Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

November 27, 2017

Hockey Players and Dental Implants


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Hi Dr Hall

My son in college is a hockey player who just lost his front tooth due to a direct hit from a hockey puck. He started the process for an implant, meaning they removed the tooth and added a plug. He was recently told by other teammates that an implant is not a good option until he finishes playing the sport because a second trauma is possible. Is an Encore Bridge or a Zirconia Maryland Bridge a good option? He wants it also for cosmetic reasons as he will be getting married later this year. He Lives in CA and would be willing to come to see you if needed.

Thanks
Geoff from California

Geoff,
Thanks for your question! I had never heard about this concern before – placing a dental implant in a hockey player, but your son’s teammates make sense. I went to the University of Minnesota Dental School. One of our oral surgery professors was official team dentist for I think it was the Minnesota North Stars hockey team at the time, and we heard a lot about hockey dental injuries. I would listen to those teammates. Getting a tooth knocked out is one thing. With that tooth anchored on a dental implant, the implant would be ripped out of the bone damaging who knows what else and requiring bone grafting on top of everything else.

There’s no harm in having the root fixture placed, but I would hold off on putting a crown on the tooth until after his hockey career is over. Meanwhile, no, a bridge is not a temporary restoration – whether it is an Encore bridge or a zirconia Maryland Bridge. A bridge requires tooth preparation on the adjacent teeth if it is placed properly. Besides, now you’re hooking three teeth together and that is going to magnify the risk to all those teeth should he have another accident.

What he needs is a removable flipper partial to tide him over. I would go to one of our recommended cosmetic dentists to get a great match of the false tooth to his other front tooth, which might require spending a little more money. Done well, no one will know it’s a false tooth.

– Dr. Hall

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Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

October 17, 2017

A Maryland Bridge is not a temporary restoration


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Hello,
I have a 10-year-old son who is planning to undergo removal of his front tooth as a result of a bike accident and two unsuccessful root canals. I would like to know what would be the best options for him post-surgery (flipper vs. Maryland bridge or anything else?). Also, I am concerned about long term health risks involved in the surgery techniques (removal of entire ligament) and potentially toxic materials used. Could you please provide any recommendations and/or questions I can address to our surgeon? Your advice is greatly appreciated.
John from Idaho

John,
I get this from a lot of people—that their oral surgeon has suggested a Maryland bridge as a temporary restoration to replace a front tooth while waiting for a young person to get old enough to be able to do a dental implant.

For the benefit of others who may be reading this, the reason we don’t want to do a dental implant on a young person is that their face is still growing and jawbone is continuing to be laid down. Natural teeth move along with the newly grown bone, but a dental implant remains fixed. As the child continues to grow, he or she would then develop a discrepancy between the vertical position of the natural teeth and the position of the implant tooth. So we wait until growth has completed and then place the implant.

But what to do in the meantime?

I don’t fully understand the resistance to giving the patient a removable temporary tooth. A dental flipper, otherwise called a flipper partial, is inexpensive and looks fine. a flipper partial replacing a single front tooth It can be made without clasps, as shown in this picture, or with a couple of metal clips over back teeth. Yes, I suppose the child could lose it, but you could buy several of these flippers for the cost of a Maryland bridge. And there is a strong motivation for the child not to want to be seen without their tooth.

I have to believe that those dentists who suggest using a Maryland bridge as a temporary tooth replacement haven’t done many Maryland bridges. The main problem with doing a Maryland bridge in this situation is that it probably won’t stay in unless you do some tooth preparation on the adjacent healthy teeth. And if you are drilling into those teeth, that’s not what I would call a temporary restoration, because the traces, or scars if you will, will remain there forever.

Maryland bridge preparation

Diagram of a tooth properly prepared as one of the abutments for a Maryland bridge

If the teeth aren’t prepared, then the bridge probably won’t stay on for long. If it actually does stay on, you have an added complication in the difficulty in removing it without damaging those supporting teeth.

Furthermore, if the Maryland bridge is metal, the flipper will be more esthetic. The metal wings of the bridge are bonded to the backs of the adjacent teeth, which will darken them.

About your other question on the other risks of the surgery, I don’t understand the question. When a tooth is removed, usually the entire periodontal ligament comes with it. If it doesn’t, your body will resorb it, so I don’t understand what the issue is. And there are no toxic materials used in an extraction.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

January 11, 2016

Maryland bridges keep coming off. Is there another solution?

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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 the two missing laterals, which is probably the way your daughter looks now:
missing lateral incisors
And here is a photo showing what a smile looks like with the canines moved into the position of the lateral incisors:
missing lateral incisors after orthodonticsShaving 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, the second best in my opinion 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 twoflipper partial replacing lateral incisors 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.

 

Do you have a comment? We’d love to hear from you. Enter your comment below.

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

October 3, 2012

Should I change dentists in the middle of my dental implant procedure?

Good Morning Dr. Hall,
I recently visited my local Dentist to have a price quoted to repair a cracked #5 tooth (upper right first premolar), while at the same time, have the #7 tooth in front redone (upper right lateral incisor), which had been ground down and “capped” back in 1978. For the #5 tooth I was quoted a cost to me, the patient, of $4,736.00 which includes the extraction of the #5 tooth, the bone graft, to provide me with a Lava Crown and one custom implant abutment. This cost also covers the Implant Specialist and absorbs additional misc costs passed onto me, the patient as well.

For the #7 tooth I was quoted a cost to me of $4,736.00 also, which includes the same breakdown as above. I agreed to the price and the procedure began with the extraction of both my #5 and #7 teeth, including bone grafts completed on both teeth, immediately following with the installation of a Maryland Bridge to stay in place for a period of 3 months while both surgery sights heal. Once they have both healed properly,the Lava Crowns and Implants will be installed which will complete the procedure.

However, since I’ve had the Maryland Bridge installed 3 weeks ago, I’ve had to have it replaced 3 times and wonder if that’s unusual. If not, I would appreciate knowing if the reason is due to the fact that a neighborhood Dental Office, practicing General Dentistry did the work instead of a Cosmetic Dentist? If so, at this point, would you recommend that I find a Cosmetic Dentist to complete the procedure on both teeth, picking up where the General Dentist’s Office left off? Or would you recommend that I stick with the General Dentist and trust that aside from their not being able to perfect the Marilyn Bridge on the #5 and 7# teeth and keep one in my mouth for more than just a few days at a time without it breaking apart, that they are capable of completing the work and providing me with the professional results that a price tag totaling $9,472.00 should buy? I appreciate and thank you in advance for the time and effort(s) you put into providing me with accurate answers to the questions I’ve asked herein. My email address is: Hollywoodnights@cox.net and I look forward to hearing from you soon Dr. Hall.

– Holly from Arizona

Holly,

Yes, I would agree that the inability of your dentist to keep this Maryland bridge in place is troubling. And it would tend to indicate a lack of training or experience in dealing with esthetic dentistry technology. If I were in your shoes, I would switch dentists.

A Maryland bridge is made of a false tooth or teeth suspended between two metal wings. The wings are etched, and the backs of the adjacent teeth are etched, and then a bonding composite is sandwiched between the wings and the backs of the teeth. If it comes off prematurely, there is a flaw either in the design or the technique or both. The flaw needs to be fixed and then the metal needs to be re-etched by the laboratory for it to re-adhere. I’m guessing that your dentist doesn’t know that, and also may be clueless about the flaw that caused the de-bonding in the first place.

And not only are the esthetics of your case very important, but implant dentistry is not for beginners either. If your dentist had much experience replacing anterior teeth with dental implants, he or she would have settled on a reliable temporary technique. But no, it appears that he or she is in unfamiliar territory – a second troubling aspect to your case.

It is an ethical obligation of all dentists to cooperate any time you want to change dentists. So when you tell your dentist you want to switch, he or she should provide the new dentist with any information needed to properly complete the procedure. And since you are at a good stopping place in the procedure. there shouldn’t be any extra costs for anything having to be re-done. Except possibly for the cost of the temporary tooth. If the Maryland Bridge technique isn’t one that appeals to your new dentist, he or she may want to create a new temporary. Most implant dentists would probably lean toward a dental flipper as a temporary tooth replacement in this situation.

Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

June 20, 2012

This complex appearance-related question won’t be solved by an unmotivated dentist

Dr. Hall,
I am a 67 year old woman who has had surgery for gum disease within the last six months. Also, because of the gum disease I have 6 missing upper teeth (3 on either side). I do have the front six and a back molar on each side. I suppose due to bone loss from the gum disease my front two upper teeth have a major gap between them. At the moment I contemplating either implants but due to the cost that may not happen. I have talked to my dentist about “partials”…currently I have a flipper. I have also been to an orthodontist to discuss braces to close the gap between the top 6 teeth, particularly the middle two. The problem with braces is that the flipper won’t fit and due to the amount of movement needed a partial would have to be remade multiple times. I am not sure if I just live with the gap and get the partial for the uppers and be done with it (even though I am 67, I still work, very active and I HATE that gap). My oral surgeon does do implants but he is talking well over $20,000 and that is a great deal of money. Any suggestions would be appreciated.
Janie in Texas

Janie,
If you’re going to get this aesthetic problem solved, you’re going to have to get out of this group of conventional-thinking dentists and find a dentist who is passionate about doing appearance-related dentistry.

I can think of a couple of possible solutions to your problem that might work, but each one would depend a lot on assumptions about your condition that I really shouldn’t make via e-mail. A specific solution would require a complete examination to let me know the bone levels on the existing teeth, the sizes of your front teeth, the size of the gap, the prognosis of the remaining teeth, and how everything fits together.

Now maybe there are no good solutions other than what your oral surgeon is suggesting, given everything the way it is in your mouth, but I can tell you that the prevailing thinking in established dentistry would be that this isn’t that big of a problem and it’s not worth trying very hard and certainly not worth taking any risks. The way we were taught in dental school is that patient concerns like you are expressing over this gap are relatively trivial, and to give them too much weight is pandering and unprofessional. They would not want to APPEAR to be thinking that, but in their professional circles as they talk behind the scenes among themselves, this is the thought pattern that we see all too often.

I would suggest getting a dentist who truly believes that appearance is important. Go to our list. There are actually several of our recommended dentist within 30-50 miles of you. They are all screened carefully by me personally to be highly sympathetic to appearance-related concerns like yours and to have excellent skills.

Dr. Hall

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

May 12, 2012

You were right – and thanks!

Filed under: Thank yous — Tags: , , — mesasmiles @ 3:42 pm

Last week, Kathy from Oregon wrote and said that she wanted a Nesbit partial, but her dentist said that they were illegal in Oregon. I told her that I was skeptical and gave her some advice about how to proceed.

Click here to read the original post, Are Nesbit Partials Illegal?

Kathy wrote back and confirmed my suspicions. Here is her thank you:

Dr. Hall,
Thank you….for the reply.

I hate my flipper partial. My speech is slurred and my mouth is dry since wearing it. I feel like I have a clump of peanut butter on the roof of my mouth all day long. I am wearing it to keep my teeth supported on either side of the extraction and also because the gap is very apparent when I talk or smile. I do have a consultation from a dentist I found using your site and his front desk did confirm that he did work with nesbit partials. Thank you for being honest which is more than I got from the dentist who took my tooth out.

Thanks….so much, Kathy from Oregon

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

May 10, 2012

Are Nesbit partials illegal?

Filed under: Partial dentures — Tags: , , — mesasmiles @ 12:06 pm

Dr. Hall
I had my #4 upper tooth (upper right second premolar) removed – the root had cracked. My dentist, very nice, states that a Nesbit partial is illegal to offer me in the State of Oregon due to a very few swallowing or inhaling the small dental fixture. I am currently wearing a temporary fixture. It has a large plastic palate piece with wire attachments at the back of my upper teeth on the right and left side of my mouth.

I am not happy. I do not want to purchase the permanent fixture that is made of metal. The nesbit makes sense to me and I am prepared to go back to Montana and see my dentist of 20 years. I moved to Oregon 16 years ago. What states “outlaw” the nesbit? Vancouver, Washington is just 10 miles away. I will wear this one while healing and to keep the teeth on either side supported. Two months to heal and then I would like to get a Nesbit. Do you have any suggestions? Wish I had friends to visit in your state.
Kathy from Oregon

Kathy,
I am skeptical about the Nesbit partial being illegal to place in any state. Really? Maybe it is illegal in Oregon, but that would surprise me if it is. I would bet instead that your dentist is probably worried about being sued should you actually swallow or aspirate the appliance. Maybe that’s the equivalent of it being illegal.

But I, too, am leery of the Nesbit partial, for that very reason.

How do you like the temporary fixture that you are now wearing as a tooth replacement? The way you are describing it, it sounds like a flipper partial – a small plate of plastic held in by tiny wire clips. Why don’t you just keep wearing that? There’s no law that says you have to throw that away after two months. I’ve seen those flipper partials last for years and years. They’re not ideal, but they work.

If you really want a Nesbit, I would start by asking other dentists in your town. I’d be surprised if you have to go into a neighboring state.

Dr. Hall

Links: read more about removable partial dentures
Click here to ask the dentist a question.

Follow-up: Kathy wrote back and confirmed that I was right – Nesbits are not illegal in Oregon, and she found a dentist who will do one.

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

April 10, 2012

A dentist is ethically obligated to give you all your options

When I was a child I was hit in the mouth twice, once from falling out of a wooden school swing and the other time from throwing a croquet ball up in the air and catching it with my front tooth. Needless to say the older I’ve gotten the more yellow brown it has become. My dentist told me I would have to get an implant because there was no root but yet I still have the VERY UGLY BROWN TOOTH.

I also have several back teeth that need filings and at least 2 that need to be capped. I don’t have a lot of money to be putting into just one tooth when I have several others that need to be fixed, although the one that gives me an UGLY SMILE is the one everyone can see. PLEASE HELP ME.

Thank You so very much for your time.
Sincerely, THE GIRL WITH THE UGLY BROWN TOOTH
Danielle in Tennessee

Danielle,
I would switch dentists, and I will explain why.

One of these two traumatic incidents with your front tooth jarred it enough to sever the nerve and blood supply that go to the tooth. This would cause the tissue inside it to die, which would then cause it to become infected. It’s possible that if this tooth had received a root canal treatment at that time, it could have prevented the root of the tooth from being eaten away, but it’s also possible that would have happened anyway, as a side effect of the traumatic injury. The process is called root resorption, and it can happen because of an untreated infected tooth, or because of traumatic injury to the tooth.

But now that the tooth has no root left, you can’t save it.

There are three basic ways, however, to replace a missing tooth, and your dentist is negligent in only presenting one of them to you. He or she has an ethical obligation to give you all the options that would work. And while the implant option is probably the best choice for you, it is also the most expensive. Did you tell your dentist that this was too expensive for you? If you did, and you still didn’t get any options given to you, then it shows not only negligence but a lack of character on the part of your dentist.

A dental bridge is the traditional way to replace a single missing tooth. A bridge requires that the two adjacent teeth be covered with crowns (you may know them as caps), and then a false tooth is suspended between them. This is a little less expensive than an implant.

Another option is to use a removable partial denture that clips onto your other teeth and has a false tooth on it. While less comfortable than either a bridge or an implant, it is a fraction of the cost of a bridge. A flipper partial is the simplest way to do this, and it can cost as little as a couple of hundred dollars.

Find a dentist who is willing to give you all your options and who will work with you to keep the costs down. I don’t know everything that went on in your visit with your dentist, but just from the information that I have it doesn’t appear that you should trust this dentist.
– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

January 31, 2012

Correct treatment for a dens in dente

Filed under: Root canals,White fillings — Tags: , , , — mesasmiles @ 6:16 pm

Dr. Hall,
I had a case called dent in denti (tooth within a tooth). This strange tooth got an abscess and wasn’t subsiding with antibiotics. I had a root canal done and then had the tooth extracted. Now what are my options?
Victoria, from Victoria, Australia

Victoria,
You refer to a condition called dens in dente, which in Latin means “tooth within a tooth”, and what happens is you have a deep pit, almost like an inverted small tooth, that grows within another tooth, almost always a lateral incisor. A dentist should pick this up on routine x-rays and fix it before it gets to be a problem, and if so, it will require a simple filling. In my practice, I would clean out the pit really well and then fill it and seal it over with a white composite filling, and the issue was done.

But if it isn’t caught preventively, the pit can decay, and since the pit goes very deep into the tooth, the cavity will progress quickly to an infected tooth, requiring a root canal treatment.

Anyway, this tooth has been extracted, and you need it replaced. That can be done with either a dental implant, a dental bridge, or a removable partial denture. The cheapest replacement would be with a dental flipper.
– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

February 28, 2011

Can I use a flipper to make my teeth look straight?

Filed under: Invisalign — Tags: , , — mesasmiles @ 5:56 pm

I have teeth that are not straight. I was wondering if I could get a flipper that could go over all my teeth and make my smile look straight. I don’t want to go and pay a lot to go and get braces when it takes a long time … and is more painful. thanks
– Taylor from New York

Taylor,
A dental flipper is used to replace one or more missing teeth, and it snaps onto your existing teeth with a small wire clasp.

What could work for you is a Snap-On Smile. This snaps over your teeth, and could work if you have crooked teeth – it will make them look straight.

But especially if you have teeth that stick out a little, the Snap-On Smile would have to be made even a little extra bulky. It might not look great for you. I’d recommend going to an excellent cosmetic dentist so you get an honest opinion about how this would look.

If it’s the pain of braces and the long time it would take, the best thing may be Invisalign invisible braces. It takes about half the time of conventional braces – most cases can be done within 9 months to a year. And there are no painful brackets or wires. I’d check that out.
– Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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