Dr. Frank Vascimini, Sound Bites, 7/15/14

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Best to keep teeth, implants separate entities

By Dr. Frank Vascimini

Q: I have had differing opinions from my dentist and my oral surgeon. Can a bridge be attached to an implant? Also, can a bridge be attached to a tooth that has had a root canal done on it? I hope you can clear up this confusion.

A: This is a good question. As I have always said, the opinions in this column are my own. I will answer this question as I feel on the subject and add any thoughts that I think may help you to make a good decision.

There are times when joining an implant to a natural tooth is considered acceptable. However, the conditions need to be very specific and the way that the occlusion (or how the upper teeth meet the lower teeth) is set up is critical. If the restoring dentist is not familiar with the rules regarding this, things can, and do, go bad with the restoration.

In general, it is always best to keep natural teeth and implants separate entities. There is considerably less failure when things are set up this way. I would always opt for adding an additional implant to the scenario if the goal was to use an implant as terminal support of a three-tooth bridge on one end and use a natural tooth as the support on the other end, leaving a missing support in the center of them. The best way to handle this is to leave the natural tooth out of it and place two implants behind it. Once integrated, those implants can be joined with a single restoration.

The second part of your questions deals with making a bridge on a tooth that has had a root canal. The short answer to this is yes, a bridge can be made using a tooth that has had a root canal as one of the terminal supports while using another tooth on the other end. If you were referring to an implant on the other end I would advise against this. The main factor to consider with this scenario is how stable the tooth is that had the root canal. If it is a very sound tooth, there is no issue. On the other hand, if the tooth is considerably compromised, there may be a better way to address the situation.

Dentistry has a lot to do with mechanics and physics. The restoring dentist needs to be very knowledgeable in both these areas in order to be able to construct dental appliances that have the ability to stand the test of time. In addition to the mechanics and physics, the dentist needs to consider how prone the patient is to dental decay and periodontal disease. They need to have a feel for the genetic component to the decay and periodontal disease, as well as the level of home care the patient is committed to.

Whether the patient is regular with their preventive maintenance is also a consideration. These facets are more easily known if there is a longstanding relationship between the patient and the dentist. If this is not the case, the consultation appointment is critical. If very little time is spent reviewing the medical and dental history, and if the right questions aren’t asked, things may not go as well as they could have.

As you have read in the past, if you are a regular reader of this column, the dentist also needs to be a good listener. Sometimes this can be the most critical part of whether something is successful or not.

Dr. Frank Vascimini is a dentist practicing in Homosassa. Send your questions to 4805 S. Suncoast Blvd., Homosassa, FL 34446 or email them to him at info@MasterpieceDentalStudio.com.