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Dentistry/is it better for me to get new bridge or implant?


My gold onlay bridge span from 18-20 broke. #18 abutment separated and the gold came out. #20 abutment is holding #19 pontic in place. This bridge lasted 10 yrs. What is the life expectancy for such a bridge? My dentist (not the one who placed the bridge) thinks the gold was too soft and not enough palladium was used. He suggests I get an implant for #19, composite to fill in hole in #18, and keep the gold already in #20. He thinks this is the preferred, conservative route. But he is open to making a new, stronger gold onlay with a higher percentage of palladium.
Can my dentist construct a new bridge without prepping or drilling deeper in my teeth? The hole is already present in #18, and he can easily pop out the gold from #20, so shouldn't this procedure be considered the more conservative treatment? It's not as if my dentist is starting with two perfectly untouched abutment teeth.
If I decide on an implant, will I likely need a bone graft? And will the implant provide a better facial appearance than the bridge? I already Have #16 extracted and #15 will likely be too due to a furcation, so is the implant in #19 a necessity for less distorted facial look?

All studies show that the average life span for bridges are about 7-10 years. So your bridge served well, but the question should be what made the bridge fail.
I don't understand what do you mean by "#18 separated". Do this mean that the tooth broke or the "hole" is just decay. Either way the dentist will not be able to make a new bridge without prepping that tooth.
I also don't understand how the composite is going to cover all the tooth surface covered by the onlay on #18. The composite can cover one or two surfaces of the tooth but there are other surfaces that were covered by the onlay of the previous bridge
I think the Xray should show what is going on on #18 and 20 and whether there is decay on the margin.
So your options are as follows:
1. Remove the bridge and make a new one
2. Implant #19, leave the crown on #20 and whatever is need on #18
I also don't think that missing one tooth should distort your facial look. You still have tooth #18 which sits behind #19 so there is still cheek support from #18. I think having any of the above options is not going to change your facial look much.

Hope this answers your question.
Dr. Elsafi


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Mohamed Elsafi, DDS, MS, FACP


I am a board-certified Maxillofacial Prosthodontist. I do head and neck prosthetic reconstruction for patients with congenital and acquired defects. This also includes trauma and cancer patients. I can answer questions about prosthetic rehabilitation of the head and neck area. I am also a board-certified prosthodontist and can answer questions about dental reconstruction including crowns, bridges, veneers, partial and complete dentures and implant restorations. I can also answer questions about TMJ problems. I can not answer about surgical reconstruction.


I am a board-certified prosthodontist and maxillofacial prosthodontist and have been practicing denitstry for over 15 years.

American Academy of Maxillofacial Prosthetics. American College of Prosthodontists.

I received my dental degree from University of Southern California. I did my prosthodontics residency at University of Florida and my maxillofacial prosthetics fellowship at MD Anderson Cancer Center in Houston.

Awards and Honors
Chief Fellow at MD Anderson Cancer Center.

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