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My Dentist Won’t Admit He Ruined My Bridge

Posted on by AllSmiles.

While placing two new crowns last December, my dentist nicked one of the crowns in a Maryland bridge that I got in 2002. The bridge is old, but I had no intention of replacing it because it is in good condition. And the nicked crown is my left front tooth. Two weeks later, I noticed silver showing through the crown that my dentist nicked. He insisted that the problem was from grinding my teeth, but he knew better. My dentist quickly notices any changes in my teeth, so he would have told me if my teeth grinding was causing a problem. Besides that, I wear a nighttime mouth guard.

Anyway, when I complained about the silver dot, my dentist asked me to schedule an appointment, and he placed composite over the dot. Now the dot is showing through the composite. I know the crowns have metal beneath them, but I am concerned that I need a new bridge. Now I don’t trust my dentist. I was supposed to get silver fillings replaced next, but I am hesitant to have him do any more work on my teeth. Do I have a choice or an alternative to replacing the Maryland bridge? – Wendy from Queens, NY

Wendy,

Thank you for your question. Although many dentists have adjusted a patient’s bite and damaged the crown, it usually does not happen to front teeth. Your dentist probably does not want to admit his mistake because it would obligate him to replace your Maryland bridge.

We suggest that you find a dentist for a second opinion. Ask the dentist if the crowns on your bridge show signs of teeth grinding. Some dentists use this method to detect the cause of damage:

  • Glide a metal explorer over the porcelain, which will not leave a mark if the damage is not from a dental bur. The metal explorer would leave a mark if a dental bur damaged your crown.

Ask the second-opinion dentist to document their findings. Return to your dentist with an explanation of the results.

Repairing a Nicked Crown in a Maryland Bridge

It is challenging to repair a nick in a porcelain-fused-to-metal crown without replacing the Maryland bridge. Your dentist’s attempt to improve the crown with composite did not work. Panavia is a brand of dental bonding cement that will bond to metal. An experienced cosmetic dentist may successfully hide the metal with these steps:

  • Grind away more of the metal to make room for the Panavia dental bonding cement
  • Use a micro-etcher to roughen the metal
  • Prime the metal before applying a thin layer of the bonding cement
  • Cure the cement and apply composite that matches the crown color
  • Shape and polish the cement

Whenever it is time to replace the bridge, newer ceramic options will give you durability and natural-looking results. You can also ask about replacing your silver fillings. This technique is not a guarantee. Seek a highly experienced cosmetic dentist for a second opinion to evaluate your Maryland bridge and discuss your options for saving it.
Image left of silver amalgam fillings loaded with mercury. Image right: mercury-free composite fillings

Dr. Duane Delaune, a Metairie, Louisiana, cosmetic dentist, sponsors this post.

 

maryland bridge before a dental implant

Posted on by writeradmin.

I’m trying to figure out what to do. My daughter has a congenitally missing lateral incisor. We did orthodontics to open the space. Now we’re working on the temporary tooth replacement. Our dentist decided on a Maryland Bridge. We did non-metal wings because I wanted them to be as natural-looking as possible. The problem we’ve had is the bridge has fallen off twice in just a couple of weeks. After the first time, she (our dentist) tried a different bonding cement, but that didn’t make it any stronger. Now she wants to try doing it with metal wings. Here’s the thing. My daughter is 14. She’s going to have to wear these for a few years. I don’t want her to feel self-conscious. I have two questions:
1. Will these stay on better? 2. Will the metal be a better choice?

Karyn

Dear Karyn,

I’m a little concerned about some things I’m hearing here. First, I would not consider a Maryland Bridge a temporary replacement. This requires tooth preparation, which means you’re reducing tooth structure. If you’re doing that, you might as well stick with a dental bridge and not get a dental implant.

Another thing is the bonding issue. It doesn’t sound like your dentist understands bonding principles. She placed the bridge with a cement and it fell off. Then, she gets (I’m assuming) a stronger cement and it still falls off. Her next thought is to switch to metal wings.

Maryland Bridge Preparation

That’s not likely to work out any better for her. The non-metal (zirconia) wings are usually easier to bond than the metal ones. My guess is the problem is with her tooth preparation. If you look at this image on the left. You can see that a groove should be cut into the tooth to support the wings. Without this, she’s likely to have trouble no matter what type of bonding she uses.

While she could go back and make the correct grooves, I am going to recommend a completely different direction. While you can go ahead with the bridge, once she gets her dental implant, you’re going to need another procedure to have these grooves filled in. Why do that when you can instead get a temporary tooth which will not require any modification to her adjacent teeth?

I’m not trying to discourage you from your future plans of getting her a dental implant. It is the best tooth replacement around. It will be a great solution for her when her jaw is fully developed.

I am trying to discourage you from the dental bridge. Instead, I’m going to recommend something else.

Removable Partial Flipper

A removable partial flipper will be perfect for her situation. When well cared for it can last long enough for her to get her dental implant. Even if something happens, it is significantly less expensive than any other tooth-replacement option. You could replace several of them for the cost of a single Maryland Bridge.

They can be made to look beautiful too, so your daughter won’t look self-conscious.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.