Q: I am a thirty-five-year-old man who has led a very active life as a child, teenager and adult. I'm interested in and play most sports.
Five years ago I lost four front teeth playing hockey when I caught a stick fighting for a puck behind the net. They tried to save the teeth but they were too badly broken so they had to come out. At that time I decided to go with a removable partial because I didn't want to spend a lot of money only to have an expensive bridge knocked out.
I've decided recently to spend more time as mentor and coach to my three boys and one daughter-so it's time to get my teeth fixed. I know about the fixed bridge option but I have enough bone for implants. My dentist said that two implants would do to make an implant bridge and that would be best because the teeth on each side of my gap have no fillings. When I asked about replacing each tooth with an implant and a crown he said it wasn't necessary.
What would you advise? By the way I lost my upper right eye tooth and three other front teeth beside it, only my left lateral front tooth and the eye tooth remain.
A: You are fortunate to have retained good bone volume. Accidents like yours often cause severe bone loss. I would recommend you not do a conventional bridge. The eye tooth takes tremendous force in the mouth. If you do a conventional bridge using your own teeth as the anchor teeth you not only cut down natural teeth but you will have to (most likely) use two bicuspids (teeth behind the eye tooth) on the right side and your lateral incisor and left eye tooth in order to have enough strength for stability and longevity. The roots on most bicuspids and lateral incisors are not strong enough to take the forces generated at your right eye tooth location so in time the bridge will fail.
Placing an implant in the right eye tooth position and one in the left central incisor position to create a bridge would work. You would get great service from it. Because this area of your mouth is in the esthetic zone of your smile over time the bridge might appear less esthetic because your underlying bone will shrink.
The strongest and most esthetic option is four implants and four crowns. It is the most expensive but it will prevent bone shrinkage and you will develop papilla (gum between the teeth) which will give you a natural look.
Strength, beauty, preservation of bone makes this the best option. Use of what you've got today to prevent loss tomorrow.