oh maryland

[maryland]

hi,
I'd really like some second opinion re my Maryland bridge - no bridgeS. My dentist whom I trusted very much has since Nov last tried to fit me with one (4th left top). The first one was too high, so taken out, filed own and re-bonded, failed; re-bonded, failed. Left out as still temp during healing period.
Nr 2 fitted perfectly, had only one wing, - failed, fell out immediately.
nr 3 was prepared too short (i.e. gap between lower and upper teeth showing without dentist telling me beforehand) - fell out immediately;
nr 4 was too big all around; dentist crammed it in just in case - but it was too high, so she tried to take it out, but could not, so she took off the wings and left it to fate (fell out within a day).
At the moment I have got
nr 5 as dentist agreed there had been some issues with lab in the process; this again is too high, which I knew immediately but dentist said I might just have to get used to it. so she cemented it in regardless; It is too high but not as bad as nr 1. when I bite on it left, my right-side jaw does not close, but I can sort of chew and I don't have any pain.
Fact is though, it is too high. What I can't remember is whether the dentist will be able to file it down without taking it out? I can't remember whether she tried that with nr 1.
- any other ideas? I could kick myself that I agreed to her fixing it against my gut feeling, but honestly what can you do lying there with your feet up in the air and her standing over you? (sorry about my language, I am female and so is the dentist, I don't mean to imply abuse, just feeling powerless and frustrated.)

 

[comfortdentist]

Maryland bridges have their place but they are the most difficult type to perform successfully. Many dentists don’t do them because they have a tendency to fall off.
You can’t try them in once the surfaces have been prepared for bonding. This is why you have had problems with the bite.
Both the lab and the dentist must be absolutely cautious to both optimize the surface and avoid contamination during the placement. Personally I like to use a rubber dam for this step. The bridge must also have retentive features without the adhesive. Your situation may not be good for this type of restoration

 

[Gordon]

It should be possible to adjust the bite on it if the dentist is careful...

 

[comfortdentist]

It should be possible to adjust the bite on it if the dentist is careful...

The bite may certainly be adjusted after it is bonded in place. It shouldn't need much adjusting unless something unusual was planned.

 

[maryland]

The bite may certainly be adjusted after it is bonded in place. It shouldn't need much adjusting unless something unusual was planned.

well I am getting the impression the lab - unless they are applying the Dahl model without telling the dentist are making them up as they please. The bit is high at the moment, only bridge closes with bottom tooth and the other side does not close at all. But chewing is not as difficult as it was with nr1 - so it may not be quite as high.

 

[Gordon]

The lab will want to make the connector as thick as they can get away with, this stops flexing and makes the bridge less likely to fail. However sometimes they can overdo it a bit. There are some other technical reasons why the bite can be high, but nothing the dentist shouldn't be able to sort out.

 

[maryland]

The lab will want to make the connector as thick as they can get away with, this stops flexing and makes the bridge less likely to fail. However sometimes they can overdo it a bit. There are some other technical reasons why the bite can be high, but nothing the dentist shouldn't be able to sort out.

thanks - that helps; dentist is going to try and file the bridge down later today. One question that I am still puzzled about is why the dentist does the bite test only on the treated side and not both sides - then the issue would be evident immediately? same for the impressions upper and lower-?

 

[Gordon]

Because you can easily see the high area when you do the test if it's bad enough to cause an issue. You've lost me on the impression question, do you mean why don't they take upper and lower impressions?

 

[maryland]

Because you can easily see the high area when you do the test if it's bad enough to cause an issue. You've lost me on the impression question, do you mean why don't they take upper and lower impressions?

- for the first part I think the dentist was trying me whether I was just a bit sensitive... to give her the benefit of the doubt; for the second part yes, that is what I meant. TY

 

[Gordon]

Wait, are you saying the dentist didn't take upper and lower impressions?

 

[maryland]

no they did not; - I don't remember whether they did in Nov when the first bridge was commissioned from lab but recently when they called me back as lab said the model/impression had been around for a bit, could they have a new on..., she definitely only took the upper (where I had the tooth out). That said she has now filed bridge down (technical term escapes me) and bite is much better tho' not ok yet...

 

[Gordon]

That's very sloppy, no wonder the bite was off...

 

[maryland]

here we go again - my nth maryland bridge has fall out again, after about a month or so. Dentist said she sends it to lab for re-etching and the puts it back in. It appears that possibly previously my use of (too much) tea tree oil in/as tooth paste) may have contributed to early failure. But the story continues. The one that fell out a wk or so ago was again too high and filed down sort of okish; I still had a sense of my bite being slightly off. Now it has been out for a while and this morning I suddenly felt - my bite is mine again. Mmh. Also, mild symptoms at the one opp. (i.e. below 4 l (maybe loose), where bridge/gap is 4l upper, have returned (not a serious inflammation this time but rather a sense like having a bruise in the jaw there, mild pain when moving jaw only, Paracetamol does not affect this at all (the last time these were the symptoms as the infection was subsiding but now - no change for 6 days). I am a bit concerned and wondering whether a) the loose tooth has something to do with the bridge falling out and b) whether my sensation that bite was still very slightly off (sideways-ish if that makes sense) would not now be a question borderline for what in Germany would be called Kieferorthopaede? - orthodentist? Finally, also have very mild symptoms at the upper left 5th - i.e. next to gap/bridge which may be very early caries - could that be related to the new failure? Any thoughts would be much appreciated.

 

[Gordon]

Who told you that about the tea tree oil? It's complete rubbish.

The opposing tooth may feel a bit "loose" because the ligaments that hold the tooth in place have been traumatised by the high bite, most likely.

Can't comment on the upper left 5, but caries won't really cause a maryland bridge to fail, unless it's so gross that the entire supporting structure has been destroyed, I'm guessing that's not the case here!

 

[maryland]

thanks for the strong support - when my previous editions of the maryland failed within a few hrs/days and we were running out of ideas what caused it, I asked my homeopath (very experienced but not herbalist) whether she thought it might ... and she said yes: I was using tea tree oil pure, 1 drop on baking soda on toothbrush at the time but admittedly, a couple of them failed before I had a chance to get to them with a toothbrush. At least this one lasted a month - will say what she says tomorrow when I expect her to re-bond the re-etched latest edition. Thanks in the meantime.

 

[Gordon]

It sounds like there's a fundamental issue with the design of the Md bridge, they should last pretty well if they've been properly designed and fitted.
Basically the metal work has to be thick enough in the right places not to flex in use, which will cause failure of the tooth bond. If your dentist has never supplied the lab with proper models to get the bite correct, as you posted before, then it will potentially be overloaded in some areas during function which will cause it to fail.
Any chance of some photos of the bridge in situ or in your hand if it fails again?

Otherwise there's a failure in the bonding method, it could be something subtle like there's some oil getting into the dentist's air supply, but this would result in almost all their bonded work failing, so you'd hope they would notice that fairly quickly!

Good luck with getting it sorted.