Greetings Dr. Hall,
My 12-year-old daughter is genetically missing #10, the maxillary left permanent lateral incisor. We had orthodontic treatment done to move the teeth far enough apart to put in a replacement tooth with an implant. That was completed in December. She now has a permanent wire bonded to the backs of the top 3 center teeth.
Since she is too young for a dental implant right now, we opted to go for a Maryland bridge at the recommendation of her Orthodonist because we did not want to have her deal with an upper Hawley through her teen years. Two weeks ago (after taking impressions and slightly preparing teeth #9 & #11 about a month ago), our family dentist put in her Maryland Bridge. There was no metal on it and she cemented the two non-metal wings to the adjacent teeth. The next day we got new impressions for a new retainer and then the next morning, the Maryland Bridge fell out. She ordered a different type of cement and yesterday evening the same bridge was replaced; this morning while eating a waffle the bridge fell out again.
Now, the Orthodontist and Dentist want to make her a new Maryland Bridge with metal wings instead. Here are my concerns/ questions in which I am looking for an expert second opinion:
We are going back to the dentist next week for new impressions and for a new Maryland bridge with metal wings to be made (which I am not paying any additional money for.) Also, is there a price difference generally in the bridge that is all porcelain versus one with metal wings? Just curious.
Thank you for taking the time to read this, it is TRULY appreciated. I just want to do what is best for now and especially for her future dental needs.
Maryland bridges can work well, but it’s not just a simple matter of making space for the wings and then bonding it on. There has to be some preparation done, and in that preparation there has to be what is called resistance form created in the teeth to which the bridge is bonded. There have to be some grooves or something placed to keep the bridge locked onto the teeth – you can’t rely on just the bonding to do it. So when you made reference to “slightly preparing” the adjacent teeth, that spelled trouble. The number one reason that Maryland bridges come off is inadequate preparation.
Here’s a picture of a front tooth with a groove similar to the type of groove that would help this Maryland bridge stay in place. This is deeper than would probably be required here, but you get the idea.
So your dentist did this “slight preparation,” and the bridge came off. She theorizes it must be the cement – let’s try a stronger cement. Nope, comes off again. Now she theorizes it must be the zirconia – if we switch to metal, it will stay on. No, it won’t work, because the problem isn’t in the materials, it’s in the design.
Now she could go back and do the proper grooves or whatever is required to get the bridge to stay on, but then it makes no sense to do a dental implant later. The main reason for doing a dental implant is to avoid having to prepare the adjacent teeth. Once they’re prepared, you may as well stick with the bridge.
The easy solution here is to do what we call a flipper partial. It’s just a false tooth affixed to a small plastic plate that fits behind her teeth and snaps on with metal clips in the back. In some cases the clips aren’t even necessary. But even when clips are used, people can’t see them. I’ve seen these hold up for many years and look extremely natural on very attractive women. A Maryland bridge isn’t an appropriate temporary restoration because the teeth have to be prepared. And if the preparation is adequate enough to hold the bridge in, it will later need to be filled in. It’s against my sensibilities to permanently prepare teeth for a temporary restoration.
So, to answer your questions:
I’m guessing that your current dentist should have no problem making a flipper partial that will work for your daughter. If you run into any trouble, get back with me and I’ll refer you to someone who can do this right.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Thank you for the thorough explanation Dr. Hall! I really wish it was explained to me BEFORE her teeth were prepared for a Maryland Bridge that though this is intended to be temporary, the likelihood of irreparable damage to the adjacent teeth is there. I was able to find another highly recommended dentist in our area that put the existing bridge back on and so far (3 days) there have been no issues. My daughter even says that it somehow feels more secure. I decided against the Maryland Bridge with the metal wings and should the bridge now become the permanent solution (we’ll see how long it stays) I will likely opt for a new one where the adjacent teeth are more prepared so that it has a more natural look. The dentist that we saw over the weekend did suggest, however, that the areas that were prepared could be filled in (almost like a cavity) should we move forward with an implant once my daughter is ready. Thank you for the advice and I will surely want to consult an expert cosmetic dentist in my area for any future dental work for her- if you have any recommendations in the Phoenix metro area I would appreciate it. Thank you!!
Response by Dr. Hall,
So it appears that the bonding technique your dentist was using was also a problem. We’ll see how long the bridge stays on this time. Either way, the metal was not a solution.
Makisha Hiller says
Dr. Hall- I wanted to follow up to thank you again for this detailed information and to give you an update on my now 13-year-old daughter. After two more attempts to keep the original Maryland bridge in last year, it came out last fall and actually went down the drain. I also noticed that tooth #11 appeared to have ‘moved’ as there was a larger than before space between it and #12 than it was in early 2016 after her braces were removed. Sure enough, the orthodontist confirmed there was a slight shift and he put her back in braces (6 brackets) for approximately 3 months, with an artificial tooth attached to the wire. Needless to say my daughter was pretty much devastated (she is also a model and pageant queen so her smile is extremely important.) In March, we decided to pay a visit to Dr. Michael Kelly at Aesthetic Dentistry of Scottsdale for a consultation as he has been noted via my research as one of the best dentists in Arizona. One month ago she had a laser procedure performed on her gums to augment and shape the area as well as remove the abundance of melanin in the space where the tooth was missing and two weeks ago she received her new gorgeous Maryland bridge. He removed the wire from behind teeth 7, 8 & 9 and prepared 9 & 11 just a bit more and we have opted to make this the permanent solution for her (no implant!) It is beautiful and the tooth looks like it is growing right out of her gums- perfect size, color and everything. Right now, tooth #10 has shifted slightly as well and she is wearing an Essex retainer full time for about 2-3 months to push it back in place (hopefully.) This has been quite the journey but I wanted you to know I appreciated your opinion and information. Thank you!
Response by Dr. Hall
You’re welcome, Makisha.
Dr. Michael Kelly is one of our recommended cosmetic dentists in Arizona.