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Maryland Bridge on Dental Work

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I am getting some dental work done. First, I need a tooth extracted that is between two teeth that already have dental implants. In addition, I’ve got a chipped front tooth. I am going to have dental bonding done to fix that and feel comfortable with that choice. What is worrying me is the missing tooth. Would a Maryland Bridge be able to bond to dental work?

Catherine

Dear Catherine,

Applying a Maryland Bridge

While the short answer is yes, there are complications in trying this. First, most dentists don’t understand the proper procedure for bonding a Maryland Bridge. They think it is simply a matter of grinding the adjacent teeth and bonding on the metal wings of the bridge to the teeth. This is not enough and will cause the bridge to dislodge too easily. Little grooves need to be added to the teeth to help secure the wings, as pictured above.

A second issue is that the wings of the bridge do not bond to porcelain as securely as they do to natural tooth structure. Bonding to porcelain is completely different than bonding to natural teeth and not many dentists understand this difference. This is an additional risk for your bridge.

The best thing would have been for your dentist, knowing that you’ve already lost the two adjacent teeth, to do some forward planning. Hopefully, your dentist thought ahead and placed your dental implants in a way that would make the abutments parallel and used screw retained crowns. This way when the tooth in the center is lost, he or she could just unscrew the crowns and attach a bridge to it.

If your dentist did not do that and you have enough room, a good solution would be to place a third dental implant between the other two.

The Most Important Decision Regarding Dental Bonding

before and after dental bonding

As for the repair to your front tooth. Dental bonding is a fantastic way to repair a chipped or gapped tooth. One thing to bear in mind is that this is an advanced dental procedure that has to be done freehand. If you want to make certain that you have a beautiful, natural looking result you will want to check that your dentist has advanced cosmetic dentistry training. This is especially important because it is a front tooth.

These are more exposed to the light and all the variations of your teeth are exposed. In your place, I would look for a dentist accredited by the American Academy of Cosmetic Dentistry (AACD). This is different from a simple membership. AACD accredited dentists passed stringent exams and have proven artistry. They will give you a result that blends both naturally and beautifully.

This blog is brought to you by Jenkinstown, PA Dentist Dr. Michael Weiss.

Which Dentist Should I Trust?

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I had a dental bridge that went across the front of my mouth. My two canine teeth were the anchor teeth. Then, those became too loose to support the bridge and had to be extracted. At the time, I was going to Comfort Dental. They suggested I replace those teeth with a partial denture. I wasn’t thrilled but did it. I found the partial to be remarkably uncomfortable. Now they are talking about placing mini implants for those teeth, which they said should last me ten years, as well as using a flexible partial for four teeth I am losing on my lower arch. I sort of lost confidence in them so went to get a second opinion. This left me totally confused because this dentist’s plan is totally different. He wants to do three full-sized dental implants that support a bridge. One that is in the center and two on either side of the bridge. He also thinks the bottom teeth need to be dental implants as well. This second option is obviously much more expensive. I’m trying to decide which is better. I’d save money with Comfort Dental, but am not sure I trust them. Do you have a recommendation as you have no skin in the game?

Braden

Dear Braden,

While it is more expensive, I defintely suggest you go with the plan from the second dentist for reasons I’ll explain in a moment. First, I want to talk about why you lost those canine teeth. Using those to support your bridge was a bad idea on the part of Comfort Dental. The twisting forces would lead to those teeth being lost, which is exactly what happened.

Looking at Comfort Dental’s plan, I would not hold out much hope for mini implants to last you ten years. They’re not really designed to do what they’re suggesting. But, let’s say by some miracle that they do last that long. What will you do after that? You can’t just replace dental implants, even mini implants. You have to replace the bone that was lost when they are removed. That means an additional surgery of bone grafting. Only then will you be able to replace them.

Cantilever Bridge Diagram

Let’s look at the engineering principles for the second dentist’s plan. Here you would still have your canines as anchor teeth, so why is this any less dangerous? It is because he is suggesting a third implant placed in the center (where your front teeth would be). How does that help? Because it stablizes the bridge in a way that eliminates the twisting forces that would damage the canine implants. Done this way, your dental implant supported bridge could last you the rest of your life.

What About the Bottom Teeth?

While you can often get away with a removable denture on your top arch because they are held in with suction, your bottom arch depends on the bone ridge to support the denture. The problem with that is the minute your teeth are removed, your body immediately begins resorbing the jawbone to use elsewhere in your body. This has the unfortunate consequence of slowly shrinking your jawbone. In about ten or so years, you will no longer have enough bone left to support a denture. This is known as facial collapse.

Placing dental implants prevents that from happening by having prosthetic roots in your teeth. This signals to your brain that there are still teeth to support and will leave your jawbone intact.

I hope this helps. This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Buying Dental Implant Parts Online

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I have snap on dentures and have recently hit a serious rough patch financially. I’m 53 years old and was laid off. It is challenging to find someone to hire a person at my age. In the meantime, I need new locater caps for my implant dentures. My dentist charges $25 for one. I noticed online I can get a set of 4 for $20. This is much more doable for me, however they only sell to dentists. Is there any way for me to get these? Money is so tight that I’m worried in a couple of months I won’t even be able to buy food.

Chris

Dear Chris,

Diagram of an affordable dental implant, which is a snap-on denture hovering above two dental implants in the lower anterior gums and bone.

Snap-on dentures

While I understand that dentists have overhead and, as a result of that, need to mark up the costs on some items. This particular item is such a small profit that I can’t imagine he would not be willing to work with you. Most dentists are compassionate and want to help people. This is why they went into their field. I would start by simply talking to your dentist. Tell him about your situation. My guess is he would be willing to sell them to you at cost. If he is not, you still have options.

Your second option would be to just call around to other dental clinics. It is usually the staff that orders these things with the dentists information, not the dentist himself. Tell them the problem and see if they’d be willing to add one for you to the order.

If that doesn’t work, then I noticed that eBay has these for sale from overseas sellers. You do not have to be a dentist to purchase them. The only downside to this is you need to know all the information on the technical aspects to get them. For instance, what strength and resistance is needed.

What are Sanp-on Dentures?

For those who are like, “What the heck are snap on dentures?” let me help you out. These are for patients who can’t afford a full grouping of dental implants in order to get implant overdentures, but want to keep their dentures secure while preserving at least a little bit of their bone. It works with two dental implants and then your denture is snapped onto the fixtures, holding them in place.

This blog is brought to you by Philadelphia Dentist Dr. Michael Weiss.

I Hate the Way My Implants Look

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Can you help me? I had dental implant overdentures done and when the bridges came in I was very disappointed in them. While they were very bright and white, they looked monochromatic, which in my opinion makes them look fake. They’re also bulkier than I would have expected and the surfaces of the teeth are very round and protruding. My dentist insists that they are up to the highest professional standards and I will get used to them. Is there anything I can do?

Andrea

Dear Andrea,

Woman covering her mouth

I am sorry this happened to you. It sounds like you went to a general dentist who does not understand the foundation of cosmetic work. Her saying it is up to the highest professional standards only refers to functionality. It has nothing to do with beauty of the results. When you are talking about your smile, beauty is an important factor.

The monochromatic look is very telling of your dentist’s cosmetic skill (or lack thereof). Our natural teeth are not uniform. The middle is more opaque than the remainder of the tooth. Plus there are grooves and other texture. All of this requires a high level of technical knowledge on the part of the dentist in order to properly convey instructions to the lab.

What you need is a true cosmetic dentist to re-do this dental bridge for your implant overdentures. At least the upper bridge. Look for someone who is AACD accredited. These are the top cosmetic dentists in the country. I don’t know that you will be able to get a refund from your current dentist on the upper bridge but you can certainly ask.

I hate it when a dentist says, “You just need to get used to it.” That’s dental speak for “I don’t know how to fix this so I’m just going to semi blame you for being too picky and whiny.”

It is unfortunate that your dentist did not care about how you felt about the smile she created you. Fortunately, a better cosmetic dentist can give you something stunning, that you will be proud to show for the remainder of your life.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Are there Soft Dentures?

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Do you know if it is possible to get soft dentures for the upper part? I have complete dentures, but the plate (I think that is what they call it) at the top is hard. Not only is that uncomfortable but sometimes the feeling makes me gag and I can’t even keep them in.

Daisy

Dear Daisy,

Dentures

I am sorry you are dealing with this. Many patients struggle with dentures. Not just with the upper plates, but with the food that gets under them, with the slipping and sliding, and with the difficulty chewing. There are some soft liners that will help patients that have a bony ridge where the lower denture sits. However, there isn’t a soft plate for a denture.

Implant Overdentures Solve this Problem

Illustration of dental implant overdentures

While that may sound disappointing, I do have a solution for you. Your best option is to have some dental implants placed and then have your dentures anchored to them. These are called implant overdentures. This eliminates the problem you have with the plate because the plate is unnecessary. You will find that not only do you not have to worry about the plate, but that your quality of life goes up tremendously. You will even be able to eat whatever you want again, including steak!

One of the most important benefits, however, is the protection to your jawbone. When your teeth were removed, your body began resorbing the minerals in your jawbone perceiving that they were no longer necessary to retain your teeth roots. After ten or so years, there will no longer be enough jawbone left to even retain the dentures you currently have. This is known as facial collapse.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

 

Why Won’t My Dentures Stay In?

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I am a smidge over 60 years old and have trouble keeping my dentures in, this is true even when I put in the adhesive. They still slip right out of my mouth. Is there anything I can do to keep them in at this point?

Matilda Lynn

Dear Matilda Lynn,

Illustration of dental implant overdentures

I am so sorry you are going through this. You are in a tough spot. However, the good news is that there is a solution for you. I don’t know if the dentist who originally provided the dentures for you had warned you about bone resorption. When your teeth are removed, your body recognizes that and begins resorbing the minerals in your body to use elsewhere. This slowly shrinks your jawbone. Eventually, you lose so much of the bone that you can no longer retain the dentures in your mouth. This is known as facial collapse and why your dentures will not stay in, even with adhesives.

The Solution to Facial Collapse

The first thing you’ll need to do is have bone grafting done. This will build up the missing bone in your jawbone. After this is healed, you have two options.

Your first option is to have new dentures made. Now, you’re only in your 60s, so you should be aware that the cycle of resorption will start over again. Eventually, you’ll be right back to the situation you are in now.

A second option is to get implant overdentures (pictured above). This uses between 4 – 8 dental implants per arch and then anchors a pair of dentures to them.

Benefits of Implant Overdentures

  • Because the implants are prosthetic tooth roots, your body interprets that as you still having teeth and you will no longer have to worry about losing your bone.
  • Your dentures will be completely secure. No more slipping and sliding.
  • You will find your quality of life increases, including your chewing capacity. Even the best-fitting dentures will lower your chewing capacity by 50%. With dental implants, you’ll be able to eat anything you want, including steak.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Can I Get Dental Implants Instead of Dentures

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I have to replace all my teeth and my dentist wants me to get dentures. I asked him if I can get dental implants instead, but he said because I previously had gum disease that is not possible. Is there any way around this? I really feel too young for dentures. I’m only 42 years old.

Paula

Dear Paula,

Illustration of dental implant overdentures

 

I am sorry you are having to go through this at your age. Before I answer your question I have one of my own. You said you previously had gum disease. Does that mean you have already undergone treatment and no longer have periodontal disease? If that is the case and you are otherwise in good general health then there really should not be a reason you could not have dental implants. If you currently have gum disease, you will need to deal with that first.

It is possible you will need to have some bone grafting done, depending on how much bone structure you lost during your period of gum disease. That can be done outpatient.

Dental implants are an advanced procedure and it really requires that a dentist has post-doctoral training. Often, when a dentist is telling a patient that they can’t have a procedure it is because they are not comfortable doing that procedure. Don’t pressure your dentist to do it, though. There are way too many dental implant horror stories from patients who had the procedure done by dentists without the necessary additional training.

Look for a dentist who has training at one of the following institutions:

  • The Las Vegas Institute for Advanced Dental Studies
  • Dawson Academy
  • The Kois Center

Why Dental Implants Are Important

When your teeth are removed, your body immediately begins to resorb the minerals in your jawbone in order to use those resources in other places in your body that may need them more. It does this because you no longer have any teeth roots there so there is no need for the bone to support the teeth. While an efficient way to manage your body’s resources, it has the unfortunate side effect of shrinking your jawbone. After around ten years, it will become difficult for you to keep your dentures in. Shortly after that, it will be impossible. This is known in dental circles as facial collapse.

At your young age, this would be devastating. Having dental implants placed causes your body to recognize there are still “roots” there for your teeth. Because of that it will leave your jawbone intact.

When you are talking about removing all of your teeth, it is common practice to get implant-supported dentures, also called implant overdentures. This uses between four to six dental implants and then anchors your dentures to them. That amount of dental implants will both secure your dentures and provide the protection you need from facial collapse.

One other word of caution. Make sure your dentist has the cosmetic skills to provide you with beautiful dentures. Look at their smile gallery to see what type of work they do.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Help! I Look Like Jim Carrey!

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This quarantine has almost destroyed me. First, I tried to cut my own bangs which were almost down to the tip of my nose. Then, the other night I had WAY too much to drink and tripped, which resulted in chipping my front tooth. I seriously look like Jim Carrey in Dumb and Dumber. Help! My dentist still isn’t open but tell me there is a solution for this once he is. For now, I’m just going to hide indoors and ignore the doorbell. No one can see me like this.

Stephanie

Dear Stephanie,

Jim Carrey in Dumb and Dumber

Jim Carry in Dumb and Dumber

For the benefit of those who may not know Jim Carrey or the role he played in Dumb and Dumber, I’ve posted a picture above. Don’t feel too bad. This quarantine has been hard on us all. There are more than a few bad haircuts in the grocery stores these days. You’re also not the only one to hit the wine bottle either.

While a dentist can’t do anything about the cereal bowl haircut, you can certainly get that tooth repaired. The first thing the dentist will want to do is make sure there is no underlying damage to the pulp of the tooth from the trauma. If everything is okay there, the standard repair for a chipped tooth is dental bonding. This uses a composite resin that the dentist will sculpt on your tooth to make the tooth whole again. This is done freehand, so you don’t want your average dentist to do it. Dental bonding takes experience and artistry to make it look natural.

Finding an Expert Cosmetic Dentist

before and after dental bonding to repair a chipped tooth

Your family dentist may also be an expert dentist. Just make sure before having him work on your tooth. The top cosmetic dentists are AACD accredited. This means they have passed stringent exams on the technical knowledge and procedural process in cosmetic work. In addition to that, they also had to submit visual evidence of a substantial number of cases they’ve personally done to be examined by a board of experts for the quality and beauty of their work. Any dentist who reaches accreditation is in the top 1% of cosmetic dentists in the country.

What if Your Dentist Isn’t Accredited?

Just because your dentist isn’t accredited, doesn’t mean he can’t do beautiful work. This is a process which takes many years and there are some artistic dentists out there who are still in that process. I would first look to see if he is listed on the mynewsmile.com website. If not, then your next step would be to ask for before and after images of dental bonding cases he’s personally done. Don’t settle for stock photos. If you are not absolutely thrilled with the results, don’ t let him near your smile.

Expert cosmetic dentists are used to having patients come to them just for the one procedure and then staying with their family dentist when that is through. There is no shame in that. He’ll understand and your dentist should understand as well.

I hope this helps. Try to keep away from the booze for a while, you don’t want to end up needing dental implants. Hopefully, this whole Coronavirus mess will be over with soon. I know dentists are ready to get back to work!

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Will Dentures be Ugly

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I’m losing my teeth. It’s too late to do anything about that, but I’m in a tough spot. I can’t yet afford dental implants, though I am saving up. I need teeth so told my dentist to go ahead and start the process for dentures. He told me I am going not going to be happy with dentures. I”m in tears. Does this mean my smile will be ugly? I know that’s better than no teeth, but I just want to be prepared.

Sylvia

Dear Sylvia,

The way your smile looks depends more on the cosmetic skills of your dentist more than it does on whether you get dentures or dental implants. In reality, when you lose all your teeth, what you get is implant-supported dentures. Your dentist would know that, so this tells me he meant something else when he told you that you wouldn’t be happy with dentures.

The Problem with Dentures

Two profile photos of a woman who experienced jawbone shrinkage and facial collapse, which can be prevented with implant overdentures, available from Philadelphia cosmetic dentist Dr. Michael Weiss.

The results in facial collapse

Even the best fitting dentures will reduce your chewing capacity by 50%. Additionally, there isn’t anything keeping them in so they will move around. The top arch is held in by suction, but also requires a plate to do that. Some people find that difficult to deal with. Those with a sensitive gag reflex find it almost impossible.

The bottom arch simply rests on top of the jawbone. Therein lies the biggest problem with dentures. When your teeth are removed, your body recognizes that. As a result, it begins to slowly resorb the minerals in your jawbone. This shrinks your jawbone. After around ten years, you no longer have enough jawbone left to support your denture. This is known as facial collapse.

If you place dental implants in your jawbone, the prosthetic roots signal to your brain that you need your jawbone to sustain the roots.

I do know you said you couldn’t afford dental implants. As you’re saving up for them, you should be fine. You could start with snap-on dentures which use as few as two dental implants and then work your way up to more. However, there are some options you can use for paying for this you may be unaware of.

Generally, the procedure is paid for in two installments. The first when you have the implants placed. The second, after a period of healing, when they place the dentures. In addition, most dentists are willing to work through Care Credit which is a medical payment plan. This can break up the payments even further for you.

Getting a Beautiful Smile with Dentures

before and after smile makeover

A case done by Dr. Weiss

A great cosmetic dentist can give you a beautiful smile, even with dentures. I would do your research on the dentist before deciding. Your family dentist may not be one who is capable of the artistry and skill necessary to give you a smile you’ll be proud of.

The top of the line cosmetic dentists are AACD accredited. You’ll want one who is also highly trained in dental implants. This way he can plan ahead for when you are able to get the implants you want.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Dentist Gave Me a “Wallace & Grommit” Smile

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I have a disastrous smile makeover. The closest way I can describe it is he’s given me a Wallace & Grommit smile. My front teeth are way too big and make it hard to even close my mouth all the way! He also provided a few mini implants for missing teeth in the back of my mouth. What do I do? It is so bad that my friends ask me if they made my dentures too big. I don’t have dentures! That’s how ridiculous I look. My dentist thinks it is fine. What do you recommend?

Monica

Dear Monica,

Image of Wallace & Grommit

I’m sorry this has happened to you. I’ve put a photo of Wallace & Grommit here for the sake of those who may be unfamiliar with the reference. I’m afraid we hear about these smile makeover disasters way too often. Most of the problem stems from dentists who are inexperienced in cosmetic work. While cosmetic dentistry isn’t a recognized specialty, it does require specialized training. Smile makeovers aren’t taught in dental school, so they have to invest the time and training to study the skills in a post-doctoral setting. Not all dentists have invested in the necessary training or could just be he’s just started out. We have all had our first few cases.

Generally, if the problem with your case is simply it doesn’t look good, you don’t have much recourse. You could appeal to the dentist’s sense of integrity in his work or get another cosmetic dentist on your side to appeal to the dentist’s sense of peer respect. Another option is to threaten to write a bad review.

That being said, you are in a better position. Your mouth doesn’t close. This causes serious problems to your dental health and would not be considered a clinically sound case. When your mouth doesn’t close, it leads to dry mouth. This means you are not producing enough saliva. Our saliva is a key factor in preventing cavities. It contains minerals and other properties that help fight the bacteria in our mouths. People with dry mouth suffer from decay and gum disease and a much higher rate than normal.

Getting Your Smile Makeover Fixed

Frankly, your case needs to be redone. This is actually good news for you. I don’t want your current dentist doing the work. I’m concerned about what I”m hearing from you. You need a better cosmetic dentist. So, before you ask for your refund, I want you to see a better cosmetic dentist, preferably an AACD accredited dentist. While you are there, ask them to look at your implants too. I don’t like hearing he put mini implants in. While they are fine to help with securing a denture, they are not a good option for a single dental crown. For that, you would need a full-sized dental implant.

If your second opinion dentist thinks they are fine, then you can simply get a refund on the other work. If he thinks you’ve had the wrong tooth replacement then you will want to get a refund on both. Plus, have him pay the additional cost of the bone grafting which would be necessary to do the replacement.

You then have your second opinion dentist do the work or get another dentist.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.