Will Metal Wings Be a Better Solution on a Maryland Bridge?

My daughter had orthodontic treatment to make room to replace a genetically missing tooth. We needed a temporary tooth replacement in order to keep the space open for a dental implant a few years from now. Her dentist provided a Maryland Bridge with zirconia wings to blend better. Unfortunately, that fell off. She decided to try again but when it fell off the second time, she has decided we are going to have to switch to the metal wings in order to get it to stay better. I have a couple of questions. Will the metal show? Will the metal damage her teeth?


Dear Andrea,

First, I’m going to say I’m glad you have chosen a dental implant for your daughter’s permanent tooth replacement. Great job in picking the top of the line replacement for her. Unfortunately, your current dentist isn’t top of the line. I don’t know the name of your dentist so none of this is said out of malice. She doesn’t understand the bonding procedure for a Maryland Bridge. Nor does she understand what a temporary replacement means.

Let’s start with the problem with her bonding and then I will answer your questions. She tried her traditional bonding method and it didn’t work. Rather than question the method, she questioned the material. Maybe I need metal instead of zirconia. Nope. That’s not the problem.

example of preparation for a Maryland Bridge

Maryland Bridge’s require some tooth preparation in order to stay bonded properly. Without that, the bridge will fail regardless of the type of wings your dentist uses. Grooves will need to be cut into her adjacent teeth, like what you see in the picture I’ve posted directly above. My guess is she didn’t do this type of tooth preparation, which is why it keeps falling off.

Now, to answer your questions. Will the metal show? Yes. It will darken the tooth structure. This is one reason dentists who use a Maryland Bridge are moving to the zirconia wings, which will keep the color unaffected. Your second question is will it damage your tooth? Yes, if she makes the grooves to properly attach the wings.

You could have her go back and do the grooves, but I’m going to recommend you switch temporary replacements here. One of the many benefits of dental implants is that the adjacent teeth aren’t impacted. To me, when you have to remove any structure from a tooth to use the replacement, it is no longer considered temporary. Instead, I’d like you to get a dental flipper for your daughter. This is truly a temporary replacement that she can take in and out at will. Good news for you is it is significantly less expensive than any type of dental bridge.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Should Dental Implants be Postponed Due to COVID-19?

I’m wondering if the coronavirus pandemic will impact or should impact my appointments for dental implants. To be clear, I started the process more than a year ago and I had all sorts of procedures already done. We started with bone grafting and had the implant placed already. I’m coming due for the appointment where I can (finally!) get the crown added to the top and have a full smile again. I was really looking forward to it. But, as I understand it, all non-essential appointments are supposed to be a no-go right now. Technically speaking, I’ve been living without these teeth for ages, so it’s not urgent. Should I reschedule my dental appointment a few months out or is it okay for me to go in for my dental implants now?



Dear Mark,

illustraition of a dental implant next to natural teeth

This is a great question. It seems everyone these days is trying to figure out what qualifies as essential and non-essential excursions during the coronavirus outbreak.

You Should Skip Non-Essential and Elective Visits

You’re on the right track with exploring what’s really essential. The latest from the CDC indicates anything that’s not urgent be postponed until the outbreak subsides. The problem is, they don’t actually outline what they consider to be non-essential. That’s why a whole lot of companies that provide personal services, like salons, are keeping their doors open, depending on the state you live in. Some states have even closed down barbers.

If you had an issue like a toothache, this wouldn’t even be a question. You’d need that taken care of right away. Ignoring a toothache, which could be a sign of infection, can be fatal. This is why they are considered dental emergencies. However, this isn’t a toothache and, as you noted, you’ve been in the healing phase for quite some time. Waiting for a few weeks wouldn’t hurt.

Dental Implants Restore Form and Function

On the flip side, dental implants aren’t just about making your smile look nice (although they do that too). They’re replacements for your natural teeth. Chances are, you’ve had to change your eating habits and perhaps more since you lost those teeth. Are you able to eat a normal, healthy diet without them? If not, then you’re also impacting your health and immune system. There are lots of nuances like this in the decision of whether to keep your appointment or not, but don’t assume that, just because you’ve been waiting, that it’s a good idea to keep waiting.

Talk to Your Dentist

The reason why the CDC and other agencies are so vague is because each case is different. What’s urgent for one person might not be for another. In your case, an argument could be made for either decision—to keep or not keep the appointment. Your dentist knows your situation better than anyone else. As such, he’ll be the best source of personalized information for you. Additionally, each state is in a different place with this virus and will need different levels of lock-down as a result.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Unhappy with Porcelain Veneers

I’m a little frustrated. My daughter had a bicycle accident when she was younger and it knocked her tooth crooked. We originally wanted to get her teeth straightened but the orthodontist told us the ligament damage would make that a bad idea. So, we opted for porcelain veneers when she got older. We went to see a dentist who said he was a cosmetic specialist and had six porcelain veneers placed. We never really got to see them on her before he cemented them on. Neither of us likes how they look. Plus, they’re too big for her mouth and look bulky as well. Is there anything we can do about this? Would the dentist be obligated to make them pretty?


Dear Penny,

Woman covering her mouth

It is a horrible feeling when our children are embarrassed by their smile. Normally, when getting a smile makeover the dental board will only consider whether or not the work is functional. If it is, then it would be up to the dentist’s personal ethics to do something about this. However, somethings you’ve mentioned regarding your daughter’s porcelain veneers make me wonder if you might have some more leverage here.

There is No Such Thing as a Recognized Specialty in Cosmetic Dentistry

Did the dentist tell you he was a specialist? There isn’t such a thing as a recognized specialty. If that’s the case he misrepresented himself which could work in your favor. Any general dentist can call themselves a cosmetic dentist if they do any type of cosmetic work, but there isn’t a specialty. That doesn’t mean it doesn’t require special training. Unfortunately for the patients, it is up to the dentist how much, if any, training they get. Smile makeovers aren’t taught in dental school. They have to invest in post-doctoral training on their own to develop the knowledge, technical skills, and artistry necessary.

Another thing you mentioned which has me wondering is that they are too big for her mouth. If it causes one of two problems, this will mean they aren’t actually functional. The first problem could be speech-related. Maybe she’s having trouble forming certain letters or sounds that weren’t a problem before.

Another problem with her porcelain veneers being too big could be dry mouth. If she’s having trouble keeping her mouth closed naturally, it will dry up the saliva in her mouth. Our saliva is an invaluable tool in our fight against decay. It contains key minerals which fight bacteria. If her mouth is dry as a result of her veneers, then you have a great case to get this made right.

Getting Her Porcelain Veneers Done Correctly

The first thing I’d do is just ask for a refund. You paid for a beautiful smile. You should get one. If he says no, then you’ll have to get another cosmetic dentist on your side. Sometimes, a dentist will listen to a peer when they won’t listen to a patient. I recommend you see an expert cosmetic dentist. Without a specialty, how will you know who is an expert and who isn’t?

The easiest way to do that is to see an AACD accredited dentist. You can find them on aacd.com. These dentists are proven for both their skill and artistry. The accreditation program requires them to pass rigorous exams as well as provide visual evidence of their artistry on a large number of cases they’ve done.

If they agree with you that the case needs to be re-done, it will be a huge help in you getting a refund so this can be done properly.

This blog is brought to you by Boston Cosmetic Dentist Dr. Randall Burba.

Her Dentist is Incompetent or Dishonest

I need some advice. I have horrible dry mouth which is wreaking havoc on my daily life. I’m constantly drinking water, which means I’m also constantly in the bathroom. In addition to that, my teeth are getting super yellow. I have one crown and two porcelain veneers. When I talked to my dentist, he suggested replacing all those teeth, plus the remainder of them with crowns. He said a full-mouth reconstruction will take care of my aging restorations as well as whiten my smile. This seems pretty aggressive and I have no idea if it will also fix my dry mouth. What do you think?


Dear Katherine,

image advising she stop with this dentist

I do not want you to see this dentist again. Either he is either incompetent or dishonest. This is a massive overtreatment. A full-mouth reconstruction is for the most severe of cases. This is not the treatment you need. So, why is he recommending it? Let’s start with the whitening of your teeth. This would bring your dentist a few hundred dollars. With a full-mouth reconstruction, he can bring in between 30-60 thousand. Which one do you think is the better moneymaker for him? To me, this speaks to dishonesty.

Now let’s talk about those two porcelain veneers. He wants to replace these with dental crowns? That can only be because he doesn’t know how to do veneers well enough. So, instead of sending you to a dentist who knows what they’re doing, he hides the fact he doesn’t do that particular procedure and suggests something more aggressive. The best dentists try to save as much tooth structure as possible. Your dentist is more interested in his reputation and his bottom line.

Now, let’s talk about that full-mouth reconstruction. This is one of the most advanced procedures a dentist can do. My gut tells me your dentist doesn’t have the training or skills to pull this off. Not only can it give you permanent dry mouth, but he could also throw off your bite so significantly you are in constant pain with TMJ disorder.

My very strong recommendation is you find a different dentist. In your case, one with great skills and cosmetic dentistry. Look for an AACD accredited dentist. They will whiten your teeth and replace your porcelain veneers and dental crown in a way that is beautiful and blends seamlessly.

About the dry mouth. This will be detrimental to your oral health, which you already know. I’d like you to talk to your medical doctor. It’s possible he has you on some medication which is causing this. If that’s not it, he or she can do some investigating to figure out what is the true cause and hopefully get you some relief.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.