implant/fix bridge/bond bridge??? 
Author Message
 implant/fix bridge/bond bridge???

I am a bioengineer working in the area of orthopaedics that needs advice
on a dental procedure.  My job in orthopaedics is to create finite element
(computer) models of implant and long bone structures.

At 12 years of age I was struck by a hockey puck which chipped both top
front teeth.  The right front tooth had root canal, was ground to the gum
line, then had a post and cap installed.  The left front tooth was built
up.

today: 32 years of age
Seven months ago my family dentist noticed an absys(sp?) on my gum
adjacent to the right tooth.  An {*filter*}surgeon peeled back the gum, found a
crack, drilled the crack into a circular shape, then filled with
amageom(sp?).  After a healing period the family dentist cemented a new
crown.

After 5 months I noticed the crown was slightly loose, also had one day of
tooth pain.  Examination by the family dentist and {*filter*}surgeon indicated
that the crown was loose on the post.  The {*filter*}surgeon said I should work
the crown loose and then have it recemented.  This past Monday I felt the
crown was loose enough.  The family dentist removed the crown under
novacain (sp?) and discovered that the root had fractured.  The crown came
out with the post and approx 1 cm of posterior bone.

The family dentist is recommending tooth extraction.  At this point my
treatment options seem to be:  1) fixed bridge, 2) bonded bridge, and 3)
implant.  I have researched these options through Medline and the IADR '94
abstract book.  Listed below is the information I have at this point in
time.  

1) fixed bridge - also called Maryland bridge?
Requires shaping of adjacent two teeth.  Possible issues with bone
resorption below bridge (because the bone in this region would not be
loaded).  Produces good results.

2) bonded bridge
Requires minimal modification of adjacent teeth.  Same issue with bone
resorption.  Good long term results possible (IADR abstract says 19 yrs).

3) implant
Requires insertion of metal post into jawbone, 4-6 months of healing, then
fitting of crown.  Short term results seem reasonable, problems occur with
loosening.  A search of the FDA uncovered numerous MDRs (medical device
reports, ie failures) of the Branemark implant.  I am hesitent about this
option because of loosening (we also have loosening problems in
orthopaedics).  Have been unable to locate an unbiased long term study of
results.  The metal post is threaded and bone growns next to it, in
orthopaedics we have found that threaded implants overload the bone and
cause atrophy.  Most ortho implants are porous coated for bone ingrowth.
Also a choice of HA, results for this addition seem mixed.

I would appreciate any comments relative to the options listed below, or
other possible options.  I would also appreciate references to appropriate
journal articles.

Mark Harbaugh
Memphis, TN
day = 901-396-2121 x6604
night = 901-753-1710

MSME Mechanical Engineering
Registered Professional Engineer



Mon, 26 May 1997 23:20:23 GMT
 
 [ 1 post ] 

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