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Brian LeSage, DDS, FAGD, FAACD

Imagine yourself with an
exquisitely beautiful smile.

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Archives for August 2020

Missing lateral incisors, and a Maryland bridge that keeps breaking

My daughter is 23 years old, and her lateral incisors never erupted. Her dentist recommended braces and left enough space for a Maryland bridge to replace the missing teeth. But since getting the Maryland bridge, the wings on it keep breaking. Each time they break, the dentist cements them on, but this is annoying. My daughter is job searching because she was laid off from work. Now she doesn’t have dental insurance. I’ll help her as much as I can, but I don’t have unlimited funds. We spoke with one dentist who recommends bone grafting and dental implants. Is that better than repeating braces or getting Invisalign to move her teeth closer together and filing down her canines to match the length of the teeth in front? – Thanks. Stephanie from Oregon


If your daughter’s Maryland bridge keeps breaking, it was probably poorly designed. Although braces or Invisalign are great for aligning teeth, we don’t recommend moving canine teeth in place of her incisors. Moving canine teeth with orthodontics isn’t a solution for replacing incisors.

Canine teeth

  • Shape – They are thick and protrude in the front. Moving them to an unnatural position detracts from your smile.
  • Function – Canine teeth protect back teeth from lateral stress. If you move them forward, their purpose is lost.

We included patient photos from mynewsmile.com, a cosmetic dentistry website. The photos are an example of a patient whose lateral incisors didn’t erupt. Her dentist used braces to move her canine teeth into the position of the lateral incisors. Although the dentist shaved her canine teeth, her smile doesn’t look normal.

Before-and-after photos of missing lateral incisors, from mynewsmile.com

Photos courtesy of mynewsmile.com

Replacing Missing Incisors

In the above case, many skilled cosmetic dentists would use orthodontics—Invisalign or braces—to move canine teeth back to their original position and use another treatment to replace the missing teeth. Two options for replacing teeth are dental implants or a dental flipper.

Dental implants – Although your budget is limited, dental implants are the best solution. An implant dentist or oral surgeon places artificial tooth roots in the jawbone. After a healing period, replacement teeth, or crowns, are attached to the top. Implants look and function like natural teeth.

Dental flipper for lateral incisors

Dental flipper
Photo courtesy of mynewsmile.com

Flipper partial – A cosmetic dentist can offer your daughter a well-made flipper partial that looks natural. A flipper includes a plastic plate and replacement teeth. It fits on the palate, and wire clips snap onto back teeth to secure it. Although a flipper is the most affordable option, it isn’t ideal. Some people say that the flipper is uncomfortable and challenging to eat with. Over time, your daughter’s jawbone will continue to shrink.

Dental bridge – Although some dentists might recommend a dental bridge, it requires grinding down your daughter’s healthy teeth to anchor the bridge. Many advanced cosmetic dentists, including Dr. LeSage, preserve healthy teeth and avoid grinding down teeth for crowns.

Schedule an appointment with an advanced cosmetic dentist to examine your daughter’s teeth and the area of the missing incisors. Expect the dentist to recommend dental implants as the first treatment option. If you qualify for financing and affordable payments, implants will be the best long-term solution. But if a dental flipper is the only thing you can afford now, encourage your daughter to think about saving for implants after finding employment and having sufficient income. Implants will be better for her long-term oral health.

Beverly Hills cosmetic dentist, Brian LeSage, DDS, FAGD, FAACD, sponsors this post.

Three out of five dental implants came out on the third day!

I paid $1800 each for six dental implants to support my dentures. After they heal, I’m supposed to get two more implants. The third day after implant surgery, 3 of the 5 implants came out. Should I have to pay for three implants that came out? What should I expect from the dentist? – Samuel from Nevada


Successful dental implants stay in, so you shouldn’t have to pay for unsuccessful treatment. But more than that, your dentist needs to explain why three out of five implants came out. Authority Dental estimates that dental implants have a 5% failure rate that mainly results from poor surgical technique. And they fail within months or years after implant surgery—not days. But you’ve experienced a 60% failure within three days. You deserve an explanation.

Why Do Dental Implants Fail?

Dental implants can fail for a variety of reasons, but six typical culprits include:

  1. Diagnostic shortcuts and failure to accurately assess bone volume to support implants
  2. Incorrect implant placement
  3. Patient’s medical issues (less common)
  4. Poor-fitting fixtures that lead to infection
  5. Prematurely loading implants with dentures or crowns before they fuse with the jawbone
  6. Substandard implant fixtures
Diagram of a two dental implants - before and after crown placement

Dental implants must fuse with the bone to anchor dental crowns or overdentures

A few things to think about:

  • The two remaining implants – If three of five implants failed on the third day, will the remaining two last?
  • The two implants you’ll receive later – If you receive two more from the same dentist, they might be at risk of dislodging.
  • You don’t have overdentures yet – Dental implants usually fail after placing stress on them. But if yours failed without stress on them, it’s unlikely that the remaining implants would support your overdenture.

Unfortunately, you are the victim of a dental implant horror story. But what can you do about it now?

  • Ask your current dentist for copies of your dental records and diagnostic studies. He is ethically obligated to give you copies.
  • Find a dentist with expertise in dental implants who is a distance away from your current dentist to ensure they don’t know one another. Look for a dentist who partners with an oral surgeon to place implants or has fellowship status in an implantology organization.
  • Ask for a second opinion as to why the implants failed.
  • Depending on what the second opinion dentist or oral surgeon tells you, demand a refund for everything you paid your current dentist—not just the three implants that came out. If you have any difficulty from your dentist about issuing a refund, the state dental board would be interested in knowing it.
  • Don’t allow your current dentist to do any further work in your mouth. Find another trustworthy dentist to correct and complete your treatment. And be patient with the process of getting your implant overdentures done right.


Brian LeSage, DDS, of the Beverly Hills Institute of Dental Esthetics sponsors this post.

Three out of five dental implants came out on the third day!

“Because of your smile, you make life more beautiful.”
– Thích Nhất Hạnh

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