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Dentistry/piece of onlay bridege separated


QUESTION: Dr. Kaufman, I had a gold onlay bridge 18-20, #19 is pontic. Today, the onlay separated and came out of #20. My dentist(not the one who did the bridge) thought the gold was too soft and probably needed more palladium. His said there are two options: A new onlay containing less gold and more palladium. Or an implant in #19, fill the hole in #18 with composite, and keep the existing gold onlay in #20. He thinks the implant route is more conservative. What do you think?
#19 was extracted 10 yrs. ago due to fractured roots. At the time of extraction, I went for the bridge because it seemed less of an ordeal. By the way, is 10 yrs. an acceptable period for a bridge to last?
If I go for an implant, what are the chances I need a graft? Can a simple x-ray show if I need a bone graft? It may also be worth noting that #16 was extracted, and due to extensive root decay #15 may soon be extracted. Will my left face look distorted because of 3 extractions? In order to maintain a better facial appearance, should that weigh in my decision to have the #19 implant? I am 45.
Thank you very much.

ANSWER: Dear Michael:
Sorry to hear that your bridge needs to be replaced.  However, after ten years, it is a reasonable time for this type of construction.  I cannot remember the last time that I have designed a bridge in this way, since implants are a much more contemporary treatment.  The inlay bridge was designed to conserve tooth structure when implants were not such a predictable and viable option.
I cannot comment on your specific situation as far as the implant conditions are concerned.  This is up to your dentist and/or implant surgeon to decide.  I cannot evaluate bone and location without a physical examination of you and looking at your X-rays and/or a CT scan.  However, I do agree with your dentist as to the treatment plan.  If your physical circumstances such as bone availability are favorable, implant treatment and restoration of the adjacent teeth with small restorations is the most conservative way to go.  It will save your teeth over time and will also save you money.
Best of luck,
Dr. Zev Kaufman

[an error occurred while processing this directive]---------- FOLLOW-UP ----------

QUESTION: The oral surgeon saw my panoramic and said I have plenty of bone so I'll go for it. The oral surgeon said that prior to implant placement he will saw off the pontic and that the abutment tooth (#20) should hold the remaining gold inlay intact.
Do I have the tooth with the inlay hole (for clarification this is #18) filled by my prosthodontist (using composite) prior to the implant or after? Does it make a difference?
Prior to implant placement, should my prosthodontist take an impression of the pontic to help him figure the dimensions of the new restoration? Are impressions taken prior to implant and after, or only after?
What material is best for the restoration of #19?
Your advice is greatly appreciated!

Dear Michael:
Sorry for the delay... busy week.
You are on the right track!
Have the prosthodontist repair tooth #18 as soon as the bridge is separated and the implant is placed (I am assuming the same visit with the oral surgeon).  You do not want to leave the opening in the tooth for a long period of time so that it decays.
Make sure that you show your self to the prosthodntist PRIOR to the implant placement by the oral surgeon.... he might want to talk to the oral surgeon and ask for a specific type of implant or preferred placement position, since he/she will have to restore the implant.
He might take a diagnostic impression before the work starts (which I always recommend).  The implant will be impressioned for the crown after it is placed and integrated (2-6 months time, depending on the implant and your bone).
Communicate with your dentists.  It is the best way to get the best results.
Best of luck,
Dr. Zev Kaufman


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Zev Kaufman, D.D.S.


I can answer any question from simple routine dentistry to very complex dentistry with emphasis on reconstructive, cosmetic, and implant dentistry. My expertise is in co-ordination of very complex treatment plans with other dental specialists or as a one-man-team, since I have extensive training in Prosthodontics, Surgical Implantology, and orthodontics.


Over a decade in private practice of Surgical Implantology and Prosthodontics. Founder and owner of Prosthodontics & Implant Surgery of Manhattan, PC. Clinical Assistant Professor at the Post-Graduate Department of Periodontics & Implant Dentistry at New York University College of Dentistry. Lecture weekly since 1999 on advanced Implant Prosthodontics at New York University College of Dentistry Post-Graduate Program in Periodontics & Implant Dentistry. Former clinical assistant professor of Dental Radiology at the NYU College of Dentistry. Former clinical and lecture faculty at Lincoln Hospital, Dental residency program. Former clinical and lecture faculty at St. Barnabas Hospital (Bronx, NY) dental residency program. Lecture nationally on Prosthodontics and Implant Dentistry.

Memeber of the American College of Prosthodontics. Memeber of the Acacdemy of Osseointegration. Member or the Omikron Kappa Upsilon (OKU) Honors Dental Society. Member of the American Dental Education Association.

Graduated with Honors from New York University College of Dentistry. Post-Graduate training and certificate in the specialty of Prosthodontics. Post-Graduate training and ceritificate in Surgical and Prosthetic Implant Dentistry. Honors-program in Comprehensive and Applied Practice Management. Honors-program in Orthodontics.

Awards and Honors
NYU Cervice award to the community. OKU honor society. National Dean's List. National Who's Who.

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