Previewing my Options

From: Martha Gallagher (marza_at_patriot.net)
Date: 06/09/04 

Date: Wed, 9 Jun 2004 13:17:10 -0400

Hey SMDers,

Checking back in as I need your input and advice.

Set the way back machine a couple of years ago. I had osseous surgery on
one bottom molar that had a lot of bone loss from juvenile periodontitis
and had the opposing molar extracted and then replaced with an implant.

The implant is fine and not the problem here although it may be a
contributing factor.

The bottom molar stabilized nicely, the graft took, it's all been good.
The only slight problem was what with one thing and another the molar
hyper-erupted (is that the word? I've forgotten), not having been opposed
at a time when it was somewhat loose anyway from the periodontitis and
stuff. I'd had some senstitivity in that tooth, but using a toothpaste for
senstitive teeth seemed to do the trick.

Just a couple of days ago, the tooth suddenly became extremely sensitive
to cold and heat. I saw my dentist this morning and she agrees that the
root has become more exposed and that's what's causing the sensitivity. On
the x-ray, the tooth was noticeably more "out" than on previous x-rays. No
pain when I close my mouth, bringing those teeth together, though.

When I talked to my dentist, she said it might be that the tooth is not
adequately supported by the bone. But she also said that it looked like
the crown of the implant may be snagging the molar slightly, pulling it
out of position. The alternatives she mentioned so far are that adjusting
the bite may be enough to keep the problem from getting any worse. She
also suggested the possibility of a root canal.

I'm going to see my periodontist on Tuesday.

I was hoping that you all could fill me in on some of the considerations
involved, so I have an idea of my options and the pros and cons.

First, when my dentist suggested a root canal, that didn't make any sense
to me. The pulp doesn't seem to be involved in any way. But then I
realized that if you remove the nerves it won't hurt any more. But, I
dunno, that still doesn't seem like a solution. What would be involved in
doing a root canal for a tooth in a situation like this? It's got a
filling in it, if that makes any difference.

If we can keep it from getting worse by adjusting my bite, that would
obviously be a good start, but I'll still have the degree of exposure I
have now, right? I mean, there isn't any way of pushing really hard and
getting the tooth back down deeper in the bone, is there? So, is there any
way of protecting the exposed root? If not, leaving aside the pain issue,
doesn't it leave the exposed sections much more subject to decay and
stuff? Anything that can be painted on to provide protection?

If the amount of bone loss has just turned out to be too great, and it's
now a tooth whose time has come, well that's ok, I have options there,
although, of course, I'd prefer not.

I have one last question. If I end up with another implant, what are my
options for building up the bone in that area? I know my OS will work on
making sure there is adequate bone there to support the implant. The
implant I have now is rock solid, but it does have a deficit in the line
of the gum like someone scooped out the support above the implant with
their little fingernail. Functionally, it's fine, but aesthetically it's
ugly (well, *I* can see it) and it makes an awkward transition with the
crown, leaving a ledge where food collects. Is it possible, sensible to do
some additional grafting in the area, before / at the same time the
implant is placed to fill out that area? At the moment, you can't see that
sort of deficit where the existing tooth is, but I assume that's cause of
the tooth's roots under the gum.

Sorry for the long post. I just like to have some idea of my options so I
know what I'm possibly looking at.

Thanks,
Martha 

-- 
Only those who risk going too far can possibly find out how far one can 
go.  (T.S. Eliott)

Relevant Pages

  • Re: Failed Apicoectomy?
    ... I don't think that endodontists have gotten into the mindset of implants as an alternative therapy. ... Actually, if the endodontist felt the tooth had a poor prognosis, it was his responsibility to communicate this with your dentist. ... you should discuss the implant option with your general dentist before any other treatment is performed on this tooth. ... he'd be a fool to routinely perform molar apicoectomies that he thinks are likely to fail. ...
    (sci.med.dentistry)
  • Re: Previewing my Options
    ... A RCT in the upper tooth would just be done if the pain was too distracting ... getting enough bone for the implant. ... cover root with filling ... > and had the opposing molar extracted and then replaced with an implant. ...
    (sci.med.dentistry)
  • LR1M: Intrusion or Extraction?
    ... furcation either (whether it's active perio, a Fx'd tooth or whatnot). ... support of the teeth on either side. ... I was thinking fast intrusion and hope that the bone stays at the same ... None of this would be necessary of we do an implant, since AFAIK, ...
    (sci.med.dentistry)
  • Re: Late posts??
    ... > The bone was eroded and the skin discoloured. ... > or dig into savings and have an implant. ... A false tooth is then fitted ...
    (uk.business.agriculture)
  • Re: Intrusion or Extraction?
    ... I'd have a tight chest trying to successfully intrude the beat-up tooth. ... > The way I see it, it's either exo and implant (after we control the ... > support of the teeth on either side. ... > implants are not active in the bone. ...
    (sci.med.dentistry)