DENTAL CARE

Q: How Do You Know the Correct Size of My New Tooth?

A: I have patients that come to me from all over. Sometimes patients move away and travel back to see me. Of course, this is because we get comfortable with a health care practitioner and switching can be an issue. If we move across town, then the drive back is not a big deal. If we relocate out of state, then we use visits to family and friends as an opportunity to get a checkup and cleaning. The patient who asked me about the size of her tooth did not fall into either of those categories. Her situation was different. Her son and family live in the area. Unfortunately, her son is ill, so she is spending a lot of time in Ohio. She lives a few states south of us. About a year ago, she had an emergency involving a cracked tooth on her partial denture. I arranged for her to go to one of my labs which are known for excellent efficiency in terms of time. Her front tooth repair happened without a glitch, and her happiness was without bounds. She would not have walked out the door with a cracked front tooth. She came back to me this year with some discomfort on a back tooth. She thought that she had a cavity and was correct. This tooth helped secure her partial denture. This tooth replacement device which was made very quickly several years ago. It replaces her front tooth and one back tooth. This partial is a lot of hardware for two teeth and was very worn. I suggested that she replace her partial denture which comes in and out, and only replaces two teeth, with something that is more permanent. The partial was no longer serving her well. My first thought in discussing permanent teeth involved implants. The front tooth had very little space but enough for a mini implant. At the same time, the back tooth had two issues. The first issue was an insufficient bone for an implant. There was some bone, and I could add to it. This necessity for bone adding just adds to the procedure and might affect how it progresses. The second issue centered around the size of the tooth. The space that was taken up by the partial was more than an average size tooth. It worked on a partial denture but would not work well with a crown on a single implant. The space was too broad and would stress the supporting implant. We have a situation where the front tooth space is too small, and the area for the tooth in the back is too big. My patient then proceeded to tell me that she had braces over a decade ago and the orthodontist created the spaces. I don’t know who was calling the shots on the space size after teeth movement. Was the captain of the ship the orthodontist or the general dentist who made the partial? In either event, enough space was present in the front for the front tooth and whatever was left over would be handled by the partial. This spacing worked for years, but the move to a permanent solution has problems. I strive to make tooth size look natural and be harmonious with the teeth around the new tooth. This can be done when I have enough space to work. When I am limited, the results will not be as ideal as I would like them to be. In my patient’s case, she had two choices. The first choice would be to undergo orthodontics again with either braces or clear aligners and enlarge the front space which would result in a narrowing of the area in the back of the mouth. Then, we could do two standard size implants with normal size crowns on them. The second approach involved making a permanent bridge in the back of her mouth and sticking with a mini implant in the front of her mouth. This old partial which had outlived its usefulness and now created problems. My patient did not want to do orthodontics again and move the teeth. She chose our second plan involving a bridge in the back of her mouth and an implant in the front of her mouth. She would eliminate the need for her partial denture and have a permanent solution for her two missing teeth. If you have an old partial denture in your mouth, it may be time to look at and see if a change is warranted. They degrade over time and are not designed to last forever. The solution may be a new partial or as in our patient today an improvement to a permanent fix for her missing teeth. Call Megan at 440.951.7856 and make an appointment for an evaluation. It never hurts to ask and find out information. I look forward to meeting you. The Healthy Smile 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com