Posts Tagged bridges

Subtle Changes

This bridge has failed due to the fracture of the central incisor which was root canal treated but not properly reinforced due to cost factors. The result is a compromised restoration that failed after 2 years. We cemented a post to strengthen the tooth and redid a new PFM bridge with subtle but noticeable improvement in aesthetics.

 

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The root canal treated tooth has fractured off, dislodging the bridge it was supporting. The patient had initially asked of the bridge to be recemented. He was told it would not work and did not listen at first.

 

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The bridge came off again. We insisted that he either did a new bridge or go somewhere else to recement. Good dentists shouldn’t just do what their patients tell them to do.

 

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 Some gingivectomy was done on the lateral incisor.

 

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The overall shape and contour look better than that of the patient’s old bridge.

This is a PFM bridge and we could have done better with the aesthetics, but the patient could not be convinced to take it up like he was convinced to buy a full HD over a HD ready TV.

 

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Bridging The Gap

This is not really a cosmetic/aesthetic case. The patient, a middle-aged office worker, had a missing premolar for many years and finally decided to replace it with her bridge. Her supporting teeth have been previously crowned. As she had several other teeth to crown and gaps to bridge, she opted for a PFM bridge which does not look as good as emax but suits her requirements.

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A missing tooth. Very obvious when the patient smiled. We are surprised she put up with it for so long.

 

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Here’s the PFM bridge fitted in her mouth. We tried to match her crown on the other side. Her left central incisor will be crowned later.

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A crown for the left central incisor and a new filling for the lateral will make her look much better.

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It could have been better with emax or zirconia, but the patient is quite satisfied that her missing tooth is finally replaced.

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Long Span Bridge

Long span bridges are difficult to manage. The supporting teeth must be prepared in perfect alignment in order for the bridge to fit properly. The technician’s challenge is to fabricate this huge complex of porcelain and metal without distortion. In this case, the 2 mains issues are the patient’s resorbed ridge and budget problems. It should ideally be treated with augmentation surgery and zirconia bridge. She’s settling for PFM bridge, short pink porcelain flange and no surgery.

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The patient is missing 4 incisors in front and one premolar on the right side. She wore a denture which looked awfully short because it kept sinking into her somewhat deficient front. Bone and soft tissue grafting was suggested, but the patient did not want surgery.

 

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 The compromise would be to add some pink porcelain to the front part. It makes the bridge more difficult to clean but it props up the front part a little.

 

 

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 Here’s the bridge in the mouth. As mentioned earlier, the pink flange is not ideal. Surgery would have produced better results. Still, the margin between porcelain and gum is visible only when her lip is lifted.

 


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Given our limitations, the bridge fits reasonably well. A zirconia bridge would have been easier to fit and might look a little more natural, but in spite of the compromises, this bridge turned out looking pretty natural with good colour match.

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The Irony Of Updates

I survived 2 days of lectures at a dental symposium held over the weekend at a hotel in Orchard. Usually, the best parts of such seminars are the food, the comfortable chairs and the chance to catch up with members of the fraternity.

Of course, I have already attended many seminars, conferences, meetings, symposiums or whatever the organisers call them. To be fair, this is not the worst and most time-wasting. Why am I talking about it in my blog? Because this particular symposium brought out a big irony of “updating” ourselves at compulsory continuing education seminars.

The whole rationale of making continuing education compulsory is to ensure that dentists don’t become dinosaurs. We need to be updated on the latest technology. Very few members of the public would argue against that. We are bombarded by new technology every day. Almost without thinking, we accept that the latest #$%&* Plus as superior to #$%&*.

zincphosphate

Many people wonder what dentists use to “glue” their crowns on prepared teeth. The material you see above is one such cement. When I was a student, I cemented all my gold inlays with this cement. However, many young dentists would not have seen this cement, let alone use it. Of course, I don’t expect them to be very familiar with gold inlays either. Of course this cement can be used to cement other types of crowns. It’s just that newer, sexier, hi-tech and much more expensive materials came into the market and everybody forgot about zinc phosphate. In some developed countries, you shouldn’t even tell people you have used zinc phosphate cement if you don’t want them to know how old and oudated you are.

In the first lecture of the symposium, the elderly speaker spoke on the development of dental cements over the decades. It was an enlightening history lesson. Some cements worked well. Some didn’t work so well, but dentists later found out why and managed to solve the problems. Some gave disastrous results. Dentists also found out why, but the they didn’t manage to solve the problems. Some of these disastrous innovations, strongly touted by some of the biggest and most reputable dental material manufacturers as the best cements during their time, quickly got pulled off the shelves when crowns broke and teeth fractured.

Dentists have been conned. Patients suffered and sued. I can’t say that I find the speaker very objective, but he does share some of my thoughts. If something has been working well for years, why change to something new and untested? Frankly, I have not even heard of some of the cements the speaker mentioned. And it’s certainly a case of ignorance is bliss. My patients ought to feel so fortunate that continuing education wasn’t compulsory back then. I would have attended one of those seminars, got conned into using those new products and done my patients a great disservice.

The big irony here, is that the “update” we’re getting here is telling us that all the cement “updates” we have been receiving all these years are not really “upgrades”. We wouldn’t have lost much if we had ignored them all and stuck with good old zinc phosphate.

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The conclusion? Our speaker strongly advocates gold restorations and zinc phosphate cement. Some of these combinations have lasted 40 years in the speaker’s patients’ mouths. As a practitioner of cosmetic dentistry, I wouldn’t want to have any gold inside my patients’ mouths and I’m sure they won’t get mad at me if their crowns don’t last 40 years. But this speaker made a very valid point which the organisers and administrators of continuing dental education should take note of.

Not all “updates” are “upgrades”. Many, or should I say too many new dental products simply don’t work as well as their ancestors. Such guided evolution panders to the public’s insatiable appetite for new technology. As discerning professionals, we shouldn’t be so obsessed with the latest tabloid news. We can already see a confusing explosion of information and misinformation on the internet. How much of what is released is worth listening to? With a rigid 70 point criteria to be fulfilled in a 2-year period before your dentist can renew his practising certificate, are you not worried that he pays his way to be fed with misinformation which will cost you in more ways than one?

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