Clinical Question: Removing a Bridge

[FreshBreath]

I was curious to know what was the best way to remove a 3unit bridge (LR) with a double abutment? Obviously, I know extraction is the end result, but before the extraction does not one section through the pontic? What about the double abutment? What burs work best? Your response would be appreciated.

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[aphistis]

I was curious to know what was the best way to remove a 3unit bridge (LR) with a double abutment? Obviously, I know extraction is the end result, but before the extraction does not one section through the pontic? What about the double abutment? What burs work best? Your response would be appreciated.

A double abutment 3-unit bridge? You're saying it's cantilevered?

 

[JavadiCavity]

A double abutment 3-unit bridge? You're saying it's cantilevered?

Yeah, this sounds odd.

 

[Frank Cavitation]

Has the crown-tapping tool failed? I would try to knock the bridge loose first before grabbing the drill.

 

[FreshBreath]

A double abutment 3-unit bridge? You're saying it's cantilevered?

I guess I should be more descriptive, than maybe I can get more help. The 3 Unit bridge is from # 29X31, thus where # 30 is the ponitc. # 28 is also crowned and it is attached to # 29. The problem is # 29 has fractured and needs to be extracted, and # 30 is compromised with decay, thus causing the removal of the bridge. I know I can go through the pontic, but with what, and in addition, what about the joint between #28 and # 29. We are placing a lower transitional partial denture to replace the distal extension. Sorry for the confusion earlier.

 

[DrJeff]

Section between 28 + 29 first. Very, Very often, just putting a forcep on the then remaining bridge (forcep on the pontic) and giving a little bit of luxation will be enough to seperate the bridge from 29 and 31 without having to section the bridge there.

A little bit of force with a forcep is very often no match for any dental cement out there!

 

[drem2006]

The crown-tapping tool is probably the easiest. If you don't have one of those, you probably have to cut it off. If you are extracting the fractured tooth, just section the bridge at the attachment, don't worry about getting the crown off that one.
For the other abuttments, use a diamond or great white to get through the porcelain. Carbides wear out really fast if you use them on porcelain. Once you get to the metal, use a carbide. then you should be able to use a crown spreader to get the pieces off.

 

[scalpel2008]

Section between 28 + 29 first. Very, Very often, just putting a forcep on the then remaining bridge (forcep on the pontic) and giving a little bit of luxation will be enough to seperate the bridge from 29 and 31 without having to section the bridge there.

A little bit of force with a forcep is very often no match for any dental cement out there!

i agree with dr jeff. In this case you are saving #28 and want to leave it crowned. OMS always appreciates it when extractions involving bridges are sectioned in the right spots because we usually don't have the equipment to do that. Then I usually pop the bridge off with cold stainless steel (no need to section at the pontic), extract 29 and 31, and send the pt back to the general dentist to smooth off the rough edges on crown #28.

 

[DrJeff]

i agree with dr jeff. In this case you are saving #28 and want to leave it crowned. OMS always appreciates it when extractions involving bridges are sectioned in the right spots because we usually don't have the equipment to do that. Then I usually pop the bridge off with cold stainless steel (no need to section at the pontic), extract 29 and 31, and send the pt back to the general dentist to smooth off the rough edges on crown #28.

Oh come on, you OMS guys have such fine control over a big old bone-cutting fissure bur in a Stryker to leave a nice, smooth post cut surface when sectioning a bridge😉 😀 🙄

 

[scalpel2008]

Oh come on, you OMS guys have such fine control over a big old bone-cutting fissure bur in a Stryker to leave a nice, smooth post cut surface when sectioning a bridge😉 😀 🙄

I can honestly say it's easier for me to harvest a big chunk of a hip graft with a reciprocating saw than it is to section a bridge with my Stryker handpiece with a #703 fissure bur. The restorative dentist in me afraid the abutment crown will pop off and i don't remember how to mix cement.