The crowns and bridgework that had been completed only 5 years earlier was chipping, had gum recession, and had exposed metal margins. Frequently, dental implants are now used to replace missing teeth. When there is not enough room in the jaw to place an implant or the patient does not want to have an implant, fixed (non-removable) bridgework can be used.
Rather than having implants placed where she was missing front teeth, the patient elected to have a new porcelain on gold (PFM) bridge with PFM crowns placed on all of her other upper teeth. The patient brought in a picture of how she wanted her new upper teeth to be shaped.
Bridges vs Dental implants
An all porcelain bridge is a restorative dental treatment used to address missing teeth. In some instances, a bridge may be used when a dental implant is not possible. Above are before and after pictures of a new style all porcelain bridge. There are reasons to use a bridge as alternative to implant.
Choosing dental bridgework over dental implants
Oftentimes, all porcelain bridges are chosen over dental implants due to a patient’s specific dental imperfections. For example, implants may initially be chosen, for a patient who has spaces between the cuspids or “eye-teeth”. However, due to inadequate space to fit the implants in, the dentist may then decide as we did above, that an all porcelain bridge will be the restorative treatment that will provide the alignment and uniformity needed.
Congenitally missing lateral incisors
It is fairly common to be missing one or both of the adult lateral incisors (one out of 50 people). These are the smaller neighbors to the upper front two teeth. These teeth normally erupt at age 7 but proper radiographs taken by your family or pediatric dentist can forecast the lack of development of these teeth at age 4-5.
Often an Orthodontist gets involved
When the lateral incisors do not develop, the other adult teeth often drift into the space. Orthodontics is needed to keep the two front teeth from separating (forming a gap) or having the eye teeth tipping forward. Prior to the development of implants, it was common for orthodontists to move the eye teeth into the missing tooth positions. This led to more abusive occlusal relationships of the back teeth.
The other option was for the orthodontist to maintain the normal tooth positions leaving a space where the congenitally missing tooth was supposed to be. A fixed / cemented bridge was then later made to fill the gap/s.
The implant option
Today, with the refinements of implant dentistry, a dental implant has become a viable alternative to a bridge. Implants can be placed about 1-2 years after the individual’s jaws have stopped growing. For young women, this is around age 18 or 19. For young men, this age is 20-21. Traditional orthodontic treatment can be finished by the age of 12-17 years. This means that usually, orthodontic treatment is completed on kids long before they are old enough to have implants placed. There are very specific retention recommendations to maintain the correct tooth placement while waiting for the future implants to be placed.
Post-orthodontic management of congenitally missing laterals
Retainers are often used to hold teeth in the proper arrangement after braces until the jaws are done growing. Standard retainers are not appropriate to maintain the space for future implants. It is common to need to wait 6-7 years after braces are removed before the implant can be placed. The roots can drift into the location that the implant is to be placed. The only way to fix this is to redo the orthodontics. The average width of a lateral incisor is 6.5mm and the orthodontist hopefully leaves at least 6mm of space between the central incisors and the eye teeth from the clinical crown all the way to the tip of the roots. This gives room for the surgeon to later place the implant. Standard orthodontic retainers will hold the space at the crown level but offer no retention of the root positions.
The best way to make sure that adequate room for the implant is maintained is to use a “Maryland bridge”. A Maryland bridge provides a temporary crown that is bonded into the lateral position between the central incisor and the eye tooth. The temporary crown has metal wings on each side that attaches to the backside of the proximal teeth. This effectively maintains the exact parallel relationship of the central incisor and eye tooth that the orthodontist created.
Learn more about treatment options and choosing a bridge as alternative to implant
If you are contemplating bridgework as an alternative to dental implants, contact our Chicago, IL practice, and schedule a consultation with Dr. Fondriest, by calling 847-234-0517. Dr. Fondriest and his staff look forward to providing you with quality service.