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Dentistry/part of onlay bridge broke, now what?

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Question
I'm in my mid-40's and have a gold onlay bridge with the span covering 18-20, 19 is the pontic. Today, the onlay of 20 separated from the bridge and came out. I saw my dentist (not the one who placed it) and he thought 18 came out because the gold was too soft and should have contained more palladium. He suggested a new onlay with higher percentage of palladium. Or I can get an implant for 19, keep the existing gold onlay intact for 20, and have composite for 18. My current dentist thinks the implant is more conservative and is the way to go.
Number 19 was extracted 10 years ago because of fractured roots. At that time I thought the bridge would be the quicker and easier procedure. What is the typical life a bridge similar to mine?
What are the odds of needing a bone graft at this stage, if I decide on the implant? Does an x-ray always reveal if a graft is needed? Should I be concerned that the left side of my face will change in appearance if I DON'T get the implant? I already have #16 missing, and #15 may also have to be extracted because of deep root decay. What do you suggest?

Answer
The simplest approach is to replace your current bridge with either another onlay bridge or an ordinary fixed bridge. Although the lifespan of a bridge varies, a well made fixed bridge can last between 10 and 30 years.

To see whether you are a good candidate for an implant usually the best idea is to have a 3D cone radiaograph taken of the potential implant sight and at this point it may show that bone grafting is needed.
Your face will not change shape due to the extraction of 15 and I do not believe getting or not getting an implant to replace #19 will have an effect on your face shape either.

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Lawrence Spindel DDS, www.lspindeldds.com

Expertise

Cosmetic Dentistry, Endodontics, General Dentistry, Preventive Dentistry, Comprehensive Dental Care

Experience

Former Clinical Instructor of Comprehensive Dentistry, and Prosthodontic Department New York University School of Dentistry. Also former instructor of Preventive Dentistry Columbia University School of Dentistry.

Publications
Ask Dr Spindel Dental Blog also numerous articles on http://www.lspindeldds.com (over 100 pages of original content)

Education/Credentials
1980 DDS New York University College of Dentistry 1981 GPR Manhattan VA Hospital

Awards and Honors
OKU 1980 Honor Society 1980 Long Island Academy of Odontology award for highest combined Academic and Clinical Achievement.
In 1997 he was elected to Fellowship into the International Academy for Dental Facial Esthetics

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