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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
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. 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.
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
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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.