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Dentistry/should i choose implant over bridge

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Question
I had a gold onlay bridge that lasted for 10 yrs. (What is the typical life of a gold onlay bridge?) I got it because I thought an implant would have been too much of an ordeal. The span covered #18-20. #18 separated and the gold popped out of #18. My dentist (not the one who placed it) thought the gold was too soft and didn't contain enough palladium. He recommends I get an implant for #19, fill the hole in #18 with composite, and keep the gold already in #20. Or he can make a new bridge with less gold and higher percentage of palladium. He favors the implant route as being more conservative. Do you think this is the better option?
If I get a new bridge, will there be a lot of prepping or derilling? Can't my dentist just clean the area without additional drilling?
Since it has been 10 yrs. after extraction, what are the chances that I'll need a bone graft if I go for the implant? Will my facial appearance look better with the implant than with the bridge? I must add that #16 was extracted and #15 will likely be extracted also due to a severe furcation. Will my left side of the face look distorted from the three extractions? And should I have the implant for #19 as a way to compensate for these extractions and thus improve my facial appearance? By the way, I'm in my mid-40's.

Answer
The biggest question, in choosing bridge or implant, is the strength of the tooth in front and back . If there is bone loss, deep pockets or looseness, deep wear or fractures, a bridge will probably not last. If the teeth are otherwise healthy, a full prepped bridge will be your best solution, to prevent # 18 from shifting out of position due to loss of the upper molar. Once the bridge loosened, the seal of cement did as well,The palladium should not be the problem. The biting forces could be too high, there could be looseness of the teeth causing rocking, the preparation could have been less retentive than necessary, the fit of the bridge may have been insufficient, or there may have been decay. Before an implant is done, a CT scan should be done to assess the quality and quantity of bone in the area, and where the nerve is, so that it will not be harmed.
As for 15, 16 being extracted, your face will not collapse. The first molar, # 14 is the biggest tooth in your mouth, and will keep you looking yourself.
A new bridge preparation will require more drilling to allow for full coverage of the teeth. The preparations from before will no longer be sufficient.
Best of luck to you with whatever you choose.

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Marielaina Perrone DDS

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I am a Family, Cosmetic, & Implant Dentist. I am well versed in virtually all of dentistry including dental surgery, dental implants, endodontics, periodontal disease, cosmetic dentistry procedures, dental phobia treatment, etc. Essentially if it is dental related I can help. Cosmetic Dentist Henderson Nevada Las Vegas Cosmetic Dentist Las Vegas Dental Implants

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I graduated from Stony Brook University School of Dental Medicine in 1997 with my D.D.S. degree and have been in private practice ever since. I currently maintain a private practice in Henderson, Nevada.

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Dental School: Stony Brook University School of Dental Medicine 1993-1997 Post Grad: Stony Brook University School of Dental Medicine Advanced Education in General Dentistry 1997-1998

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