Dentistry/implants

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Question
I have implants in 8 and 9. I now need one for 10. Is a cantilevered bridge with 8 and 9 as posts, something I should consider? What are pros and cons of having cantilevered bridge vs. the implant? What would you do if you were in my situation?

Answer
Hi Mark,

Cantilever bridge is always a safe choice. The two implants provide sufficient support for #10. We cantilever lateral incisors even on one implant. The reason is, the lateral incisor is the only tooth in the mouth which does not touch the opposing teeth and has minimal function.
The pro-s of #10 cantilever are:
- less trauma (no surgery)
- less expense
- predictable esthetics: you will know how the final result will look like even before starting the surgery, because the gumline will not change. With additional implant the papilla (spear-shaped gum between the teeth) may recede, compromising the esthetics because it will be shorter than the papilla between #7 and 8. The reason is, papilla between two implants is not supported as good as papilla between two teeth or tooth and an implant. The papilla between #8 and 9 is exception, because the bone between central incisors is spiking up and therefore supporting the gum well even between implants.

The con-s of #10 cantilever, if any, is change in hygiene habits. You will not be able to floss between #8,9 and 10. If the dentist uses submerged esthetic emergence profile for #10 (meaning, the root-part of #10 is surgically positioned below the gum and looks like naturally erupting tooth), then you don't have to clean below the tooth as the gums will form connection to the porcelain which should not be disturbed. You would only floss between #7-8 and #10-11. If the dentist uses the standard profile for #10, there will be no root part for #10 and you will be able to floss underneath with access from #10-11.

If I was in your situation, I would discuss this with the surgeon and make the decision based in the condition of the bone, available space and papilla heights. In excellent conditions, you can do equally good with both solutions. In compromised conditions, cantilever will perform better and it is always a safe choice.

Good luck with your treatment.  

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Veselin Shumantov DDS

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Ask questions about: - minimally invasive implant and reconstructive dentistry - single tooth, partial and full implant reconstructions with its options and alternatives - sinus lifts and its alternatives - case-specific implants; allergies; reactions to implanted materials; alternative implantable materials - immediate implants; teeth in a day; staging of treatment with dental implants; combined perio-ortho-cosmetic cases

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