Re: Dental Implant help needed

nycpatient wrote:

My first molar on my bottom right jaw is loose and also has an
infection (currently taking antibiotics).  I had a root canal done to
this tooth over 10 years ago.   Last week, I went to 2 periodontists
to get their opinions.  Here is what they told me:

Periodontist #1: He said I have gum disease and require scaling and
root-planing (deep-cleaning). He also said I needed bone-grafting as
my bone line was too low for the implant. Therefore, his recommended
treatment plan was:
(a) Tooth extracton
(b) Scaling of all 4 quadrants in my mouth
(c) Bone-grafting (d) After 6-9 months, perform dental implant
(e) After another 3-6 months, peform abutment and crowning.
Total time: about 12-15 months.

Periodontist #2:  He did not mention that I needed scaling.  I asked
him specifically if I needed bone-grafting and he said it looked like
I had enough bone for the implant.  But he would only be able to know
definitively after he extracted the tooth and was able to see inside
the gums.  Therefore, his recommended treatment plan
was:
(a) Do just basic teeth cleaning with oral hygenist
since I had not cleaned them for over 2 years (no
scaling required).
(b) Tooth extraction and placement of implant on same
day (said he liked to limit number of surgical procedures).
(c) After 3-6 months, perform abutment and crowning.
Total time:  about 3-6 months.

I would consider my general oral hygiene and gum health as not good. Bleeding gums, tartar buildup, etc. Hardly flossed on regular basis.


I'm having difficulty deciding which of these two treatment plans I
should go with.

It would seem that Perio #1 is taking a more conservative approach,
get the tooth out, clean up any residual infection near site and rest
of mouth, make sure I get enough bone in there (bone-graft), and then
do the actual implant afterwards, when the area has healed up
properly.

On the other hand, Perio #2 has alot quicker treatment time of 3-6
months. However, is he being less careful (since I'm still taking
antibiotics for my infection) or just have more updated techniques or
maybe lower success rate by doing the implant without bone-grafting
first. 

I guess my main issue is do I need bone-grafting or not?  Why does one
tell me yes and the other no?  Will the success rate for both be the
same, but it's just a matter of personal style in terms of the
treatment plan?

I would appreciate any expert opinions on this, as I hope to decide in
the next couple days.

Thanks in advance for your help.



There obviously is no way to even give an opinion in any but the most general sense. I refer to surgeons who are more or less conservative in practice; I had a patient who wished multiple implants told he could only get one or two, whom I subsequently sent to an OMF surgeon who placed 4 without grafting and with no problems. It is also quite possible if you are in NYC that I know one or both periodontists.
I have found in general that OMF surgeons are somewhat more daring. However, the Brooklyn OMFS who did my wife's implant took about a year from start to finish.
If there is significant periodontal bone loss it seems likely to me that even if you don't absolutely NEED a bone graft, you will be able to get a longer implant with superior support without getting near the nerve in the jaw if you have a successful graft. Grafting at the time of extraction or soon after is likely to be the best recourse. In my wife's case the surgeon grafted at the time of extraction, which surprised me as she had a substantian mid-facial infection. This was, mind you, a very cautious surgeon.
It is possible that severe periodontal problems in the area may influence the final decision, but all other things being equal, you're probably better off with the graft.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
.

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