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Dentistry/Tooth Replacement Options


Dear Dr. Kaufman,

I was hoping that you could help me with an issue that I currently am having.  I have a fixed bridge on #13-15, with root canals on both #13 and #15.  I recently had to have #12 extracted due to a fracture. I did not have a bone graft done at that time.  I am trying to get some information on what my replacement options would be.  

My dentist suggested an implant on #12 or remove the bridge and make a cantilever bridge that would cover #12-15 so that #11 would not have to be cut down.  I am a little fearful of the implant process but would consider it as a possibility.  If I did choose the implant would it be a problem to place it next to a root canaled tooth?  Are there any other possibilities that exist that I am not aware of?

I am planning to make an appointment with a prosthodontist in the future but wanted to get some ideas before hand.

Thanks so much for your help!

Dear Lisa:
It is hard to give you a specific answer to your case without looking at your x-rays and examining you physically.  However, if your tooth #12 was properly extracted (a graft is most times NOT needed or desired) and and implant can be placed, in a situation such as yours, there is really only one "proper" treatment plan and it is to replace #12 with an implant.
If your bridge 13-15 is functional and does not require replacement it should be left alone and you should not incur the unnecessary expense of having it replaced.  If the teeth #13 and #15 are compromised (have decay, or are periodontally involved), taxing them with a new bridge, and especially one which has an additional cantilever to replace tooth #12, is a very poor risk over time.  The teeth will fail prematurely.
Since implants have been used very successfully for the past 40 years, the guidelines are simple:
If you have virgin teeth (without any restorations) next to a missing tooth, the teeth should not be prepared for a bridge and an implant should be used to restore the missing tooth.
If you have teeth that are already restored (have crowns, root canal treatment, etc.) to the sides of a missing tooth, they SHOULD NOT be connected to make a bridge either, since they are already compromised and a bridge will further compromise their prognosis over time.  The implant is still the better choice.
I rarely make bridges between teeth these days (only when an implant cannot be placed due to medical considerations).  The only bridges that I make these days are between implants, since implants are completely immobile in the mouth and bridges work much better when implants are involved.
I am glad that you are going to see a prosthodontist first, since that is the correct specialist to see BEFORE any work is done.  
The implant is the better option and will give you the best prognosis.  The process itself is also quite routine.  It actually takes me less time to place an implant than to prepare and make a filling.  Ask your prosthodontist to show you photos of implants he/she has placed and restored and  educate you.
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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