Q: Many years ago, I lost my upper left eye tooth in an accident. I was in may late twenties and they gave me a flipper partial. It was there for appearance only and was a nuisance if I tried to eat with it in because it would get food under it and feel gross. Some years later I got a bridge that was attached to the lateral incisor (the tooth beside my left front tooth) and the first bicuspid (the tooth that sits behind the eyetooth). For about twenty years it worked well. Then both teeth got abscesses and needed root canals.
Fortunately, the bridge was still OK after the root canals. It worked for another ten years up to this past year when all of a sudden while chewing I heard a crack and the whole thing broke out. I saw my dentist and he said, after taking x-rays, that the roots, holding the bridge were a lost cause so out they came and he gave me a partial denture. I hate it and it doesn’t look natural.
Things have healed well but when I asked about another bridge I was told it might not be strong enough. When I asked about implants I was told there wasn’t enough bone. I think they said the bone where the roots were taken out had collapsed and there was just three and a half millimeters whatever that means. I really can’t live with this partial. Is that all there is? I like to smile--it’s just who I am--but not now! Advise please.
A: I must say your bridge gave you good service. I say that because this area takes stressful forces during chewing and grinding.
When teeth are removed, bone should be placed in the sockets so that the bone width is not compromised. (It is especially important in the area of the mouth you’ve described). Later when bridging or implant placement is considered the underlying bone is stable and wide enough for either service.
At this point it is probably possible to make another fixed bridge but anchoring on either side of the now large gap will require two teeth per side. This means both upper front teeth and a bicuspid and a molar.
As far as implants are concerned, if you have three and a half millimeters, that generally means boney width, you need six millimeters. There are two ways this can be accomplished. The first is to add bone to the existing bone thus creating the right width. The second is to “stretch” the bone at time of implant placement. If the bone meets the requirement for expansion this technique will allow faster healing and thus a shorter period to new fixed teeth.
Based on actual patient cases
Calvin Ross Crapo
Victoria Implant Centre