Archives for November 2019

I have some questions about my daughter’s missing tooth. We are trying to figure out the best way to go about replacing her missing #10, the maxillary left permanent lateral incisor, which she never had due to genetics. She’s 12 years old and we’ve been planning on getting her a dental implant as a permanent solution. First, we went to see an orthodontist to move the teeth into a location that would better accommodate the placement of a dental implant. That initial treatment is complete. Now, they have her wearing a wire that is permanently bonded to the back of three center teeth.

It sounds like she is still too young for a dental implant. So, we decided to have her get a Maryland bridge because that is what was recommended by the orthodontist. So, we moved forward with that plan. We had impressions done and teeth #9 and #11 were slightly prepared for the bridge. Then, the Maryland bridge was placed a couple weeks ago. The appliance didn’t have any metal in it. So, the wings were cemented to the surrounding teeth. The next step was impressions for a new retainer. Then, to our surprise, the Maryland bridge fell out the next morning after the impressions. The orthodontist decided to try another kind of cement and the bridge was re-cemented. Then, this morning, the bridge fell out again while my daughter was eating breakfast.

Now, the dentist wants to redo the Maryland bridge using metal wings this time. I have to say if I’m honest, I’m beginning to question the plan. I am starting to lose faith and I feel terrible that my daughter is having to endure so much dental work.

So, I’m looking for a second opinion. Here are my specific questions.

1. Will the metal wings help the bridge stay in place better? We need it to last for at least 5 years until she is old enough for a dental implant.
2. Will getting the bridge redone cause damage to her other permanent teeth that it is attached to? I don’t want her to have any issues with the teeth #9 and #11 because they have been fine so far.
3. Will the metal cause some cosmetic issues? The porcelain wings were supposed to blend in and look natural. Since this is all being done on her front teeth, they will show when she smiles. I don’t want her to have to deal with self confidence issues as she approaches her teenage years.

It would be amazing to have your input and opinion before we go back in to have the Maryland bridge redone. Thank you for listening to my rather detailed story. We very much appreciate your time.

-Sylvia in South Carolina

Sylvia,

Thank you for reaching out with your questions. Let’s start off by saying that is always difficult to give specific recommendations without having seen your daughter in person. However, here are some thoughts regarding your situation with the dental bridge.

First, it should be assumed that your dentist is trying their best. But, it doesn’t sound like he or she is focused on the aesthetics of your smile or is in an expert in using advanced dental bonding techniques. In short, I would advise against a metal-based Maryland bridge. This is because it sounds like the same thing may continue happening. Here’s why that is.

In most cases a Maryland bridge will work just fine. But, there is more to it than bonding the wings in place, which it sounds like what is going on here. In order for a Maryland bridge to be successful, the supporting teeth need to be prepared properly. You mentioned some “slight” preparation. They must have “resistance form” done to support the bridge when it is bonded. There needs to be some grooves or something resembling grooves put in place to keep the bridge locked in place. Bonding alone won’t do it. It will not matter what kind of material the wings are made of if the surrounding teeth are not prepared correctly.

In the photograph, you can see an example of a type of groove that will help the bridge stay in place. This isn’t the exact type of groove required for your daughter’s situation. It’s probably too big. But, it does give you the idea.

So, when your dentist is thinking that the cement was the issue and now is recommending metal wings, it will not matter. It’s the design of the prepared teeth that is likely failing.

At this point, the surrounding teeth can still be prepared properly. But, that defeats the purpose of getting a dental implant down the road. The teeth #9 and #11 will be prepared when they don’t need to be. The whole point of doing a dental implant in the first place is to keep the surrounding teeth healthy, as they are now. If you move forward with having them prepared, you might as well stay with the bridge and not get the implant when your daughter is older.

There is a less invasive option to consider called a flipper partial. It is essentially a false tooth that is affixed to a small plastic plat that fits behind her teeth. It snaps in place using metal clasps. And in some cases, the metal clips aren’t even required. Also, they won’t be visible on her front teeth. Overall, the flipper is a much more appropriate temporary solution when compared to a bridge. It will hold up well for several years and it will look nice too. The bottom line is that you shouldn’t have to permanently prepare the surrounding teeth for the bridge in what is intended to be a temporary solution, until a dental implant is appropriate.

So, here are the direct responses to your initial questions.

1. The metal wing will not improve the functionality of a Maryland bridge. In fact, there is a good chance that the dentist had issues bonding the metal wings in place because it can be more difficult to bond than porcelain.
2. Yes, there will be damage done to teeth #9 and #11. Even though you mentioned a “slight” preparation previously, they have been damaged to accommodate the bridge. And if the dentist continues to prepare the surrounding teeth, they will be further damaged.
3. Yes. Metal will make the tooth appear darker and will not be aesthetically-pleasing, especially on front teeth. It will likely be noticeable when your daughter smiles.

If you’d like to move forward with the flipper partial at this time, your current dentist can likely do it. However, if you’ve begun to lose faith in the dentist’s capabilities, it may be worth seeing another dentist in your area that may be more cosmetically-focused. Good luck! And thank you for reaching out. Hopefully, this gives you another feasible option to consider.

This post is sponsored by Petaluma dentist Rick Lane, DDS