Maryland bridges keep coming off. Is there another solution?

Dr. Hall,
I have a question about my daughter’s teeth… The two lateral incisors did not come in. The dentist put on braces and left a place to use a Maryland bridge. The wings are both broke and she has had them cemented several times. She is 21 now and has no dental insurance. Her dentist said that she could have implants but she will have to have a bone graft.. Would it be better for her to go back and have braces applied again to the top teeth only to pull them all close together and file them down… Then again I’m wondering about the price?
– Alaina from West Virginia

Alaina,
So your daughter is missing her two lateral incisors.

I would absolutely not bring the teeth together to close the space and then file down the canine teeth. I had a patient who had that done and later came to me as an adult to ask me to help make it look normal and there was no way to make the result of that look normal. The canines are thick, fat teeth that stick out in the front and that simply doesn’t work. Furthermore, the canines perform an important function in protecting the back teeth against sideways stresses and if you move them to the front, they can’t do that.

Here is a photo first showing two missing laterals, which is I’m guessing is the way your daughter looks now:

And here is a photo showing what a smile looks like with the canines moved into the position of the lateral incisors:
Shaving the canines and even bonding to them or doing porcelain veneers would not look normal. Yes, it looks better than missing teeth, but as a cosmetic dentist, if a patient comes to me looking like this and wants the ideal solution, I would have them put in braces to move the canines back to their normal position and then use one of several methods to replace the lateral incisors.

The dental implants would be the best solution, no question. If there is money to do that, that’s what I would recommend.

However, an acceptable compromise, if you have a limited budget, would be a simple flipper partial. I had an office manager for my dental practice that used a flipper partial the entire time she worked for me. You would never know, meeting her, that her lateral incisors were not real. It’s a simple plastic plate with the two teeth attached. It fits up on the palate and there are two wire clips, one on each side, that snap over the back teeth to hold it in. The cost should be pretty reasonable – maybe a couple hundred dollars, more or less. Here’s a photo of what that appliance would look like.

This isn’t the ideal solution. Some people have difficulty eating with these flipper partials and they have to remove them to eat. And over time, the jawbone shrinks where the missing teeth were. For a few hundred dollars more, you could get a more elaborate partial.

She could also get conventional porcelain bridges replacing these teeth, but that would require grinding down the healthy central incisors and canines. I would rather see her do the flipper and save up her money for implants later.

This monkeying with Maryland bridges, I would not do that. Not only do the wings of a Maryland bridge make the central incisors look darker, you can have problems with them staying in. I suspect that your daughter’s Maryland bridges were poorly designed, for all the trouble she has had with them. But even with a good design, they can be some trouble. I would prefer the flipper partial.

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