Medical Forum / General / Dentistry / June 2006
Rebuilding Crowned Lateral Incisor with 4 unit bridge
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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
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