Hi poilj,

Ideally a bridge needs anchor teeth on both sides of the fake tooth/teeth for proper support and to help maintain healthy musculature the jaw alignment.

A bridge that has one anchor tooth, say #20, and one attached fake tooth, say #19, will put a lot of pressure on tooth #20 during chewing. This could eventually cause #20 to become fragile and mobile. Infection or fracture often occurs in the lone anchor tooth and eventually it needs to be removed. If #20 is already root canaled, it is already unhealthy and the added pressure of chewing would cause the problems I have stated.

It is not ideal to remove #18 tooth and leave the 3 unit bridge intact. The bridge would be referred to as a cantilever bridge. Meaning keeping #20 crown attached as the only anchor tooth to 19 pontic and 18 crown (pontic after extraction). The pressure with chewing would be extreme on #20 and you would not be able to clean effectively underneath 19 and 18. So food debris would become trapped leading to an infection.

If tooth #20 is healthy and you are to keep just that one tooth, then the bridge can be cut at the junctions between 19 and 20 and between 18 and 19. Leaving #20 crowned tooth to stand alone. The pontic #19 is discarded and #18 is extracted. This can all be done in the mouth without removing the bridge to cut it.

If the bridge/crown is loose on #20, then it is best to remove the entire bridge and diagnose the reason for the mobility of #20 and extract #18 at the same time. This extraction and cutting of the bridge appointment can be coordinated between your dentist and an oral surgeon if you want an oral surgeon to remove #18.

If you are going to an oral surgeon for the removal of #18, irrelevant of whether or not you are keeping the pontic attached to #20, then your general dentist can cut the bridge and let the oral surgeon remove #18. This is usually an appointment that is coordinated for you between the two offices.

I hope I have explained that okay. Any questions, just give a holler.

Bryanna