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
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.
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.