To Bridge or Implant?
Q: I have a beautiful daughter, she’s twenty-one. When her permanent teeth were coming in as a child, we found that she was not going to get the upper lateral incisors (the ones just beside her front teeth). Our dentist said when the rest of her teeth came in, she should have braces. One idea was to move her eye teeth into these spaces, but we didn’t want her to have fangs beside her two front teeth. We chose the route where the teeth were straightened and gaps for those laterals were created for future teeth to be put in. This was done as a teenager and then when the orthodontist said the spaces were adequate for the teeth to be put in, we took a temporary measure and had filler teeth bonded in place to the teeth on each side. She’s worn these for six years and they’ve been okay. Now it’s time to put permanent teeth in place and we have been told the space is right for implants. We got a good opinion after having x-rays and models taken of her teeth. We found, however, that the bone thickness is really not adequate and must be augmented before or at the time of implant surgery. We also found her bite doesn’t really mesh properly. When her joints are in their correct relationship, her teeth don’t fully mesh. We also discovered that her front teeth aren’t as long as they should be and aren’t working as front teeth are supposed to work, protecting and guiding her bite. We didn’t know any of this but that explains why she was always breaking her bonded bridges. We didn’t know that, because of her bite, her teeth came forward and broke the bridges repeatedly. It was frustrating to say the least. We have several options; all include correcting the bite and getting front teeth properly aligned. Do we go with regular bridges that are permanent or do we go with implants?
A: Bridges or implants – that is a popular query. If the bite is in good balance, it may come to these factors. Are the teeth on either side of the space virgin – meaning they’ve had no decay or fillings? If they’re virgin teeth on either side, I recommend implants. Having said that, her teeth have already been reshaped by the bonding of the special temporary bridge. In that case, filling those spaces with conventional bridgework will protect her teeth and make a pleasing appearance as well as help with the bite. When individuals don’t want bridges, implants are the answer but the altered teeth in all likelihood will need crowns for protection and functional reasons. In conclusion, care must be taken in the total treatment to ensure harmony between her bite and the related chewing muscles and joints. Unhappy joints and muscles because of bite imbalance will lead to future pain and ultimate breakdown of the bridgework or implant restorations.
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Based on actual patient cases
© Calvin Ross Crapo
Victoria Implant Centre 778-410-2080