Re: Previewing my Options

From: Dr Steve (nospam_at_home.net)
Date: 06/09/04 

Date: Wed, 09 Jun 2004 17:55:04 GMT

Hi Martha,

Nice to see you are still around.

A RCT in the upper tooth would just be done if the pain was too distracting
to normal life. A RCT is very seldom ever done in a tooth without a filling
in it. Often the filling makes RCT easier, in that the filing comes out
faster than cutting a new hole in the tooth. Your OMFS would be thinking
about bone grafts, sinus lifts, distraction osteogenisis and other ways of
getting enough bone for the implant (if you had to go that route). Root
sensitivity can be treated many ways.
1) Special toothpaste
2) desensitizers such as Gluma and Hemoseal (short duration)
3) cover root with filling
4) cover root with crown
5) RCT
6) Sometimes the pain goes away if clenching forces are removed 

-- 
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
....................................................
This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here.  Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
......................
"Martha Gallagher" <marza@patriot.net> wrote in message
news:Pine.LNX.4.44.0406091237390.11401-100000@adams.patriot.net...
> 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)
>

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