Expert: Mark Bornfeld DDS - 11/5/2007

Question
I am women age 57 . My problem is I am missing front teeth #7 and #8 as well as #3,#11,I think #13. I have gone to several dentists over the course of a year and have been told by most their thoughts and procedures with numerous fees which I cannot possibly afford. I have finally met a dentist that is willing to work with me .He actually suggested I do this investigation on his procedure for me. His suggestion is to do an abutment crown on tooth #9 and #6 with replacements for missing teeth 6 & 7 - fixed crown. My insurance would cover a removable partial crowning #9 and #6 (both good teeth)and then a removable partial for #7 & #8. My concern with DDS procedure is my gum and bone retention concerning #7 & #8. I would like what lasts the longest if not rest of my life. My question to you is of course your opinion on what my dentist is trying to do vs insurance company suggestion as well as would I be better off with a removable partial that covers all missing teeth -This was never suggested by any of the dentists I went to as  I am unsure if is even feasible.  
Looking forward to your response and looking forward to actually smiling again!

Answer
Dear Inca,

It is difficult to determine just which course of treatment would yield the most durable result without access to the necessary diagnostic information, because the considerations vary depending on the unique circumstances in a given person's mouth. One thing I can say is that your hopes for a guarantee that any treatment will last for the rest of your life are a bit unrealistic, unless you're not planning to hang around that much longer-- at age 57, I would wish you many more years-- preferably in good health.

Also, keep in mind that your insurance plan's preference for a removable partial denture is based on their desire to pay out in benefits as little as possible-- this has nothing to do with what would be considered clinically preferred treatment.

That being said, there is no reason why you could not make a partial denture and wear it, although it is a virtual certainty that you would find your dentist's plan of treatment preferable. The subjective experience of wearing a fixed bridge is far closer to that of the natural teeth than is a removable prosthesis.

Of course, you are not obligated to limit yourself to one course-- you may opt to have a partial denture made, and if you are not happy with the result, you could always have a fixed bridge made later. However, if money is in limited supply, there is no question that you'll be happier with a fixed bridge, and you will avoid paying for two prostheses rather than one by just selecting that route first.

If you have a need to corroborate your dentist's judgment, then I urge you to seek a second opinion in person so that the relevant diagnostic factors can be sufficiently considered to make a more reliable assessment.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY