Q. I am a forty-three year old healthy female. I am congenitally missing my (#24 and #25) permanent left and right mandibular central incisors, as well as, a few other teeth in the back of my mouth. After my primary mandibular central incisors fell out, I never developed the permanent teeth. The space where the permanent teeth belonged lessoned over the years and became nearly unnoticeable. Esthetically, it didn’t look that bad. My teeth originally were not crowded on top; however, I have been told that due the the malocclusion caused by the missing lower teeth, my upper incisors (left and right of center) became crooked. At the age of thirty-one, I decided to get braces to straighten my uppers to gain a more attractive smile. My doctor explained that I would need to have a full set of braces due to the malocclusion. He closed the slight gap that remained in the bottom front which resulted in a very restricted and uncomfortable bite. Due to that result, he fitted me with an expander. After two expanders, I now have an opening large enough to accompany two slightly smaller than normal teeth. The goal was to get implants to replace the missing teeth. Unfortunately, once I was out of my braces, my nightmare began. The periodontist said that I am not a candidate for implants. The only option is a bridge. At the time, my dentist didn’t like that option for me because he would need to use the two teeth on either side for he bridge to gain enough stability. Since they are healthy, he suggested waiting in the hopes that technology would advance enough to give me more options. I was fitted for a partial denture instead. I have had my partial for approximately ten years now. My dentist, periodontist, and oral surgeon all say that I have healthy teeth. I have experienced extreme recession of the gum tissue and bone loss in that area since I got out of my braces. I have had thr

ee periodontist tell me that I am not a candidate for implants or bone or gum grafting. I am seeking a more permanent solution to replace my partial denture. Last week, the periodontist that I saw strongly suggested a Maryland Bridge. Are there any other options available to me that I should check into? Do you feel that a Maryland Bridge is a better solution for me over replacing my current partial denture? Thank you.

A. A well designed wing retained bonded bridge may be a good option.  I would recommend a bonded bridge made of ceramic material rather than traditional metal wings used in a Maryland bridge.  Good luck.  Dr. Lemongello

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