Thursday, December 6, 2012

Dental Flipper choices

I have a front tooth missing and am waiting for my implant!!  What looks and functions best for me???

So you lost, or you never had, one or multiple front teeth.  You have made the wise decision that implants are the best option for you long term.  However, now you are either young and waiting to stop growing or you're an adult and waiting for the implant site to heal (post extraction and/or bone graft) or the right time to spend the money and you CAN NOT walk around with no tooth in the front.  If you are spending the money to get an implant, it is safe to say you are now not the kind of person that finds a missing front tooth acceptable.  

So you have 6 choices on what to do.  I will cover each in more detail below.  There is also info. available on our website and my implant blog.

1. Place a mini screw in the space and a single crown on that.  (This option is only for someone who is still growing and awaiting their final implant placement.)  Some people are doing this but research is showing it has a negative impact on the bone as a young adult grows and can result in not enough bone development in the site for a final implant.  Although this can be done successfully and there are tons of great before and after cases; you can shoot yourself in the foot with this technique.  So I am not offering it.
2. Bonded Maryland bridge.  This is the only fixed option I offer.  They look nice and are functional.  In years past, pre implant popularity, this was by far the most common procedure done because it can last a lifetime if needed.  If you are definitely getting implants done this is probably overkill.
These last four options are removable and are most likely what you are looking for.
3. Removable flipper or retainer.  If you had orthodontics you know what a retainer is.  This one just has teeth attached to it.
4. Delineator (or similar) is like a removable flipper but is a newer product being offered.
5. Essix style retainer.  This looks like a bleaching tray or Invisalign tray but has teeth in it.
6. Snap-on smile.  Covers multiple teeth.  This is like a removable bridge and covers all the front teeth.  

1. As I said I am not offering the mini-screw option currently.  My wife uses the same technology called TADs, but for different purposes.
2.   Maryland bridge is a type of dental bridge that consists of a metal or porcelain framework with a porcelain artificial tooth which is put into the front of the framework. It has 1 or 2 wings.  I only do a wing on one side and do not have any issues with them coming off.  However, most dentists use a wing on each side as shown below. These wings get bonded onto the teeth next to it.  This bridge was developed at the University of Maryland, thus got its name as Maryland.
                                     Artistic rendition of a Maryland bridge.
Advantages of Maryland bridge
  • The Maryland bridge is a conservative treatment for splinting or replacing missing teeth. 
  • Esthetics are good
  • As it combines a composite resin cemented to acid etched enamel, it is proven for its bond strength. It is strong enough that you can eat normally and do not have to worry about it falling out.
  • No teeth need to be damaged putting it in or taking it out.
  • Used for a many years as a permanent lifetime solution so clearly is more than strong enough for your temporary solution.
Problems Associated with a Maryland Bridge
  • They are tough to get a perfect match.
  • They are most expensive option
  • They occasionally require some tooth modification, ie cutting of teeth next to the space.
  • They can pop out although that is rare.

3. Removable Flipper looks very similar to a retainer but has teeth on it and not as much metal.  There is essentially no metal in the front. Here are pictures of three different examples.


An acrylic tooth is selected that most closely matches the shade of your teeth, and a pink plate is molded to fit your palate (on the upper) or to fit just inside the tongue side of your teeth (on the lower).  For a little extra cost, wires with little ball ends can be placed to help secure the dental flipper in your mouth. Otherwise, it is secured by the pink acrylic snapping between your teeth.  Here is an example of one replacing two front upper lateral incisors with metal clasps in the back.  If you look close you can just see the metal in the back.

 Advantages of flipper
  • Cheapest option
  • They can be made quickly (with in a day or 2)
  • Works well most of the time
  • They are still likely considered the “standard of choice” by most dentists
Problems Associated with a flipper
  • They are tough to get a perfect match.
  • They press somewhat on the gums and so are not very healthy for the gums.
  • They also break easily.
  • It can be difficult or impossible to eat with them-they may not be strong enough to eat on and often must be removed for meals.
  • For replacing just one or two teeth, it is a lot of "hardware" in your mouth.

4. Delineator is very similar to the choice above but is made of a moderately pliable product. We have used this material to make removable partials for years now and I think this is a great idea to use for some people.  Some labs are starting to do this more now such as Bayflex.  As I mentioned it is new and I have not used yet, but am looking forward to trying it out.

 Advantages of flipper
  • Can look very esthetic
  • Works well most of the time
  • Only has to touch 2 teeth next to empty area 
  • Great idea when have a tooth in or near the back when want something but exact match not critical
Problems Associated with a flipper
  • They can be tough to get a perfect match.
  • They press on the gums and can be irritating.
  • They are hard to adjust
  • It can be difficult or impossible to eat with them-they may not be strong enough to eat on and often must be removed for meals.
  • They can not be added to or repaired

5. Essix style is a custom clear retainer, similar to the Invisalign product, that snaps over all of the upper or lower teeth.  It is a fairly hard acrylic.  Here is someone wearing one
 Here is what it looks like
  . Advantages of essix
  • Comfortable to wear
  • Works well most of the time
  • They can be made quickly (with in a day or 2)
  • Pretty strong you are unlikely to break
  • Acts as a retainer also so do not need to wear the retainer.
  • Can eat with it but be careful
  • Will protect area of implant when it is first placed because no pressure is on the tissue
Problems Associated with an essix
  • They are tough to get a perfect match.
  • They can make you talk a little funny at first

6. Snap-On Smile is the name brand of a product used for improving people smiles that can not afford veneers.  It can also be used to temporarily replace a single tooth or two.  Rather than copy information from their website here is the link to what it is.  Snap-On 
Advantages of Snap-On
  • Comfortable to wear
  • Can look great
  • Strong
  • Can eat with it but be careful
  • Will protect area of implant when it is first placed because no pressure is on the tissue
  • If thinking about veneers, it can give you a trial run of what they might look like.
Problems Associated with a Snap-On
  • They may be too bulky.
  • They may mess with your bite some so important to remove it at night and preferably for as many meals as possible.
  • More expensive (about 3-5x cost of flipper, essix, or delineator)

Personally, I would go with either option 3, 4, 5, or 6.

Here is someone who had both an essix and a snap-on made while waiting for her implant to heal.  She had both made and chose the snap-on.  It is often hard to say which will look better ahead of time.

View with nothing on

Snap-on in

Essix retainer in

Final crown

Bryan Bauer, DDS, FAGD                                                                
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Wednesday, October 3, 2012

Permanent Maryland bridge

This is an example that I did on a young girl using a modified Marlyand bridge in which I use only 1 wing.  By modifying this way we reduce the back side of only one tooth instead of cutting the back side of both teeth.  In this particular case these are her final restorations that she will have for as long as she can keep them, quite possibly for most of her life.