The Cosmetic Dentistry Blog

October 15, 2009

Why wasn’t I given Maryland Bridge as an option?

Filed under: Dental bridges — iowasmiles @ 5:49 pm

Why didn’t my dentist mention the option of a Maryland Bridge? I only found it by an internet search.
- Deborah in Kansas

Deborah,
A Maryland Bridge doesn’t work for most cases where you have a missing tooth. Plus, some dentists don’t know how to do them, and there are technical problems with their use in that they aren’t as strong or reliable as a conventional bridge.

If you have a missing tooth, in my opinion the dentist should give you the option of either replacing it with a conventional dental bridge or with a dental implant. In some cases, a removable partial denture may be an appropriate option. Only in special circumstances would a Maryland Bridge or an Encore Bridge be an appropriate option.
- Dr. Hall

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August 7, 2009

How best to replace a front tooth – taking Fosamax

Filed under: Dental bridges, Dental implants — iowasmiles @ 9:45 am

I had a next to the front tooth extracted. My surgeon cautioned about an implant as I have been on fosamax for about 10 years. I am now wearing a flipper which annoys me and has a sour taste in my mouth. I read about the Encore Bridge or Maryland Bridge. The tooth next to the one pulled has a cap on it. Am I eligible for an Encore Bridge? My dentist hesitates to give a regular bridge as he would have to file down a front large tooth. Any advice?
- Susan in Massachusetts

Susan,
I have a couple of points that may be helpful.

First, taking Fosamax doesn’t mean you can’t have a dental implant. There is a slightly increased risk of serious local bone problems when you are taking Fosamax and you have oral surgery that involves the bone, which placing dental implants does. The risk is small, but the potential consequences are serious, so I wouldn’t ignore the risk. However, you can temporarily suspend taking the Fosamax and work around it, if your oral surgeon coordinates this with your physician.

If you don’t want to deal with that, then some type of dental bridge would be best. But I would leave it up to your dentist to choose the type of bridge. An Encore Bridge is a nice service and is esthetic and conservative. But I wouldn’t want you to be the first patient your dentist had ever done an Encore Bridge on. The procedure is very tricky and has some strength limitations. Stick to the types of bridges your dentist suggests, because then you can be fairly certain your dentist is comfortable doing that type of bridge.

If your dentist is a typical general dentist, I would recommend doing the conventional, tried-and-true regular bridge, filing down the front teeth like has been done millions of times before for other patients, and it works.

There is no perfect solution for you. Given the assumptions I have made in this answer, I think the conventional bridge has the smallest downside and the least risk for you.
- Dr. Hall

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February 5, 2008

How soon can you place the bridge after the extraction?

Filed under: Dental bridges, Extractions — iowasmiles @ 7:05 am

Dear Dr. Hall,
I had a tooth extraction of an upper molar and immediatley after my dentist set a bridge on top of the extraction without the allowed time for the site to have pressure applied and make sure the blood clot does form. Is this a normal way of practice or was the procedure rushed?

Thank you!
- Kelly from Texas

Dear Kelly,
It’s hard for me to tell without having seen this, but it sounds like everything turned out okay, and if it did your dentist probably did the right thing.

You didn’t say whether the dental bridge your dentist placed was a temporary bridge or a permanent one, but in either case, the bridge could have put some pressure on the site. However, the pressure may not have been necessary. Sometimes it doesn’t take long for the bleeding to stop–maybe five minutes is all. And there are other ways besides using pressure to make it happen more quickly, such as placing gelfoam, placing an astringent, or using electrocautery. And sometimes the bleeding stops fairly quickly without any pressure or other aids. Pressure is just an easy and convenient way to help insure that it stops if the dentist isn’t right there watching it.

The thing that is nice about what he or she did is that, when a tooth is extracted, the teeth on either side tend to move, and movement can disrupt your bite or lead to other problems. Placing the bridge immediately would prevent any movement of adjacent teeth.

Dr. Hall

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September 26, 2007

Dental bridge or removable partial

Filed under: Dental bridges, Partial dentures — iowasmiles @ 3:07 am

Dr. Hall
My dentist says I need a five unit bridge. I have a lot of bone loss from gum disease and he is afraid a partial will place too much pressure on my teeth since they are somewhat loose. The price he quoted is $5500 plus extraction costs. Is this a reasonable price or should I look elsewhere?
- Lela in Texas

Dear Lela,
The fee is in line for Texas. But I don’t understand why he’s suggesting a dental bridge instead of a removable partial denture. Maybe there’s something different about your situation. But a removable partial places less stress on the adjacent teeth and is much less risky. A bridge puts a lot of stress on the teeth it attaches to. And then, if you have a problem with one of those teeth it is resting on, you have to scrap the whole thing and start over, whereas with a partial you can later add a tooth to it without a lot of work or expense.

I’d encourage you to get a second opinion to see if the bridge is really the best treatment for you.
- Dr. Hall

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August 30, 2007

Dentist says ovate pontic won’t work for her. Is that true?

Filed under: Dental bridges, Finding a cosmetic dentist — iowasmiles @ 2:19 pm

Hi Dr. Hall, I have a question. I am having a bridge done next month Sep 4th. And I asked for the ovate pontic technique bridge, and he replied that in my situation he can’t do it because my gum is already healed and basically its not in shape to do the ovate pontic bridge. He said that is only done when the teeth are freshly extracted. Is that true? Can you please tell me if there are other ways of making it look like its coming out of my own gums and more natural? Thanks.
- Brenda in Florida

Brenda,
No, it isn’t true that this technique is only used for a dental bridge when the tooth is freshly extracted. It is primarily used when the ridge is fully healed. Your dentist is deflecting your request. Based on what you’re telling me about what he said, I don’t think he would be what I would classify as a true cosmetic dentist/artist. Don’t push him–disaster lurks.

Your approach here is a common mistake people make. They underestimate the degree of training and commitment to cosmetic dentistry that separates your family dentist from those who truly dedicate themselves to this. And they also don’t realize the difference in personality characteristics between a general dentist who says that he or she does cosmetic dentistry and a true cosmetic dentist, who is an artist. And they think they can research a technique on the Internet and then teach their dentist how to do it, or simply ask for it. It won’t work–there’s a steep learning curve for these techniques, and there has to be a passion for appearance-related issues that the dentist feels.

Your dentist has been trained to exude confidence toward you. This makes you comfortable in his chair and reduces your anxiety. He doesn’t want to tell you, “You know, I really don’t understand much about the ovate pontic technique. Could you teach me?” He’s not going to do that. So he says, based on his limited understanding of the technique, “It’s not appropriate for your situation.” Again, don’t push him.

A dentist who really knows how to do the ovate pontic technique will not do a bridge on front teeth without using that technique. You will not have to tell him or her to do it. But there are very few who know how. And then the dentist has to train the laboratory technician, because this technique is truly revolutionary as far as how you shape the pontic. When I did them, it took several cases before the laboratory technician truly understood what the requirements were.

If you want an anterior bridge that looks beautiful, natural, and creates the illusion that the false tooth is growing out of the gum, you need to find an expert cosmetic dentist. If you’re going to stay with your present dentist, let him do it the way he knows how to do it and don’t try to push him out of his comfort zone. If you want to try a second opinion on this, check with one of our Florida cosmetic dentists.

And there is a lot more than an ovate pontic that will make a bridge replacing a front tooth look natural. The biggest issues are color and translucency, and, just like the ovate pontic technique, very few dentists master these issues to the extent required to create a beautiful bridge. But an expert cosmetic dentist will know all of these things. That’s where I think you should go.

I hope this is helpful.
- Dr. Hall

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April 2, 2007

What to do if I can’t have a dental implant.

Filed under: Dental bridges, Dental implants — iowasmiles @ 11:47 pm

Hello, and thanks for letting me ask a question. I was in an auto accident – hit head-on by a drunk driver. This required many surgeries, and one of my teeth sustained a spiral crack that extends up through the root. It is a front top tooth, third from the center. They tried to repair it with an “apicoectomy” but the crack was too extensive – about 10 years ago. While having all of the surgeries, they discovered that I also have had sarcoidosis at some time, which is inactive now and has never been symptomatic. Now this tooth is getting quite painful, and I need to determine what to do – I understand that if you have sarcoidosis, you can’t be a candidate for dental implants. I am an author, and frequently have to travel to conferences to give speeches – so my smile is important. What can be done if I can’t have a dental implant?
Thanks,
Amanda in Tennessee

Dear Amanda,
A dental bridge works very well for replacing front teeth. A crown is done on the tooth on either side, and the false tooth is suspended between them.

And if the appearance of your front teeth is important, then be sure you go to an expert cosmetic dentist such as we recommend. Dental bridges can be done so that they create the illusion that there is no false tooth there, but it takes quite a bit of aesthetic sensitivity for a dentist and a laboratory technician to create this illusion.

Dr. Hall

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March 28, 2007

Maryland bridge won’t stay in.

Filed under: Dental bridges — iowasmiles @ 7:38 pm

Dr. Hall
Due to a failed root canal, I had tooth #12 removed and a bone graft in preparation for a dental implant. My dentist and the oral surgeon agreed that a Maryland bridge would be a good temporary plan for me cosmetically. My dentist placed it post surgery and it fell out after only 12-13 hours.He again placed it and it fell out in less than 2 days. He has taken another impression for another bridge but I have to wonder if the new Maryland bridge will be any more successful than the original one. I have eaten only soft foods post surgery 5 days ago. I am at my wits end and would like any recommendations you may offer.
- Betty from New Jersey

Betty,
One thing about Maryland bridges is that they are bonded in, not cemented, so they require a knowledge of bonding technology that may be beyond the training of some general dentists. So here I have a list of possibilities why your Maryland Bridge didn’t stay in. I don’t know why it fell out. Things go wrong in every dental office from time to time. But here are some possible reasons:

1. It was placed too soon after the surgery when there was still oozing and bleeding from the surgery that contaminated the bond. And now that a little more time has passed, it will be easier.

2. The bleeding and oozing from the surgery had stopped, but the dentist still wasn’t able to completely control contamination from saliva. He should be able to get that done trying one more time.

3. The dentist didn’t make an adequate preparation for the Maryland Bridge. (There have to be certain grooves and divots placed in the adjacent teeth to hold a Maryland Bridge well.)

4. It was the oral surgeon’s idea, and your general dentist really doesn’t know how to do a Maryland Bridge, but didn’t want to appear to have a lack of knowledge.

Once a Maryland Bridge falls out, it’s hard to re-bond it. The metal surface of the wings of the Maryland Bridge are etched, and if it falls out, those wings should be re-etched in order for it to stay in.

If the Maryland Bridge doesn’t work this third time, maybe you should have him do a dental flipper for you. Read more about dental bridges in the main section of mynewsmile.com.
Dr. Hall

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