Dave

Dear Dave,

While technically you can use a Maryland bridge between the two implants, I would not recommend that option. First, to properly place a Maryland bridge your dentist would have to cut grooves into the crown, as shown above. Second, the best bond you can get is when you affix the wings to natural tooth enamel. The bond to the porcelain will not be as strong. I do not think that your bridge will hold long.

So, what do you do? Ideally, your dentist would have anticipated that you could lose the tooth between the two implants you already have. Then he would have aligned the implants in a way where you could unscrew the two adjacent dental crowns and affix a traditional bridge to the two implants. If that is not possible, then I would see if you can get an additional dental implant in the spot. If you’ve only recently lost that tooth, then there should still be enough space to fit another implant.

There are other options if that doesn’t work, such as a removable partial denture or even a dental flipper. Obviously, though, the ideal will be the implant, so start with those options. Either way you do need to replace the tooth with something. If you don’t it will throw off your bite. In addition to jaw pain, headaches and bite problems, you could end up with TMJ Disorder.

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Carol

Dear Carol,

I’m glad you wrote. First, let me say that I am glad you picked a dental implant for her permanent tooth replacement. It is the best tooth replacement you can get her.

I am not sure why your dentist recommended a Maryland Bridge for your daughter. One of the reasons that your daughter’s Maryland Bridge is not staying on because cement isn’t enough for this type of tooth replacement. There actually needs to be a bit of a notch made into the tooth, like you see in the image above. Because of that, I would not consider it a temporary tooth replacement. Once she is old enough and your remove the Maryland Bridge, that notch will have to be filled in with dental bonding material. So, yes, it will damage the tooth.

I would not let her do the metal wings. They will not stay any better without the notch we talked about and they will stain her adjacent teeth.

Instead, I’m going to suggest that you get her a dental flipper. This will hold the space open, it is much less expensive than what your dentist is currently using, and it will not damage her tooth in any way. Then, once she is old enough for a dental implant, you can replace her tooth permanently.

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Sean

Dear Sean,

I share your concern about your dentist. A dental implant porcedure is much more advanced that a Maryland Bridge. Plus, there is much more training for a dental bridge in dental school than there is for dental implants. To do it well requires post-doctoral training. There are way too many dental implant horror stories as a result of patients going to inexperienced dentists for this procedure.

It is not too late to switch dentists. In fact, you can switch during any procedure at any time. Your dentist is ethically obligated to share all his diagnostics and notes with whichever dentist you end up choosing.

It’s good that you are thinking this through now instead of after the implant surgery, where you would risk dental implant failure.
By the way, a dental implant is a fantastic choice for a tooth replacement. When done well, they are the closest thing to having a healthy, natural tooth in your mouth again.

This blog is brought to you by Moline Dentist Dr. Goebel.

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