I am just a patient of dental professionals, but I learn so much from your lectures. As someone who has had a lot of dental procedures, I like having the knowledge. Thank you Dr.
I have never had any problems with a tooth to implant bridge over many years. You would obviously prefer to have the bridge connected to two teeth or two implants, but sometimes that situation does not present itself.
i know this video is 3 years old, but i'm hoping you'll see this. are you sealing off the gutta percha with anything? if so, are you just sealing the gutta percha or are you sealing off the dentin as well...i.e., mesial to distal fuji/composite? are you grafting on top of the root at all? or just rely on the blood and temporary pontic to mat up the blood to heal?
You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
8:39 combining an implant that fuses with the bone and a natural tooth that has periodontal ligament that permits micro motion of the natural tooth , combing these two structures into one solid non flexible prosthesis as a dental bridge , what impact is it gonna have on the natural tooth when occlusal forces try to push it within the socket ? and on the prosthesis itself , having one end motionless and the other able to be compressed ?
That is a great question and one that restorative dentists must all consider. When I first started placing implants, following my oral surgery fellowship, in the early 80s, it was believed you could not anchor a fixed bridge with an implant and a natural tooth. As I have been in practice for 40+ years, I have faced many situations when the terminal tooth for a fixed bridge was either going to be an implant or the patient must be resigned to a removable partial denture or, if the maxillary posterior teeth were missing, a sinus lift with bone grafting and all the missing teeth replaced with implants or an implant supported bridge. A really big procedure! So, I started placing fixed bridges supported by an implant and natural tooth along with a nightguard to be worn at night while sleeping to protect the teeth, implant and prosthesis from the stress of nighttime bruxism. To my knowledge, having placed these "hybrid" bridges many times in 40 years of practice, I have never had an issue with a fixed bridge or lost a bridge abutment tooth or implant abutment in a "hybrid" bridge. I always appraise the patient, in writing on the signed consultation sheet, that the situation is not ideal and there is always the possibility they could have an issue with the bridge or the abutment tooth, but it a much easier and less expensive procedure that the alternative restorative/surgical options. Most patients want a fixed prosthesis vs. a removable patrtial. Life choices are not always "ideal" and without some risk, and the patient must be in on the decision and committed to wearing the nightguard, not chewing real hard things on the "hybrid" bridge just to be on the safe side. I am not claiming to be an expert in the physiology of this restoration, but I can say these "hybrid" fixed bridges have worked in my practice for these many years without incident as far as I know and this is the restoration I would want if I were the patient. What are your thoughts? If the patient was a big daytime clincher I would be concerned and, possibly, go with another option. But any restoration is a gamble with a daytime chilcher and/or a bruxer because you are depending on the being compliant with home care instructions and taking care of the restorations. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
22:40 Have you had any complications with "sleeping" these tooth roots? I'd also be worried about litigation should that "sleeping" root ever wake up. Obviously your recommendation regarding only doing this on vital teeth is important but I wonder how many of these teeth abscess over time...
I have "slept roots" for over 40 years and never had a problem. It is a common procedure with lower posterior teeth when the roots separate from the body of the tooth, for whatever reason, and the doctor does not want to take a chance of damaging the inferior alveolar nerve by trying to surgically remove the root tip. This situation is especially common with mandibular impacted third molars. You should explain what has occurred to the patient and make a note in the chart. If you have paper charts, have the patient initial the notation in the chart. I have never had a patient who did not understand the rational behind sleeping the root. I have also slept quite a few maxillary anterior roots to preserve the height of the alveolar crest if a fixed bridge were to be placed in the aesthetics zone vs. an implant and never had a problem. If there was infection, then you would not want to "sleep" a root that had infection unless the root was a lower posterior tooth approximating the IA nerve. You might perform endodontics on the slept root to be especially careful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
No, not if you graft the extraction site and let the extraction site heal for 3-6 months prior to impressing the bridge. Be sure the pontic on the bridge is in intimate contact with the soft tissue over the edentulous ridge, such that the pontic blanches the tissue when the bridge is placed. Also, create a gingival pontic receptor site during abutment teeth preparation so the pontic appears to have grown out of the gingiva, just like a natural tooth. Watch the video on bridges in DentistryMasterClasses.com. As stated, I normally do not like implants in the aesthetic zone (maxillary anterior) if the patient has a high lip line when they smile. Never forget, most patients, especially women, are not so concerned with the type restoration as they are with how it will appear. You can control the aesthetics (gingival line, papillae, no dark "shine through" the tissue) better with a fixed bridge than you can with an implant. Do I place implants in the aesthetic zone? Yes, but I try not to do it unless the patient has a low lip line when they smile. As a matter of fact, I am placing a couple of implants in the aesthetic zone on a physician this morning, but he only displays about 1/2 of his central incisor teeth when he smiles, so the gingival line and dark shadow "shine through" is not an issue. Sometimes you have no choice, implants are the only option. In those cases, you discuss the aesthetic situation with the patient preoperatively, write down what you discussed, and have the patient sign it. I always have written consultation forms signed by the patient. Watch the video in DentistryMasterClasses.com on NP exams and consultations. Very important!
Doctor I want ask you about stem cells in the future will it be possible to replace the lost teeth with using it what is your option can we create new and Norma teeth one day
You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
i know this video is 3 years old, but i'm hoping you'll see this. are you sealing off the gutta percha with anything? if so, are you just sealing the gutta percha or are you sealing off the dentin as well...i.e., mesial to distal fuji/composite? are you grafting on top of the root at all? or just rely on the blood and temporary pontic to mat up the blood to heal?
I use BC sealer with the gutta purcha. The sealer is actually what "seals the canals, not the gutta purcha according to endodontists who have presented at my hands on teaching center in Dallas. I normally build up the tooth following endo with IRM. I'm not sure what your question is about the "grafting on top of the root." Can you clarify? Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
No, I do not perform endodontics on teeth unless there is a reason for the endo, such as preoperative hypersensitivity, decay into the nerve. or the tooth is in the aesthetic zone and, due to gingival recession, significant preparation must occur on the root of the tooth. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I was told to NOT put a 3 unit bridge connecting a natural tooth and an Implant. As the tiny movements of the PDL over time will cause the bridge to have a shorter life span than normal. What are your thoughts?
I heard that also, many years ago, but sometimes that is the only option. I have placed many fixed bridges to teeth and implant abutments and, to my knowledge, have never had a failure. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I find that bone loss in the edentulous area of a fixed bridge is not a problem. I'm not sure why it does not occur, but I cannot remember seeing bone loss in that area occurring. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Probably several years is not a huge problem. The issue is, once a tooth is missing, the adjacent and opposing teeth begin to shift into the edentulous space. You do not want too much shifting to occur prior to implant placement and restoration of the edentulous space. Shifted teeth can cause you to have a bad bite, leading to a host of dental, facial muscle and TMJ problems.
You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I like this video Doctor, you create the pontic receptor, and place the provisional bridge to maintain it. But when do you take the impression for this provisional bridge ??? 😍
I fabricate a PVS matrix for the provisional bridge from the preoperative study model. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
@@centerforard thank you ! But did you add flowable composite under the (provisonal) pontic ? Because in tve preoperative model you have flat pontic...
Yes, I add flowable composite to the tissue side of the provisional pontic once I create the gingival pontic receptor site. I want the pontic to be in intimate contact with the soft tissue pontic site, such that is places a bit of pressure on the soft tissue when seated.
FIRST OF ALL ALL YOUR VIDEOS ARE TOP CLASS.THANK YOU FOR THAT .MY DOUBT IS ,IF YOU MAINTAIN A BROCKEN ROOT WHAT ENTRANCE FILLING YOU USE INSIDE AFTER OBTURATION??
Pretend it's a "reverse" apicoectomy with retrofiill. Whatever material you would use to fill the apioectomy retrofill hole, i.e., IRM or root perforation sealer are the 2 materials I have always used. Root sealer paste is the primary hole filler I use currently. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Great video, as always! When you create the pontic receptor sites, how do you preserve them with the provisional bridge so that it does not collapse and heal back to its original form? Do you build the provisional pontic yourself, so that it keeps the pontic receptor in shape? Best regards from Zürich!
Yes, my assistants and I fabricate all our provisional crowns, veneers and bridges ourselves in my office. You preserve the gingival pontic receptor site with the provisional pontic. The gingival side of the pontic is in contact with the gingiva prior to taking the final impression. If the tooth from the edentulous space has just been extracted, idealize the gingival pontic so that as the edentulous soft tissue grows, it grows against the ideal pontic to create an ideal gingival pontic receptor site. You may need to remove the provisional bridge after 3 months of extraction healing and modify the gingival side of the pontic to create the ideal tissue conformation. Please say hello to master technician, Willi Geller, for me. He is in Zurich. We worked together for about 15 years in the 90s. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Hello, I had an bridge on my lower incissors , but now I think I made the wrong decision , actually i had a unfortunate communication misunderstanding with my dentist. So I wanted to ask are bridge that bad option , and i am 22 years old ,i had to replace my teeth because it was my milk tooth and was small. Could you guide if taken proper care and replaced at proper times , could bridges could also survive for lifetime?
Isn't the 3-6 month healing process too long for the patient to use the temporary restoration when we consider the aesthetic expectations of the patient in cases where we apply the root removal procedure?
Don't mess with Mother Nature! Healing time is what it is. Do you think the patient would rather wait a bit longer and have a successful result or rush it and have an implant failure. My practice is based on a successful product, not accommodating the patient if the expectation is incorrect. I make that clear to the patient from the get go.
im a little confused.. do inplants on upper vs bridges cause you to have bigger gingival margin? or does it vary on patients for example my pt would look better in an upper bride because it would show a lower gingival how can you tell if an implant or bridge would be better?
It's much more difficult to control the gingival line and papillae with an implant, not to mention dark implant shine through the tissue. A fixed bridge in the aesthetic zone is normally more aesthetically predictable, especially if the patient has a high lip line and displays gingiva when smiling. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Hello Dr. Steven, I'm 22 and I have congenitally missing lateral incisors, I have a low lip line but unfortunately I can't get implants due to insufficient space between the roots. My doctor suggested a bridge where he'll have to shave my 2 front teeth and a bit of the canines, I'm scared that my gums will start receding and maybe even in 10 years from now the bridge will cause some dental problems. Is there a way to limit gum recession ?
Yes, but it's a specific procedure involving gingival pontic receptor site creation, intimate contact (blanching of the tissue) between the pontic and gingival tissue and a Nightguard to prevent gingival recession from teeth movement from nighttime bruxism.
I typically have very little issue with gingival recession following veneer or crown and bridge placement because all these patients receive flat plane, hard acrylic CRO night guards to wear while sleeping, and I instruct the patients on the primary cause of gingival recession, i.e., teeth clinching. I encourage the patients to hummmmm, without making the humming sound, during the day when not wearing the Nightguard. The humming puts the lips together and the teeth apart, which prevents teeth clinching. Over time, if the patient develops gingival recession, you know they were not wearing their Nightguard or were clinching their teeth during the day when not wearing the Nightguard. Also, veneer fracture in the gingival 1/3 of the veneer can occur, just like tooth abfraction, if the patient clinches the teeth without a Nightguard. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Unlike a natural tooth root, an implant cannot migrate through alveolar bone, and cannot be moved by orthodontic techniques. This can be good or bad. If the natural teeth are in danger of shifting. anchoring them to the implant can help prevent them from shifting. If the natural teeth can benefit by natuarl migration, the implant can interfere with this. Also, a natural root is surrounded by a cushion of soft tissue, which function as a shock absorber when you eat. An implant is not. Bone and implant material are tightly packed together. They call it "osseointegration" the way the bone almost grows into the implant.
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I am just a patient of dental professionals, but I learn so much from your lectures. As someone who has had a lot of dental procedures, I like having the knowledge. Thank you Dr.
Glad the videos are helpful. Steve
How is THE prognosis for implant to tooth bridges in this case?
I have never had any problems with a tooth to implant bridge over many years. You would obviously prefer to have the bridge connected to two teeth or two implants, but sometimes that situation does not present itself.
Very useful video, not alot of dentists seem to know about keeping the roots under those pontic sites.
You may be correct. Glad you liked the video.
@@centerforard what that mean keeping the roots under Pontiac site?
i know this video is 3 years old, but i'm hoping you'll see this. are you sealing off the gutta percha with anything? if so, are you just sealing the gutta percha or are you sealing off the dentin as well...i.e., mesial to distal fuji/composite? are you grafting on top of the root at all? or just rely on the blood and temporary pontic to mat up the blood to heal?
Fantastic presentation!
Glad the videos are helpful.
I thank you so much for your professional advices.
You are welcome.
Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
Click here to subscribe:
membership.dentistrymasterclasses.com/purchase/?plan=513
8:39 combining an implant that fuses with the bone and a natural tooth that has periodontal ligament that permits micro motion of the natural tooth , combing these two structures into one solid non flexible prosthesis as a dental bridge , what impact is it gonna have on the natural tooth when occlusal forces try to push it within the socket ? and on the prosthesis itself , having one end motionless and the other able to be compressed ?
That is a great question and one that restorative dentists must all consider. When I first started placing implants, following my oral surgery fellowship, in the early 80s, it was believed you could not anchor a fixed bridge with an implant and a natural tooth. As I have been in practice for 40+ years, I have faced many situations when the terminal tooth for a fixed bridge was either going to be an implant or the patient must be resigned to a removable partial denture or, if the maxillary posterior teeth were missing, a sinus lift with bone grafting and all the missing teeth replaced with implants or an implant supported bridge. A really big procedure! So, I started placing fixed bridges supported by an implant and natural tooth along with a nightguard to be worn at night while sleeping to protect the teeth, implant and prosthesis from the stress of nighttime bruxism. To my knowledge, having placed these "hybrid" bridges many times in 40 years of practice, I have never had an issue with a fixed bridge or lost a bridge abutment tooth or implant abutment in a "hybrid" bridge. I always appraise the patient, in writing on the signed consultation sheet, that the situation is not ideal and there is always the possibility they could have an issue with the bridge or the abutment tooth, but it a much easier and less expensive procedure that the alternative restorative/surgical options. Most patients want a fixed prosthesis vs. a removable patrtial. Life choices are not always "ideal" and without some risk, and the patient must be in on the decision and committed to wearing the nightguard, not chewing real hard things on the "hybrid" bridge just to be on the safe side. I am not claiming to be an expert in the physiology of this restoration, but I can say these "hybrid" fixed bridges have worked in my practice for these many years without incident as far as I know and this is the restoration I would want if I were the patient. What are your thoughts? If the patient was a big daytime clincher I would be concerned and, possibly, go with another option. But any restoration is a gamble with a daytime chilcher and/or a bruxer because you are depending on the being compliant with home care instructions and taking care of the restorations.
Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month.
Click here to subscribe:
membership.dentistrymasterclasses.com/purchase/?plan=513
Thank you so much, for sharing.
You are welcome. Glad you like the videos.
22:40 Have you had any complications with "sleeping" these tooth roots? I'd also be worried about litigation should that "sleeping" root ever wake up. Obviously your recommendation regarding only doing this on vital teeth is important but I wonder how many of these teeth abscess over time...
I have "slept roots" for over 40 years and never had a problem. It is a common procedure with lower posterior teeth when the roots separate from the body of the tooth, for whatever reason, and the doctor does not want to take a chance of damaging the inferior alveolar nerve by trying to surgically remove the root tip. This situation is especially common with mandibular impacted third molars. You should explain what has occurred to the patient and make a note in the chart. If you have paper charts, have the patient initial the notation in the chart. I have never had a patient who did not understand the rational behind sleeping the root. I have also slept quite a few maxillary anterior roots to preserve the height of the alveolar crest if a fixed bridge were to be placed in the aesthetics zone vs. an implant and never had a problem. If there was infection, then you would not want to "sleep" a root that had infection unless the root was a lower posterior tooth approximating the IA nerve. You might perform endodontics on the slept root to be especially careful.
Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month.
Click here to subscribe:
membership.dentistrymasterclasses.com/purchase/?plan=513
What material I like to use for your bridges, anterior or posterior, thanks
Normally zirconia framework with lithium dislocate (e-max) overlay (veneer).
Great video, I am curious about the esthetic prognosis of the bridges that have no roots under. wont the gingiva and alveolar process resorb?
No, not if you graft the extraction site and let the extraction site heal for 3-6 months prior to impressing the bridge. Be sure the pontic on the bridge is in intimate contact with the soft tissue over the edentulous ridge, such that the pontic blanches the tissue when the bridge is placed. Also, create a gingival pontic receptor site during abutment teeth preparation so the pontic appears to have grown out of the gingiva, just like a natural tooth. Watch the video on bridges in DentistryMasterClasses.com. As stated, I normally do not like implants in the aesthetic zone (maxillary anterior) if the patient has a high lip line when they smile. Never forget, most patients, especially women, are not so concerned with the type restoration as they are with how it will appear. You can control the aesthetics (gingival line, papillae, no dark "shine through" the tissue) better with a fixed bridge than you can with an implant. Do I place implants in the aesthetic zone? Yes, but I try not to do it unless the patient has a low lip line when they smile. As a matter of fact, I am placing a couple of implants in the aesthetic zone on a physician this morning, but he only displays about 1/2 of his central incisor teeth when he smiles, so the gingival line and dark shadow "shine through" is not an issue. Sometimes you have no choice, implants are the only option. In those cases, you discuss the aesthetic situation with the patient preoperatively, write down what you discussed, and have the patient sign it. I always have written consultation forms signed by the patient. Watch the video in DentistryMasterClasses.com on NP exams and consultations. Very important!
@@centerforard very interesting I have learned a lot and i'll check your link. Thanks again for the great video
@@centerforard very interesting I have learned a lot and i'll check your link. Thanks again for the great video
@@centerforard very interesting I have learned a lot and i'll check your link. Thanks again for the great video
How would you recommend finding a dentist for implants? Nowadays everyone seems to offer them.
Thanks so much!
I don't know what to tell you. Reputation.
Doctor I want ask you about stem cells in the future will it be possible to replace the lost teeth with using it what is your option can we create new and Norma teeth one day
I have no idea.
I think I am becoming a dentist, the explanation is fantastic
Thank you.
Thanks alot about this valuable vlog
You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
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i know this video is 3 years old, but i'm hoping you'll see this. are you sealing off the gutta percha with anything? if so, are you just sealing the gutta percha or are you sealing off the dentin as well...i.e., mesial to distal fuji/composite? are you grafting on top of the root at all? or just rely on the blood and temporary pontic to mat up the blood to heal?
I use BC sealer with the gutta purcha. The sealer is actually what "seals the canals, not the gutta purcha according to endodontists who have presented at my hands on teaching center in Dallas. I normally build up the tooth following endo with IRM. I'm not sure what your question is about the "grafting on top of the root." Can you clarify?
Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month.
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Hello , do you prefer elective RCT before bridge on good teeths . So that there is no chance of future infection under a bridge?
No, I do not perform endodontics on teeth unless there is a reason for the endo, such as preoperative hypersensitivity, decay into the nerve. or the tooth is in the aesthetic zone and, due to gingival recession, significant preparation must occur on the root of the tooth.
Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
Click here to subscribe:
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I was told to NOT put a 3 unit bridge connecting a natural tooth and an Implant. As the tiny movements of the PDL over time will cause the bridge to have a shorter life span than normal. What are your thoughts?
I heard that also, many years ago, but sometimes that is the only option. I have placed many fixed bridges to teeth and implant abutments and, to my knowledge, have never had a failure.
Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month.
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Tank u very natural in saying
Thank you.
What if the patient missed the maxillary canain.
FPD or implant we use..
Thank you
I personally have a maxillary cuspid implant from a previous sport injury.
Hello dr, what about bone loss under a dental bridge and without an implant how can we minimize that?
I find that bone loss in the edentulous area of a fixed bridge is not a problem. I'm not sure why it does not occur, but I cannot remember seeing bone loss in that area occurring.
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Once a bone graft is installed on a newly-extracted molar, how many months or years, at the most, can one wait for the implant to be done?
Probably several years is not a huge problem. The issue is, once a tooth is missing, the adjacent and opposing teeth begin to shift into the edentulous space. You do not want too much shifting to occur prior to implant placement and restoration of the edentulous space. Shifted teeth can cause you to have a bad bite, leading to a host of dental, facial muscle and TMJ problems.
@@centerforard thanks so much....does the bone graft "harden" more the more i wait or does it reach maximum hardness after x months?
Thank you for the video!
You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
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I like this video
Doctor, you create the pontic receptor, and place the provisional bridge to maintain it. But when do you take the impression for this provisional bridge ???
😍
I fabricate a PVS matrix for the provisional bridge from the preoperative study model. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
@@centerforard thank you !
But did you add flowable composite under the (provisonal) pontic ? Because in tve preoperative model you have flat pontic...
Yes, I add flowable composite to the tissue side of the provisional pontic once I create the gingival pontic receptor site. I want the pontic to be in intimate contact with the soft tissue pontic site, such that is places a bit of pressure on the soft tissue when seated.
@@centerforard Thank you Doc
Thank you for your videos, all your educating work, tour dentistrymasterclasses ! We love it
Terrific.
Was the gentleman in first case, in your opinion, a candidate for a graft less solution? Possibly zygoma implants?
I don't know.
FIRST OF ALL ALL YOUR VIDEOS ARE TOP CLASS.THANK YOU FOR THAT .MY DOUBT IS ,IF YOU MAINTAIN A BROCKEN ROOT WHAT ENTRANCE FILLING YOU USE INSIDE AFTER OBTURATION??
Pretend it's a "reverse" apicoectomy with retrofiill. Whatever material you would use to fill the apioectomy retrofill hole, i.e., IRM or root perforation sealer are the 2 materials I have always used. Root sealer paste is the primary hole filler I use currently. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
Click here to subscribe:
membership.dentistrymasterclasses.com/purchase/?plan=513
@@centerforard thank you Dr ..I will join your classes
Great video, as always!
When you create the pontic receptor sites, how do you preserve them with the provisional bridge so that it does not collapse and heal back to its original form? Do you build the provisional pontic yourself, so that it keeps the pontic receptor in shape?
Best regards from Zürich!
Yes, my assistants and I fabricate all our provisional crowns, veneers and bridges ourselves in my office. You preserve the gingival pontic receptor site with the provisional pontic. The gingival side of the pontic is in contact with the gingiva prior to taking the final impression. If the tooth from the edentulous space has just been extracted, idealize the gingival pontic so that as the edentulous soft tissue grows, it grows against the ideal pontic to create an ideal gingival pontic receptor site. You may need to remove the provisional bridge after 3 months of extraction healing and modify the gingival side of the pontic to create the ideal tissue conformation. Please say hello to master technician, Willi Geller, for me. He is in Zurich. We worked together for about 15 years in the 90s.
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@@centerforard
I will do if I cross him anyhow. Thanks for quick answering, and I will take a look at it. Wish you all the best doctor!
Thank you.
Hello, I had an bridge on my lower incissors , but now I think I made the wrong decision , actually i had a unfortunate communication misunderstanding with my dentist.
So I wanted to ask are bridge that bad option , and i am 22 years old ,i had to replace my teeth because it was my milk tooth and was small.
Could you guide if taken proper care and replaced at proper times , could bridges could also survive for lifetime?
A properly done fixed bridge can certainly be a good restoration and can last a long time if taken care of properly.
Isn't the 3-6 month healing process too long for the patient to use the temporary restoration when we consider the aesthetic expectations of the patient in cases where we apply the root removal procedure?
Don't mess with Mother Nature! Healing time is what it is. Do you think the patient would rather wait a bit longer and have a successful result or rush it and have an implant failure. My practice is based on a successful product, not accommodating the patient if the expectation is incorrect. I make that clear to the patient from the get go.
im a little confused.. do inplants on upper vs bridges cause you to have bigger gingival margin? or does it vary on patients for example my pt would look better in an upper bride because it would show a lower gingival how can you tell if an implant or bridge would be better?
It's much more difficult to control the gingival line and papillae with an implant, not to mention dark implant shine through the tissue. A fixed bridge in the aesthetic zone is normally more aesthetically predictable, especially if the patient has a high lip line and displays gingiva when smiling. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
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Hello Dr. Steven,
I'm 22 and I have congenitally missing lateral incisors, I have a low lip line but unfortunately I can't get implants due to insufficient space between the roots. My doctor suggested a bridge where he'll have to shave my 2 front teeth and a bit of the canines, I'm scared that my gums will start receding and maybe even in 10 years from now the bridge will cause some dental problems. Is there a way to limit gum recession ?
Yes, but it's a specific procedure involving gingival pontic receptor site creation, intimate contact (blanching of the tissue) between the pontic and gingival tissue and a Nightguard to prevent gingival recession from teeth movement from nighttime bruxism.
Hello @Mehdi Ait Mouha I also had the same problem , did You also got the root canals on two abutment teeths ?
Hi what did you end up doing I have the same situation
Thanks for the amazing video. How likely is it that the gum recession happens after placing veneers or bridges and what can be done about it please?
I typically have very little issue with gingival recession following veneer or crown and bridge placement because all these patients receive flat plane, hard acrylic CRO night guards to wear while sleeping, and I instruct the patients on the primary cause of gingival recession, i.e., teeth clinching. I encourage the patients to hummmmm, without making the humming sound, during the day when not wearing the Nightguard. The humming puts the lips together and the teeth apart, which prevents teeth clinching. Over time, if the patient develops gingival recession, you know they were not wearing their Nightguard or were clinching their teeth during the day when not wearing the Nightguard. Also, veneer fracture in the gingival 1/3 of the veneer can occur, just like tooth abfraction, if the patient clinches the teeth without a Nightguard.
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@@centerforard thanks so much Dr.
Unlike a natural tooth root, an implant cannot migrate through alveolar bone, and cannot be moved by orthodontic techniques. This can be good or bad. If the natural teeth are in danger of shifting. anchoring them to the implant can help prevent them from shifting. If the natural teeth can benefit by natuarl migration, the implant can interfere with this. Also, a natural root is surrounded by a cushion of soft tissue, which function as a shock absorber when you eat. An implant is not. Bone and implant material are tightly packed together. They call it "osseointegration" the way the bone almost grows into the implant.
Nice comment. Steve
dr what if gingival line is already low than rest of teeth
The gingival line can often be modified with gingival grafting or periodontal crown lengthening surgery.