Hi james pierson,
Thank you for the kind words
I do try to be of help to people even though the information I offer is not always what someone wants to hear.
I have read your post and looked at your xrays and scan photo...thank you for sharing those.
To sum up the dental situation based on these xrays, the scan and your dental history ... the jaw bone in your upper right quadrant is less than ideal in all areas of the bridge. The scan clearly shows infection in the bone above tooth #4. The last molar appears to have decay and extensive bone loss. So that last molar would not be ideal for an anchor tooth for any bridge. There would be no longevity there. The bone area above extracted #3 (indicated as #5 on the scan) shows extensive bone loss and possibly incomplete healing of the bone. Not a great place to put a dental implant.
To be very honest with you, any measures that are taken to try and rebuild the bone, do a sinus lift, etc in this quadrant are heroic at best. The health of the bone concerning #3 site, tooth #4, and possibly even tooth #2 is very questionable. Your dentist should be explaining to you the high rate of failure with performing any invasive dental work in that quadrant.
To surgically remove tooth #4 while keeping the bridge in will only be addressing a part of the problem. It can be done, but access is difficult and visibility is limited. This would still leave you will a questionable #2 and a very unstable bridge which will contribute to additional bone loss as the pressure upon #2 and #6 anchor teeth will be very hard on the bone and periodontal ligaments. Chances are the bridge will fracture #2 and 6 and fall out.
Are you missing teeth on the other side of your upper arch? Have you considered removing #2 and #4, keep #6 crowned and have a removable partial denture?
Bryanna
Quote:
Originally Posted by james pierson
First of all I want to think Bryanna for the great service she provides to the large population of patients that are taking their health seriously and responsibly learning to be able to make an educated decision and not just blindly follow someone else's here say.
You are an ASSETT to this forum and I bless you for helping so many that are desperately in pain and totally uninformed of what is happening. And hopefully new patients will learn enough to become part of their health team and not leave their welfare in the hands of one individual as well as know enough to select the correct and best professional to treat their malady.
Having said that here is my case and a few questions to help me on my decision,
I have tooth #4 which is an anchor to a 5 tooth bridge ( anchored in #'s 2, 4 & 6 with 3&5 pontics) that according to dentist has a large cavity under the crown and quickly says it needs to be extracted. Needless to say I do not want to extract it unless there is no other way. The Xray shows a slight gray in the bone at the root end (which concerns me as a possible infection). Its not inflamed and does not hurt unless I floss it or brush it.
I find this disturbing because I complained of a slight pain in this area a year ago and the dentist said there was nothing there after checking. I came back 3 months later and told him still had the pain he took another periapical X-ray and said all is well. I later went to my perio and he said the same. Then 4 months later when I go for the cleaning the hygienist says I have a cavity on this tooth which the dentist confirmed. I asked, but you said there was nothing there less than 4 mo ago? His reply was you can't see the cavity under a crown and it spreads quickly. I wonder if it really can spread so quickly as to rot the tooth and Apparently reach the bone?
I would like to see if there is ANYWAY to save it. I mentioned root canal (even though I understand how bad this is but may last my lifetime) and he said no since he says he can insert his probe through the teeth now and extraction is the ONLY solution.
So the 1st question: Do you see anyway to save it?
Assuming I have to extract it a Perio (which also agrees with extraction) has offered me he could extract it (in pieces) w/o removing the bridge leaving me with a working set of teeth. Of course this would leave the bridge anchored only in tooth #2 and 6 with 3&5 pundits and the extracted #4 socket making it less sturdy and more prone to failure. He says we can then see how long it will hold up. Question # 2: Will Taking it out this way involve additional trauma or the same as normal extraction. He mentioned he would extract it in pieces? Can he do this effectively and clean the socket under the bridge?
The other choice he gave me was to cut the bridge, extract 4 and place an implant in 3 and 5 with a 3 teeth bridge anchored in the implants in 3 & 5 and 4 as a pundit.
He mentioned he would need to do a sinus lift in # 3 which I'm not too happy to hear. My 3D Xray ( 3D ConeBeam scan) shows I have up to 5 mm of bone depth in 3 up to the sinus membrane.
Question #3:
Can I not have a 5 mm Bicon implant in there (in 3) w/o the sinus lift?
Question #4:
Can I have instead an implant in 4 (after extraction) and replace the bridge with 4 6 &2 as anchors as before? This will entail only one implant and the bridge can be done with Bicon Trinia fiber re-inforced composite material by Bicom (or similar) that is strong and somewhat flexible that will help on the minor movement of the natural teeth. I know most professionals don't like to do this but some do.
Of course the implant could be done at same time as extraction assuming the bone is not infected. Also I'm concerned with the darker area in the bone shown on the Xray. Will the doctor need to debride the bone to get the infection (if there is one) so he can do the bone graft or can he do it w/o debriding and rely on the antibiotic?
I'm a senior citizen and trying to use the less invasive procedure with the lesser trauma possible and minimum or no drugs although I'm in good health and take no medicines.
Question #5
Ultimately what would your recommendation be if you were treating me?
Thanks
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