Question about bridges...

[Ypo.]

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[DrTacoElf]

I have several missing teeth and have heard from numerous people that when getting a bridge, the dentist will grind down the teeth next to the gap. I was told this is done so that the crown can be fit and the bridge attached. But I have heard that this can cause the teeth next to the gap to wear down and need to be replaced...

I have weak teeth already, and so I was considering getting implants instead of a bridge. But I have a new dentist now and he says that getting a crown/bridge will not wear down the teeth next to the gap. In fact he seemed pretty irritated that somehow I had gotten that idea...

I have heard conflicting reports, so now I'm not sure what to believe! The truth is I don't have dental insurance and won't be able to afford to replace the missing teeth for at least five years, so in the meantime I am wearing a retainer at night to prevent the teeth from slipping out of place, and trying to take really good care of my teeth by flossing and brushing everyday.

So, bridge or implants? Advice would be much appreciated! Thanks

What teeth are missing and how many? No doubt implants are better in most cases but its nearly a year long process to complete (including healing time). For any fixed bridge the adjacent teeth have to be prepped in order to attach to. This isn't totally desireable because its never good to grind down virgin tooth structure.

 

[ItsGavinC]

Implants are probably ideal, but if your current dentist is recommending a bridge, then that might be the best choice for your current situation.

 

[Fullosseousflap]

Gotta see the radiographs and clinical photos first!

then.......OPINION!

 

[toofache32]

Implants are probably ideal, but if your current dentist is recommending a bridge, then that might be the best choice for your current situation.

...unless he's an old-timer and doesn't do implants. He may want to keep you in his practice by giving you what he can do.

Also, if implants fail you still have the option of the good ol' bridge as a backup. But if the bridge fails, you have committed the 2 adjacent teeth to crowns forever (hopefully).

 

[Fullosseousflap]

OK, I'm not really asking for a diagnosis/treatment plan here.

***What I'm trying to ask is---Does the process of putting a bridge in (ie-grinding down the teeth on either side of the gap) cause those teeth to wear down and need to be replaced later on? *** It would seem like grinding them down would weaken the tooth structure.

I have seen fixed brdiges last over 40 years with no detriment to the abutment teeth.

It really depends upon the case.

 

[lnn2]

OK, I'm not really asking for a diagnosis/treatment plan here.

***What I'm trying to ask is---Does the process of putting a bridge in (ie-grinding down the teeth on either side of the gap) cause those teeth to wear down and need to be replaced later on? *** It would seem like grinding them down would weaken the tooth structure.

the answers are No and No when it's done properly and good oral hygiene from the patient!

If you are a candidate for implant and money is not a problem then implants are the best option. Go get a second opinion from a Periodontic or an Oral surgeon to see whether you're a good candidate for implant. Keep in mind that implant takes a minimum of 4-6 months, maybe longer.

...unless he's an old-timer and doesn't do implants. He may want to keep you in his practice by giving you what he can do.

Also, if implants fail you still have the option of the good ol' bridge as a backup. But if the bridge fails, you have committed the 2 adjacent teeth to crowns forever (hopefully).

I agree
Some of these old farts don't even mention implant option to the patients or refer out for implant.

 

[Fullosseousflap]

the answers are No and No when it's done properly and good oral hygiene from the patient!

If you are a candidate for implant and money is not a problem then implants are the best option. Go get a second opinion from a Periodontic or an Oral surgeon to see whether you're a good candidate for implant. Keep in mind that implant takes a minimum of 4-6 months, maybe longer.



I agree
Some of these old farts don't even mention implant option to the patients or refer out for implant.

Most of the old farts I know, including myself, do the implant surgery as well as the prosthetics.

No mystery in most routine implant placements requiring an oral surgeon or perioodontist.

However, in the real world, not all abutments are ideal and fixed bridges work well and can be successful for a long long time.

 

[Ypo.]

It really depends upon the case.

But does it depend more on the diligence of the patient in caring for their teeth, or does it depend on genes?

I mean, I have $hitty, weak, danish teeth that are prone to cavities, but I brush and floss, and see the dentist regularly. given my crappy teeth, I really don't want to do anything to compromise the intergrity of the few remaining teeth that I have!

Sheesh-at this rate I'll be toofless by the time I'm 40.

 

[lnn2]

Most of the old farts I know, including myself, do the implant surgery as well as the prosthetics.

No mystery in most routine implant placements requiring an oral surgeon or perioodontist.

However, in the real world, not all abutments are ideal and fixed bridges work well and can be successful for a long long time.

I agree that you don't need a specialist to place an implant. What you need is an EXPERIENCED and SKILLED dentist for the proper tx and placing the implant.

There's no doubt that fixed bridges can be successful for a long long time but implant has many advantages when comparing to a fixed bridge.

 

[Fullosseousflap]

But does it depend more on the diligence of the patient in caring for their teeth, or does it depend on genes?

I mean, I have $hitty, weak, danish teeth that are prone to cavities, but I brush and floss, and see the dentist regularly. given my crappy teeth, I really don't want to do anything to compromise the intergrity of the few remaining teeth that I have!

Sheesh-at this rate I'll be toofless by the time I'm 40.

Then it sounds like implants may be the best fit for you.

 

[Fullosseousflap]

I agree that you don't need a specialist to place an implant. What you need is an EXPERIENCED and SKILLED dentist for the proper tx and placing the implant.

There's no doubt that fixed bridges can be successful for a long long time but implant has many advantages when comparing to a fixed bridge.

Agreed!

Yes, but it depends upon the case.

 

[cosmo]

My advice is not coming from a dental professional, but rather a dental patient. If you get a bridge, ensure you go to someone who is experienced in doing bridges. When I had mine done, I was my dentist's first bridge out of dental school. I was in the Air Force at the time so I had no options-it was either her or no bridge. I would have been better off with no bridge. She didn't adequately prepare my surrounding teeth and as a result my bridge was way too big. After a year of ear pain, trips to get adjustments, referrals to allergy and ENT for mystery symptoms, it was finally determined that my bridge was too big. They had to pry the damn thing off and do crown lengthening surgery and make me a new one. The second one was done by a prosthodontist and fits much better. But in that year I developed a teeth grinding problem and TMJ disorder, which I now get a VA disability for. If I could do it again, I would either go with an implant or nothing at all. If you do go for the bridge, MAKE SURE you aren't someone's guinea pig.
Good Luck.

 

[lnn2]

Agreed!

Yes, but it depends upon the case.

Of course, everything depends upon the particular case One size does not fit all.
Fixed and implant might not be an option. It might turn out that the guy needs complete dentures all along but he just doesn't know about it yet!

 

[Fullosseousflap]

Of course, everything depends upon the particular case One size does not fit all.
Fixed and implant might not be an option. It might turn out that the guy needs complete dentures all along but he just doesn't know about it yet!

This is correct..... the 150/1 comes in different sizes and grips!

 

[DcS]

Rather than get into a discussion of implants versus FPDs, I will attempt to answer your question about the bridge weakening adjacent teeth. It is true that if you do opt for the bridge, the teeth that will be the abutments for the bridge (the teeth next to the gap that will be the support) will have structure removed to be able to fit a crown on it. Now concerning your question about its effect on the strength of those teeth, it depends. If those teeth on either side of the gap are virgin teeth with no decay or fillings, then getting a crown put on certainly does weaken the tooth. After all, you are removing healthy tooth structure to put a crown on, inherently making that tooth weaker. If, on the other hand, the teeth on either side have big fillings and my need crowns down the line (as you seem to indicate), then removing those old fillings for the placement of a crown may actually strengthen those teeth. Especially if it's treatment you may need down the line.

Bridges have pros and cons...if the teeth around it need crowns anyways, I think it is a good treatment option. Keep in mind, though, that since that bridge depends on the health of the teeth next to it, you need meticulous oral hygiene of those crowns to keep them healthy. Since they are on a vital tooth, it is susceptible to decay, in which case the bridge will fail. There are many bridges, though, that can last 10 years +.

On the other hand, implants can be a great alternative. There are several benefits from implants that you do not have with a bridge. First off, the titanium implant placed in your jaw will actually maintain the bone height for it's lifetime. With a bridge, unfortunately the bone underneath the spaces where there are no teeth (the pontics) will resorb over time. In addition, since implants are no susceptible to decay, they will last a long, long time. The most likely thing to happen is have the crown on top fracture, but that only needs replacement with a new crown. On the downside, implants cost more than bridges and there is a surgery involved, with more risk. That extra cost might be less in the end if you are looking at new bridges/crowns down the line.


I hope this helped answer your question. Many times on SDN people neglect to answer the orginal posters' questions in an attempt to get into a pissing match to see who knows more. If you have any more questions, let us know.

 

[Ypo.]

Rather than get into a discussion of implants versus FPDs, I will attempt to answer your question about the bridge weakening adjacent teeth. It is true that if you do opt for the bridge, the teeth that will be the abutments for the bridge (the teeth next to the gap that will be the support) will have structure removed to be able to fit a crown on it. Now concerning your question about its effect on the strength of those teeth, it depends. If those teeth on either side of the gap are virgin teeth with no decay or fillings, then getting a crown put on certainly does weaken the tooth. After all, you are removing healthy tooth structure to put a crown on, inherently making that tooth weaker. If, on the other hand, the teeth on either side have big fillings and my need crowns down the line (as you seem to indicate), then removing those old fillings for the placement of a crown may actually strengthen those teeth. Especially if it's treatment you may need down the line.

Bridges have pros and cons...if the teeth around it need crowns anyways, I think it is a good treatment option. Keep in mind, though, that since that bridge depends on the health of the teeth next to it, you need meticulous oral hygiene of those crowns to keep them healthy. Since they are on a vital tooth, it is susceptible to decay, in which case the bridge will fail. There are many bridges, though, that can last 10 years +.

On the other hand, implants can be a great alternative. There are several benefits from implants that you do not have with a bridge. First off, the titanium implant placed in your jaw will actually maintain the bone height for it's lifetime. With a bridge, unfortunately the bone underneath the spaces where there are no teeth (the pontics) will resorb over time. In addition, since implants are no susceptible to decay, they will last a long, long time. The most likely thing to happen is have the crown on top fracture, but that only needs replacement with a new crown. On the downside, implants cost more than bridges and there is a surgery involved, with more risk. That extra cost might be less in the end if you are looking at new bridges/crowns down the line.


I hope this helped answer your question. Many times on SDN people neglect to answer the orginal posters' questions in an attempt to get into a pissing match to see who knows more. If you have any more questions, let us know.

Thank you!!!

Well, that does answer my question, I really appreciate it.

What I am going to do is wait about five years before getting a bridge/implant. In five years I will be through medical school, and should be able to afford to replace the missing teeth. Right now I can't afford either alternative, so I will just keep wearing my retainer and brushing/flossing. It is true that some of my teeth have had cavities, some of them substantial size, so in five years if I need a crown anyways, I will probably opt for the bridge. But if the teeth are still in good shape (relatively) then I will opt for the implant. I'm only 26 but my dentist says I have lost much more bone than I should have for my age, so the fact that implants will retain bone sounds good. My teeth are so prone to cavities even though I take good care of them, I have a feeling that taking care of them with crowns over them is going to be even harder, plus the last thing I need is to lose more bone!

Actually, one thing I wonder about is whether or not I have substantial bone for an implant-that would be something to take up with my dentist. But, I'm told that they put a surgical post in first, and then wait to see if it takes up or gets rejected. So does anyone know...If it gets rejected would I then be out of thousands of dollars?? in other words, it seems like a gamble with your money -whether or not the procedure will work...

Thanks again for all the help.

 

[DcS]

Thank you!!!



Actually, one thing I wonder about is whether or not I have substantial bone for an implant-that would be something to take up with my dentist. But, I'm told that they put a surgical post in first, and then wait to see if it takes up or gets rejected. So does anyone know...If it gets rejected would I then be out of thousands of dollars?? in other words, it seems like a gamble with your money -whether or not the procedure will work...

Thanks again for all the help.

If there was not adequate bone available they can and should graft bone for the implant. There is always the possibility of the implant (you refer to it as a post) not integrating but if the DDS does his legwork and initial workup, plans carefully etc they have a very high success rate >94%. One relative contraindication is if you are a smoker, in which case the failure rate is a little higher.

 

[Ypo.]

Thanks again.