By Dr. Edward Feinberg
Natural Teeth are commonly being extracted today that can actually be saved! Extractions are being done for mechanical reasons rather than for pathological reasons. In other words, teeth that have adequate roots and bone to support dental restorations are being extracted only because there is little tooth structure above the gums. Crown and bridge techniques taught in every dental school rely on tooth structure above the gums to hold crowns in place. The rubber impressions that most practitioners take in order to fabricate the models for crowns and bridges do not register enough root surface for the retention of crowns and bridges. (Fig 1)
To compensate for missing tooth structure above the gum, most dentists attempt to “build-up” the tooth structure with core materials or with posts, if the tooth had prior root canal therapy. Often these attempts fail. Patients and dentists alike have been conditioned to accept that it is normal for crown and bridge restorations to require periodic “re-cementing”. It is not normal. Once a crown falls out, it is always suspect–because if it can fall out, it can also leak and decay. Decay left unchecked will eventually result in tooth loss. When dentists have no confidence in restoring these teeth, they turn to implants.
Implants are relatively easy to place where there is adequate bone and they do enjoy a high percentage of success. They don’t decay and are usually simple to restore because all of the components are precision-machined to fit the implant. The over-use of implants, however, has resulted in a “piecemeal” approach to dentistry that has become commonplace. Single tooth implants only fill a hole or a space and do nothing to correct the problems around it. Properly designed bridgework, on the other hand, can compensate for periodontal bone loss and correct deformities in an entire area. This approach is far more likely to prevent future disease and tooth loss. As a result, patients may be better off when implants are placed as a last resort, rather than as a first resort. (Fig2)
There is a precision technique with copper bands that has been used for crown and bridgework for well over seventy years. This technique is not taught in dental schools because there is a perception that the techniques are too difficult for students to master. Ask any patient who has crowns and bridges in their mouths for several decades, and the odds are very high that the copper band techniques were used to make them. Modern practitioners have been conditioned to think that this technique is “old fashioned” and that modern approaches with technology are superior. There is absolutely no evidence to support this idea. A collection of more than 100,000 pictures of crown and bridge cases taken since 1950 easily refutes this premise. In Dr. Feinberg’s collection, all of the teeth were prepared with the copper band technique and the outcomes were documented with X-Rays for decades. More than 95% of these restorations last at least 10 years, including teeth with very little tooth structure above the gum.
The copper band technique focuses on registering tooth structure below the gum to retain crowns and bridges, and it does not require any tooth structure or posts above the gum! Crowns made with this technique can be worn without cement and they will not fall out. They also have margins that are far enough below the gum that they are not visible. They rarely have recurrent decay when they are designed on the principle of the Mason Jar cover—the best device ever invented for food preservation. (Fig 3)
As with any technique, there is a learning curve to master the technique. However, the copper band technique is far less time consuming than placing cord to take rubber impressions in custom-made trays. A faulty copper band impression is easily corrected and retaken in seconds! Contrary to popular beliefs dentists can master the copper band technique, as they have already mastered more difficult procedures. All that is necessary is the desire for excellence and the determination not to settle for impressions that are less than ideal.
It is important that practitioners realize that implant restorations are not the solution to every restorative problem. A doctor who has a strong background in crown and bridgework will be able to provide alternative treatment options to patients–including options that are rarely offered to patients in this day and age.
Dr. Feinberg’s presentations point out common pitfalls where practitioners experience difficulty with crown and bridgework. Many teeth that are being extracted in favor of implants can actually be saved.