Healthy Smile: I’m 62 and Don’t Want A Denture

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

Interestingly enough, this case is a follow-up to last week’s discussion concerning replacing bridges. I met this new patient due to a referral from another patient who lives partially here in Northeast Ohio and partially in Florida. He travels back and forth and sought out my care last year. I worked long distance with a doctor down South, and I helped this gentleman get back teeth with which to chew. He referred his friend to me to help him with a bridge that was 30 years old. The bridge consisted of 10 lower teeth, including the front teeth, which brings cosmetics into play.

My new patient came to me yesterday, late in the day, with a complaint of a loose lower bridge. Attempts at re-cementation occurred a few times, but the results were not what he wanted, as only four teeth held the ten-piece bridge. Each time the cement washed out, leaving the underlying teeth exposed to saliva and bacteria. He had already lost one tooth during this off-and-on process requiring tooth extraction. I told him that he would eventually lose all his teeth if he followed his current path.

He realized that he needed to make a real fix to his lower teeth. Without corrective action, he would not be forced to do what he did not want to do in moving to removable teeth. Although this is a great option for many people, others do everything possible to have permanent teeth in their mouths.

Previously, we have discussed that when a tooth comes out, the remaining bone will slowly decrease in size over time. In some patients, the jawbones can almost disappear. This minimal height and width of the bone in our mouths make denture wearing very difficult. Before we get to that point, many try to place a dental implant to create a base for permanent teeth and preserve bone. I can only place an implant when I have enough bone. That requirement means that a dental implant should be placed immediately or as close as possible when a tooth extraction occurs.

Our patient had his large bridge for decades. Finding sufficient bone for implant placement was a challenge. Fortunately for most of us, our lower front teeth are a great place to place implants as the bone in that area is abundant, and our chin structure keeps it that way. The chin area is a unique area of the mouth in this regard.

Remember that approximately two-thirds of his lower teeth were part of the bridge. Decay or any other mishap around the bridge, which brought him into me in the first place, requires a whole new replacement bridge with ten teeth. I recommended that we take the lower ten tooth bridge and create three more manageable sections. A wise physician once told me that the smaller the scope of your treatment, the lower the quantity and degree of problems.

I plan to make two three-piece bridges on his natural teeth and one four-piece bridge on two implants in the front area of his mouth. As I wrote earlier, the lower front area of the mouth, which runs into the chin, can give me a great place to place lower implants. These two implants will anchor a permanent bridge for him.

Large permanent bridges are preferred by many for a variety of reasons. Creating uniform size and color is easier to do when everything is one. As time goes on, some maintenance or replacement may be indicated. Smaller components and increments can be a help to all when needed.

If you have a bridge on its last legs, please call us. I would love to help you. You can call Nikki in our office at 440-892-1810 for a consultation, and I look forward to seeing you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 • www.jeffreygrossdds.com