add teeth on existing bridge?

[bluesky12]

D3, new to clinic here. Transfer pt to me. Received a 34-36 bridge in May, it's solid. He had to have his 33 extracted (before me). He originally wanted an implant but now has changed his mind.

What other options does he have? Single tooth RPD at 28 y.o. isn't great. doesn't want implant. I don't want to waste the bridge he just paid for. Is it possible to remove a bridge, send to lab to add in 32-x- and attach to his current bridge, then I can prepare 32 and put on new bridge? Or is it possible to cantilever on 33 and not prepare 32?

thanks

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[Mackchops]

D3, new to clinic here. Transfer pt to me. Received a 34-36 bridge in May, it's solid. He had to have his 33 extracted (before me). He originally wanted an implant but now has changed his mind.

What other options does he have? Single tooth RPD at 28 y.o. isn't great. doesn't want implant. I don't want to waste the bridge he just paid for. Is it possible to remove a bridge, send to lab to add in 32-x- and attach to his current bridge, then I can prepare 32 and put on new bridge? Or is it possible to cantilever on 33 and not prepare 32?

thanks

Why did the patient change his mind on the implant? Why was 33 (lower left first molar?) extracted? Assuming money wasn't an issue (HA!), are there any problems with either of the options you're proposing - a distal cantilever or a premolar piered abutment?

This is a tricky one. I HATE molar cantilevers and piered abutments aren't so hot either. You could consider a stress-breaker but the studies show that those end up being a problem as well. If the bridge is solid I would push implant or nothing - if he doesn't want the implant bad enough to pay for it, don't compromise the health of the rest of the teeth in the quadrant to replace it! Let him take ownership of his mouth and don't automatically assume you have to bend over backwards to fill every space in a mouth...

Great questions though! Just my 2 cents.

 

[bluesky12]

Sorry - those are all Canadian denominations for teeth (ie. 33 = lower left canine, 34-36 = lower left first premolar-first molar). Does that change your response - as it won't be a molar cantilever - but a canine?

 

[beannaithe]

Every cantilever I've ever seen has failed...and failed spectacularly. If it's a lower canine, I'd push for implant or flexi-partial/interim RPD until he's ready to go forward with the implant. Unfortunately, adding a tooth to an existing bridge is difficult and compromises the prosthesis. Doing so for a tooth that takes so much occlusal force (canine), makes the bridge very, very guarded.

The only cantilevers I've ever seen last are either laterals (off a canine) or a central (maybe - off a double-abuted lateral/canine). Only under extreme circumstances would I consider doing a cantilever molar/premolar. Otherwise, occlusal forces will rock the bridge and eventually cause failure. It takes the right type of patient that's made aware of the potential (or probable) failure and accepts that the failure could happen to do anything 'outside the box.'