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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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.

April 26, 2017

My dentist put a screw post in my front tooth

Filed under: Root canals — Tags: , , , , — mesasmiles @ 11:58 am

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Hi Dr Hall,
I just had a front right central incisor break at the gumline after getting a root canal treatment. My dentist has used a metal screw post for the temporary crown. I have a continuous dull feeling in nasal cavity area but no pain. Is the screw a good idea for this type of problem as I cannot afford a bridge?
Many Thanks,
Frank from Pietermaritzburg, South Africa

Frank,
These screw posts generally are pretty solid as far as staying in the tooth, but they are risky. They exert a lot of stress on the root. The risk is that the root will split from the pressure. Is that happening in your case and is that why you have this dull feeling in the nasal cavity (which would be where the end of the root of this central incisor would be)? That could be, but I would wait it out.

But a front tooth that has broken off at the gumline is a tough situation. Many dentists would consider the tooth to be unrestorable. There are rotational forces on a front tooth that over time can loosen the crown and/or the post. My advice would be to go ahead with the crown, cross your fingers, and hope this post and crown last a long time. My guess would be that they would fail at some point.

If you can’t afford a bridge, the budget option for replacing a single front tooth would be a flipper partial. That may be where you end up.

In retrospect, it would have been good if your dentist had placed a simple post in your tooth after the root canal treatment, before the tooth broke off.

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.

March 7, 2016

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

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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

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

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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.

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.

 

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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.

September 2, 2015

How about a flipper for my 2 1/2-year-old?

Dr. Hall,

My 2 1/2 year old had to have his two front teeth removed due to nerve damage from a fall. His dentist retired and we were sent to a new one. I mentioned a “flipper” or some sort of press-on cosmetic tooth (teeth). The dentist was slightly rude and told me, “he’s 2, he won’t cooperate for a flipper”. What is your opinion?
He has Medicaid so I’m going to assume that this wouldn’t be covered. The Do-It-Yourself kits online are all made for adults. Ughhh, I don’t want his teeth shifting and he’s already had to walk around like this for 10 months!
Any help would be greatly appreciated
-Kristine from Michigan

Kristine,

It’s unfortunate that your dentist was rude. However, as a parent who raised five children and one who had a lot of experience treating child dental patients, I can tell you that he is right. Not only would it be impossible to get a child of that age to understand the need to cooperate with wearing a flipper partial, there are other issues.

dental flipper partial

a flipper partial

It wouldn’t be safe, for one thing, as a flipper has the potential to come loose and choke your child. Just as you wouldn’t give your child certain toys with small parts or plastic bags that would pose a choking hazard, so you wouldn’t put something in their mouth that could easily come loose.
Besides this, there is a functional problem. A flipper is held in by metal clips or plastic parts that clip or press against other teeth. At that age where teeth are in development and the mouth is growing so quickly, you couldn’t get an appliance to stay in for any prolonged period of time.
However, there is good news in this situation, and that is that first, his baby teeth won’t shift at all because of missing front teeth. The shifting because of missing teeth in children occurs because of missing back teeth, and when those teeth are lost prematurely, a space maintainer is usually needed.
Second, children at this age are not self-conscious at all about missing teeth. So many children both younger and older have missing front teeth, either because their baby teeth haven’t come in yet, or they have lost baby teeth and are waiting for the permanent teeth to erupt. But even if that weren’t the case, I came to know several children who lost baby teeth due to accidents and it didn’t seem to faze them at all.
Bottom line–I wouldn’t worry about it.

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.

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.

January 10, 2011

Disappointed with the Snap-On Smile

Filed under: Snap-On Smile — Tags: , — mesasmiles @ 6:21 pm

I just purchased a snap-on smile and I’m very disappointed! I have a gap where my canine tooth should be and it REALLY bothers me so my hometown dentist recommended the snap smile but I think it’s awful. It looks so fake to me. It seems so big and bulky. everything I’ve looked up says no cash refund but that’s too much money for me not to ever wear it but it just looks fake. Should I see if my dentist can make a new mold and ask for it to be slimmer? I hate my smile I have a 2yr old son and hate taking pictures because of my gap but I don’t want our pictures to look like I’m a crazy person either. Any advice will be great, thank you.
– Heather from Missouri

Heather
I don’t know what to tell you to make this better. Most dentists aren’t very artistic, and I’m wondering if your hometown dentist is one of those. You can try to work with your dentist and see if he or she can make this better for you. That’s the best you’re going to be able to do. Don’t expect a refund.

Dentists vary greatly in their artistic sensitivity and ability to create beautiful smiles. Dentists, as a rule, go into the profession because they like to fix things. They have an engineering mentality, and they simply aren’t artistic. An excellent cosmetic dentist, such as we recommend on this website, will give you realistic expectations about the results you’ll get from a Snap-On Smile. Yes, your teeth will look larger and bulkier. That can’t be avoided because the appliance has to snap over your teeth, and in order to do that, the end result is going to be bigger teeth.

Generally, if someone is missing one or two front teeth and that is all that is wrong, my recommendation would be to get a flipper partial. This is an appliance that also just snaps into your mouth, but all it does is replace those teeth with plastic teeth – it doesn’t add anything to the other teeth. You might try asking your dentist to replace this with a flipper for no charge. If you were his first Snap-On Smile patient, which made you a guinea pig, I think that’s a reasonable request. Your dentist may have been expecting something nicer-looking, too, which made this a good learning experience for him or her.

– 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.

October 7, 2010

Snap-On Smile vs Flipper Partial

Filed under: Snap-On Smile — Tags: , , — mesasmiles @ 12:50 pm

Hello Dr Hall,
I have been contemplating about “Snap On Smile” temporary teeth. I’m not sure if I would be eligible though. You see I am missing 2 front uppers with one other that might have to come out as well. I can’t afford dentures or implants, so I don’t have many options. I realize that a visit to the Dentist is the only true way of being sure, but before I spend the money I would like to have some idea if I am eligible. I’m 54 years old and in good health. Please let me know what you think.

Thank you very much,
Douglas from Texas

Douglas,
I don’t understand the condition of your mouth well enough to give you a recommendation, but I’ll try to be helpful.

You are missing two front teeth, and have another that might need to come out as well. It kind of sounds like you have periodontal disease, and that is why these teeth have to come out. That would mean that other teeth are loose and are in danger of needing to come out when they get too loose. The problem with doing a Snap-On-Smile in a situation like that is that it snaps on to your existing teeth, which means that it will put additional stress on the remaining teeth and accelerate the periodontal disease. Additionally, it may be very difficult to get a good fit if the teeth the dentist is fitting it to are mobile.

There is another option that would be even less expensive, and that would be a flipper partial. That provides a relatively inexpensive plastic tooth for each missing tooth. It doesn’t do anything to cover up other teeth, but if your other teeth look okay, the flipper partial would be much less expensive and easier to make and fit.

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.

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