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Medical Forum / General / Dentistry / August 2007

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Molar Problem - Bridge, Implant or Gap?

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stephen - 15 Aug 2007 14:09 GMT
I've been experiencing intermittent pain in a tooth on the lower right
side near the back for a few months & my dentist has recommended the
tooth be removed. He gave me antibiotics and said I'd be lucky to go 2
months before the pain came back and it seems he was right!

The tooth has had a lot of work over the years - 2 root canals (the
2nd one to fix the 1st one), fillings & a porcelain inlay. All of this
was very expensive and I feel bad about now having to pay money again
to have the tooth taken out. One tooth next to it has also had
extensive work.

The dentist gave me 2 options to fill the gap - a bridge for £600 and
an implant for £2000. I could also do nothing and leave the gap.

AIUI the pain is caused by infection in the root space (?). I don't
understand why the infection keeps coming back.

I'm concerned that if I choose a bridge the dentist will have to work
the tooth beside the gap to allow it to support the cantilever bridge.
I'm also not sure how durable and rebust a bridge is and if material
can build up underneath which could cause problems later on.

I would like to have the implant but it's too expensive and would also
require a 3 month wait until the bone is ready.

If I choose to do nothing & leave the gap unfilled will it grow
smaller over time?

Thanks for your help!
Mark & Steven Bornfeld - 15 Aug 2007 14:55 GMT
> I've been experiencing intermittent pain in a tooth on the lower right
> side near the back for a few months & my dentist has recommended the
[quoted text clipped - 25 lines]
>
> Thanks for your help!

    Generally cantilever bridges are a compromise.  You usually have to
crown at least a couple of teeth on the side of the space in order to
support the significant torquing and dislodging forces such a bridge
creates.  If the tooth being lost is the last tooth the only alternative
if it is to be replaced is generally an implant.  If there is a tooth in
front and behind the tooth being lost, what is the reason a traditional
3-unit bridge isn't being considered?  If one of the adjacent teeth is
weak, you should consider now what is to be done if that tooth is lost.
 In other words, you should look at the total condition of your mouth
when major restorative decisions are to be made, not just the individual
tooth.

Steve

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

stephen - 15 Aug 2007 15:07 GMT
On Aug 15, 2:55 pm, Mark & Steven Bornfeld
<bornfeldm...@dentaltwins.com> wrote:
> > I've been experiencing intermittent pain in a tooth on the lower right
> > side near the back for a few months & my dentist has recommended the
[quoted text clipped - 44 lines]
> Brooklyn, NY
> 718-258-5001

Thank you for your reply. The dentist suggested the bridge could be
attached to only one neighbouring tooth rather than 2. I don't know
about these things but it seems to me this would put that tooth under
a lot of strain as you mentioned and possibly weaken it & the bridge
over time.

I will discuss with the dentist the possibility of having the tooth
removed and leaving the gap  until I can afford the implant. I would
also have to find out if he would need to do any additional work on
the gum/bone in preparation for the future work of fitting the
implant.

Man, I so wish I had looked after my teeth when I was growing up :(
Newbie - 15 Aug 2007 15:12 GMT
>On Aug 15, 2:55 pm, Mark & Steven Bornfeld
><bornfeldm...@dentaltwins.com> wrote:
[quoted text clipped - 52 lines]
>a lot of strain as you mentioned and possibly weaken it & the bridge
>over time.

Cantilever fixed partial dentures are, in general, just a bad idea.
Avoid them when possible.

>I will discuss with the dentist the possibility of having the tooth
>removed and leaving the gap  until I can afford the implant. I would
[quoted text clipped - 3 lines]
>
>Man, I so wish I had looked after my teeth when I was growing up :(
Newbie - 15 Aug 2007 15:08 GMT
>> I've been experiencing intermittent pain in a tooth on the lower right
>> side near the back for a few months & my dentist has recommended the
[quoted text clipped - 39 lines]
>
>Steve

Agreed.

There is another treatment alternative after the eventual extraction.

Perhaps an all acrylic "flipper" as a space maintainer or even
a cast frame partial if there are missing teeth on the contralateral side.

This would at least maintain the space until more definitive treatment
can be done.

Me ?  I'd just go for the implant. Already have one, another wouldn't
be a big deal. Time consuming, yes; Costly, hmmm not really in light
of the projected longevity; and in light of the treatment time the cost
can be spread.
 
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