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Bridge or Post and core/Crown
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Bridge or Post and core/Crown

An issue has come up regarding my four upper middle teeth.  #9 is missing and #8 will be extracted soon. I've been given two options:
Option 1 - Implant the two outer teeth (#7 and #10) and put a four-tooth bridge in.
Option 2 - Crown lengthen, root canal, post and core the two outer teeth (#7 and #10) and implant the two inner teeth (#8 and #9).

Given that the crown/root ratio is OK for the 7 and 10 (I've been learning a lot), then I can't seem to get two dentists who agree on this.  I'm doing this at a dental school where the prosthedontics instructor likes option 2, the pros. resident likes option 1, the period. resident likes option 2, others including non-school dentists I've asked outside have strong opinions on both.  I'm less concerned about appearance though that's important, than I am about both functionality (ability to eat real food, comfort, etc.), likelihood of these lasting a long time, ease of maintenance, etc.
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Avatar_dr_m_tn
This is a really good question and you seemed to have done your home work. I think the reason you have gotten divergent opinions is because I think there is no right answer. As far as function is concerned I don't think that is a problem with either the implants or the crowns on 7 and 10.I don't know the condition of 7and10 so it would be wrong for me to diagnosis this over the phone so to speak.I think the doctor that is doing the case in consultation with you will come up with the correct treatment plan for you.I don't know your age and I think that would also be a factor.
3 Comments
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Avatar_n_tn
hello! I'm not a dentist, but I have worked for a prosthodontist for 2 years(in the past but now in pediatrics for 8 yrs total). I would like to share what I think I would do, and information I recieved from working with a newer dentist. I'm not sure if you have any other teeth missing in the upper arch, but if you do I think you should go with the option of doing implants in the place of #7 and #10. Because it will help the bone in the anterior part of your mouth be strong (because the tytanium that the implant is made of actually simulates bone to grow.) Then do the 4 unit bridge with the two in the middle being the pontics (or "fake" teeth). This way if you ever loose more teeth in the upper arch you could have an over denture of some kind that would snap onto the implants and you would be much happier with this. The denture sounds a little scary, but if you have the implants spaced out it would be a better position for the over denture to be retentive.(I hope this makes sense)Also your canine or what some people call "eye teeth" are very important because if you loose these teeth it affects the shape of your face and will make you look much older than you probably are. It kind of makes your face look sunken in. With the implants being in the position of #7 and #10 this would help you retain your bone structure if you were to loose more teeth in the future. I also would like to mention if you are a smoker and you are planning to do the implants either way please try to stop smoking. Smoking depleats the vitamin C in your system and WILL cause your implants to fail. Then you would have gone through all of this for no reason. Implants are like a second chance to permanent teeth. I hope you make a good choice. Not to be ugly or anything, but a lot of the younger dentist are more agressive and they are ready to jump in and do some of the latest technology. Please let me know if I can help anymore! I love teeth! Good luck and let me know what you decide!
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Avatar_n_tn
While you have been recieved good advice you need to keep in mind the force that will be put on the teeth.  If 7 and 10 have endo already performed then all you are doing is condeming the tooth to fracture by placing a 4 unit bridge.  The crown to root ratio of the teeth that are being replaced are much larger than those of 7 and 10.  This violates a trusted law in Dentistry called Ante's law.  There for to fix this you could do a bridge but I would recomend a bridge from 6-11.  This will give you the best esthetic result as well as a strong restoration.  How ever a bridge from 7-10 on implants would work great.  Keep in mind that the implant bridge will probably not give you the best look.  Good luck
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Avatar_m_tn
A related discussion, Ante´s law was started.
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Jerome Tsang, DDSBlank
Irvine Modern Dentistry
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