Is it possible to save crowns on a bridge to make room for an implant?

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.

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.

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!

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.

Good luck

Dr. T

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