My daughter has a genetically missing lateral incisor (#10). We’ve finally finished most of her orthodontic work to open up the space, however she is too young for a dental implant and it will be another five years or so. We needed a temporary replacement. Our dentist fitted her for a Maryland Bridge with non-metal wings. We had to go in for a retainer fitting and the bridge fell off. The dentist decided to try a different type of cement. But, the bridge fell off again. Now she’s wants us to come back in for another fitting and this time she’ll use metal wings. Here are my questions:
1. Will the metal wings show?
2. Will metal bond better?
3. Will metal damage the adjacent teeth?

Thank you,
Carol

Dear Carol,

It sounds like your dentist is doing her best, but doesn’t really understand how a Maryland Bridge works. When the first one fell off she thought maybe the problem was the bonding cement, so she tried another brand. That didn’t work so now she wants to try metal wings. That’s probably not going to work the way she’s doing it either.

I’ll go through your questions and then give some additional, helpful information.

Will the Metal Wings Show?

While you won’t be able to see the metal wings, they will darken the adjacent teeth. This is why more and more dentists are going to the zirconia wings, which are strong, but will match the color of the teeth thereby not darkening them.

Will the Metal Bond Better?

No. In fact, metal is harder to bond than the zirconia she was using.

Will the Metal Damage the Adjacent Teeth?

Yes. The reason for this is the tooth has to be properly prepared. Your dentist likely hasn’t been doing this which may be a large part of the reason hers keep falling out.

If you’ll look at the image to the left, you will see there are grooves cut into the adjacent teeth. It is this combined with the cement bonding that keeps a Maryland Bridge in place. Whenever you are removing tooth structure, that doesn’t spell temporary replacement to me. Those teeth have permanent damage.

While your choice of replacing her tooth with a dental implant is spot on and the best tooth replacement available, the “temporary” replacement she chose is not a great course of action. Anything that damages tooth structure is not temporary. Instead, I would get her a dental flipper. This is significantly less expensive as well.

One other issue. I’m hoping her dentist or orthodontist did a splint on the back of her teeth. This will keep her teeth from drifting back into that open space causing her to need a second round of orthodontics.

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