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Dentistry/should i get new bridge or get implant?

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QUESTION: I had a gold onlay bridge that recently separated. The span covered #18-20, and #18 separated and the gold onlay in it came out. #20 gold onlay is still holding #19 pontic in place. My dentist (not the one who placed it) said the gold was too soft and should have contained a higher precentage of palladium. He said he can make a new stronger onlay, but he said it is more conservative to get an implant for #19, fill the hole in #18 with composite, and keep the gold onlay already in #20.

The bridge lasted me 10 yrs. Is this the expected life of my bridge? I'm concerned that if I get the implant I'll need a bone graft because it has been 10 yrs. after extraction. Does my dentist have to prep or drill a lot to construct a new onlay bridge? Is it really more conservative for me to get the implant, since I already have the hole in #18, and he can easily pop out the gold in #20? It's not as if he's dealing with two untouched abutment teeth. What would you do?
Will my facial appearance look better with the implant than with the bridge? I must add that #16 was extracted and #15 likely will be too due to a severe furcation and extensive root decay. I highly doubt that an implant can be done for #15. Can three extractions on my left side of the face cause it to look distorted? And because of this, should I get the implant in #19 and not the bridge?

ANSWER: hi mike
yes you should get implants done. SIMPLE REASON: IMPLANTS PREVENT FURTHER BONE LOSS! just like the roots of a tree hold soil. even if it means getting a bone graft. YES! YES!
days of bridges are numbered as its a technology that leads to bone loss in the missing tooth region( as the bone remains unstimulated due to the absence of a tooth).

from a financial point of view... see it this way. if anything happens to any component of a bridge then the whole thing gets replaced. you will land up paying three times the amount for this onlay bridge.
if however you had individual onlays and crowns then you save money as only the tooth which has a problem gets treated ( believe me crowns, onlays and bridges have limited shelf life ~ 10years)
though an implant may be expensive initially, it saves you a lot more later on.


yes your facial profile will look better.
i hope i have answered your queries
best wishes
dr mayank kaurani
india

---------- FOLLOW-UP ----------

QUESTION: Thanks so much for your excellent advice! You've convinced me to have the implant. I've chosen a highly recommended oral surgeon for a consultation. Unfortunately, his office doesn't have a digital panoramic x-ray machine. I've heard that the digital panoramic x-ray is superior in that the patient is exposed to much lower radiation. What is the advantage of having an x-ray taken by the non-digital machine?
I've phoned a dental office that has the digital panoramic, and was told that I can pay to have a panoramic digital x-ray taken. I will be provided with what they called a "high resolution" print out on paper of the x-ray. I will not receive the x-ray in the digital format. Are you familiar with this kind of print out on paper? Do you think my oral surgeon can view the bone structure well on this x-ray paper print out?

When panoramic x-rays are taken (digital or film) why isn't the patient given a lead apron to wear for protective measure? I was told by a technician that the apron interferes with the x-ray. Is that true?
In your view, should one make that special effort to choose the digital x-ray over the old style film x-ray?
I really appreciate your comments!

Answer
Hi mike
Yes digital panex images provide greater clarity and reduced xray exposure. Plus one can manipulate and enhance digital images with the software of the xray.
Are the best digital images better than best manual xrays? Yes!
Do you need lead aprons? Yes you do.
Does a lead apron interfere with xrays? No it doesnt.

In all its entireity..... I would get a digital panex done. As far as the print of the final enhanced image is concerned.... If its printed in a high resolution....... Its great. Alternatively u can ask the technician to email you a high res jpeg image too.
Best wishes
Dr mayank kaurani
India

Dentistry

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dr mayank kaurani BDS, MDS

Expertise

rootcanals, cosmetic dentistry, dental pain, cavities, tooth colored fillings, endodontic diagnosis, post & cores, ceramic veneers, composite fillings, dental whitening, bleaching etc. please remember: i cannot treat you online and neither can i touch your teeth or test their health! i can give you general suggestions and critically evaluate various treatments and offer my advice.

Experience

14 years of clinical experience. i am a professor in a postgraduate dental school, in the department of endodontics. my primary field of specialization is in endodontics and conservative dentistry. i am a consultant endodontist in private dental clinics and run my own clinic restricted to conservative dentistry & endodontics since 2006.

Organizations
DENTAL SPA, JAIPUR (INDIA). Mahatma Gandhi Dental College, jaipur(india)

Publications
new york state dental journal journal of contemporary dental practise

Education/Credentials
BDS, MDS (conservative dentistry & endodontics)

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