I have a three unit bridge with short rooted but not mobile crowned abutment teeth. I would like an implant in the pontic area but I want to minimize messing with these delicate abutment teeth and avoid the recrowning process. The bridge is porcelain. It is not about the money it is about minimizing risks. The abutment teeth may make it to be replaced by bioteeth if i minimize risks (10-15 years)!!! These teeth are in the front. A bone graft will be required in pontic area. Thanks
Is It Possible to Save Crowns on a Bridge to Make Room for an Implant?
Doctor Answers 9
Saving Abutment Teeth On A 3 Unit Bridge
I have sectioned bridges successfully numerous times in order to place an implant. There is always the potential of fracturing the porcelain when sectioning the bridge, therefore you should be prepared to replace those abutment teeth with crowns if needed. Good luck.
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Implant vs. bridge
This is a common question. An implant placed into a space left by an extracted tooth can be the least invasive option because the bridge option requires preparation of the teeth on either side of the space. If the proximal teeth already have been restored with old crowns or large restorations, the bridge may be a better option.
Replace bridge with implant
You don't mention whether you are a good candidate for an implant. What is the bone level around the abutments? Would they function well on their own after being splinted by a bridge? What's wrong with your current bridge? Yes, the bridge can be sectioned leaving the abutments intact, but there is always a chance that the porcelain on the abutments would be damaged during the sectioning process.
My advice is if the bridge looks good and funcions well... IF IT AIN'T BROKE, DON'T FIX IT
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Saving abutment crowns
If you want to get an implant in the pontic area of present bridge you need to find a restorative specialist - prosthodontist who will evaluate your over all dental situation and will advise you the best what suites your needs. Maybe there is a good reason why your dentist who fabricated a bridge did not offered you and implant because he/she wanted to minimize risks for you, as you are mentioning. If your only complain about your bridge is that abutment teeth are short rooted, I would highly recommend to get an opinion of specialist who will discuss pros and cons of leaving a perfectly fine bridge vs. sectioning ceramic bridge( high risk of fracture), undergoing bone grafting procedure (success and failure rates, time and financial involvement) and finally going through implant placement, osseointegration, restoration. Managing anterior esthetic case can be challenging sometimes and it is very important to find a doctor who has knowledge and skills to do that. I wish you all the best!
Yes it is possible to save crowns on a bridge
I agree with your thought process that the less you do the less that can potentially go wrong. As an added benefit it should be less costly.
There are some "ifs" . If the color and shape of the two abutment crowns are what you want, if you don't mind wearing a removable appliance during the healing phase, and if the bridge pontic can be cut off without damaging the porcelain and without exposing any metal substructure that may be visible; then I would recommend to do this. It will be slighly more difficult to match the color when it comes time to do the implant crown. I have done this several times and it works out very nice.
The removable appliance should be an Essex appliance. This will not put pressure on the healing site. Once the area heals it can be changed out to a more conventional "flipper" or transitional partial denture until the implant is ready to be loaded with the implant abutment and temporary crown.
From a restorative point of view and a convenience point of view, cutting off the whole bridge and placing a long-term temp bridge will be more convenient because you will avoid the removable appliances and the three crowns can be made together for better match.
Make sure the proper bone and gum grafting is done by the surgeon so that the proper soft tissue contours are achieved. Otherwise it may not look natural.
Implant around bridge?
The shor answer is yes. The dentist will section the bridge remove the pontic and then place an implant; however the risk is when cutting the pontic our the porcelain can fracture and a new bridge will be needed. Please keep in mind most dentist remove old crowns everyday and should provide no danger to the teeth underneath these crowns. If you were a family member I would redo the crowns and place the implant better result good luck
Kevin Coughlin DMD, MBA, MAGD CEO Baystate Dental PC
Using abutment teeth in a 3 unit bridge.
You obviously know your dentistry. The pontic can be cut thus maintaining the integrity of the abutment teeth. The problem is that it may be hard to match the colour of the eventual implant crown. In the back of the mouth this would be a reasonable plan, in the front it may be an aesthetic compromise.... good news is that if it proves to be difficult aesthetically there is always the option of 2 new crowns.
Save Crowns and Make Room for a Dental Implant
Dental implants in the front of the mouth can be very challenging to get the ideal cosmetic result! Beware of the aesthetic risk. If you, your implant dentist and your general dentist are up for the challenge, I would recommend the following. First, seriously consider the prognosis of all the adjacent teeth. If the abutment teeth to the bridge are short without mobility they should have a good prognosis. Remove the bridge and replace with a long-term temporary bridge for the duration of the dental implant procedure. This temporary bridge can be removed by your implant dentist to do the bone graft and the dental implant and re-cement it afterwards. You will never be without your tooth and you wont have anything removable. You definitely do not want any removable temporary devices which touch the gums near the bone graft... that is very important. Then once the bone and implant are healed, your restoring dentist can replace the temporary bridge with two individual crowns on the natural abutment teeth and one dental implant crown on the implant. These crowns should not be difficult to make look good but the concern is the gum tissue contours. This is were you could be disappointed depending on what bone and soft tissue is available at this time. Your smile line is also very important. If you show a lot of gum when you smile, this will be much more of an issue. Continue to ask a lot of questions and be we educated going into the procedure.
Dr. Hank Michael - Dentist in Sarasota