Home | Contact Us | FAQ | Search & Site Map | Link to Us
Sign In | Join | Other 45 Sites in Network
Home
Discussion Groups
General
GeneralCardiologyVisionDentistryPharmacyLaboratoryNutritionAlternative
Diseases and Disorders
AIDSAlzheimer'sArthritisAsthmaCancerBreast CancerDiabetesEpilepsyGlaucomaHepatitisHerpesLupusProstate BPHProstate CancerProstatitisSinusitisTinnitus

Medical Forum / General / Dentistry / June 2006

Tip: Looking for answers? Try searching our database.

Rebuilding Crowned Lateral Incisor with 4 unit bridge

Thread view: 
Enable EMail Alerts  Start New Thread
Thread rating: 
Wilson - 20 Jun 2006 04:04 GMT
My front four upper teeth had crowns installed 17 years ago.  This was
done to close a gap between the central incisors, and because #7 and
#10 were "peg teeth".  I am also missing #6 and #11 (cuspids), which
never came in with adult teeth.

Recently, my #10 (Lateral incisor) crown broke off at the gumline,
while biting into submarine sandwich.  (Hey, there's a tooth in my
sandwich.  HEY!! IT'S MY TOOTH!!! )

The dentist said there wasn't enough tooth left and pulled the
remaining root.  He said putting a post in wasn't an option, as the
roots were very short.

Now, he wants to build a bridge across #9 through #12.

Is this a reasonable option?  I like this option because it fills in
all of the gaps on the one side.  Will it be strong?  Will it last?  Is
an implant a better option?

Would it be better to (gulp!) bridge from #5 through #12 and fill in
all gaps and get a nice white smile?  (#5 and #12 are strong teeth, but
worn) Is it likely that I will have to replace crowns #7 and #8 soon?
I am in my early 40s.

Thanks to all who contribute to this forum. It is very helpful !
Alexander Vasserman DDS - 20 Jun 2006 06:03 GMT
An implant is definetly a better option.
If there was a root in there and it was extracted atraumatically
without squeezing the ridge you should be able to place an implant in
there.
If the extraction was not ideal and you ended up with some ridge
distruction bone grafting and or ridge augmentation procedure may be in
order.
I do not recommend placing  a bridge which connects your back teeth to
the incisor teeth. This is relatively a new thinking of how to restore
these teeth.
If by chance there is no way to place the implant then I would choose a
different design for a bridge, such as a cantilever from the incisor
teeth. You had those 4 crowns done a very long time ago and we have
metal free/or very little metal materials resulting in much more
cosmetic restorations. Additionally you are not cutting down more
healthy teeth.

Alexander Vasserman DDS
www.smilesbyalex.com

> My front four upper teeth had crowns installed 17 years ago.  This was
> done to close a gap between the central incisors, and because #7 and
[quoted text clipped - 21 lines]
>
> Thanks to all who contribute to this forum. It is very helpful !
Mark & Steven Bornfeld - 20 Jun 2006 14:55 GMT
> My front four upper teeth had crowns installed 17 years ago.  This was
> done to close a gap between the central incisors, and because #7 and
[quoted text clipped - 21 lines]
>
> Thanks to all who contribute to this forum. It is very helpful !

    First of all, I'm assuming that #6 and 11 ARE in fact missing
congenitally.  These teeth are frequently impacted.  You must be sure
your dentist has taken adequate x-rays to rule out this possibility.
    It seems that you are entertaining a complex restorative plan to
replace one tooth.  What I don't know is what the condition of your
current crowns, what your current appearance is, etc.  I personally
would have been loathe to crown all your front teeth to close gaps in
the first place--very aggressive treatment, when porcelain laminate
veneers or even resin bonding might have achieved as good a result
without drilling down your teeth so much.  So it comes down to a value
judgement and appearance, money, and your wilingness to sacrifice tooth
structure for esthetic appearance.
    I happen to agree with Alex, esp. if your other teeth look OK.  I
wouldn't worry about losing the crowns if they look OK.  There could be
extenuating circumstances that may make placing a single tooth implant
difficult.  But for me the choice would be clear.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Wilson - 20 Jun 2006 17:11 GMT
Mark & Steven & Alex:

I like his approach of a bridge across #9 through #12, because it fills
in the gap of missing #10 and #11.
I am not as comfortable with the implant because of the 6 months to get
this fixed, and the amount of pain involved.

Yes, crowning four teeth was aggressive.  But 17 years ago the Internet
did not exist, so it was much more difficult to learn about all of the
options.  (It's really hard to even remember what it was like before
the Internet, isn't it?)  At the time, I *thought* that I was getting
porcelean veneers, but what he installed were crowns.

I don't see it as (more) complex to remove an existing central incisor
crown and replace this with a four-unit bridge.  I sort of know what to
expect with this procedure.  The implant is more of an unknown (to me).

I'm not sure how long-lasting the bridge (in this location) would be
vs. an implant.  Is the additional pain/cost/time of an implant really
worth it? It is hard for me to judge.

What would be the "impact" of the possibly impacted teeth to this?
Could they preclude the implant or have to be removed first?

Also, how "thick" are the teeth in a bridge compared to normal/crowned
teeth?  Will they seem "natural" to my tongue?

Thanks,

> > My front four upper teeth had crowns installed 17 years ago.  This was
> > done to close a gap between the central incisors, and because #7 and
[quoted text clipped - 46 lines]
> Brooklyn, NY
> 718-258-5001
Mark & Steven Bornfeld - 20 Jun 2006 17:54 GMT
> Mark & Steven & Alex:
>
[quoted text clipped - 24 lines]
>
> Thanks,

    If the teeth are adequately prepared, they should have pretty normal
contours.  Yes, depending upon the location of any impacted teeth,
placement of implants in this area may not be possible without removal.
    I understand your motivations, and your plan may well give the best
cosmetic result.  You will see figures bandied about concerning how long
a bridge will last vs. an implant--I personally wouldn't worry about the
statistics out there.  I have a patient with 60-year old bridges still
serving (not pretty, but they work).
    I would generally assume any dentist would check for impacted canines.
 Statistically, lateral incisors are more frequently missing, and
canines more frequently impacted.  But as I said, these are just statistics.
    Make sure you understand what is planned, and it's always a good idea
to get a second opinion with complex treatment plans like this.

Good luck,
Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Alexander Vasserman DDS - 21 Jun 2006 00:48 GMT
Wilson

You're trying to play dentist on your own and the fact is you are
missing a lot of important information which will lead you to make a
bad decision.
Implant surgery in not very painful at all.
Now if everything is good as far as bone you only need to wait 3 months
and there are things you can do to such that during the healing process
you still have a tooth there.
For example there is immediate placement and loading which is becoming
to be more successful. There are also many ways to make a temporary
tooth to fill the space during healing.
You said
"Is the additional pain/cost/time of an implant really worth it? It is
hard for me to judge."
I would have to say yes. If you get decay under one of those crowns you
are going to have to replace the whole bridge, risk more drilling of
your teeth and more chance of something needing a root canal.
Also by avoiding the bridge you will be able to floss like you do with
natural teeth, a bridge needs an extra tool called a floss threader to
maintain flossing.
And if you don't floss now or barely floss imagine what it would be
like when the floss threader is not around.
Again you suggestion for a bridge is connecting incisors to posterior
teeth, the current philosophy is begining to change advising this
should be avoided.
As far as closing gaps, you are not an expert on the best way to do
this and there are many other ways maybe less expensive and better than
what you are proposing.
There is a saying "Anyone who tries to be their own doctor has an idiot
for a patient.", you do not want to be an idiot. Leave the treatment
planing to the professionals. That does not mean you should not
participate in it, you need to express your concerns ask all the right
questions, reveal all your habits and go through different treatment
options. But don't try to play dentist by thinking something is going
to be better and look nicer than something else, you do not know and
you have not seen what everything looks like to make that decision
yourself.
Good Luck.

> > Mark & Steven & Alex:
> >
[quoted text clipped - 47 lines]
> Brooklyn, NY
> 718-258-5001
Wilson - 21 Jun 2006 02:30 GMT
Alexander,

Thank you for your comments.  No, I am not playing dentist on my own.
I am just trying to educate myself about the alternatives.  My
experience with the dentists that I have used in the past are that they
always present options quickly and then make their recommendation,
without *really* describing the options in detail.
For this current decision, I was presented with A - post (not viable),
B - bridge, or C - implant.  My dentist recommends B.
I will discuss this with him in more detail, and have better questions
because or your comments.
Thanks!

> Wilson
>
[quoted text clipped - 87 lines]
> > Brooklyn, NY
> > 718-258-5001
Alexander Vasserman DDS - 24 Jun 2006 05:49 GMT
In dentistry it can get frustrating for most dentists to keep repeating
the same thing over and over especially when most people do not have
enough dental background or do not care to hear all the details. Some
patients are so frightened by having any procedure done that they do
not want to hear these details and just leave the decission up to the
dentist which as you can imagine can leed to misunderstandings an
frustrations.
I'm not trying to make an excuse for these dentists just an explanation
of what may go on in their minds and what the patient should do to make
the most during treatment planning.

> Alexander,
>
[quoted text clipped - 100 lines]
> > > Brooklyn, NY
> > > 718-258-5001
Joel344 - 25 Jun 2006 15:06 GMT
Post a nice photo here at the website or e-mail it to me
for confidentiality ........ it should only be seen by six,
maybe seven million people at most.

Joe

--
Joel34
 
Sign In
Join
My Latest Posts
My Monitored Threads
My Blog
My Photo Gallery
My Profile
My Homepage

Start New Thread
Enable EMail Alerts
Rate this Thread



©2008 Advenet LLC   Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.