Category: Dental Bonding

By: Dr. Elizabeth Eggert

How did this start?

Connor started seeing Dr. Elizabeth in the fall of 2020.  Connor was born without two lower teeth.  The teeth were congenitally missing, a condition often known as hypodontia.  To mask this, Connor had been wearing a metal wire retainer (Hawley retainer) with two teeth attached to it since his braces were removed many years prior.  Why some people are born without certain teeth is unknown.  While there are often genetic or heredity links, it isn’t always that parents pass this condition on to their children, in fact, it is often found to skip a generation.  Treatments for congenitally missing teeth usually include bridges, dentures, or dental implants.  Often orthodontic treatment is also necessary to make sure the spacing available is adequate.

What was recommended?

Dr. Elizabeth talked with Connor about treatment options for the future, should he ever decide that wearing a retainer full time wasn’t for him.  In an ideal world, implants can replace congenitally missing teeth without altering any other teeth in the area.  Connor did go for a consult with the oral surgeon, hoping to hear that he could undergo implant treatment whenever he was tired of wearing his retainer.  Unfortunately, Connor doesn’t have enough space for implants.

What this means is that Connor will have to undergo orthodontic treatment (again) before any implant surgery can be done.  Connor and his mom and dad weren’t excited about that option and wanted to know what alternative treatment options he has.  Connor goes to college and does not feel that orthodontic treatment at this point in his life is what he wants.

Connor could choose traditional bridges, but Dr. Elizabeth was not in favor of this option because the bridges would be built on small anchor teeth.  Initially, Connor planned to keep wearing his wire retainer, but then last summer, his retainer finally broke.  Connor was tired of wearing a retainer so Dr. Elizabeth Eggert suggested Connor consider having bonded composite “bridges” completed.  She talked with Connor about how conservative the preparation could be for the anchor teeth and was confident that the results could look good.  Another advantage of the composite bonded “bridges” was that if Connor does decide to move forward with orthodontics and implants later in life, his neighboring teeth will still be in good shape.

What did he want?

After discussing the pros and cons with Dr. Elizabeth, Connor and his parents decided on composite bonded “bridges,” which is a type of fixed dental prosthesis for the replacement of a single missing tooth.  The design of the bonded bridge consists of an artificial tooth made out of plastic filling material with a wing-like extension, which is bonded to the neighboring tooth or teeth.  The tooth which supports the resin bonded bridge is called an abutment.  The tooth which is replaced by the bonded bridge is called a pontic.  Usually only minimal preparation is done to the abutment tooth and this treatment is considered minimally invasive.

What was involved?

After deciding to move forward with the composite bonded “bridge,” Dr. Elizabeth took impressions to get a model of Connor’s teeth so she could design the new restorations.  Connor also wanted his teeth to be whiter so he did over-the-counter Crest White Strips to bleach his teeth.  Connor then had an appointment with Dr. Elizabeth and in one day, he left the office with two new teeth as part of his composite bonded “bridges.”

What does he think?

Once the treatment was completed Connor was very happy with the esthetics and his bite.  When we asked him some questions following treatment he said that he did not think much about having the procedure done, but just that it may take a while.  He was surprised at how quick and easy the procedure appointment was and notes “I actually fell asleep for awhile I think!”  Connor says “I love them!  They’re super easy and they feel pretty normal already!  It’s been great.”  He would tell anyone that needed the same procedure to definitely do it!  “It’s totally worth it.”

Thank you, Connor, for trusting us with your smile, we look forward to working with you for many years to come.

By: Dr. Elizabeth Eggert

How did this start?

Elena came to Eggert Family Dentistry at the age of 15 as a referral from our orthodontic colleague, Dr. DeVoe.  Dr. DeVoe wanted Dr. Elizabeth Eggert to evaluate restorative options for Elena because she is congenitally missing (was born without) one of her lateral front teeth and her lateral incisor on the other size is undersized.  Dr. DeVoe anticipated that Elena would want a solution for her smile after her braces were removed.   

A congenitally missing tooth is one of the most common dental developmental abnormalities.  In fact, roughly 20% of adults have at least one tooth that never developed.  Why is that number so high? Well, we’ve all heard of that person who didn’t develop all, if any, wisdom teeth.  If you take wisdom teeth out of the picture, the percentage of adults with congenitally missing teeth drops to only 5%.  Other permanent teeth we often see missing are second premolars, upper lateral incisors, and lower central incisors.

A wisdom tooth that never develops would typically be thought of as a good thing – one less tooth to remove!  However, being a person with a missing front tooth can be quite a different story.  Teenage years are difficult enough without having to worry about your smile.  With the emotional roller coaster of being a teen, we need to give our children any excuse to smile and no reason not to!

What was recommended?

Dr. Elizabeth had some options for Elena for replacing her missing tooth.  One option was to use a “flipper,” which is a removable partial denture that contains one or more artificial teeth.  A flipper is often made from denture acrylic and can blend in well with your smile.  The flipper is custom made using an impression or digital scan of your mouth.  Flippers can be uncomfortable to wear and they do come in and out of the mouth, which can be inconvenient.

To replace missing teeth, you can also consider a bridge.  A traditional bridge uses the neighboring teeth as anchors to “fill in the gap.”  Since Elena was still growing and developing, a traditional bridge wasn’t Dr. Elizabeth’s first choice.  A more conservative option for Elena’s age was to consider a composite bonded bridge, which still stays fixed in the mouth like a traditional bridge, but is much more conservative for neighboring teeth and can more easily be altered with growth, if needed.

Another common method to replace missing teeth is to use a dental implant.  With a dental implant, a small post, usually made of titanium, is placed into the jaw bone and serves as a substitute for the root of the tooth.  Then, through a series of attachments, a tooth is added to the implant.  Again, because of Elena’s age, a dental implant wasn’t indicated…yet, anyway.  

Dr. Elizabeth discussed pros and cons with Elena and her mom of these options and emphasized that something would have to be done to last through Elena’s teenage and early adulthood, even though a dental implant may be the best long-term approach.

What did Elena want?

For the undersized lateral on her right side, composite bonding was done to change the shape and size of the tooth.  A porcelain veneer could have been done, but with Elena’s age, the composite material can more easily be changed, if needed, for future growth and development.  As an adult, Elena could choose to convert her composite bonding to a porcelain veneer for ideal color match.  After much discussion, Elena and her mom decided that for her missing tooth on her left side, Elena would use a flipper during the day and an orthodontic retainer at night.

Then what happened?

Throughout Elena’s high school career, she found it was inconvenient for her to wear her flipper and she also didn’t wear her retainer much so her teeth moved somewhat.  In thinking of her life after high school, Elena wanted to review her options.  Elena and her dad came to consult with Dr. Elizabeth she told Dr. Elizabeth, “I am interested in a bridge now.”  Once again, Dr. Elizabeth reviewed Elena’s options in regards to how the most conservative approach would still be preferred.  Dr. Elizabeth recommended that Elena complete a composite bonded bridge.  Dr. Elizabeth would be able to artistically create a “fake” tooth and attach it her surrounding teeth.  This choice is good for the esthetics and will buy Elena some time until she is older and can make some alternate decisions, if needed.   

What does she think?

When asked how Elena felt about getting the procedures done, she said “I was looking forward to my tooth looking like a normal sized tooth.”  She also said that her mom had a bridge done and so she was not worried about it.  “I like it a lot and it looks good.  It doesn’t feel weird to my bite.  It does not feel weird when I chew or eat.”  She is really happy to have her palate free!  She would recommend that anyone needing the same or similar treatment done go for it.  She says, “I like it!  It’s nice to have a normal smile where all my teeth are a normal size.”

Congratulations on your amazing results Elena and thank you for putting your trust in us!  We are delighted to help you move into your college years!