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rsweeney

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What are the advantages and disadvantages of a distal cantilever bridge vs. an implant to fill a single edentulous space?
 

Happy2th

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rsweeney said:
I have not learned too much about these topics yet. I am interested in all opinions. My dad is trying to decide b/w the two. He has a single edentulous space where a second molar used to be, and all of his wisdom teeth have been extracted. The adjacent first molar is present as well as the opposing tooth. From my understanding, distal cantilever bridges are really not used anymore--especially in the posterior region. So--Bridge or implant and why.
Impossible to say without radiographs.
 
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DrTacoElf

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Bridge will cost less initially but have a shorter life most likely. Also not that this is an aesthetic area but to me implants + crown done properly almost always look nice than bridges. Disadvantages of implants are cost, and time of placement (healing time). Also if there is not sufficent alveolar bone for an implant you'd have to consider a graft. And as you know occlusal forces in this area are high so based on all the considerations if he has good bone i would go implant.
 

ElDienteLoco

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If you are doing a distal cantilever bridge (which always causes destructive forces on the abutment teeth) you'll probably have to double abut which will put your patient cost pretty close to implant-crown. A three unit bridge isn't a cheap option. Unless contraindicated, I would say this is a no brainer - implant is the best Tx. If the pt can't afford the implant, I would suggest an RPD to fill space.
 

12YearOldKid

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Cantilevers suck unless you are replacing a lateral. And even then I wouldn't put one in my own mouth. Even if you take the pontic out of occlusion there is no way to eliminate all the torquing forces on the abutment. I have done one for a patient, but there were extenuating circumstances.
 

drhobie7

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Depending on the occlusion you could just leave it as is. Restoring a 2nd molar probably won't add much functional or esthetic benefit. You'd have to see if there was an occlusal stop for the opposing tooth to prevent supraeruption. I have a patient like this and he's just leaving the spot open.
 

rsweeney

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drhobie7 said:
Depending on the occlusion you could just leave it as is. Restoring a 2nd molar probably won't add much functional or esthetic benefit. You'd have to see if there was an occlusal stop for the opposing tooth to prevent supraeruption. I have a patient like this and he's just leaving the spot open.

If, for example, there actually is a contact on the distal marginal ridge of mandibular first molar, isn't it possible the first molar could tip distally (even though there would be no supereruption of the opposing maxillary second molar)?
 

DDSSlave

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drhobie7 said:
Depending on the occlusion you could just leave it as is. Restoring a 2nd molar probably won't add much functional or esthetic benefit. You'd have to see if there was an occlusal stop for the opposing tooth to prevent supraeruption. I have a patient like this and he's just leaving the spot open.
I'd second your recommendation. If there is an opposing tooth I'd recommend an occlusal guard depending on patient compliance to prevent supraeruption. If he really wants the space filled, go with the implant if possible. No dentist worth his salt would place a cantilever bridge to replace a 2nd molar. And the possibility of a 1st molar tipping distally is slim. I'm sure it happens, but not to the extent of mesial drifting.
 

rsweeney

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DDSSlave said:
I'd second your recommendation. If there is an opposing tooth I'd recommend an occlusal guard depending on patient compliance to prevent supraeruption. If he really wants the space filled, go with the implant if possible. No dentist worth his salt would place a cantilever bridge to replace a 2nd molar. And the possibility of a 1st molar tipping distally is slim. I'm sure it happens, but not to the extent of mesial drifting.

All responders, thank you for the suggestions. I spoke with him, and he really does not care about having an empty space so far back in the mouth. He only worries about the impact the empty space would have on the existing teeth. Thus, after presenting options to him, he really likes the idea of leaving the space empty and wearing an occlusal guard.

Much obliged
 

ItsGavinC

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12YearOldKid said:
Cantilevers suck unless you are replacing a lateral.
I agree. We aren't allowed to even tx. plan cantilievers.
 

rsweeney

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ItsGavinC said:
I agree. We aren't allowed to even tx. plan cantilievers.

I discovered another treatment option: an etched metal splint. Any thoughts?
 

ElDienteLoco

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rsweeney said:
I discovered another treatment option: an etched metal splint. Any thoughts?
As an option instead of a distal cantilever? Are you talking about a Maryland-ish bridge? I don't see how that could fill the distal space you are suggesting.
 

rsweeney

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ElDienteLoco said:
As an option instead of a distal cantilever? Are you talking about a Maryland-ish bridge? I don't see how that could fill the distal space you are suggesting.
Oh, im sorry. The metal splint would not be used to fill the space. It would be used to suport the opposing tooth thus preventing it from hypererupting into the edentulous space--this splint is bonded to the adjacent stable tooth. This option would be selected assuming the space is to remain empty.

Sorry for the confusion :oops:
 

ElDienteLoco

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That makes sense. Unsupported teeth don't always supraerupt either, right? So maybe you wouldn't need anything? Just a thought.
 

rsweeney

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ElDienteLoco said:
That makes sense. Unsupported teeth don't always supraerupt either, right? So maybe you wouldn't need anything? Just a thought.
True that. Thank you for the input. I will do some more research for the efficaciousness of these splints.

Enjoy finals, for me at least :scared:
 

ItsGavinC

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ElDienteLoco said:
That makes sense. Unsupported teeth don't always supraerupt either, right? So maybe you wouldn't need anything? Just a thought.
True. I'd factor in the age of the patient when it comes to explaining tx. options.
 

drhobie7

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ElDienteLoco said:
That makes sense. Unsupported teeth don't always supraerupt either, right? So maybe you wouldn't need anything? Just a thought.
True. It depends on bone density, age of patient, angulation with respect to mesial tooth, and probably some other factors I'm not aware of. Supraeruption isn't going to happen overnight. I think if your patient wore an occlusal guard 1-2 nights a week he'd probably be fine. Maybe he should be wearing one anyway (bruxism?). My patient had #2 EXT and #31 was unopposed, but the instructor I consulted said 31 had a sufficient occlusal stop against 3 to prevent supraeruption. My patient is bothered by the space however and still wants the implant. But he doesn't have the coin.
 

crazy_sherm

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I have a congenitally missing #10 and after ortho, had a maryland put in. It fell out once when I was in high school and my dentist redid the bridge. When I was 24 (27 now), the cement debonded on 9 but 11 was holding on tight, so i had my dentist turn it into a cantilever so I would be able to clean behind 9. It's still been holding on pretty well, but everytime i accidentilly chew with 10, my hard skips a beat praying it doesn't fall off. The pontic looks like crap btw, gingiva screams bridge to everyone who sees it. I'm definitely gonna get an implant and some perio done before I graduate.

Reason I went with the bridge over the implant 10 years ago was because insurance covered it. I didn't feel the need to make my parents fork out an extra $6k. Though prices have come way down on even better implants, unless your patient is either rich or vain, it still might be hard to convince them to go for the better treatment.
 
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