Confused and desperate... Please help?

[djdynamix]

First, Hi everyone.

Where to start... Well, I currently have a 7-tooth bridge, which extends from the upper right canine to the upper left first pre-molar. I have had it for nearly 15 years, and when it was first fitted, the dentist warned me that it would need replacing in about 10 yrs, so, to be honest, it's done quite well.

About a year ago, two of the five supporting teeth gave way (broke off at gum-level). Shortly after this, thanks to the extra strain placed on it by the lack of the other two teeth, the root of a third tooth, which contained a particularly complex metal post, also became loose. As I am somewhat "dentalphobic", I struggled on regardless, until the pain of a periodontal infection forced me to make a dentist appointment. (I swear,at that time, if I could have self-prescribed some Metronidazole and carried on, I would have! )

By the time I reached the dental surgery, the bridge had fallen out completely, leaving only two of the supporting teeth (two incisors together in the middle of the bridge) intact.

I discussed several options with the dentist, including implants, dentures, and something he called a "German Bridge", which is apparently some sort of semi-removeable telescopic device. In the end, I persuaded him (after much pleading!) to recement the current bridge onto the two remaining teeth. He told me that it wouldn't last long, but I explained to him that I am a professional singer, and would lose all my work without front teeth. For the same reason, I can't consider regular removeable dentures, as they would alter the shape of my palate.

All the options other than plate dentures which we discussed cost far more than I can afford, so I struggled on with the 7-tooth bridge hanging on two teeth.

A few weeks ago, one of the two remaining teeth finally gave up the ghost, leaving the whole bridge hanging on one single (rather loose!) tooth. I am now at the point where I'm living on soup, and expecting the last tooth to give way any day. I have consulted several dentists, but the bottom line is that there is no way I can afford the kind of treatments they are proposing. The biggest expense seems to be the manufacture of a new bridge. By comparison, where I live (in the Canary Islands), the cost of the actual implants is quite small.

Here is what has been suggested following removal of the 5 old tooth roots:

1) 14-tooth bridge across the whole top set, using 6 existing back teeth and 4 implants - 4 x 500€ for the implants plus 14 x 300€ for the bridge, plus 900€ for a temporary denture, plus 5 x 60€ for the extractions and a surcharge for sedation (which, for me, would be essential!) - I couldn't afford that lot this side of the next Halley's Comet!

2) "German" telescopic bridge at a total cost of about 2000€, but two other dentists say that this kind of bridge might not last more than a few months, depending on the state of the teeth each side of the gap. Apparently, it is meant more as a temporary measure while implants are healing.

3) A new type of removeable denture which is made on a "flexible plate", and doesn't cover the whole palate. I didn't even ask the price, as I am so averse to removeable dentures. To be honest, if I can't sleep in it, I ain't wearing it!

What I got to thinking, however, was that, given the major cost of any of the cosmetic treatments seems to be the manufacture of the actual prosthetic bridge, is there no way a dentist could use my existing 7 tooth bridge to make it more affordable? Here is my idea: Given that the teeth each side of the gap are already crowned, bond an extra tooth to each end of the existing bridge, using one of the new glass ionomer adhesives, which would then replace the crowns. Then use two deep implants (the kind you can hang teeth straight onto, rather than waiting 6 weeks), for support in the centre. Drill & post the corresponding teeth on the old bridge, then hang the 9 teeth across two crowns & two implants. I understand that I would have to be careful with it, and that no dentist would probably guarantee that kind of "botch job", but the difference in price would be staggering! e.g., total cost of option 1) above, about €7500 , total cost of my "botch job" - 2 crowns at €300 each, plus two implants at €500 each and €300 for the extractions equals €1900.

First, can anyone think of any legitimate reason why my money-saving idea couldn't work? Second, can anyone come up with any other affordable ways of doing this? Third, can someone tell me some more about that "german bridge" thing? Fourth, has anyone had experience of those new "floppy dentures"?

Finally, given that I have a very small budget, and no credit rating, what advice would you all give me?

Thanks for reading this, and thanks in advance for your advice.

Ian

[Dr Pav Khaira]

Your money saving idea about retrofitting your existing bridge will not work as the precision required to make bridges fit is fractions of a tenth of a millimetre. Similarly, the mechanics for bridging teeth is different to bridging implants.

Given what you have described I would recommend that you either go for the flexible type denture, which will cover part of your palate, or have the implants done. The telescopic bridges can be ok but tend not to last long. Without a full consultation I really can't offer any more advice

I hope this helps

[djdynamix]

Thank you for your reply, @Dr Pav.

Given what you are telling me, I think my only option may be to consider a trip to a country where the bridge can be made more cheaply. Only drawback is that I would necessarily have to have the whole job done in 7 days to obviate the travel costs. Hence, I'd be looking for an "instant load" solution.

I have seen two "immediate load" systems, and I wonder if anyone can tell me the pros & cons of them (or maybe you know of a better one)?

One is the Sargon system, but it looks quite expensive, and I don't know if they could do it in any of the less expensive countries like India, Korea or Hungary. The other is the Noble "All-On-4", which looks like it might be cheaper, but I think I would have to sacifice my 6 healthy teeth for this one to work.

Is it possible to do something like the "All-On-4", but just use two front implants with my own 6 healthy molars for support?

Thanks again.

[Nilesh]

Thank you for your reply, @Dr Pav.

Given what you are telling me, I think my only option may be to consider a trip to a country where the bridge can be made more cheaply. Only drawback is that I would necessarily have to have the whole job done in 7 days to obviate the travel costs. Hence, I'd be looking for an "instant load" solution.

I have seen two "immediate load" systems, and I wonder if anyone can tell me the pros & cons of them (or maybe you know of a better one)?

One is the Sargon system, but it looks quite expensive, and I don't know if they could do it in any of the less expensive countries like India, Korea or Hungary. The other is the Noble "All-On-4", which looks like it might be cheaper, but I think I would have to sacifice my 6 healthy teeth for this one to work.

Is it possible to do something like the "All-On-4", but just use two front implants with my own 6 healthy molars for support?

Thanks again.

Hi there,

I'm sorry to hear about the situation you're in, there is no easy solution I'm afraid. My first response is to think VERY CAREFULLY before going abroad seeking cheap implant systems and treatments. These things are expensive for a reason and can fail very quickly and cause you a huge amount of trouble if not done correctly. Furthermore, if you did go abroad and had the work done, you would be hard pressed to find a dentist here who would offer you any help if the implants started failing or if the bridges started causing problems. Im sorry to be so pessimistic but its something which I am seeing ALOT of lately. No doubt that there are very skilled implant surgeons in all of the countries you mentioned, but their prices are very similar to what we charge here in the UK.

With regards to immediate load, some research has shown they may have a similar success rate, but you are more likely to encounter complications in the long-run. They are not always suitable, but may be possible where multiple implants are splinted such as in your case.

Joining teeth to implants is NOT done very often as the implant is an immobile object and teeth have a small amount of "give" in them which means making long span bridges incorporating teeth and implants very tricky! Its not something I would be inclined to do.

Lastly, dentures, I would really urge you to TRY a good set of metal dentures first. Imagine if you got used to them! It would solve you ALOT of hassle and money! The plastic floppy dentures arent something I have had much experience with, but I have treated a few singers and barristers all who coped very well with a well made set of metal dentures, some on a temporary basis and some on permanent basis. It may be a useful stop-gap until you are in a position to have a more complete and long-term fixed solution made.

Regards