Dr. Jay Goldstein's Blog

I had a bridge replacing one tooth, and it had two more teeth attached. This was done in 2004. In 2007 it came off and my dentist recemented it. Now, in July 2009, it has come off again but he has told me that the tooth that has the crown is dead and I have to surgically have it removed because it is brittle.

Did the crown cause this? What do I do with three teeth missing now? He suggested implants. What do you suggest? HELP. It is very noticeable when I smile.
- Debbie from Wisconsin

Debbie,
If you take good care of a dental bridge, it should last for many years. Five years is a minimum standard set by many insurance companies – if it doesn’t last for five years, they won’t pay any benefits on its replacement. I’m wondering why the bridge came loose after only three years, and why now, after only five years in service it appears to have failed.

I think a second opinion would be a good idea.

But your case illustrates one of the advantages of replacing missing teeth with dental implants. When you have a bridge, there are three teeth involved. If there is any problem with the bridge, you have to re-treat all three teeth. With a dental implant, you don’t touch the adjacent teeth, and the maintenance and long-term care is simpler.

I am 55 years old. I had the upper right (next to last tooth) molar removed due to multiple cracks in the tooth. The missing tooth is not noticeable as it is so far back but I’m concerned about the shifting of my upper teeth. I have perfectly straight teeth at this time. None of the tooth replacement options seem ideal to me. What would be your recommendation?
- Denise from Pennsylvania

Dear Denise,
You’re smart to be concerned about the possible shifting of your teeth, because this is a serious issue, especially if you are missing a first molar (that’s the tooth that is second from the back in most people). The teeth on either side tip into the space and the tooth below usually drifts upward some, and it can really mess up your bite. It can cause TMJ disorder and muscle spasms in your chewing muscles because your bite which is supposed to be harmonious doesn’t mesh properly any more. In addition, it can promote loss down the road of the tipped teeth, which are now subject to unnatural stresses. It’s important to get a missing molar replaced before these teeth start to move, which occurs in a matter of weeks.

Of the two replacement options, having a dental implant is the nearest thing to having your own tooth back. The drawback of that is that it is a surgical treatment. But if the teeth next to the missing tooth have large restorations, it would make sense to do a dental bridge, since that will put dental crowns on those teeth, which may be close to needing crowns already anyway.

The most unattractive option is doing nothing, because that could lead to serious other problems down the road.

Dr. Goldstein,
I am missing both my lateral incisors. Right now I have a retainer with two fake teeth on it. I wanted to get Lumineers but I don’t know if I can with this retainer. I want the Lumineers to make my smile more full and warm.

- Amanda in New York

Amanda,
Lumineers won’t really work if you have missing teeth – they only work to cover existing teeth. But the good news is that you have a couple of other options, depending on what you want to accomplish.

If you want to change the shape of your existing teeth, then what would probably be best is to have a couple of dental bridges to replace the missing teeth. A dental bridge involves full crowns covering the two teeth adjacent to each missing tooth. If the missing teeth are the lateral incisors, that would mean you would have crowns on both central incisors, the lateral incisors would be false teeth, and the canines would both be crowns. So you would have a whole new smile.

But if you like how the other teeth look and you just want to replace the missing ones so that they blend in with the others, then your best bet would probably be dental implants. That is much more conservative, because nothing would have to be done to your other teeth.

With either treatment, I would recommend teeth whitening first or your remaining teeth, so that you can have the brightest and loveliest smile possible. Then match the new dental work to the new, whiter color. But be sure you go to an excellent cosmetic dentist who is really artistic. Most dentists aren’t really that artistic.

Dr. Goldstein,
Is a 4-tooth bridge or a partial denture for the upper molars better? Which is less costly? What is the least expensive type of cap or crown available that won’t be seem?
- Judy from Illinois

Judy,
You would need a four-tooth dental bridge if you have two missing teeth, side-by-side. In a situation like this, a bridge would be better than a partial denture, and here is why:

The full name would be a “removable partial denture.” This is where false teeth are fastened to a plate, which is then clasped to your teeth. Not only can this be uncomfortable, but if you don’t take great pains to clean them after every time you eat, it can easily promote decay on the spots where the partial attaches.

But you left out the option that I think is really the best, and that is dental implants. Especially if you have two missing teeth side-by-side, the bridge has a drawback in that it now places all the stress for four teeth onto the two teeth that the bridge is attached to. But if you have dental implants, there is no grinding away of those adjacent teeth, and no extra stress put on them. And the implants will require less maintenance and probably a lower risk of failure or complications down the road.

Cost is another issue. Depending on your dentist, the fee for the dental implants and for the bridge are going to be close to the same, or the implants may be somewhat higher. The removable partial will be much cheaper, at least in the short run. It will probably be around half or even one-quarter of the cost of the other options. Of course, if the teeth that are clasped are eventually damaged and then you lose those or need to have them crowned, the removable partial could be the most expensive option in the long run.

Related information:
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