Is a cantilever bridge the way to go or a 4 unit bridge?

A cantilever bridge is done as a compromise and it has a few less than ideal characteristics. It creates a lever arm that produces larger than normal forces on the teeth (or implants it attaches to. Hanging a molar sized tooth to a single implant in the premolar area is a bad idea that can cause the implant to fail or something to break. A semifixed bridge with the molar pontic having a rest on the premolar implant is also a compromise but with better engineering principles behind it. Ask your dentist about doing something like that. Good luck!

A 4 unit bridge is a big mistake, especially using an untreated tooth as the mesial abutment. A cantilever bridge is almost as big a mistake. It's like the choice of jumping off the Brooklyn bridge or off the south rim of the Grand Canyon. You die either way. The oral surgeon wants to do the surgery now. He is really not concerned with restorative engineering principles if he has recommended a cantilever bridge. A much better alternative is grafting the edentulous site and placing 2 implants in # 29 and #30 site after your graft matures. X-rays would be helpful in confirming my recommendation.

Would it be a better option to remove #29 and #31 and do an implant bridge? #31 has a very old root canal and #30 has been missing since I was 13 and I am 57 now. I want a long term solution.

I agree with Tim Hacker...bone grafting # 29 and 30 site would be ideal. However, without x-rays, I only know half the story. Do not do a 4 unit bridge and do not do a cantilever bridge wth the molar being the cantilever. Extracting 31 is not recommended unless 31 is also failing. Why take out a healthy tooth. Can you post x-rays and perio readings?

I agree it is hard to comment without films. That being said another alternative is to splint 31 to an implant in the 29 site with some sort of stress breaker. Of the 4 options listed , grafting 30 and placing 2 independent implants in the 29 and 30 site is the best option but I feel that the implant/tooth option is definitely acceptable.

A long distal cantilever off one implant is an extremely poor design. You may consider extracting 31 and have an implant placed and bridge from the 29 implant to the 31 implant. This is a well designed treatment. I do not like to abut on root canal teeth, unless it's the last resort.

The bone loss at the #30 site may be such that grafting can not be done in a way that would be what the patient is willing to undergo. With enough money and time almost any site can be grafted. Inquire about what would be needed to place an implant into the #30 area. Even a small implant in this space would be far better that a cantilever especially if it is splinted to another implant at the #29 space. The surgeon may have been considering only an implant large enough to support the #30 by itself.

If I am correct, I have not read a suggestion of placing an implant in the #29 site and constructing a three unit bridge with #31 as the distal abutment? For the patient, this is the same design you have now but using an implant to anchor the front part of the bridge. There are those that caution against splinting implants and natural teeth yet I have found this to be an excellent solution many times, especially in a circumstance such as this. Grafting is an excellent procedure for sure, but from scratch, that is, after a site has healed there is considerable added expense (in real, applicable terms) here, especially if the restoring dentist is not grafting and specialist fees, while justified, are involved. It is my belief and experience that once an implant is found to be solidly integrated, it serves at least as well and perhaps even greater than a "natural" tooth as long as solid principals of tried and true restorative dentistry are followed with regards to occlusion and support.

i feel, its better to have 29 implant and #31as abutments for all practical reasons, rather than ext. of 31., if grafting and others are not possible for any reasons.

I have been going through an implant on #12(painful) I have to have #11 extracted(no implant). Surgeon suggested cantilever 11 off of 12 implant. Would it be better to get a 4 unit bridge crowing 13 and 10 as my anchors?

can a cantilever bridge be used to replace an upper #3 molar without any problems?