Re: implant poking through gums
- From: "Dr Steve" <nospam@xxxxxxxx>
- Date: Thu, 21 Apr 2005 12:20:59 GMT
If the healing cap of the implant is poking through--no harm.
If bone is poking through--you must get it addressed ASAP.
Just wait until you can afford work then get the best you can for the
conditions at that time. This is one of the problems of getting work
started with no plan to finish it. You need a "blue-print" of what you are
going to do before starting work.
--
~+--~+--~+--~+--~+--
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.
.......................
"Allan Adler" <ara@xxxxxxxxxxxxxxxxxxxx> wrote in message
news:y9364yhmf12.fsf@xxxxxxxxxxxxxxxxxxxxxxx
>
> Around 1993, a periodontist in Rhode Island removed my canine #11 and
> simultaneously gave me an osseous bone graft. The bone graft didn't take
> but a few weeks later he proceeded with his plan to install an implant.
> There was not enough time to stay for it to heal completely, since I had
> to move to France for a year or so. At the time I left, there was still a
> gortex barrier in place. At the time I had the implant done, I did not
> have a primary dental care provider; I only had the periodontist and he
> knew that. However, he somehow forgot that when it came to planning the
> implant and related procedures and informing me about what was involved.
> In particular, he just ASSUMED that I had already made arrangements with
> a regular dentist to have an artificial tooth placed on top of the
> implant,
> something I didn't realize until after the surgery. He said something
> about
> wanting to write an article about what he was doing and took some
> photographs
> for that purpose; he was also a photographer operating under a different
> professional last name, which didn't bother me since he was up front about
> it and it made sense that he would want to keep his dentistry and his
> photography separate. He said he would give me a copy of the photos but
> never did.
>
> Since it was obvious that I was going to need continued care when I got to
> France, he looked in his list of periodontists with the proper training in
> Paris and referred to me to an old school chum of his whom he described
> as,
> "a crazy kind of guy" (henceforth, CKOG). This old school chum is a big
> fan
> of a technique that involves taking a piece of bone from the patient's
> chin,
> for example, and simply installing it in the relevant spot that needs
> bone.
> Accordingly, he told me I had to contact the periodontist in Rhode Island,
> ask for my money back and give it to him so he could rip out the implant
> and do it all over his way.
>
> I needed some of my old records and, in any case, wasn't too sure about
> the
> advice he was giving me. I wrote to the guy in Rhode Island and eventually
> received X-rays. Meanwhile, I went to CKOG for cleanings and also started
> buying chlorhexidine over the counter, which one can do in Paris, and
> using
> it. The gortex barrier kept protruding further and further through the gum
> and eventually I understood that this was because the gum was getting
> thinner.
> Finally, I went to the CKOG and asked him about it. His response was to
> take
> a pair of pliers and just try to rip out the barrier, which he largely
> succeeded in doing, but not completely, and a few weeks later it was
> infected.
> By then, I had received a letter from the guy in Rhode Island, containing
> my
> xrays and a letter telling me how glad he was that I had not allowed his
> friend, who he now realized was just as crazy as he had been in dental
> school,
> to remove the implant. He provided me the name and coordinates of another
> periodontist in Paris. I went to him and he fixed the problem: the
> infection
> was only on one side of the gortex that and could be removed without
> complications. After I healed from the new surgery, the gum over the
> implant was thin but it did cover it.
>
> When I returned to the US in 1995, I went to Berkeley, CA, and found a
> dentist
> through some phone referral service. I told the dentist that I wanted to
> have
> a tooth put on the thing. He told me that he didn't think there was enough
> bone support and recommended against it. When I moved to Bowling Green,
> KY,
> my dentist there agreed with that opinion. When I moved again, the dentist
> also agreed with that opinion. However, he apparently forgot that he had
> done
> so, since a year or so later, when he got interested in putting a tooth on
> it,
> he told me that there was plenty of bone support. For that inconsistency,
> and
> also because he did something to the canine #27 that caused pus to start
> gushing out of the gum the next day, without telling me that there was any
> risk of a reaction like that, I decided to find another dentist and soon
> found
> a practice consisting of a regular dentist and a periodontist.
>
> This new periodontist told me that there was definitely enough bone
> support
> but that the implant was pointed in the wrong direction. He also told me
> that
> the implant was poking through the gum but that there wasn't much risk of
> infection. I took a look at it when I got home and I could see a kind of
> grey
> disk a couple of millimeters wide, that I hadn't realized was exposed
> bone,
> instead of oddly colored gum tissue. During a subsequent visit, we
> discussed
> the implant again and he explained a little more to me. There is,
> apparently,
> plenty of bone support in the sense that the implant is not just standing
> like the Washington Monument in the middle of a valley: it is solidly
> supported
> by bone on all sides. However, the implant itself is only about 6 mm long
> and goes right up to the sinus. Due to the complications of dealing with
> the
> sinus, he wouldn't want to get involved in removing and replacing the
> implant,
> although he doesn't necessarily think there would be anything wrong with
> someone else doing it. On the other hand, the tooth that would be placed
> on
> the implant would probably be more like 9 mm long, since it is a canine.
> He told me that in general, one wants the implant to be about 1.5 times
> as long as the tooth that it will support, whereas in this case the ratio
> is reversed. In that sense, it seems to me, there is not enough bone
> support.
> I don't know what the implications are of having something like that
> break,
> particularly right next to the sinus, but I think it is risk I should not
> take. So, I'm against this procedure, based on what I think I know about
> it.
>
> Last time I went to him for my regular clearning, he told me that the
> problem with the misdirection of the implant could be solved by using
> what he described as an angled abutment. So, now he thinks there is enough
> of a plan to proceed.
>
> I have various reasons for not being convinced:
> (1) The one I mentioned above about the recommended ratio between the size
> of the canine and the size of the implant. It occurs to me that I don't
> HAVE to have a 9 mm tooth put on it just for cosmetic reasons and that
> perhaps a tooth of ordinary size, would be perfectly alright. So what
> if
> my mouth is asymmetrical? That might improve the ratio of the lengths
> to
> about 1, which might be more tolerable.
> (2) Another complication is that I no longer have a record of the exact
> size
> of the implant, although I am pretty sure it is a Branemark implant.
> The
> periodontist eyeballed it to one of two possibilities but says he can't
> tell without trying out the abutment to see which fits better. That
> would
> involve ordering two abutments, trying one and sending the other back
> if
> the first one fits and, if not, trying the other and, I think, paying
> for both of them. That sounds like abou $400 to measure a screw and I
> would hope there is a better way to do it, especially since we don't
> really
> know if either of the conjectural sizes is correct. I am unable to
> locate
> my old periodontist from Rhode Island. First of all, he retired shortly
> after giving me the implant. Second, I've gone to perio.org and entered
> the town where I had the work done and can no longer find the practice
> in
> a 50 mile radius.
> (3) I am chronically unemployed and have no medical insurance. I'm
> basically
> living on charity. Even if I could convince someone to pay for the
> work,
> which is a possibility, do I really need a cosmetic false tooth more
> than
> I need a colonoscopy, which I've never had, and which is recommended to
> people my age?
>
> I agree that I need to do something about the implant poking through the
> gum. Now that he has a plan to install a tooth on it, he's changed his
> mind
> and decided that there really is a risk of infection. I do believe that
> there
> is and, in any case, I think that as long as it is untreated, the area of
> exposed bone is likely to get larger. That is probably undesirable. So I
> do
> think it makes sense to try to cover up the exposed bone using a gum
> graft.
> That probably costs a lot less and, for the same total expenditure, also
> lets
> me get a colonoscopy.
>
> Let's assume I'm right about that. This still leaves the question of what
> to do with the implant itself. I don't know what the implications are of
> leaving it under the gum, pointing up as it does now. Maybe that would
> result
> in thinning of the gum and having it eventually poke through once more. If
> that
> is a problem, maybe it is a good idea to grind it down, but maybe not,
> since
> it is conceivable that there could be more bone loss in the future that
> would
> leave the implant sticking up again, so the effort of grinding it down
> would
> have been wasted. Maybe removing it is a good idea (except for cost).
>
> Another possibility that I am seriously considering is registering as a
> patient at a dental school. I could be mistaken, but I think my case has
> enough unusual features that it would be of interest to people teaching
> periodontics and implants as an example for their students. They would
> consult with each other about the best way to do it, the work would be
> supervised and it would cost a lot less.
>
> At the moment, I'm only using Listerine and brushing to protect the
> exposed
> bone from infection, since that is all that the periodontist recommended.
> --
> Ignorantly,
> Allan Adler <ara@xxxxxxxxxxxxxxxxxxxx>
> * Disclaimer: I am a guest and *not* a member of the MIT CSAIL. My actions
> and
> * comments do not reflect in any way on MIT. Also, I am nowhere near
> Boston.
.
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- From: Allan Adler
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