Hello!
Many years ago, in an accident, I damaged my upper four front teeth (2,1,1,2). I wore a social-insurance bridge for 13 years, and apart from its unattractive appearance I never had any problems with the broken teeth. Last year, however, when I had the bridge replaced with a metal-ceramic one, the problems started. The lateral incisor that had remained vital all those years began to hurt badly. The X-ray was normal. Within a few months the gum above the bridge also began to burn and bleed. It was found to be an allergy, and after 6 months of wearing the bridge they removed it. Since then, the other lateral incisor, which has had a post since the accident, has also been painful. The vital lateral incisor was treated and is now root-filled, but it still hurts, while the X-ray again shows everything is fine. The lateral incisor with the post has had an inadequately filled root for 25 years. He says this cannot be corrected because the post will not come out. I understand all that. What I do not understand is that he would soon make a zirconia bridge on the existing condition. What risk does this mean for me? After all, in six months I went through bridge removal twice, and the last time it took considerable force to get it off; it was really awful when it simply would not come off! Apparently nothing was broken. What would you do if I were your patient? I am genuinely worried about these teeth, because even after so many years I have not come to terms with this loss, which strongly affected my self-confidence. I sincerely thank you for your answer and wish you a nice day.

Question

Hello!
Many years ago, in an accident, I damaged my upper four front teeth (2,1,1,2). I wore a social-insurance bridge for 13 years, and apart from its unattractive appearance I never had any problems with the broken teeth. Last year, however, when I had the bridge replaced with a metal-ceramic one, the problems started. The lateral incisor that had remained vital all those years began to hurt badly. The X-ray was normal.  Within a few months the gum above the bridge also began to burn and bleed. It was found to be an allergy, and after 6 months of wearing the bridge they removed it. Since then, the other lateral incisor, which has had a post since the accident, has also been painful. The vital lateral incisor was treated and is now root-filled, but it still hurts, while the X-ray again shows everything is fine. The lateral incisor with the post has had an inadequately filled root for 25 years. He says this cannot be corrected because the post will not come out. I understand all that.  What I do not understand is that he would soon make a zirconia bridge on the existing condition. What risk does this mean for me?  After all, in six months I went through bridge removal twice, and the last time it took considerable force to get it off; it was really awful when it simply would not come off!  Apparently nothing was broken. What would you do if I were your patient?  I am genuinely worried about these teeth, because even after so many years I have not come to terms with this loss, which strongly affected my self-confidence. I sincerely thank you for your answer and wish you a nice day.

Accepted Answer

Dear Sir/Madam!
Any decision to make a new prosthetic construction on abutment teeth that are non-vital carries a certain risk. In every case we try to bring the condition of the abutments as close as possible to optimal (correct existing root fillings, insert posts...). Assessing the prognosis is difficult; the key factor affecting it is the size or presence of existing periapical processes. To answer, I would need to see an X-ray (local or panoramic). If possible, you can send it to me by email.
Have a nice day!

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