Expert: Lawrence Spindel DDS, www.lspindeldds.com - 2/3/2009

Question
My wife's Maryland Bridge (for one tooth) fell out recently.  Todays Dentists seem to not practice this procedure for a variety of reasons & offer alternative procedures.  One subsitution is where the tops of the two teeth, which are adjacent to the missing tooth are broken, & are replaced with tabs to hold in the new bridge.  She refuses to take this option because she is afraid that it could do unforseen damage to the two neighboring teeth over time.  The other opiton, a porcelain veneer bridge, she was given, she is more keen about but has one hesitation:  Her one reservation is that she has had procelain fillings back in the early or mid-90s, which eroded quickly, and she ended up having a root canal in order to fix the problem.  Would she experience a similar misfortune with the porcelain veneer bridge or is this procelain made of stronger materials.  She was told by one dentist recently that this porcelain was probably a porcelain subsitute.  Are there any other options to a Maryland Bridge and what are their pros & cons?  Also, what would the average rates be for these procedures?  She is also unsure of cosmetic dentistry.  Would it be more beneficial to go to a cosmetic dentist over a general dentist to have these procedures done?

I hope you don't mind that I asked more than one dentist this question in a Socratic fashion.  I plan to compare the best answers for the best possible conclusion.

Answer
Dear Alexander,

Maryland bridges have fallen out of fashion due to their high failure rate.  Most of them have to be repeated recemented.  Onlay bridges and veneer bridges may seem promising. These restorations have a core of zirconium with feldspathic porcelain baked over them. The Pros of these restorations is that less tooth structure will be removed. The cons are that they may not last as long as more conventional options.  I do not offer these restorations in my practice, since I am not confident that they will stand the test of time. Who Knows how long they will last?. Your wife's fear may be justified . As to the costs, I think the costs are comparable to a conventional fixed bridge fee.

I personally only offer two fixed options for replacing a missing tooth. Either a conventional fixed bridge or an implant restoration.  Both of these restorations,  when fabricated carefully can and do last many years.  

As to which materials to use, the most sturdy and cosmetic materials involve using a zirconium core(Lava or Procter for example) covered with feldspar porcelain. If you would like to see some of these single tooth restorations you can copy and paste these links into your browser:

http://www.lspindeldds.com/implants

http://www.lspindeldds.com/metal_free_cementable_crowns

In my practice a fee for a three unit bridge or an implant+restoration would be approximately $5,000 .

As to whether you should use a 'cosmetic' dentist or a regular dentist? I think 'cosmetic dentist' is an over used term that is used primarily to advertise that a dentist does nice looking restorations.  Pick your dentist because he is actually good, and not because he advertises this fact.


I hope this information is helpful to you and please feel free to contact me again with any future dental questions.