Dental Bridges: Options After Second Molar Extraction

Second molar

Hello Doctor: I have had my lower right second molar and wisdom tooth extracted, but my lower left molars are still intact.
I would like to ask the following questions:
1.
If I want to have a dental bridge for the lower right second molar, do I have to grind down the adjacent healthy teeth? (I really don't want to do that.) Can I opt for a Maryland bridge instead? (I am not considering implants at this time.) Also, since this is the last molar, will it be unstable?
2.
Is it necessary to get a prosthetic tooth after the extraction of the lower second molar? Can I choose not to have one?
3.
If I do not get a prosthetic tooth, will it cause my upper and lower teeth to shift or tilt?
4.
Given my situation (with both the lower right second and third molars missing, while the lower left third molar is still present), will this asymmetry in my lower jaw affect my facial symmetry? (Will one side of my jaw appear larger?)

leonard, 30~39 year old female. Ask Date: 2006/10/10

Dr. Zeng Guanghui reply Dentistry

1.
The extraction of the lower right second molar and wisdom tooth results in the absence of teeth following the lower right first molar.
Using a Maryland bridge to restore the second molar is not advisable due to insufficient support (only relying on the anterior first molar).

2.
To achieve normal occlusion, it is recommended to restore the second molar.

3.
If the lower right second and third molars (wisdom tooth) are missing and no prosthesis is placed, the upper molars may over-erupt due to the loss of opposing teeth, leading to occlusal interference.

4.
After a period of time without the lower right second and third molars, there may be resorption of the alveolar bone in the lower right quadrant, potentially causing asymmetry in the lower arch.
Therefore, it is advisable to consider prosthetic replacement for the lower right second and third molars.

Reply Date: 2006/10/10

More Info

When considering options for replacing a missing second molar, especially after the extraction of both the right lower second molar and wisdom tooth, there are several factors to take into account. Here’s a detailed response to your questions based on dental principles and practices.

1. Do I have to grind down adjacent healthy teeth for a dental bridge?
Typically, traditional dental bridges require the adjacent teeth to be prepared (or "ground down") to serve as anchors for the bridge. This is because the bridge relies on these teeth for support. However, if you are concerned about preserving your healthy teeth, a Maryland bridge (also known as a resin-bonded bridge) could be a viable alternative. This type of bridge is less invasive as it uses a metal framework that is bonded to the back of the adjacent teeth, minimizing the need for extensive alteration. However, it’s important to note that Maryland bridges may not be as stable as traditional bridges, especially in the case of a last molar, where the forces of chewing are significant. Therefore, while a Maryland bridge can be an option, its long-term stability should be evaluated by your dentist based on your specific dental situation.

2. Is it necessary to replace a missing second molar with a prosthetic?
While it is not mandatory to replace a missing second molar, it is highly recommended. The second molar plays a crucial role in maintaining proper occlusion (bite) and distributing chewing forces. If left untreated, the adjacent teeth may shift into the gap, leading to misalignment, which can cause further dental issues. Additionally, the opposing upper molar may over-erupt into the space, leading to further complications. Therefore, while you can choose not to replace it, doing so is advisable to maintain oral health and function.

3. What happens if I don’t replace the missing second molar?
If you decide against replacing the second molar, there is a high likelihood that the adjacent teeth will begin to tilt or drift into the empty space. This shifting can lead to a misaligned bite, which may result in uneven wear on your teeth, jaw pain, and other complications. Furthermore, the upper molar may over-erupt, leading to further occlusal issues. Over time, this can create a domino effect, affecting your overall dental health.

4. Will the asymmetry in my dental situation affect my facial appearance?
Yes, the loss of teeth, particularly molars, can lead to changes in facial structure over time. The jawbone may begin to resorb (shrink) in the area where teeth are missing, which can alter the shape of your face. Asymmetry in tooth loss can lead to one side of the jaw appearing larger or more pronounced than the other, potentially affecting your facial aesthetics. This is particularly relevant in your case, where you have lost teeth on one side but retained them on the other. To prevent these changes, it is advisable to consider options for replacing the missing teeth.

In conclusion, while there are various options available for replacing your missing second molar, each comes with its own set of considerations. It is essential to discuss these options with your dentist, who can provide personalized recommendations based on your dental health, preferences, and lifestyle. Maintaining a balanced bite and preventing further dental complications should be the primary goals in your treatment plan.

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