Expert: Mark Bornfeld DDS - 10/14/2006

Question
my problem: i have a fixed bridge that consists of 3 crowns and 3 pontics on the top front, the bridge is connected to my 2 eye teeth and the one next to the eye tooth towards the center. i had an apicoectomy to the tooth next to my eye tooth many years ago, lately i started feeling a little discomfort there, my dentist took xrays and said the tooth that i had the apico. on was being reabsorbed, he said he has to take off the bridge and i should have this tooth worked on. he submitted pre-certification to my dental carrier for 2 crowns and 3 pontics. he received pre-authorization for 2 crowns an a partial denture, he told me that this was an unexceptable course of treatment that i should not connect a removable denture to the crowns that they are willing to pay for.also next to the crown on the eye tooth that they will pay for i have a crown, is he correct?

Answer
Dear Anthony,

I'm not sure I fully understand the proposed configuration of the planned fixed bridge. You will need a combined total of six units-- that is, some combination of pontics and abutment crowns that add up to a total of six, just as was the case in your first fixed bridge. My guess is that the lateral incisor that is resorbing is no longer able to reliably contribute to the support of a fixed bridge, and will need to be extracted. This will leave two eye teeth, between which will be four pontics (please correct me if I'm wrong). Truth be told, lateral incisors usually don't make very good abutments, and unless your eye teeth have deteriorated in some way, a new fixed bridge spanning between these two teeth should give you service equivalent to your previous bridge.

In any case, I think that most people would be happier with a fixed bridge than a removable partial denture. In addition, a parial denture will require the use of unsightly clasps on those two canine crowns unless your dentist is planning to use semiprecision clasps, which I doubt your insurer will cover either.

I think you should discuss with your dentist the consequences of these two treatments. Keep in mind that your insurer will not base their ruling on what is the best treatment for you; they will limit any benefit to the minimum, based on the provisions of your plan.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY