Your leading source for cosmetic dentistry
information and referrals.

Do I really need to have this bridge replaced?

Posted on by .

Dr. Hall,
I have a bridge on my upper right side and my dentist said I need to replace the bridge because one of the teeth holding the bridge is cracked below. I have no pain or symptoms, and replacing the bridge and crowns will be very costly.
Is there another way?
– Meredith from Newport Beach, CA

(See Dr. Hall’s answer below.)


We thank our advertisers who help fund this site.




Meredith,
Thanks for your question.The first thing that occurs to me about your situation is that your case is a great illustration of one of the chief advantages to replacing a missing tooth with an implant rather than a bridge. While a bridge may be less expensive up front, if anything goes wrong with any tooth that is part of the bridge, you will probably need to replace the entire bridge. With a dental implant, if anything goes wrong later with an adjacent tooth, it won’t affect the implant. (See my page on dental implant vs bridge for a discussion of these advantages.)

So, assuming that one of the abutment teeth in your bridge is cracked, that tooth would need to be extracted and you would need a new, longer bridge that is now replacing two teeth.

a drawing of a dental bridge replacing a missing lower first molar.

A dental bridge

Having said that, I am skeptical of this diagnosis for a couple of reasons.

First, you aren’t having any symptoms. If this tooth is cracked, it would be the root that is cracked, and there would ordinarily be some sharp pain when you bite anything hard.

Second, it would be very unusual for a tooth that has a crown on it to crack. When a tooth is weak or cracked and in danger of splitting, the proper treatment is to place a crown, which will prevent the crack from growing and destroying the tooth. I have had patients with a strong bite that is sometimes called a gorilla bite who have broken off teeth at the gumline, but I have never seen a tooth with a crown on it develop a crack in the root.

To emphasize the preservative nature of a crown on a cracked tooth, I published research a number of years ago showing that even if a tooth is completely fractured through the root, under proper conditions the pieces can be forced back together, the tooth crowned, and the tooth can be saved.

Anyway, I’d recommend getting a second opinion before you do anything. But be careful of how you do this. Don’t go to Dr. Jones and say, “Dr. Smith said one of the teeth in my bridge is cracked and I need a new bridge. What do you think?” No, don’t identify your dentist because he or she may be friends with the other dentist. Also, give as little information as possible about what you were told, so that the opinion given will be completely independent. Don’t put the idea in their head that another dentist said the tooth is cracked. If the second dentist asks, just tell them you don’t want to say until they give their opinion. Go and say, “Dr. Jones, I want a second opinion. Do you see anything wrong on my upper right?”

If your dentist’s diagnosis comes from an x-ray, you could even send me a copy of the x-ray and I’ll tell you what I think.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

The post in my tooth broke. Now what do I do?

Posted on by .

Dr. Hall,
I have a three-piece bridge and the post in one tooth broke off. What kind of dentist can do this so I can get another post put in? These are my front teeth.

This bridge was only put in a couple of years ago and is on teeth numbers 7, 8, and 9. Number 8 is the false tooth. Number 7 needed a root canal and there wasn’t much left of the tooth, so my dentist put a post in there to help hold the bridge. But now that tooth has broken off at the gumline right through the post, and the bridge is being held on by only the one tooth.
– Joan

(See Dr. Hall’s answer below.)


We thank our advertisers who help fund this site.




Joan,
The first question that comes to my mind when you tell me you want to replace the post that broke in your tooth is “What is going to keep the replacement post from breaking?”

I wrote a blog post about five years ago about removing metal posts from teeth. Both the person who asked me and the case I treated were dealing with possible sensitivity to the metal in the posts. That’s a very different situation than yours. They just wanted to get rid of the metal. You’re wanting to repair a break.

You’re dealing with several difficult problems here. First of all, with the post broken off at the gumline, there is nothing there to grab, which is going to limit the techniques that could be used to remove it. Sometimes an ultrasonic scaler instrument can be held to the post, which, given enough time, may loosen the cement and enable the dentist to twist it out of the tooth. But in your case, in order to grab the post to be able to twist it, the dentist would have to drill away a fair amount of tooth structure around the post. And this is tooth #7, which is the right lateral incisor—the smallest front tooth. Drilling around the post to be able to grab it would leave you with an even weaker situation for the new post because there would be that much less tooth to give retention to the post.

Second, in order to do any of this, the dentist would have to cut this crown off the bridge to be able to get enough access to the post. Once that is done, he or she may as well grind the entire bridge off because you would need an entirely new bridge That is one of the disadvantages of replacing a missing tooth with a bridge instead of an implant—if anything happens to any one of the teeth involved, the whole bridge needs to be replaced. Repair options are limited here.

Third, there is no reason to expect a new post to last any longer than the old one, and it would probably not last as long. I’m guessing that you have a bite that puts a lot of lateral stress on your front teeth.

My experience with patients that have heavy biting forces and teeth that have broken off at the gumline is that they will also break off dental work. I’ll give you my recommendation, with the disclaimer that I haven’t seen your case myself and don’t know everything about it, so I would defer to a qualified dentist who has examined you in person. But my guess is that in order to get a stable situation for your front teeth, you will need two dental implants—one to replace the missing tooth, and one to replace this lateral incisor (#7) that has broken off at the gumline. You could try to save #7 and go with a longer 4-unit bridge from the right canine to the left central incisor, but that will give additional stress to those two teeth, and given your history of breaking things off, would be too risky, in my opinion, again with the disclaimer that I haven’t actually examined you and don’t know the whole history here.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

My experience with “this new crown feels funny.”

Posted on by .

A recent question I had from a visitor to the website about a crown that felt funny caused me to reflect on my own experience with this sensation a couple of years ago.

I had a crown that came off and my dentist at the time, rather than try to re-cement it, wanted to make a new crown. I was uncertain that was the right thing to do, but didn’t say anything, and went ahead and got the new crown. After I got it, the bite never felt quite right. It wasn’t painful—just a very slight feeling on it. A crown, if it is done right, should not be noticeable or feel any different when you tap your teeth together or chew. Anyway, I switched to another dentist shortly after this and he made some fine tune adjustments to the bite, but there was still a vague slight discomfort when I chewed on it.

After some time passed and this feeling persisted, I showed up again at my new dentist for a scheduled cleaning and asked the hygienist to take a periapical x-ray of this tooth to see if we could see anything that didn’t look right. To my grave dismay, the x-ray showed that the tooth under my crown was maybe half eaten away with decay. The tooth had a root canal treatment, so there wouldn’t be any toothache to warn me of the deep decay. The only symptom was this vague feeling I kept having.

The fix for the problem was to have what was left of the tooth extracted, a dental implant placed, and a new crown on the implant. Everything feels fine now. The take-away lesson is to pay attention to a new crown that just feels funny. It should blend in with the other teeth and the bite should be completely comfortable. If it’s not, it needs to be adjusted or fixed or re-done to make it right.

– Dr. Hall


We thank our advertisers who help fund this site.

Question and answer go here.
 
 
 
 
 
 

Do you have a comment 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 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.

Hockey Players and Dental Implants

Posted on by .


We thank our advertisers who help fund this site.

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

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 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.

A Maryland Bridge is not a temporary restoration

Posted on by .


We thank our advertisers who help fund this site.

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 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.

Saving your tooth looks like a no-brainer to me

Posted on by .


We thank our advertisers who help fund this site.

Dr. Hall
I have to have either a root canal or implant in the first molar on the left side, bottom. There is no molar behind it, and I am wondering if there is a “snap on” smile version that would be less expensive, invasive and will allow me to cover the empty space, should I decide to have the tooth pulled?
– Beth from Washington

Beth,
Having the tooth pulled and replaced with a Snap-On Smile would be the worst of several options for treating your infected tooth.

Let me go through your options and their pros and cons.

You’re telling me that there is no molar behind your first molar. So you’ve already lost your second molar. Losing your first molar would leave you with no molars on your left side. I guess if you’re planning on going on a soft or liquid diet you won’t need to chew, but you really need something there. A Snap-On Smile is a temporary tooth replacement solution designed to help you, say, get through a job interview or a social function and look like you have teeth. It isn’t a functional replacement for molars. It isn’t very durable and isn’t all that cheap, either. The least expensive functional tooth replacement would be a removable partial denture.

But any type of appliance you put in your mouth that is removable and designed to be a functional tooth replacement is going to be much more stable if you have teeth in the back to anchor it. Imagine having a table that has legs only in the middle and on one of the ends, as I have pictured below. This is called a cantilever and isn’t very stable.
An unstable table with legs in the middle and on one end
This is like the situation you are creating in your mouth when you lose these back teeth. When you try to attach a tooth appliance onto the front teeth and expect it to replace back teeth, it’s not very stable. In addition, it creates a twisting force on the teeth that are supporting it, which can lead to the early loss of those teeth. There are partial dentures that are designed to absorb the stress with the soft tissue on your ridge, but they would require clasping other teeth, too, probably going on to the other side of your mouth.

The root canal treatment makes the most sense because that saves your own natural tooth. Being a molar, the tooth would likely need a crown also. But there are people who argue that a dental implant is a very predictable solution also. The root canal and the crown would be less expensive, though. To me, it’s a no-brainer to save your tooth.

– 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 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.

Can broken-off teeth be restored?

Posted on by .


We thank our advertisers who help fund this site.

Dr. Hall,
My husband has 2 front teeth that are broken off. The roots are intact. Other than a partial plate or a bridge is it possible to have root canals and caps?
– Jen from Ontario

Jen,

Yes, it may be possible to save a front tooth that is broken off, by doing a root canal, putting a post in that root canal, and putting a crown [cap] on the post, if there isn’t too much of the tooth broken off. It depends on the kind of bite your husband has. And it depends on the attitude of the dentist. Many dentists, I can tell you, may not want to attempt that. And recently, as dental implants have become more reliable and more popular, there may be less tendency of dentists to want to try to save teeth like this.

The mechanics of fixing a front tooth like this are tricky. A lot of dentists won’t realize that the main force working against them is a rotational force on the tooth. The front teeth are kind of roundish at the root. Then if the dentist puts a round post into the root, the resultant restoration doesn’t offer much resistance to rotational forces. Over time, then, those rotational forces can work the post loose. A way to brace against those rotational forces is to put two posts into the root.

Another problem that many dentists may not realize about this situation is that the post can end up cracking the root. There is a tendency to think that a rigid post would be stronger, and it may be stronger. But when tipping forces occur against the root, a rigid post will transfer those forces to deep inside the root where the tooth is thinner and they can crack the root. So flexible posts, such as carbon fiber or fiberglass posts should be used on front teeth.

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 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.

A smile makeover over a fractured tooth spells trouble for Aaron

Posted on by .

We thank our advertisers who help fund this site.
.

Dr. Hall,

I had a traumatic fall 12 years ago fracturing 2 front teeth and my smile was restored with root canals and Procera crowns by my family dentist. With age and time, I didn’t like the way my adjacent natural teeth looked with the Procera. Also, I had one left upper molar that had a pretty deep filling and was giving me trouble. I am 38 years old and that filling was almost 30 years old. I decided that it was time for a smile makeover. So I went to a cosmetic dentist here in Lexington who gave me a combination of porcelain crowns and porcelain veneers.

I love my new smile. After the restoration however, my #9 front fractured tooth began giving me trouble. It was tap and pressure sensitive, so I went back to my cosmetic dentist and she told me I need to get an implant and another restoration. I had a gum pimple at the time and was referred to a periodontist.

root fracture on tooth in a smile makeover

The x-ray of Aaron’s front tooth.

I went on a course of antibiotics immediately (Amoxicillin 500 mg). I saw a periodontist last week and he confirmed that extraction of my newly restored tooth was needed. I requested my x-ray, showed it to my family dentist, and he doesn’t necessarily agree that extraction is warranted. He is contacting the West Virginia University, University of Kentucky, and University of Louisville dental schools to see if this tooth can be saved by periodontics or endodontics. I really do not want to lose #9, especially after a $1500 crown was placed, and not to mention IT IS MY FRONT TOOTH. Wish me luck. Please feel free to comment. I have attached the x-ray.

– Aaron from Kentucky

.

Aaron,

I actually have a couple of problems with your smile makeover. Not with its appearance. You also sent a photograph of your smile and it looks great! But it leaves me wondering if your dentist took x-rays before doing this smile makeover or, if she did, if she fully comprehended what she saw or gave it proper weight.

Root fracture on tooth #9

Your tooth #9 doesn’t look good at all. I have a fair amount of expertise in x-ray diagnosis and taught x-ray technique at the University of Minnesota, and I’ll tell you what I see. Right in the middle of the root there is a horizontal radiolucent line that looks like an old fracture. This must date from back to your original accident. The root canal filling crosses this fracture line, so the dentist who did the root canal either didn’t see the fracture or figured he or she could navigate through it, remove all the necrotic soft tissue, and hopefully get healing. And it looks like this happened to some extent, at least. The end of the root looks healthy. But just above the fracture line, the tooth looks moth-eaten. It appears that some of the root canal filling material is gone. If the pimple on your gum traces to that area, that spells trouble. And my guess is that it does. The moth-eaten appearance suggests that there is infection eating away at the root of your tooth. If this is the case, the tooth is unrestorable.

Does tooth#8 need root canal re-treatment?

If this weren’t enough, the other front tooth is suspicious. If I had done this case, I would have addressed the problem with #9 before starting, but I would have also recommended re-doing the root canal treatment on #8, because the root canal filling stops several millimeters short of the end of the tooth. Now that the crown is on that tooth, I wouldn’t do anything more than wait to see if it flares up. There aren’t any signs on the x-ray of any infection here, just evidence of a situation in which infection could develop.

So yes, I think you’re going to lose tooth #9. From everything I can tell, your dentist is an excellent cosmetic dentist, so I would have her stay with this case and finish it. But I think she missed the diagnosis here and should make concessions on the fee to get this fixed right. If I had made this mistake, I would ask you to pay for the extraction and the implant but then not charge you anything for the implant crown. That would make it so the total fee you pay would be equal to what you would have paid had the tooth been extracted in the first place and an implant placed, which is what should have been done.

– Dr. Hall

Do you have a comment? 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 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.

On using a Maryland Bridge as a temporary restoration before dental implants

Posted on by .

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:
1. Will the metal wings on the bridge allow it to affix better to her teeth, lasting at least 5-6 years until we can get the implant?
2. Will there be damage to her permanent teeth (#9 & #11) when the Maryland Bridge is put on AND later taken off? I would like to avoid her needing unnecessary dental work on #9 & #11.
3. Cosmetically, will the metal wings make more of a difference than when they were porcelain? Since this is in the very front of her smile, it is so important that the blend is as close to perfect as can be. I am concerned that irreparable damage could occur on #9 & #11 (not to mention the self esteem of a tween girl at risk here due to this cosmetic, yet genetic flub.) Any advice and opinions are appreciated.

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.
– Makisha from Arizona

(see Dr. Hall’s response below)

We thank our advertisers who help fund this site.
.

Makisha,
I’m sure your dentist is well-intentioned, but she does not appear to be an expert in cosmetic dental bonding. And I would not let her do a metal-backed Maryland bridge, because I believe the same thing will happen, and I will explain why. There is a much easier, less invasive way to handle this.

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 Maryland bridge preparationfront 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.

flipper partial

A flipper partial replacing a single lateral incisor

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:
1. Will the metal wings allow the bridge to affix better to her teeth?
No – no way. In fact, I wouldn’t be surprised to hear that the dentist has more trouble bonding the metal on than the zirconia metal-free version. Metal is harder for most dentists to bond.
2. Will there be damage to the teeth?
Yes. There already has been some damage by the “slight preparation” and there will be more damage if your dentist keeps at this, especially if she finally gets it right and prepares the teeth enough so that the bridge will stay on.
3. Is the metal in the bridge a cosmetic problem?
Yes. The metal will darken the adjacent teeth. This is why dentists are moving toward metal-free Maryland bridges.

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

Do you have a comment? 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 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.

I’m missing a front tooth. Can I still get porcelain veneers?

Posted on by .

We thank our advertisers who help fund this site.
.

Dr. Hall,
I have a partial consisting of 5 teeth. One of my front teeth is missing as well as 3 on one side and 2 on the other. I absolutely hate the dental work. It looks horrible. I had the dentist redo it 3 times. The front tooth looks nothing like the one next to it. My insurance paid for it and Im not sure if they will pay again. I would love to have porcelain veneers but I have teeth missing. What would you suggest I do to get my smile together?
– Doris from Detroit

Doris,
Even a removable partial denture can be made to look attractive and the missing tooth can be made to look like the one next to it, but it takes the right dentist using the right dental laboratory to get that done. For most family dentists, esthetics isn’t high on their priority list, and my guess is that your family dentist is working with a dental lab for whom esthetics is also a lower priority.

One disadvantage of a removable partial is that it has to have clasps that attach to your remaining teeth. With the old style partial, those clasps used to be metal and they could end up showing when you smile. There are newer plastic materials, however, that are transparent that give a much more attractive result. You could check out the Valplast partial as an option.

There are a lot of options on how to handle your case, and how it would be done depends on your budget and what you want to accomplish. If you’re happy with how the rest of your front teeth look, then it’s just a matter of replacing the missing front tooth and the other five back teeth. The economical way to do that would be with a removable partial denture. The nicest way to do that, which would be much more expensive, would be with dental implants.

You could also take the opportunity, since you already need major work, of combining the tooth replacement with a smile makeover. You mentioned porcelain veneers. A skilled cosmetic dentist will be able to seamlessly blend the different materials—implants and porcelain veneers—into one, beautiful, harmonious look.

About your insurance—on major dental work such as dentures, crowns, and bridges, they usually have a five-year rule—they’ll give you benefits for replacing the work if it is more than five years old.

You’re in Detroit. Check out our recommended cosmetic dentists in the Detroit area. Either of them could do a great job and give you a beautiful smile.

I hope this helps.

Dr. Hall

Do you have a comment? 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 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.

Categories

Follow this blog

Get every new post delivered right to your inbox.