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This bright 19 year old girl has always tried to hide her smile because she was missing a front tooth. She had been wearing a denture which didn’t match very well and it had been an inconvenience socially, especially on starting university. She also didn’t like the same tooth on the other side because it is small in comparison to the missing tooth.

After thorough examination and discussion, we decided that the best approach was a ‘bonded Maryland Bridge’ instead of an implant, to replace the missing tooth and a porcelain veneer to correct the shape of the small tooth on the other side.

What is a Maryland Bridge?

A Maryland Bridge replaces the missing tooth by bonding a porcelain tooth to the adjacent teeth. To do this, the inside surface of the adjacent tooth is minimally prepared, to which a thin shell of porcelain is bonded in order to hold the porcelain tooth in place.

It is is usually a superb option for treating missing lateral incisor as in this case.

Why is an implant less suitable in this situation?

An implant is anchored into the jaw and has a tooth attached on top. It requires relatively invasive surgery to place it and is also relatively expensive. Because she is young, over time her upper jaw, teeth, gums and face will continue to grow downwards. However, an implant does not grow downwards along with the rest of the teeth and stays at its original level, which makes the implant tooth looks like it’s sinking into the gum. Due to this, it will need to be replaced eventually and it will become a very long tooth which looks wrong.

Advantages for Maryland bridge:

  • Relatively simple and minimally invasive procedure
  • Avoids implant surgery
  • Much less expensive than an implant (about a third of the cost of an implant)
  • The Maryland Bridge moves with the other teeth over time and remains in harmony with them. It doesn’t need to be replaced because it looks ‘wrong’
  • Long lasting aesthetics

Disadvantages for Maryland bridge:

  • The need to minimally prepare the canine to hold the Maryland bridge (but much, much less invasive than implant surgery)

To achieve the natural end result, she did tooth whitening, minor aesthetic contouring and micro-abrasion to correct the colour and white spots on her front teeth. The smaller tooth on the other side was lengthened by a minor gum-lift. Finally, she received the Maryland Bridge and the porcelain veneer. She also wears a night guard to protect her teeth from grinding, which also protects the porcelain work. She was very pleased, knowing that the natural results are long lasting and will provide decades of good service, with proper care.

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