  110  between every rung, every other rung, or every third rung  114 . The combination of ladder  110  and truss  120  forms a bridge  135 , similar to the bridge  35  shown in the constructions of  FIGS. 1-20 .  FIG. 23  shows the bridge  135  placed in into a single tooth. From an alternate view in  FIG. 24 , composite resin  58  will be allowed to flow around the entire system as well as into the apertures  126  of the truss  120  and ladder  110  insert as to bond with a tooth  52 . 
         [0109]      FIG. 25  illustrates a finished version of an insert  172  for use in individual single composite restorations. The ladder  110  and truss  120  are merged into the one piece flat plane cast insert  172 . The insert  172  can be made of an appropriate material, such as, for example, gold, titanium, laboratory processed composite, etc. The insert  172  is imbedded into unpolymerized composite resin and then the resin is tamped over and light-polymerized or cured. Thus, the insert  172  will form the contact points, the marginal ridges, and the occlusal stops of a bonded, composite restoration. The insert  172  includes multiple apertures  126  to, for example, allow resin to flow through and around the insert  172  in creating the composite restoration.  FIGS. 25   a - 25   c  are multiple views of the insert  172  to illustrate the location of the apertures  126 . The location of the apertures  126  is not limited to the locations shown. More or fewer apertures  126  can be incorporated into the insert  172  at nearly any location on the insert  172 .  FIGS. 26   a - 26   c  illustrate the insert  172  with composite resin bonding a quarter of a pontic to the insert  172 . 
         [0110]      FIG. 27  and  FIG. 28  illustrate the bridge  35  adapted for an implant bridge  74  with implant legs  76 . The implant legs  76  are adapted to be inserted into the jaw of a patient. The implant legs  76  fit around the outside of the ladder  10  and can be secured thereto. The implant legs  76  can be positioned at a variety of different locations along the length of the ladder  10 . One or more reinforcing structures  34  can inserted between the legs  76  of the implant bridge  74 . 
         [0111]    In some independent aspects, a system for making and installing a temporary bridge, in which the dentist makes the temporary bridge chair side, is provided. The dentist first selects the appropriate length of the ladder  10  and snaps in a section of the truss  20  with one, two, three, or more reinforcing structures  34  depending on how many teeth are missing. 
         [0112]    The dentist can select a reinforcement  70  that slides into the side apertures or perforations  16  in the rails  12 . The fingers  66  sit lingual to the prepared teeth (e.g., molar, bicuspid, cuspid, lateral, and central), and the dentist sets a small amount of unpolymerized light-cured composite on the occlusal surface of the prepared teeth. 
         [0113]    The dentist places the ladder  10 , truss  20 , and one or more reinforcing structures  34  into the unpolymerized light-cured composite. The dentist partially light-cures the resin without bonding the resin to the tooth. The dentist takes a vacuum-formed clear stent and fills it with acrylic or composite, then sets it over the ladder  10  and truss  20  on the prepared teeth, so that when the temporary bridge is removed, the ladder  10 , truss  20 , and pontic(s) are picked up because they are internally incorporated in the temporary bridge. The projections  24  on the truss  20  act as occlusal stops to prevent the wearing of the bridge. The temporary bridge is both reinforced and slow to wear occlusally to provide a long-term temporary bridge. 
         [0114]    In contrast, in conventional dental bridges, the laboratory fashions the temporary bridge in a different manner. After receiving the study models and bite from the dentist, the laboratory prepares the designated teeth for crown preps. The laboratory selects the appropriate length and pontic size for the bridge and appropriate lingual reinforcement systems. The laboratory constructs the reinforced temporary bridge for placement by the dentist into the patient&#39;s mouth. 
         [0115]    In some aspects, the system may eliminate any casting to be done because the individual components (e.g., the ladder  10 , truss  20 , substructure  28 , etc.) can be a part of an extensive kit available to the dentist. For the reinforced single, double, or more pontic bridge, all the dentist has to do is send the laboratory a set of unprepared study models, a bite, and a shade. The laboratory can groove the MO, DO, MOD preps in the adjacent teeth and fabricate a trim coping for the dentist to follow. The laboratory can then fabricate the bridge. When the dentist receives the bridge, the dentist only needs to put the trim coping in the patient&#39;s mouth, groove the teeth, apply the bonding resin, put the composite into the grooves, press the ladder  10  and truss  20  into the composite, tamp it over, light-cure the ladder  10  and truss  20  into the composite, and finally adjust the occlusion. 
         [0116]    The ladder  10  and truss  20  can be used in a variety of different applications. In one exemplary application, the ladder  10  and truss  20  can be used to stabilize mobile teeth up to and including an entire arch using just the ladder  10 , or the ladder  10  in combination with the truss  20  or the truss  20  with the substructure  26  for anchoring the pontic. This is accomplished by embedding the ladder  10  and truss  20  into MO, DO, or MOD preparations in the teeth to be stabilized, in which unpolymerized composite resin has been placed. After seating the ladder  10  and truss  20 , the resin oozes through the apertures or perforations  16  in the ladder  10  and the apertures  26  in the truss  20 . After the resin is sufficiently set, it is tamped down and molded. The composite resin is then light cured or polymerized to create a permanent reinforced bridge. 
         [0117]    As shown in  FIG. 17 , in an exemplary application in which two bicuspids are missing, the bridge  35  could be fabricated by splinting three molars together in the posterior. In another situation in which two anterior teeth are missing, two, three, or more teeth in the anterior (e.g., cuspid, lateral, etc.) could be splinted around the anterior arch if necessary. For the anterior portion of the mouth, if a tooth is missing, an anterior pontic could be fabricated out of composite and attached to the shield  42  with projections  44 . The shield  42  and/or the projections  44  may be formed of metal or another material. 
         [0118]    In another exemplary application, the interlocking ladder  10  and truss  20  with substructure(s)  28  and pontic(s) can be used to replace a missing tooth or teeth at any location over the arch. An artificial tooth or teeth can be formed around the substructure  28  by the dentist chair-side either free-hand or with celluloid pontic halves made from composite resin (light-cured or light-polymerized). The artificial tooth or teeth can also be fabricated in a dental laboratory by a dental laboratory technician. The resulting bridge is then bonded in two or more teeth after preparation of those teeth by the dentist and inserting the ladder  10  and truss  20  as previously discussed. 
         [0119]    In yet another exemplary application, the interlocking ladder  10  and truss  20  with or without substructure(s) or pontic(s) may be used by a dentist or laboratory technician to construct a reinforced temporary bridge with occlusal stops, eliminating the conventional use of custom castings. The ladder  10  and truss  20  with or without substructure(s)  28  or pontic(s) are incorporated chair-side by the dentist using acrylic or composite resin in conjunction with a vacuum-formed clear celluloid bridge form, or by the laboratory using heat processed acrylic. 
         [0120]    In another exemplary application, the ladder  10  and truss  20  as designed without the substructure(s)  28  or pontic(s) can also be formed as one piece, for example, by casting or another method. The formed piece can be made from an appropriate material, such as, for example, titanium, dental hard-gold alloy, crown and bridge non-precious metal, stainless steel, cast ceramic such as Empress, among other materials. The formed piece can fit within an MO, DO, or MOD restoration to act as a reinforcement, contact point or former, occlusal and marginal ridge stops for the MO, DO, or MOD light-cured composite restoration into which they are embedded to enhance the strength, longevity and durability of a light-cured or light-polymerized resin restoration. The formed piece can also be used to reinforce a single temporary crown as previously discussed. The ladder  10  and truss  20  can provide a long lasting temporary crown, which is substantially resistant to occlusal wear. 
         [0121]    In yet another exemplary application, the ladder  10  and truss  20 , with or without substructure(s) or pontic(s), may also be used by a laboratory to fabricate an all-composite (such as BELLE GLASS) permanent bridges. After the dentist supplies an impression of conventionally prepared teeth, the laboratory can incorporate the ladder  10  and truss  20  with pontic(s) into a composite bridge to reinforce spans of missing teeth. Such structure can substantially resist torquing and provide occlusal stops and mesial and distal marginal ridge stops. Additionally, all of the previously-discussed applications may all be accomplished at the same time in the same arch. 
         [0122]      FIGS. 30-35  illustrate another construction of a dental device, such as a dental bridge. An element which is common to an element described above and/or shown in any of  FIGS. 1-29  has the same reference number followed by the letter “A”. 
         [0123]    A reinforcing structure  34 A extends along an axis  178  (shown in  FIG. 32 ) and generally includes (see  FIGS. 30-31 ) a structural portion  20 A, upstanding projections  24 A, and a substructure  28 A. In the illustrated construction, the reinforcing structure  34 A includes a cross truss  32 A transverse to the axis  178 . In some constructions (not shown), the cross-truss  32 A may not be provided, and the substructure  28 A may be adapted for supporting an anterior pontic, in a manner similar to that described in a previous construction and illustrated in  FIG. 10 . 
         [0124]    The reinforcing structure  34 A is similar to the reinforcing structure  34  shown in  FIG. 5 . In the illustrated construction, the reinforcing structure  34 A is constructed as a single piece and is strong. In the illustrated construction, the reinforcing structure  34 A rests solidly on the centerline of the adjacent teeth, sitting squarely in easy-to-prepare grooves in the adjacent teeth, as described in previous constructions above. The grooves in the adjacent teeth may be generally square or may have another shape or combination of shapes. For example, the groove may be rounded or have a radius in a portion, such as the bottom of the groove, or to provide no sharp corners. In another example, the grooves may have a trapezoidal shape, such as a dove-tail shape. 
         [0125]    As shown in  FIGS. 30-31  and  33 , the projections  24 A extend above the upper surface of the structural portion  20 A in the occlusal direction, when the dental device is supported. The projections  24 A may act as occlusal stops to protect the biting portion of bonded teeth from the wear that occurs through mastication and contact with the opposite set of teeth. 
         [0126]    The reinforcing structure  34 A defines (see  FIG. 33 ) a radii surface  180  between the structural portion  20 A and the substructure  28 A and (see  FIG. 34 ) a radii surface  181  between the structural portion  20 A and the cross truss  32 A. The radii surface(s)  180  are relatively large and may protrude from the sides of the pontic (not shown), which attaches to the substructure and is preferably a bicuspid, in a manner similar to that described above and illustrated in  FIGS. 16 and 16   a , and engage grooves on the sides of adjacent teeth (not shown) to provide the pontic with additional strength and resistance to twisting forces. It should be understood that the structural portion  20 A may have any length and accordingly may include any number of projections  24 A and any number of vertical apertures  182  (which will be described later). In operation, the structural portion  20 A may be cut to a desired length in order to engage a desired number of adjacent teeth. 
         [0127]    In the illustrated construction (see  FIG. 32 ), the structural portion  20 A includes a plurality of generally vertical apertures  182  extending therethrough between the upper and lower surfaces, transverse to the axis  178 .  FIG. 35  provides a cross-sectional view of a vertical aperture  182 . Bonding resin can flow through the vertical apertures  182  which, when cured, may link tooth and structural portion  20 A together in a strong mechanical/chemical bond. The vertical apertures  182  include chamfered, angled or radiused lead-in surfaces  183  to, for example, improve the flow of bonding resin, the bond between the bonding resin, tooth and structural portion  20 A, etc. 
         [0128]    In other constructions (not shown), the structural portion  20 A may have a roughened surface in addition to or instead of the apertures  182 . The roughened surface may provide improved bonding between the structural portion  20 A and bonding resin and/or material of the pontic. The structural portion  20 A may define one or more recesses formed in the surface(s) of but not completely through the structural portion  20 A in addition to or instead of the apertures  182 . 
         [0129]    As shown in  FIG. 33 , the substructure  28 A includes a plurality of apertures  184  transverse to the axis  178 . The apertures  184  may be substantially horizontal. The substructure  28 A also includes open slots  30 A extending inwardly from a peripheral surface  186  of the substructure  28 A, into which a bonding resin and/or material of the pontic can flow and may link the substructure and pontic in a strong mechanical/chemical bond. The slots  30 A may be parallel to each other and/or to the axis  178 . 
         [0130]    As shown in  FIG. 34 , the cross truss  32 A also has open slots  30 A transverse to the axis  178  and extending inwardly from a peripheral surface  188 , into which a bonding resin and/or material of the pontic can flow. These slots  30 A may be parallel to each other and/or to the axis of the cross truss  32 A. 
         [0131]    In other constructions (not shown), the substructure  28 A and/or the cross truss  32 A may have a roughened surface in addition to or instead of the slots  30 A (and/or the apertures  184 ). The roughened surface may provide improved bonding between the substructure  28 A and/or the cross truss  32 A and bonding resin and/or material of the pontic. The substructure  28 A and/or the cross truss  32 A may define one or more recesses formed in the surface(s) of but not completely through the substructure  28 A and/or the cross truss  32 A in addition to or instead of the slots  30 A (and/or the apertures  184 ). 
         [0132]    In some constructions and for some independent features, the dental device may include an insert. The insert may be similar to that described above and shown in  FIGS. 21-26 . In such constructions, the reinforcing portion  34 A would not include the substructure  28 A and the cross-truss  32 A. 
         [0133]      FIGS. 36-40  illustrate another construction of a dental device, such as a dental bridge. An element which is common to an element described above and/or shown in any of  FIGS. 1-35  has the same reference number followed by the letter “B”. 
         [0134]    A reinforcing structure, or bridge framework,  34 B extends along an axis  178 B (shown in  FIG. 37 ) and generally includes (see  FIGS. 36A and 36B ) a structural portion  20 B, upstanding projections  24 B, and a substructure  28 B. In the illustrated construction, the reinforcing structure  34 B includes a cross truss  32 B transverse to the axis  178 B. In some constructions (not shown), the cross-truss  32 B may not be provided, and the substructure  28 B may be adapted for supporting an anterior pontic, in a manner similar to that described in a previous construction and illustrated in  FIG. 10 . 
         [0135]    The reinforcing structure  34 B is similar to the reinforcing structure  34 A shown in  FIG. 30 . In the illustrated construction, the reinforcing structure  34 B is constructed as a single piece. The reinforcing structure  34 B is strong and, in the illustrated construction, rests solidly on the centerline of the adjacent teeth, sitting squarely in easy-to-prepare square grooves in the adjacent teeth, as described in previous constructions above. Additionally, the illustrated construction is slightly larger than  34 A (i.e., longer in the axial direction) because it is sized for a supporting a molar pontic. 
         [0136]    As shown in  FIGS. 36A and 38 , the projections  24 B extend above the upper surface of the structural portion  20 B in the occlusal direction, when the dental device is supported. The projections  24 B may act as occlusal stops to protect the biting portion of bonded teeth from the wear that occurs through mastication and contact with the opposite set of teeth. 
         [0137]    The reinforcing structure  34 B defines (see  FIG. 38 ) a radii surface  180 B between the structural portion  20 B and the substructure  28 B and (see  FIG. 36B ) a radii surface  181 B between the structural portion  20 B and the cross truss  32 B. The radii surface(s)  180 B is relatively large and may protrude from the sides of the pontic (not shown), which attaches to the substructure  28 B and is preferably a molar, in a manner similar to that described above and illustrated in  FIGS. 16 and 16   a , and engage grooves on the sides of adjacent teeth (not shown) to provide the pontic with additional strength and resistance to twisting forces. It should be understood that the structural portion  20 B may have any length and accordingly may include any number of projections  24 B and any number of vertical apertures  182 B (which will be described later). In operation, the structural portion  20 B may be cut to a desired length in order to engage a desired number of adjacent teeth. 
         [0138]    In the illustrated construction (see  FIG. 37 ), the structural portion  20 B includes a plurality of generally vertical apertures  182 B extending therethrough between the upper and lower surfaces, transverse to the axis  178 B.  FIG. 40  provides a cross-sectional view of a vertical aperture  182 B. Bonding resin can flow through the vertical apertures  182  which, when cured, may link tooth and structural portion  20 A together in a strong mechanical/chemical bond. The vertical apertures  182 B also include chamfered surfaces  183 B. 
         [0139]    In other constructions (not shown), the structural portion  20 B may have a roughened surface in addition to or instead of the apertures  182 B. The roughened surface may provide improved bonding between the structural portion  20 B and bonding resin and/or material of the pontic. The structural portion  20 B may define one or more recesses formed in the surface(s) of but not completely through the structural portion  20 B in addition to or instead of the apertures  182 B. 
         [0140]    As shown in  FIG. 38 , the substructure  28 B includes a plurality of horizontal apertures  184 B transverse to the axis  178 B, and open slots  30 B extending inwardly from a peripheral surface  186 B of the substructure  28 B and parallel to the axis  178 B, into which a bonding resin can flow and may link the substructure and pontic in a strong mechanical/chemical bond. As shown in  FIG. 39 , the cross truss  32 B also has open slots  30 B transverse to the axis  178 B and extending inwardly from a peripheral surface  188 B, into which a bonding resin can flow. 
         [0141]    In other constructions (not shown), the substructure  28 B and/or the cross truss  32 B may have a roughened surface in addition to or instead of the slots  30 B (and/or the apertures  184 B). The roughened surface may provide improved bonding between the substructure  28 B and/or the cross truss  32 B and bonding resin and/or material of the pontic. The substructure  28 B and/or the cross truss  32 B may define one or more recesses formed in the surface(s) of but not completely through the substructure  28 B and/or the cross truss  32 B in addition to or instead of the slots  30 B (and/or the apertures  184 B). 
         [0142]      FIGS. 41-44  illustrate another construction of a dental device, such as a dental bridge. An element which is common to an element described above and/or shown in any of  FIGS. 1-40  has the same reference number followed by the letter “C”. 
         [0143]    A reinforcing structure, or bridge framework,  190  generally includes (see  FIG. 41 ) a structural portion  20 C that generally extends along a first axis  192  and a substructure  28 C that generally extends along a second axis  194 , which is substantially perpendicular to the first axis  192 . The substructure  28 C is adapted for supporting an anterior pontic, such as an incisor, in a manner similar to that described in a previous construction and illustrated in  FIG. 10 . 
         [0144]    In the illustrated construction, the reinforcing structure  190  is constructed as a single piece. The reinforcing structure  190  includes a labial side  196  and a lingual side  198 . The structural portion  20 C sits squarely in easy-to-prepare grooves on the lingual side of adjacent teeth. A pontic, preferably an incisor, is formed around the substructure  28 C and is disposed substantially towards the labial side  196 . 
         [0145]    The reinforcing structure  190  defines (see  FIG. 43 ) a radii surface  180 C between the structural portion  20 C and the substructure  28 C. The radii surface(s)  180 C is relatively large and may protrude from the sides of the pontic (not shown), which attaches to the substructure  28 B and is preferably an incisor, in a manner similar to that described above and illustrated in  FIGS. 16 and 16   a , and engage grooves on the sides of adjacent teeth (not shown) to provide the pontic with additional strength and resistance to twisting forces. It should be understood that the structural portion  20 C may have any length and accordingly may include any number of generally horizontal apertures  200  (which will be described later). In operation, the structural portion  20 C may be cut to a desired length in order to engage a desired number of adjacent teeth. 
         [0146]    In the illustrated construction (see  FIG. 43 ), the structural portion  20 C includes a plurality of apertures  200  extending therethrough between the labial surface  196  and the lingual surface  198 , transverse to the axis  192 . The apertures  200  may be substantially horizontal. Bonding resin can flow through the horizontal apertures  200  which, when cured, may link tooth and structural portion  20 C together in a strong mechanical/chemical bond. The apertures  200  also include chamfered, angled or radiused lead-in surfaces  183 C. 
         [0147]    As shown in  FIG. 43 , the substructure  28 C includes a plurality of apertures  184 C transverse to the axis  194  into which a bonding resin and/or material of the pontic can flow and may link the substructure and pontic in a strong mechanical/chemical bond. The apertures  184 C may be generally horizontal. For improved strength, the reinforcing structure  190  has a generally trapezoidal shape as can be seen from the side view of  FIG. 44 . 
         [0148]    In other constructions (not shown), the structural portion  20 C and/or the substructure  28 C may have a roughened surface in addition to or instead of the apertures  200  and/or the apertures  184 C. The roughened surface may provide improved bonding between the structural portion  20 C and/or the substructure  28 C and bonding resin and/or material of the pontic. The structural portion  20 C and/or the substructure  28 C may define one or more recesses formed in the surface(s) of but not completely through the structural portion  20 C and/or the substructure  28 C in addition to or instead of the apertures  200  and/or the apertures  184 C. 
         [0149]      FIGS. 45-49  illustrate another construction of a dental device, and  FIGS. 50-54  illustrate yet another construction of a dental device, such as a dental insert, or reinforcing spine. An element which is common to an element described above and/or shown in any of  FIGS. 1-44  has the same reference number followed by the letter “D” or “E”, respectively. 
         [0150]      FIG. 45  illustrates an insert, or reinforcing spine,  172 D for use in individual composite restorations, similar to the insert  172  described above and shown in  FIGS. 25-26   c . The insert  172 D is sized for use with bicuspid teeth and can be made of an appropriate material, such as, for example, gold, titanium, laboratory processed composite, etc. The insert  172 D is imbedded into unpolymerized composite resin and then the resin is tamped over and light-polymerized or cured. Thus, the insert  172 D will form the contact points, the marginal ridges, and the occlusal stops  24 D of a bonded composite restoration. Each axial end of the insert  172 D may be engageable with and provide a contact surface for the surface of the adjacent tooth. 
         [0151]    The insert  172 D includes multiple apertures  126 D to, for example, allow resin to flow through and around the insert  172 D in creating the composite restoration.  FIGS. 46-49  are multiple views of the insert  172 D to illustrate the location of the apertures  126 D. The apertures  126 D may be generally vertical or generally horizontal, as illustrated. The apertures  126 D also include chamfered, angled or radiused lead-in surfaces  183 D. The location of the apertures  126 D is not limited to the locations shown. More or fewer apertures  126 D can be incorporated into the insert  172 D at nearly any location on the insert  172 D. 
         [0152]    In another construction, the insert  172 D may have a roughened surface in addition to or instead of the apertures  126 D. The roughened surface may provide improved bonding between the insert  172 D and bonding resin and/or material of the pontic. The insert  172 D may define one or more recesses formed in the surface(s) of but not completely through the insert  172 D in addition to or instead of the apertures  126 D. 
         [0153]      FIG. 50  illustrates an insert, or reinforcing spine,  172 E for use in individual single composite restorations, similar to the insert  172 D described above and shown in  FIGS. 45-49 . The insert  172 E, however, is sized for use with molars. As can be seen in  FIGS. 50-54 , the insert  172 E can be described similarly with respect to the occlusal stops  24 E, apertures  126 E and chamfered, angled, or radiused lead-in surfaces  183 E as the insert  172 D, above. However, the insert  172 E is larger than the insert  172 D. Each axial end of the insert  172 E may be engageable with and provide a contact surface for the surface of the adjacent tooth. 
         [0154]    In another construction, the insert  172 E may have a roughened surface in addition to or instead of the apertures  126 E. The roughened surface may provide improved bonding between the insert  172 E and bonding resin and/or material of the pontic. The insert  172 E may define one or more recesses formed in the surface(s) of but not completely through the insert  172 E in addition to or instead of the apertures  126 E. 
         [0155]    One or more independent features or independent advantages of the invention may be set forth in the following claims: