Question:
I am a 43 yo woman who just had tooth #13 extracted.
Unfortunately, it was a root-canaled tooth in the center of a 5 year
old bridge (I believe my dentist called it a 'cantaliever' type?).
Anyway, a year ago I noticed some discomfort in the upper cheek above
the bridge, not really true pain. My dentist took xrays, saw nothing
and concluded it was my "sinuses". The next part is probably classic
to you docs. Six months later, viola! A large a painful abcess
developed above #13 and I am sent to the Perio to r/u gum disease. He
takes another xray, can't rule out a root fracture, and I am given my
first recommendation for dental implants. After listening to all the
graphic and gruesome details of the procedure, he drains the abcess,
packs it with antibiotic and advices me to think about it implants
seriously. I keep my fingers crossed for the next three months but of
course the abcess is still present. My dentist claims he can replace
the bridge and in fact removes just two-thirds, leaving the last crown
over a healthy tooth. I make appointment with an oral surgeon who 1)
participates in my dental plan, and 2) I thought would not push the
implant opton on me. Wrong! The surgeon not only extracts the tooth
but had to do bone graft to replace all the hard tissue loss
surrounding the tooth. He described the bone loss as "bad" and
suggested that just putting another bridge over the empty tooth sockets
will just promote more bone loss over time. Sooo...he suggested bone
implants to replace the two missing teeth, after bone grafting from my
chin.
Answer:
You really don't give us enough info to judge even theoretically
whether implants are the best option. Specifically, we have to know which
teeth need to be replaced, what teeth are still present, and what kind of
shape they are in--both structurally and periodontally.
I'm just a little uneasy about an oral surgeon prescribing a
restorative dental plan, since the restorative dentist will also have to
stand behind it. These kinds of decisions are always best handled when the
restorative dentist, oral surgeon, and patient get together to discuss the
relative merits of each potential treatment plan.
There is a gradual move toward restoring implants a little sooner.
When is your son's wedding?
Although you gave us a lot of details some important ones are missing.
What is the tooth missing and cantelevered (#12 upper left 1st bicuspid or #14
upper ist molar)?
Other than this do you have a intact healthy dentition?
How is your general health?
Root formed dental implants were first introduced over 30 years ago. They
gained recognition and popularity in the USA in 1982. Implants have been one
of the most tested area of dentistry over the last 30 years. Outstanding
documentation exists regarding their extremely high success rate. However the
skill of the operators (surgeon and restorative dentists) and the cooperation
of the patient is needed. One nightmare you can totally erase from your mind
is that implants will not decay and will not need a root canal.
Once implant(s) are placed in the upper arch, recommended time prior to
restoring with a crown(s) is usually 4-6 months. Some companies and implants
systems are now bragging about implants that can in certain circumstances be
restored immediately to 2 months after placement. Be careful with those
claims. Only very preliminary data and probably higher risk of failure.
Originally, the patient had a crown on #12, #13, and the pontic, (or missing
tooth) was #14. When #13 failed, he removed 2/3 of the bridge leaving two
missing teeth and a crown still on # 12.
Uh, no. I have a bridge on the opposite upper side, same three
teeth; crown on upper left front; and two crowns on bottom molars.
Three seperate episodes of root fractures on root-canaled teeth, and
chronic tooth grinding, which I am sure does not help any of my
problems. Healthy gums, though!
Fine save for a peskly condition called Long QT syndrome, which is
a irregular heartrate that can be made worse by medications, especially
epinephrine or many antibiotics. The only contraindication with dental
work, I suppose, is to avoid Novacaine or general anesthesia if
possible.
