December 27, 1999
Question from Pennsylvania, USA:
My daughter is 16 and was diagnosed with Type 1 Diabetes one year ago. She is missing one permanent tooth. Is there any reason why we should not choose to correct this with a surgical implant? Could this implant itself or the procedure affect her in any other way? Would it be a "safer" correction to use a bridge (which we would have to grind down and cap her front tooth)?
There are several issues to be considered. Generally a fixed prosthesis where adjacent “abutment” teeth are “ground down” in an individual is contraindicated in people below 21 years old in a healthy individual. A surgically placed implant in the healthiest person has its risks. It is an invasive procedure.
With a Type 1 diabetic in this age range the prudent thing would be to consider the newer metal-adhesive technology and the use of the “Maryland Bridge”. This is a very conservative and requires minimal tooth preparation. The replacement tooth has “wings” that are “glued” to the adjacent abutment teeth. However, the patient’s bite must be atraumatic and the adjacent teeth must be very close together. The drawbacks include possibly seeing a grey tint in the abutment teeth and the bridge loosening over time. The cementation procedure is very technique sensitive and I would recommend that you consult with a prosthodontic dental specialist in your area.
If the option is towards a surgical implant then one must look a the level of glycemic control. I do not need to explain that the level of glycemic control is related to the long term prognosis for this type of dental restoration. With the cost of “Maryland Bridge” being the least by an enormous margin then this would be my choice if it was my child at this age. Unfortunately many dentists will not do this because of the less profit margin. Of course later in life there are more options that may work but a properly placed Maryland Bridge should last a very long, long time (that is why I recommend a dental specialist or go to the fixed prosthetics department at a dental school).