Dr. Mike Malone’s Blog

I bit into a fork couple of months back. and hurt a lower tooth. I have just lost that one lower tooth(# 24). We are considering doing a bridge from canine to canine because the two on the two sides of the missing tooth are OK but kind of weak the dentist said. Options I have been given are 1) Maryland bridge or 2) fixed conventional bridge. I have tried to compare the two types from literature but I am not sure what would be my best option. I would really appreciate your opinion and advice.
- Avram from New York

Avram,
There may be more than those two options. I haven’t seen your case myself, so I can’t say for sure, but I’d maybe get a second opinion and see if there isn’t something else that can be done.

Neither of the two options sounds very attractive. A Maryland Bridge is conservative, but it is made out of metal, and it will darken the adjacent teeth. You may be interested to see a case of a Maryland Bridge that Dr. Malone removed to replace it with a more esthetic porcelain veneer bridge. The bridge from canine to canine sounds very aggressive for replacing just one missing tooth.

Was a dental implant considered as an option? I’d suggest finding a dentist who does a lot of dental implants and asking if this could be a case for an implant. There are also other conservative esthetic bridge options, such as a porcelain veneer bridge, an Encore bridge, or other choices that an expert cosmetic dentist could provide. You’re in New York. You can find an excellent cosmetic dentist by going to the mynewsmile.com cosmetic dentistry website.

Good luck.

Lafayette, Louisiana dentist

My 15-year-old daughter is missing her upper eyetooth. She had braces and after the braces came off, she had a retainer to wear during the day that had a fake tooth on it, along with a retainer to wear at night that did not have a fake tooth. She developed a reaction to the retainer, and when she would take the retainer out you could see the impression on the roof of her mouth and the roof was very red and inflamed.

We have three doctors trying to determine the best thing to do and I would like your opinion if you have time:
1. The periodontist wants to put in a temporary implant, (he will not put in a permanent implant because she is not 18) but the orthodontist says he has seen the patients that have had this done and it does not look good at all.
2. The orthodontist wants her to have a Maryland bridge done but her dentist has said the teeth will look grayish.
3. The dentist wants the orthodontist to make a different retainer that she will not have a reaction to.
- Stephanie from Georgia

Stephanie,
When I read comments like yours where you have opinions from different dentists and you’re concerned about the appearance, I look for how sensitive the different dentists are to appearance issues. In my opinion, that’s the key point you can take away from this. The vast majority of dentists are technician-minded and not that appearance conscious. Surprisingly, this is true of most orthodontists, too. People think of orthodontists as specializing in appearance-related issues, but most of them are dedicated to “straight teeth”, not to “beautiful smiles.” There’s a difference.

And with these comments, please realize that without seeing the case, this advice is partially guesswork.

Yes, a Maryland Bridge makes the teeth on either side a little grayish. Many dentists think that amount of gray isn’t significant, but to patients it is. The fact that your general dentist is sensitive to this issue is noteworthy.

A dental implant is the best permanent solution. So I’d plan on that in a few years.

For now, a removable retainer with the tooth on it, made out of a material that she isn’t sensitive to. There are a variety of materials to make these out of.

Bottom line - it appears to me that you should trust the general dentist here.

Related links:
Read more about your options if you have missing teeth.
One option is a dental bridge.
Click here to read more about fixing crooked teeth.
mynewsmile.com, the most popular cosmetic dentistry web site on the Internet, has a case of Dr. Malone’s posted with photos of a Maryland Bridge replacement. Dr. Malone did a porcelain veneer bridge.