I have two dental implants that had a natural tooth between them. Now that natural tooth needs to be removed and my dentist is recommending a Maryland Bridge. Is it possible to attach a Maryland bridge to the dental implants? I was concerned about attaching the metal to the porcelain. Have you seen this successful?
Charlie
Dear Charlie,
The short answer is yes, it is possible to bond a Maryland Bridge to a dental crown. That being said, it is tricky. The ideal bond is metal against enamel, not metal against porcelain.
It would have been better if your dentist had anticipated that when you have two dental implants on either side of a natural tooth it is very likely that the tooth will eventually need to be replaced. With that foresight, he could have placed the abutments parallel to one another so that you could have changed two screw-retained crowns to a dental bridge with little trouble.
As it is unlikely that your dentist planned ahead, I would suggest your best option will be to place a third dental implant in between the two others, if there is room.
If not, then you can try the Maryland Bridge, but it will take some preparation of the crowns to make it work.
I am only 32-years-old and have recently been diagnosed with a severe calcium deficiency. My dentist said this is why my teeth are always falling apart. He wants to extract the rest of my teeth and give me dentures. I have heard that getting dentures can make your face collapse, which makes you look like a grandmother. I still have two toddlers. I want to look like their mother, NOT their grandmother. Is there anything I can do which will help prevent this from happening? I am getting treatment for my calcium deficiency, but my dentist says it is too late for what is going on with my teeth.
Avery
Dear Avery,
For those who are unaware, facial collapse is something that happens when you get dentures. As a result of no longer having teeth, your body immediately begins resorbing the minerals in your jawbone to use elsewhere, as a means of being efficient with your body’s resources. After all, you don’t have teeth to support any longer so you no longer need that bone.
The problem with that is after ten or so years, you no longer have enough jawbone left to support your dentures and end up looking like the woman on the left side of the picture above. This woman now looks decades older than she really is.
While there is a way to prevent this that I will go over, I don’t think you will need to have your teeth extracted. Certainly not all of them. I have no idea why your dentist is blaming your calcium deficiency for your teeth issues. That has zero impact on what is going on with your teeth now.
Your teeth are fully formed so developing a calcium deficiency in adulthood will not impact the health of your teeth. It can cause cramps, nerve damage, and osteoporosis. So why is your dentist saying this? I’m only guessing here, but dentists have different levels of willingness to fight to save teeth. Yours seems to be on the low end and all he wants to do is extract them and be done.
In your place, I would look for a dentist who is willing to put in the work to save your teeth. Don’t get anything done until you get a second opinion. See another dentist for a cleaning and check up and get their unbiased opinion. Do not tell them what your other dentist said. Just let them examine you and give their recommendations.
Preventing Facial Collapse
For those who do have to have all their teeth extracted, there is a way to prevent facial collapse. If you have dental implants placed, it signals to your brain that there are still roots of your teeth there and therefore it will not resorb any of the minerals from your bone, thereby leaving it completely intact.
Once the implants are placed and integrated with your bone, then your dentist can anchor a set of dentures to them. These are known as implant overdentures and will be completely secure, unlike removable dentures.
I am having a hard time finding the right information just by looking online on the internet so I am hoping you can help me sort through some things. I need a bunch of restorative work including ten dental implants on my upper arch and five on my lower. I’m not as worried about what my lower arch will look like, but I do want my upper arch to look natural. Here are some of my questions.
1. Which brand of implants is best?
2. Would I be better off with zirconium of porcelain crowns?
3. I had one dentist tell me that white colored metal fused to porcelain, or gold fused to porcelain, will not show a black line, Is this true?
4. Are zirconium abutments for my implants, more aesthetically pleasing than all white abutments?
Kevin
Dear Kevin,
I can tell you are working hard to do your research and you have some great questions. I’d like to steer your questions in a slightly different direction. All of your questions are about the materials. What you should be asking, if you are looking for great aesthetic work, is whether the dentist has the post-doctoral training and accuracy to provide you with solid, yet beautiful work.
If you wanted to commission a beautiful portrait of your family, you probably would not be asking about which type of canvas or paint brushes should be used, but rather who would be the best artist to do the work. It is the same with cosmetic dentistry.
First, I would look for someone with post-doctoral training in dental implants. It won’t matter how beautiful they are if they don’t end up failing. After you have narrowed down some implant dentists, I would then look for their cosmetic qualifications. Have they done post-doctoral training in cosmetic work. Smile makeovers and other types of cosmetic work are not taught in dental school. Have you looked at their smile gallery to see if they produce beautiful work? Even better, do they have someone on staff that is AACD accredited?
These are the questions you need to look into. I will correct one piece of bad advice you were given. Any dental crown that is fused to metal will eventually show that black line. Additionally, it will end up looking more opaque because of the metal base that needs to be covered.
I hope this helps you.
This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.
I want to get some dental implants but my dental insurance does not cover it. They will cover the crown, but the implant itself has to come out of my pocket. Here is my question. Are the dental implants tax deductible? If they are, I may squeeze them in before the end of the year and write them off. If they’re not, I’m going to wait until my bonus comes in and then use that to pay for them. I just need to know and my dental office couldn’t answer me about it when I called.
Bruce
Dear Bruce,
I’m guessing you didn’t speak to the business manager, who handles the insurance issues but the receptionist. There is a definite answer to your question.
Yes, medical and dental expenses are tax deductible, but there is a catch. Isn’t there always with the government? According to the Topic No. 502 of the tax code you can deduct “Payments of fees to doctors, dentists, surgeons, chiropractors, psychiatrists, psychologists, and nontraditional medical practitioners.”
However, those deductions are limited to only those that exceed 7.5% of your gross income.
It may be a while since you had to do percentage math problems, but you would take your gross income and then multiply that by .075. That would be the amount you are responsible for before you can deduct anything. As an example, if you make $50,000, then you would be responsible for $3,750. Anything after that you can deduct. Bear in mind, you cannot count any of the cost that is covered by your dental insurance.
Tax rules change every year. The things I wrote were last updated on October 13, 2022, so you will want to check the code again before filing to make sure they are the same. It is always safer to work with a knowledgeable accountant if you can.
HSA’s are a Useful Alternative
Another alternative is to get a Health Savings Account. These allow you to pull pre-tax money from your paycheck in order to use it for medical expenses. Though, of course, there are requirements. There is a limit to what can be contributed to your HSA. Here is the link for the 2022 guidelines.
Your choice for getting dental implants is a great one. They are the best tooth replacements around. You will need to go to a dentist who has training in placing dental implants. It is an advanced procedure, but you will feel like you have a healthy, natural tooth in your mouth again. Whichever financial decision you make, you can at least know the money was spent well on a sound tooth replacement.
I have had a long year and a half of cancer treatments. My teeth are an absolute wreck as a result. I have several teeth needing crowns and two that are so bad they need to come out. I did brush during my treatments. Though, I threw up a lot so that might be why my teeth are so bad. I heard that vomiting can cause problems for teeth. My problem now is what to do about it. I’m on a break from treatments but need to replace these teeth and I’d like to see if I can prevent this from happening further. Do you have any advice for someone in my position?
Sarah
Dear Sarah,
I am so sorry for what you are going through at the moment. I know cancer survivors and they are a tough group of people. The treatments are as hard on your body as the disease itself. Don’t be too hard on yourself about your teeth. If you underwent any radiation, that is likely a strong culprit in the deterioration of your teeth.
First, let’s talk about replacing the teeth you lost and then we can give you some ideas about how to prevent this during the next round of treatments. The best tooth replacement is a dental implant. It will be the closest thing to having a healthy, natural tooth in your mouth again. I would actually wait until your treatments are done because it requires a prosthetic tooth root to be surgically implanted. You want to wait until you are feeling your best for that. In the meantime, I’d get a dental flipper. It will give you a temporary tooth replacement until you are ready for the implant itself.
Caring for Your Teeth During Cancer Treatment
One thing I would recommend is that you ask your dentist for a Fluoride prescription. This will help you keep your teeth as healthy as possible during treatment. A second thing to do is deal with any vomiting situation immediately. It is the acid from the situation that eats away at your teeth. The best thing for you to do is rinse out your mouth immediately after in order to neutralize any acid.
I went to my dentist for dental implants. He’s done quite a bit of them for other people so I felt fairly confident. When he went in for the first surgery, he ended up not giving me the dental implant because he said there was not enough bone structure to retain it. He suggested we do bone grafting. I agreed to that and had that procedure done. Two surgeries down. No implant. After had time to heal, we went in for the dental implant surgery again. Yet again, he said there is still not enough bone and he suggests now that I just get a dental bridge. Here’s what I want to know, is it still possible for me to get a dental implant? Did he do anything wrong?
Kevin
Dear Kevin,
I am sorry you’ve had this experience. You must be very frustrated. I have some good news for you. It is very likely you can still get the dental implant. You will just have to do it with a different dentist. You asked me if your dentist did anything wrong. That’s hard to say. I am curious what type of diagnostics he did ahead of time to determine if there was enough bone structure, but other than that, it seems like he was genuinely trying his best to give you a good outcome.
Truthfully, one thing to be grateful for about your dentist is his integrity and desire to add to his skill set. Not all dentists are even interested in learning about bone grafting let alone try and do it. Plus, when he attempted to give you a dental implant the second time, after you did the procedure he suggested, and there was still not enough bone, he was probably horribly embarrassed.
Some dentists, with less integrity, would have just placed the dental implant knowing it would fail in a few years. Instead of trying to make himself not look bad, he told you the truth, looking out for your best interest rather than his. To me, that says this dentist is a keeper. So, even after you go somewhere else to get your dental implant, I would still use this dentist for all of your other care.
My husband needs to replace his bottom teeth. His upper teeth have been gone for a while and he has dentures there. We were told that you shouldn’t do dentures on bottom teeth because they won’t stay in the way the top ones do. Our dentist said he needs to get all-on-4 dental implants. I just want to explore if there are other options before we make a decision?
Pricilla
Dear Pricilla,
All-on-4 Dental Implants
I am curious why that is the only option he gave your husband. A dentist is ethically obligated to give his or her patients all of their options. He is correct that dentures are a bad idea on bottom teeth. While it is true that dentures will struggle to stay in on the lower arch, that does not happen right away. This is an issue because of bone resorption.
When his teeth are removed, his body recognizes that and begins to resorb the minerals in his jawbone in an effort to be as efficient as possible with his body’s resources. The big problem with that is after ten or so years, he will no longer have enough jawbone left to retain his dentures. This is known as facial collapse.
This bone structure is important no matter what tooth replacement option he chooses.
All-on-4 Dental implants (pictured above) are what dentists will sometimes offer to patients who have lost some jawbone structure but still want dental implants. However, there are other options.
Implant-supported denture
The first thing to find out is whether or not he has lost bone structure. If he hasn’t, then his best option is to get an implant overdenture. This uses between for and six dental implants and then anchors a denture to them.
If he is missing bone, depending on the amount, he has two choices. First, he can have the all-on-4 procedure his dentist suggested, as long as he hasn’t lost too much bone. The one downside to this procedure, however, is that if one implant fails, the entire unit has to be redone. A second option, no matter how much bone he’s lost, is to have a bone grafting procedure done to build it back up. Then, he can do implant overdentures if he wants. He could get a denture too, but bear in mind he will end up with facial collapse. Having dental implants in the jaw bone, prevents that from happening.
I am quite sensitive to smells and I’m wondering if my husband is having a reaction to his dental implants. His mouth and breath smell awful. He’s had the implants placed and his dentist has given him temporary, acrylic dentures. Eventually, he’ll have porcelain dentures. However, I’m wondering if we need to switch his dental implants before that happens. His dentist gave him the metal implants. I’m wondering if he is reacting to the metal and that is what is causing the horrible odor I keep smelling. I mentioned to his dentist the possibility of switching him to the zirconia implants but he acted like that was a ridiculous idea. Is it?
Kaitlyn,
Dear Kaitlyn,
Metal and Zirconia Dental Implants
I wouldn’t say you were being ridiculous. It sounds to me more like you are trying to make sure your husband is okay. Even if he doesn’t think that the dental implants are an issue, he should have been more respectful of your care and concern for your husband. I am sorry you were treated that way.
That being said, your husband’s metal implants are made from titanium, which is not only one of the most biocompatible materials around, it is also inert. The inert part will tell you the metal doesn’t really have a smell. The biocompatible part means it is highly unlikely he is having any type of reaction to it. It would be foolish for me to say that no one is allergic to titanium. Each person’s body is unique. However, I would look at more common issues first.
The first thing I would check is to see if food or other debris is getting caught in his temporary dentures. This is fairly common and can cause a putrid odor. Using something like a WaterPik, will clean things out. A second possibility is an infection. However, that almost always has other symptoms such as pain or fever. You did not mention either of those.
Switching Dental Implants
Without an extremely good reason that cannot be solved any other way, I do not recommend switching his dental implants. I am not opposed to zirconia implants. They do a fine job. The problem is what would be involved in switching them out.
First, he would need his implants removed. This takes bone structure with it. Because of that, he will no longer have enough bone to retain the new dental implants you want to place. Now, your husband needs a bone grafting procedure done to provide him with the missing structure. Once that has healed, he is onto another surgery to place his new implants. If that is succesful, he will be back to where he is now.
Each of those additional procedures has a risk of failure. If he has successful implants. Keep them.
My daughter has a congenitally missing tooth. Our plan is to replace it with a dental implant once her jaw is completely developed. In the meantime, we have done orthodontics and have the space opened up. Our dentist provided a Maryland Bridge for the temporary tooth replacement as we wait for her jaw to grow, The problem we are having is the bridge keeps falling out. She used the ceramic wings. At first, she thought she’d just need to try a different cement, but that didn’t help. Now she’s thinking that maybe metal wings will stay better. My only concern about that is the metal will look darker and affect the appearance of her teeth. Is there something we are overlooking?
Lacey
Dear Lacey,
I can tell you are a good mother and are doing everything in your power to give your daughter the best care possible. Your choice of a dental implant is a great one and will serve your daughter well.
One of the things you are running up against here is your dentist, though I am sure she has good intentions, does not understand how a Maryland Bridge works.
First, you should know these are not meant to be temporary tooth replacements. In order to get these to stay on your teeth properly, there actually needs some tooth preparation on the adjacent teeth, as seen in this image below.
Maryland Bridge Tooth Prep
A small notch needs to be added to the tooth to help keep the bridge in place. My guess is your dentist is just trying to keep these on with the bonding alone, which will not work.
Switching to metal wings, won’t be a great solution either. It is actually easier to bond porcelain to natural tooth structure than it is to bond metal. So by switching, she is actually making it more difficult for the Maryland Bridge to stay on.
What Makes a Good Temporary Tooth Replacement?
The reason I do not consider the Maryland Bridge a temporary tooth replacement is because of the necessary tooth preparation. The structures of the prepared teeth are not permanently damaged. Once you remove the bridge to place her dental implant, those notches will still be there and y ou will need to fill the are with some composite bonding.
Demtal flipper
Instead, I am going to recommend you get your daughter a dental flipper. Because these are much less expensive, not only will you save a lot of money over a Maryland Bridge, but they will do no damage to her teeth, so it is a safer option as well.
My suggestion is you ask for a refund on the Maryland Bridge and get a dental flipper instead.
When it is time for your daughter to get her dental implant, make certain you research the dentist carefully. This is an advanced procedure that requires post-doctoral training. There are many dental implant horror stories that would have been avoidable if the patient knew to check the dentist’s implant training.
I wear completely removable upper dentures that can snap on. I am on an extremely tight budget and it is starting to get hard to pay for my male retention caps. My dentist charges $30 for one individual cap. I see online that I can get a set of four for $25, which would save me a significant amount of money. However, you have to be a dentist to order them. Do you know of any place you can purchase these without being a licensed dentist?
Travis
Dear Travis,
Snap on Denture
I have a couple of ideas that may help you. First, I would just talk to your dentist and explain the hardship. While I understand that there is a need to mark some things up in order to cover overhead expenses, this is such a small profit margin that I don’t think he will care about selling them to you at cost or at least much closer to it. If he or she does, you still have a couple of options.
First, you can call around to other dental offices explaining your situation. In most cases, dentists and their employees chose their profession because they want to help people. You would not have to speak to the dentist directly. It is generally an employee who orders all the supplies for the dentist anyway. You may be able to work out a deal with them.
If both of those things fail, I see that you can purchase retention caps for dental implant supported dentures on Ebay from overseas dealers for about $20 a set. They do not require verification that you are a dentist. The only downside to this is you need to know exactly what you want including strength and resistance, as well as how to place them on your denture.
