Question:
The molar in the upper left corner of my mouth has been giving me
problems. Lately it has been abcessing. My regular dentist suggested a
root canal and crown. Since I had two successful dental implants on the
lower jaw, I was thinking of extraction and dental implant. But the
dentist who did the last dental implant said that a dental implant on
the upper jaw was not adviseable since the bone is not as sturdy (or
easy to get to?) as the lower jaw. So he suggested a bridge instead.
But that doesn't make sense since a bridge needs teeth on both sides for
anchors and this molar is the last tooth on the upper left. So am I
getting the right choices? Do I have any others?
Answer:
Should to perfectley sound (or at least good) teeth be totally
grinded down to provide ONE single tooth in an empty space.
We know that artificial teeth are not as long lasting as the
natural tooth and that there is a risk for complications when
teeth are being prepared for a bridge.
Personally I do not like it. I know that I am not always serving
the patient's best interest if I routinly recommend a bridge that
involves the destruction of two healthy teeth.
I have recently had the opportunity to try another system. It is
a small stailess steel bar that is attached to the two teeth with
common composite (placed in small prepared cavities) and a
very natural looking tooth, completly filling the space between
the two teeth, is attached to the bar,
If this holds up for the "tooth of time" it is not only an alternative
for a three unit bridge, but should be recommended as the first
choice. If it fails the opportunity to make the conventional bridge-
work can always be done.
The fact that it involves "LESS DRILLING" has not yet detered
any of my patients from having that new type of bridge.
This is a tough one! You have no back tooth (distal abutment) to support a
bridge. The "lack of bone" description might have alluded to a sinus
proximity and that is just a hole in the head that wont support an implant.
Options:
1: Surgery to alter the position of the sinus, and bone grafting to
make a nice area of support for the implant. We are now talking about 2 to
3 specialists involved when the prosthodontist is included, because no
generalist in his right mind would sign on to that package.
2: living with the loss of that tooth.
3 : A cantilevered pontic. As much as I like Joel Eichen I have to
recommend that the tooth supporting such a cantilevered pontic be a full
crown and the pontic be half the width of the replaced tooth. Function will
be about the same, biting forces will be minimized and the supporting tooth
would be bonded with one of the newer bonding cements (like C and B
metabond) to resist dislodgement.
If # 3 is the choice then have the extraction and wait several months for
the extraction site to become really stable and then the 'pontic' will not
be hanging out in space for occlusal forces to do the pump handle effect on
the supporting tooth.
Or have an osseus inlay at the time of the extraction to accelerate that
stability and allow the ridge area to give support to the pontic replacing
the extracted tooth and thereby decrease the burden on the one and only
abutment.
If you ask me what I would do I will give you my subjective:
I could probably get a colleague or two to give me some professional
courtesy and save me some expense and I could get the first option in an
easy manner. But I am a pragmatist. I am practical. I would either live with
the loss of the tooth or get the cantilever, but I would make sure that it
was done according to the protocol I set forth above.
Well, I am sure that we all agree that an onlay is kinder, as it keeps
the natural part of the tooth that touches the gingiva. I tend to lean
towards NOT grinding down an entire tooth down to a little peg where
there is a whole tooth and not even a filling in it. Patients
appreciate this.
I believe that we have gotten away from inlay or onlay retained
bridgework because of the dictates and the reimbursements of the
dental insurance industry, not out of a need to hold the bridgework in
better.
