Expert: Lawrence Spindel DDS, www.lspindeldds.com - 11/18/2008

Question
I have had extensive work in my mouth in my 39 years and am quite tired of it.  If my father had not been a dentist, I would probably be in the poor house now.  So being that my dad was a dentist and I worked for him for a number of years, I do know what I'm talking about a little.  I am speaking about the maxillary jaw only.  #1 is gone, #2 has had a MOD restoration with amalgam and should probably have had a root canal - it has no crown but is all silver. #3 has has a root canal and has an old stand out "opaque" looking porcelain on metal crown. #4 is gone due to resorption. #5 has a small occlusal cavity. #6 is fine. #7 has a small lingual cavity.  #'s 8&9 have had cosmetic bonding some 25 years ago.  #10 is fine. #11 has a small lingual cavity and is gray in color. I presently have a bridge from #12 to #15 (13 and 14 were extracted due to resorption. #12 was recently diagnosed with a resorption issue, a gingival flap and restoration as well as a root canal were done.  Now, it appears that it is fractured down the middle.  My dentist is recommending a fixed bridge from #11 to #15 and another one from 2-3 with a cantilever for 4.  

Question:
1.  I know that, as a dentist, you are in the business of saving teeth but, since I have such a pronounced resorption problem and that the bridge on the left will be so large with an eye tooth as an abutment, wouldn't I be better off with a denture?  (Not to mention all of the pain and cost that I have had since my father retired - I mean the bridge on the left is only 4 years old)

Answer
Dear Chris,

There is nothing wrong with treatment planning a removable partial denture. If your hygiene is good, it will probably not stress the remaining teeth as much as a long span fixed bridge from #11-15.

I am not a fan of long span fixed bridgework,since the failure rate for them is higher than for smaller bridges and when they do fail, the abutments often have problems that can lead to root canals or extractions.

A partial can be used as a permanent prosthesis or If you are a  candidate for implants , as an interim prosthesis.
If you choose a removable option, than you will not need the cantilever bridge replacing themissing tooth #4 and using  #2 and #3 as abutments.

I personally like implant replacements, but I am not sure from your narrative if you are a candidate.  I would explore that option is you can, since implant restorations are free standing and do not depend on or 'stress' the remaining teeth. If you are missing some bone where implants need to go, sometimes grafting is possible.

I hope I have answered your question and please feel free to contact me again with any future dental question.