February 2020 - Dr. Rick Lane

I have a cracked tooth on my top arch, one of my premolars. The dentist quoted me and told be it’s tooth #5. Also, I have a really old crown on one of my front teeth. I have had that crown for decades, and that is tooth #7. My regular dentist quoted me ~ $4,700 for tooth #5. The fee includes the tooth extraction, bone grafting and a Lava Crown with one implant abutment. I was told that the quote includes some of the various fees from the implant dentist too.

Then, for tooth #7, I received a quote right around $4,700 again. It includes similar fees for the tooth extraction, bone grafting and also installation of a Maryland Bridge. It is my understanding that the bridge is supposed to stay in place for three months, while the surgical area heals. Then, after they have both healed, the crowns and implants will be placed to complete the procedure for both teeth.

I’m starting to become a bit concerned though. It has been three weeks since the Maryland Bridge was placed. I have had to return three separate times to have it replaced. They act like it’s no big deal when I go in for the replacement. But, I really don’t feel like this is normal, or they would have prepared me for the possibility. Is it possible that my general dentist is in over his head?

Is it possible to find another dentist for a second opinion once I’ve already started the treatment plan? I am wondering if this dentist is capable of placing the dental implant correctly. Or is there benefit to staying with my original dentist since he is more familiar with my situation?

I’m starting to lose confidence since the Maryland bridge keeps breaking. In my opinion, I am paying way too much money for this to keep happening.

Any information or recommendations you have would be greatly appreciated.

-Carol in Missouri

Carol,

Well, you are smart to start questioning the skill level of your current dentist, if the Maryland bridge keeps failing. It is not normal for the bridge to keep breaking and may mean he doesn’t have the necessary training or experience to be successful in your treatment plan. It would be in your best interest to get a second opinion and consider switching dentists. You don’t want to end up getting stuck with with a dentist that will put your dental implants at risk.

If a Maryland bridge is repeatedly failing, there is likely a problem with the design of the appliance, the technique used to place it or both. The bridge supports a false tooth between two metal wings. The wings are etched on the back, and a bonding composite is used on the backs of the teeth. If the flaw isn’t fixed, then it will continue to fail. It is also possible that the etching on the metal needs to be redone at the lab. It could be an issue with the bonding process too. And if the dentist hasn’t figured out the issue by now, it is time to find a new dentist who is more experienced in replacing missing teeth.

Another telling sign that your dentist may be in over his head is that he didn’t use a reliable temporary implant appliance. It sounds like it is in your best interest to listen to your gut and try to find another reputable implant dentist in your area.

Ethically speaking, your dentist must cooperate if you would like to change even if you are in the middle of treatment. He has an ethical obligation to provide the information on your case and anything required to properly treat you. It sounds like you are at a good stopping place in the dental implant process, before the surgery has taken place.

Your new implant dentist may not want to use a Maryland Bridge, so it is possible you may have some additional cost for the costs associated with a new temporary tooth treatment. Many implant dentists will choose to use a dental flipper as a temporary replacement for your situation instead. So, you’ll just have to see what the new dentist recommends.

Be sure to check out the new dentist’s credentials, training and ask to see examples and photographs of cases similar to your own. Ask about their success rate and if they agree with the treatment plan and what other recommendations they have. The good news is you aren’t obligated to stay where you’re at.

Thank you for sharing your story. Hopefully, you are able to make the change before you are at a risk for dental implant failure.

This post is sponsored by Petaluma dentist Dr. Rick Lane.

Hello,

I would like to know your thoughts on the possibility of placing a Maryland bridge in between to porcelain crowns that are anchored onto dental implants?

Here’s the deal. I have a missing first premolar and molar on top. There was a tooth between them. But, I was just told that it will need to be extracted. So I was wondering if a Maryland bridge will work to fill the space between the two dental implants?

-Shawna in Washington

Shawna,

There are many factors to consider for any dental treatment. Also, it is difficult to give you specific recommendations without having seen you in person. However, the answer to your question is yes. A Maryland bridge can be attached to porcelain crowns on each side. It is complicated and it should be evaluated very carefully, since it may not hold up very well in the long term.

Diagram of how a Maryland bridge is placed.

Unfortunately, not all dentists do a good job with Maryland bridges, which means they may not last the whole lifespan. They can be illusive because they seem easy to put into place. The teeth need to be prepared by grinding the adjacent teeth so there is space for the metal framework. Then, dental bonding is used to set it. It really does sound and seem straightforward. However, it really isn’t that simple. An experienced dentist that places a Maryland bridge will be sure to place grooves in order to resist against the inevitable force that comes with chewing and biting. If this important step isn’t done correctly, the Maryland bridge will likely end up coming loose.

Also, since you already have porcelain crowns and dental implants on the surrounding teeth, it may present some complications when the Maryland bridge is bonded in place. This is because the appliance is typically bonded directly to teeth enamel, which will provide the strongest bond. When a bridge is bonded to porcelain, the bond may not be as strong. Even if it is technically done correctly, the bond simply will be weaker. Not too many dentists know how to successfully bond to porcelain.

Then, regarding the grooves that were mentioned above, there are complications when preparing the crown in that way. It requires a great deal of skill to get the retention and resistance done properly in order to avoid any issues with it being loose in the future. If the grooves are done too deep, it may compromise the framework that lies underneath the crown, which could end up compromising the dental implants. Also, that means that the bond must be made to the metal underneath for the grooves, if it becomes exposed.

So, to reinforce the answer to your question. Yes, it can be done. Is it recommended? No, it wouldn’t be ideal since it is such a complicated, difficult procedure to do it properly.

In a perfect world, your dentist would have realized that when the original dental implants were placed, there was a possibility that the one remaining natural tooth that sits between them may require further treatment in the future. At some point, the tooth may have been at risk. If this would have been the case, the implants that were placed to replace your missing teeth could have been placed so the abutments were parallel. Then, a screw-retained crown could have been done. Then, when you are facing your current situation in losing the tooth in between, the dentist would have been able to unscrew the crowns and then install a dental bridge.

An alternative treatment at this time could be to go ahead and get a third dental implant done, as long as their is enough bone density left at the implant site.

Again, it is always difficult to provide recommendations without seeing you in person. So, please proceed with caution if you decide to try the Maryland bridge. It is always a good idea to seek a second opinion from a reputable implant dentist in your area. Hopefully, it will either confirm the treatment plan you are considering, or it will provide you with some further justification to reconsider some other options.

Thank you for sharing your story. Best of luck!

This post is sponsored by Petaluma dentist Dr. Rick Lane.

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