Dr. Hall,
I’ve had a bridge across my upper front, replacing all my front incisor teeth and anchored by the two canine teeth. About a year ago, the anchor teeth were so loose that they were extracted. I was going to Comfort Dental and after they did the extractions they suggested that I get a partial to replace those teeth plus one upper molar that is also missing. So I did that last year, but I’m finding the partial to be extremely uncomfortable and I need something different.

I asked Comfort Dental what I should do. They said they could replace my upper teeth using implants. They would use mini implants to keep the expense down for me, and they have told me it would last for ten years. I’m also missing three teeth on the lower left, and they would replace those with a flexible partial.

Because of my unhappiness with the partial they made, I became unsure that I could trust them, so I decided to get a second opinion from another local dentist. They came up with a completely different plan, which has left me a little confused, so I was wondering if you could help me. This other dentist said he wanted to do a bridge replacing the missing upper molar, since the teeth on either side of the missing one are broken down and would need crowns anyway. Then he wants to replace the two canine teeth with implants and put a bridge on them replacing all my front teeth. He said they’d be regular implants, so more expensive than what Comfort Dental was going to do for me. He said that as an option he could put a third implant in the middle of the bridge. The whole plan is considerably more expensive

I don’t have a lot of money, so I’m tempted to do with the cheaper option that Comfort Dental gave me. But after the experience with the partial, I’m not sure I can trust them.

Any advice?
Jim B.

Jim,
Yes, I can help you out with this.
First, a comment about Comfort Dental. Comfort Dental is a corporate dental clinic with about 150 locations throughout the Midwest, Southwest, and Northwest. It isn’t the type of place I would go for quality care. The corporate model of dental practice is designed to maximize profit. While many patients find them convenient and inexpensive, they tend to be attractive to dentists just out of school who are trying to get some experience before launching out on their own, so they have a lot of turnover. You are more likely to get quality care from a dentist/owner practice where the dentist is trying to establish long-term relationships with patients.

Now about the treatment plan. Mini implants are not designed to support individual teeth–they are too weak. They are cheap to place, but they are indicated primarily to help stabilize a complete denture. Giving your implants a lifespan of ten years may be generous, but even if they last the full ten years before failing, the failure of a dental implant is a serious event. What do you do after it fails? You can’t just place another mini implant because the reason the implant becomes loose is that it looses its bone support. So you have to have new bone grafted in before replacing the implant. No, you need something more solid.

The other dentist is suggesting a bridge for your missing molar. This makes sense because it sounds like you need crowns on the teeth adjacent to the missing tooth anyway. Adding a false tooth suspended between those crowns would add only about $1000 to the cost, much more practical than placing an implant with a crown on it, which could easily cost three times that.

Then about your front teeth.

Replacing four missing front teeth is a tricky proposition. You said you had a bridge replacing these teeth, but didn’t say how long that bridge had been present. I would be surprised to learn that it had lasted very many years, because of the high stress that would be on the anchor teeth (dentists would call these the abutment teeth). Let me share with you some dental bridge engineering principles. Here is a diagram of a dental arch.

Let’s imagine that the first premolar on the left side of the diagram is missing and we’re going to replace it with a dental bridge. I’ve drawn a line between the proposed abutment teeth. You’ll notice that the replacement tooth is going to be suspended directly between the abutment teeth. This is a favorable stress situation. There aren’t going to be serious twisting forces on these abutment teeth.

Here is another diagram of the same dental arch, but we’re going to imagine that we need to replace all four incisors.

Imagine now when we put stress on the incisal edges of the very front teeth. That will produce a twisting force on the abutment teeth.

This is what you had with the bridge that you lost. It’s not surprising that you ended up losing both abutment teeth–fairly predictable, in fact.

Now implants placed in the positions of these canine teeth could be more sturdy than the original natural teeth, still, trying to support all those teeth with the two implants in the positions of the canines is risky, in my opinion. Placing a third implant somewhere close to the middle of the bridge would completely eliminate any twisting effect and would greatly increase the stability of the restoration. It could well last you for the rest of your life.

My opinion. I hope this is helpful.

– Dr. Hall

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