Bridge Advice

[CShof]

My brother lost tooth #6 and the doctor recommended at minimum a 3 unit bridge (5-7) and at maximum a 7 unit bridge (5-11). This is the first tooth he's ever lost and understandably he's very hesitant to make such a drastic change. Being a denture tech I'm unfamiliar with the advantages and disadvantages between types of bridges. What is the consensus on a bridge like the following:
The DAL Monodont Bridge

 

[aidihra]

I've never made or been asked to make a Monodont bridge. Actually, this is the first time I've heard of it. Personally, I wouldn't want that in my mouth. I don't think it would last long enough. The pressures your brother would put on that tooth will be too much and he would probably end up swallowing it. A 3 unit bridge is much stronger, but there's another choice. He could get an implant with a crown on top which is generally a similar cost to a 3 unit bridge. Also, getting an implant would mean not having to trim the 2 teeth needed for supporting the 3 unit bridge.

 

[labdude]

I agree on the implant idea. Those can last a lifetime.

 

[DMC]

Winged Zirconia bridge would look great, but may get loose and need recementing. No prep! Just take your own impression.

My son has one we made. He was born without #7 (same as his grandma, usually skips a generation) Peg-Lateral is also common with us European-type folk.

Implant would be the ticket if money and mouth would allow it.

It'd be a shame to cut-up perfectly healthy tooth structure.

 

[magushnik]

i personally do mostly c & b work, aidihra has the right idea here, unless the dr see's a reason that his other teeth are going to be in trouble if he's reccomending a 7 unit, my guess is he wants more money with the 7 unit tho : ) it's a shame but ive seen it many times before. go with the implant!!!

 

[TheLabGuy]

Winged Zirconia bridge would look great
Implant would be the ticket if money and mouth would allow

AGREE, I'm curious though, why would he prep the other teeth? other than the money..........

 

[CShof]

Thank you everybody, the response time to questions is amazing on this forum.

Implant was the first thing I recommended to my brother. For some reason the doctor doesn't seem like he wants to go that route. I'm not sure if he is just uncomfortable doing implants or what. He would really like to do a 3 unit bridge. My brother is worried his bridge won't match his natural teeth, that's when the 7 unit bridge came into the conversation.

Of course in the meantime I made him a killer looking temporary partial, you couldn't even tell he was missing a tooth...and he lost it.

 

[labdude]

LOL

 

[magushnik]

he needs a new dentist

 

[kcdt]

GO WITH AN IMPLANT!!! A three unit bridge 5-7 is going to fail. The cuspid is key to anterior occlusion and takes some incredible forces. #7 is one of the weakest in the mouth and is NEVER considered suitable as a terminal bridge abutment. Turning the corner for 5 to 6 causes forces to be applied from at least two vector and is always considered risky. Go with the implant- its that important

 

[aidihra]

Thank you everybody, the response time to questions is amazing on this forum.

Implant was the first thing I recommended to my brother. For some reason the doctor doesn't seem like he wants to go that route. I'm not sure if he is just uncomfortable doing implants or what. He would really like to do a 3 unit bridge. My brother is worried his bridge won't match his natural teeth, that's when the 7 unit bridge came into the conversation.

Of course in the meantime I made him a killer looking temporary partial, you couldn't even tell he was missing a tooth...and he lost it.

You're probably right about the dentist, he may not have any experience with implants and therefore be uncomfortable with them. The dentist would have your brother see a surgeon to determine if he's a candidate for implants (if he's a heavy smoker he probably won't be). The surgeon may recommend to your brother another dentist with implant experience to continue the case (this has happened to a dentist I know). This could be a reason for a dentist not wanting to do implant cases (no money for him).

Too bad about the temp you made. Make another one with a darker shade and tell your brother that is the only one available.

 

[CloudPeakDL]

The limit on the implant may be a space problem, if they have to do surgery to raise the sinus cavity it would increase the cost greatly. I would consider a winged bridge know to me as a Maryland bridge, usually made from non precious alloys it is the most conservative restoration if an implant is not possible. I would would resist going with a conventional three unit if his adjacent teeth are virgin.
I agree with the Monodont bridge- it doesn't look like it is stable and just a matter of time before it gets swallowed.
Just my two cents.

 

[kcdt]

The amount of room for the implant may not be all that problematic. The cuspid has the longest root of any of the other teeth usually with plenty of bone to anchor it. I really have to warn against conventional bridgework here... it goes against all the principles Schillingburg lists in what is the classic textbook on fixed prostho. A Maryland type here would be strickly cosmetic and risky. We are dealing with THE key component of anterior occlusion;doing something that has risk doesn't just mean the bridge may fail- this could start to cascade into the failure of the rest of his dentition. Treating something in a manner likely to fail is flushing $ down the crapper.

 

[Synovio]

I dunno why #6 needs ta' be replaced..I mean, think of the useful oral space he has there..If he's a smoker, he can look cool wedgin' a Marlboro tween' #5 & 7. I might pull one a' my own canines so's I can look cool too. Add a black leather jacket an' a pair' a them cool gloves with no fingers,..cool sunglasses..ya - that's the way ta' get ladies..

 

[charles007]

Implant for sure with a really good dentist.........Seems like everyone does implants, but the implants I see,,,,,,, did I say find a good dentist !!!
Great ceramist might help also.....

 

[adamjhuathan]

Yeah I too, if that is only one tooth need to be replaced and fixed, I go for implant. It will cost a little bit but it can last long time and less maintenance.

 

[rmcmanus]

My brother lost tooth #6 and the doctor recommended at minimum a 3 unit bridge (5-7) and at maximum a 7 unit bridge (5-11). This is the first tooth he's ever lost and understandably he's very hesitant to make such a drastic change. Being a denture tech I'm unfamiliar with the advantages and disadvantages between types of bridges. What is the consensus on a bridge like the following:
The DAL Monodont Bridge

A max cuspid is frequently one of that last teeth to be lost. Why did he lose it and how old is he? The cuspids (and first bi's) are frequently lost because the root splits. Initially, a tooth is filled and then later breaks, A crown is made for the broken tooth and in a few years the tooth needs a root canal(which is done thru the crown) and then in a few years later the root splits and the tooth is extracted. The cause for ALL these problems is frequently the occlusion as the tooth/crown in lateral excursions get beat on till it's root splits. Just placing an implant and not seriously dealing with the occlusal proplem is a real concern as implant abutments break too. With these type problems if the occlusion on the first crown was correct the tooth probable never would have fractured to begin with.
Richard McManus

 

[kcdt]

A max cuspid is frequently one of that last teeth to be lost. Why did he lose it and how old is he? The cuspids (and first bi's) are frequently lost because the root splits. Initially, a tooth is filled and then later breaks, A crown is made for the broken tooth and in a few years the tooth needs a root canal(which is done thru the crown) and then in a few years later the root splits and the tooth is extracted. The cause for ALL these problems is frequently the occlusion as the tooth/crown in lateral excursions get beat on till it's root splits. Just placing an implant and not seriously dealing with the occlusal proplem is a real concern as implant abutments break too. With these type problems if the occlusion on the first crown was correct the tooth probable never would have fractured to begin with.
Richard McManus

That is a very valid point. Occlusion is the reason to replace it with an implant. Occlusion is the reason to diagnose the issue of the tooth's failure in the first place. Maybe bruxing? That would certainly complicate things.

 

[Wyolab]

Implants are the best option, you can floss them, the bone should maintain form and density, and you don't need to prep adjacent teeth to support a pontic.

 

[billydte]

agree with implant, just make damn sure you have a good surgeon that at least uses surgical guides and hopefully cone beams also. I'm dealing with a full mouth fixed implant restoration case now and this surgeon must have been drunk when he placed them. Its actually going to end up being a malpractice situation. I watched this patient loose 2 implants during a try-in visit Thursday. Bad situation.