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Question:
Regret getting a Bridge: I foolishly got a bridge. I had two missing teeth, one missing on each side of my two front teeth. It wasn't due to tooth decay or an accident, they simply never grew in.
The dentist who did the work suggested I get a bridge. I now feel that a bridge should not have been recommended. If I had discolored or rotten, crooked teeth, maybe, but there was nothing wrong with them.
I don't think this dentist should have filed down perfectly good teeth. If you can't tell by now, I regret the procedure. Is there anything that I can do to restore my teeth.
I foolishly had four perfectly good teeth filed away and covered, just to replace two missing teeth.
...Visitor from NY
Answer:
I agree with you. Prior to initiating treatment a patient has the legal right to informed consent. During treatment planning all of the options along with their advantages and disadvantages are required to be disclosed to the patient.
Perhaps there was a reason that the implants were not suggested, ie insufficient space, insufficient bone, etc. However many of these problems have solutions as well. The explanation should proceed as follows:
The advantages to having a bridge is that the procedure can be achieved in two visits. The shape, shade and position can be modified. In many cases insurance carriers will provide some minimal coverage. (Dental insurance maximums were $1,000 in the 1960's and have not increased much since then.) The biggest advantage is that the three unit bridge is one of the most profitable procedures a dentist can do!
The disadvantages are that four perfectly healthy teeth will need to be mutilated. Since 50% of bridges fail within ten years, depending on your age, it will have to be replaced numerous times throughout your life.
It is more difficult to clean because floss has to placed with a floss threader underneath the bridge. The stress of three teeth is spread out over two roots. As you chew your food the teeth naturally move, however the bridge does not. Something has to give.
Usually the cement/bond is broken between the tooth and the bridge. When this happens a "pump is created. Every time you bite the tooth/bridge shifts and sucks in saliva. One day the bridge comes off and every one is surprised that there is tooth decay under the bridge...and it needs to be replaced.
Another option is to leave the adjacent teeth alone and place two implants and crowns on the missing teeth. The less a dentist works on a tooth the better off the patient is. This is Minimally Invasive Dentistry.
The advantages are that the force of chewing is supported by two additional artificial roots...dental implants. The adjacent teeth do not have to be touched. The long term success rate of dental implants is higher than any crown and bridge procedure. During your lifetime the cost is much less than any other procedure.
The disadvantages are that it will take more than two visits. If there is insufficient bone, grafting may be required to prepare the site for dental implants.
I feel strongly that the standard level of care for congenitally missing lateral incisors involve implants and crowns.
What now? If you are happy with the functional and cosmetic results...wait. After a tooth is prepared it "repairs itself." Layers of tertiary or repairative dentin form in the pulp chamber to protect the tooth from the insult caused by the grinding procedure. Generally a tooth can be "worked on three times before the pulp becomes necrotic resulting in a root canal.
Since the work has just been completed, let everything settle down. Optimally, the four previously healthy teeth should have bonded all porcelain crowns. We use a material called Empress which has remarkable optical and physical properties. The implants should be placed in the missing areas and restored with zirconium abutments and the same type of crowns.
Editorial Staff
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