Very often, dentists on Long Island recommend a flipper or a removable denture to replace a missing tooth as a temporary replacement while undergoing dental implant treatment. Sometimes this is the only choice to replace a missing tooth but there are better choices. One of the best choices is a “perforated Maryland bridge.” This is a fixed and cemented bridge which is strong enough to stay fixed in place but weak enough that the dentist can remove when procedures need to occur. Many dentists are afraid that the cemented bridge will be too difficult to remove. This is a main reason the patient is never given an option for this type of replacement. Dr. Brant believes that this type of temporary replacement should be recommended if there is enough tooth structure on the tongue side of the adjacent teeth.
The trick to easy removal is the presence of perforations in the metal wings that get cemented to the adjacent teeth. In the first part of the video, note how a drill is used to drill out the cement that fills the perforations. Once the cement is drilled out of the perforations, a large amount of the “holding power” is lost. Once the holding power of the dental cement is lost, the tooth can be “wiggled free.” The video shows how a wiggling force is applied to loosen the bridge.
Once the bridge is removed, dental implant placement can proceed normally. A small incision is used to visualize the underlying bone. Good visualization leads to precise dental implant placement. A maximum amount of bone needs to surround the dental implant for long term health and success. This type of incision is conservative enough to preserve the soft tissue anatomy and esthetics. In addition, only mild discomfort is reported when this approach is used. At the same time, this style of surgery provides for precise implant placement to an experienced surgeon.
A less experienced or less judicious surgeon will likely use a more aggressive surgical approach. The only other way to place the dental implant is to use a computer guided placement jig and place the implant without any direct visualization. Dr. Brant has tried all the various companies offering this service and has concluded that the precision of these stents is lacking as of the spring of 2013. As technology improves, there will be an option not to “cut the gum.” For now, too much error exists which compromises implant position and long term success.
Once the implant is placed, an impression post is placed. An impression will be taken at the time of surgery. A tooth is made which will be supported by the dental implant. This new tooth will be inserted after the bone has matured around the dental implant. This means the fixed perforated Maryland bridge is no longer needed once the dental implant is strong enough.
The perforated Maryland bridge will be recemented. The dental implant will be allowed to mature for a period of 8-12 weeks. Once the bone has matured around the implant, a second surgical procedure is performed. A small incision will be made at the top of the gum. The top of the dental implant will be visualized.
This dental implant procedure is demonstrated in the video above and on YouTube at
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