Hi james p,

First let me say that dentists are in the business to sell dentistry. This does not mean dentists intentionally want to bring harm to anyone. It just means that if the patient is willing to allow extreme measures involving invasive procedures to be done in areas of the mouth that are not ideal for those procedures and there may be limited longevity to the work, many dentists will go along with that plan. So unless you are someone who is comfortable with going along with that sort of thing, then it is best to come up with a less risky plan that has some longevity to it.

I am going to re post your questions and answer you in bold type.

<<1. You see infection on the bone above #4 and agree with others that has to come out and see no way of saving it.>>

THAT IS CORRECT. WHEN THIS TOOTH IS EXTRACTED, THE BONE WILL NEED TO BE THOROUGHLY DEBRIDED OF ALL DISEASED TISSUE AND BONE. THAT AREA ABOVE THE ROOT OF THE TOOTH IS A CYST OF BACTERIA AND GENERALLY THESE CYSTS ARE VERY ATTACHED TO THE BONE. SO EXTRA CARE NEEDS TO BE DONE TO REMOVE THE CYST AND ALL REMNANTS OF IT WHEN THE TOOTH IS EXTRACTED.

<<2. You have also detected on the X-Rays that #2 may also have a cavity . Is that under the crown or externally bellow it?>>

ON THE SCAN THERE IS A LARGE AREA OF RADIOLUCENCY (BLACK) THAT STARTS AT THE MARGIN OF THE CROWN AND MOVES UP INTO THE FUR-CATION AND ROOT AREA OF THE TOOTH. THIS TYPE OF RADIOLUCENCY GENERALLY INDICATES DECAY. IF THAT IS WHAT IT IS, THIS TOOTH IS NOT SALVAGEABLE. ADDITIONALLY, A TOOTH THAT HAS EXTENSIVE DECAY CAN ALSO MEAN THAT THE BACTERIA FROM THE DECAY HAS INVADED THE BONE. SO WHEN THE TOOTH IS REMOVED, THE BONE WILL ALSO NEED TO BE THOROUGHLY DEBRIDED OF ALL DISEASED TISSUE AND BONE. THEREFORE THE AMOUNT OF BONE THAT IS BEING MEASURED NOW, WILL BE LESS AFTER THE TOOTH IS REMOVED.

<<3. If I extract #2 can I not place an implant the lenght of the root on the same bone holding the root?>>

NOT REALLY AS THERE IS ALWAYS LOSS OF BONE WHEN A TOOTH IS EXTRACTED. THE MORE BACTERIA THERE IS IN THE BONE, THE MORE EXTENSIVE THE BONE LOSS WILL BE. YOU NEED TO HAVE HEALTHY BONE TO PLACE AN IMPLANT PROPERLY.

<<4. Bone above #3 is small and possibly not healed well. Can I not place a 5 mm Bicon implant and bone graft with some of that bone stimulating protein? Seems like I have close to the 5 mm.>>

THE DENTAL WORK NEEDED TO PLACE AN IMPLANT IN THE AREA OF #3 WOULD BE EXTENSIVE AND THE LONGEVITY WOULD BE QUESTIONABLE IF THE EXISTING BONE IS NOT REAL HEALTHY. YOU COULD HAVE THEM TRY IT, BUT UNDERSTAND THAT THERE WOULD BE A LOT INVOLVED IN DOING THAT. SO MAKE SURE YOU ARE CLEAR AS TO WHAT THEIR PLANS AHEAD OF TIME.

<<5. the bone in this quadrant is questionable because its small or because you believe its not healthy? >>

THE INTEGRITY AND HEALTH OF YOUR JAW BONE IN THE UPPER RIGHT QUADRANT MAY BE QUESTIONABLE FOR DENTAL IMPLANTS IN ALL ASPECTS. THE 3D SCAN TELLS PART OF THE STORY. BUT IT'S WHEN A SURGEON ACTUALLY GOES INTO THE BONE, THAT IS WHEN THE HEALTH AND INTEGRITY OF THE BONE BECOMES TRULY APPARENT. MY OFFERING TO YOU IS THAT IS THE BONE IS FOUND TO BE SO SO..... DENTISTS WILL TAKE INVASIVE MEASURES TO PUT IMPLANTS IN AND YOU HAVE TO DECIDE IF THAT IS WHAT YOU ARE COMFORTABLE WITH DOING.

<<6. I agree with you dentist should be more up front and explain the rate of failure instead of saying all is fine and grafting would resolve the depth. I have been asking this question from the get go and they all say the only important thing to be a candidate for implant is your health noth the bone depth. I also feel uncomfortable with implants in this quadrant and need to be well informed to make an educated decision and not be surprised if it fails or worse.>>

IT IS UNFORTUNATE THAT PATIENTS ARE RARELY PROPERLY INFORMED OF THE EXTENSIVENESS AND RISKS WITH SOME INVASIVE DENTAL PROCEDURES. FOR THOSE PATIENTS WHO DO NOT WANT TO KNOW ANYTHING, THIS IS FINE. BUT FOR THOSE WHO WANT TO BE INFORMED, IT CAN BE LIKE PULLING TEETH TO GET THE INFORMATION!!
IT IS TRUE THAT A PATIENTS HEALTH IS IMPORTANT CONCERNING BONE GRAFTING AND DENTAL IMPLANTS. HOWEVER, OTHER ISSUES THAT ARE EQUALLY IMPORTANT ARE THE PATIENTS: LIFESTYLE, DIET, HEALTH OF OTHER TEETH/GUMS/JAW BONE, STRESS LEVEL, MEDICATIONS..... SO ON.

<<7.Removing #4 w/o removing bridge would be more involved and poor visibility. Does a dentist have visual contact with the bone on a normal extraction to be able to diagnose its health?>>

WITHOUT THE BRIDGE BEING PRESENT, WHEN A TOOTH IS EXTRACTED THE DENTIST HAS ROOM TO MANEUVER THE INSTRUMENTS IN BETWEEN THE TOOTH AND THE BONE TO LOOSEN THE TOOTH FROM THE LIGAMENT. ONCE THE TOOTH IS OUT, HE CAN VISIBLY SEE INTO THE SOCKET AND ALSO FEEL WITH HIS SURGICAL INSTRUMENTS THE INTERIOR OF THE SOCKET. THIS VISUAL AND TACTILE SENSE GIVES HIM A GOOD SENSE OF WHAT IS IN THERE AND HOW FAR HE NEEDS TO GO TO CLEAN IT OUT PROPERLY. WHEN THE BRIDGE IS INTACT, THE VISIBILITY OF THE SOCKET AND TACTILE SENSE IS LIMITED. ALSO, THE ROOT OF THE TOOTH IS THE ONLY PORTION OF THE TOOTH THAT WOULD BE REMOVED. YOU WOULD STILL HAVE A DEAD PIECE OF TOOTH INSIDE OF THE CROWN OF THAT BRIDGE. WHICH CAN GET PRETTY STINKY :/

<<8. leaving the bridge after extracting 4 would contribute to bone loss. Where under a specific tooth?>>

THE STABILITY OF THE BRIDGE DEPENDS ON HOW WELL THE ANCHOR TEETH ARE HOLDING THAT BRIDGE IN PLACE. IDEALLY, A 5 UNIT BRIDGE SHOULD HAVE 3 ANCHOR TEETH. THE LESS STABLE THE BRIDGE IS, THE MORE PRESSURE AND WEIGHT IS PUT ON THE ANCHOR TEETH. THIS PRESSURE WEARS DOWN THE LIGAMENTS AND CAUSING THE BONE SURROUNDING THE ANCHOR TEETH TO BREAK DOWN.

<<9. I would prefer to leave 2 if it can be restored to health (I assume you mean a cavity) and have it continue holding the bridge till it falls rather than extraxcting it assuming it will not cause any infection or other problems.>>

THE RADIOLUCENCY ON THE SCAN WITH #2 IS LARGE. IF THAT IS ALL DECAY, THE TOOTH IS LIKELY NON VITAL AND NOT SALVAGEABLE. TOOTH DECAY IS A BACTERIAL INFECTION AND IT PROGRESSES BEYOND THE TOOTH. THAT AREA NEEDS TO BE DIAGNOSED TO DETERMINE IF IT IS DECAY.

<<10. If I extraxt #2 & #4 that would leave me with missing 2, 3, 4, &5 and not have a back tooh to clip a removable denture? I have not thought of this because no one has given me this option. I guess I need to understand better how this would be done.>>

LOOKING AT YOUR PANORAMIC XRAY, YOU ARE NOT A CANDIDATE FOR A CONVENTIONAL REMOVABLE PARTIAL DENTURE BECAUSE THE TEETH YOU ARE MISSING ON THE UPPER LEFT WOULD NOT BE INCLUDED IN THE PARTIAL. YOU MAY BE A CANDIDATE FOR A UNILATERAL PARTIAL DENTURE WHICH IS ONE THAT REPLACES MISSING TEETH ON JUST ONE SIDE OF THE ARCH. BUT IT MAY NOT REALLY BE THE IDEAL REPLACEMENT IN YOUR CASE. PLACING MINI IMPLANTS INTO AREAS THAT ARE GOING TO HOLD THE CLASPS OF A PARTIAL DENTURE WOULD BE RISKY AS THE MINI IMPLANTS ARE NOT INTENDED TO SUPPORT THE WEIGHT OF PARTIAL DENTURES OR PERMANENT BRIDGEWORK.

Keep in mind that the bone height is only one aspect of what is needed to place dental implants successfully. The health, width and thickness of the bone are also important dental factors. Mini implants are not ideal in the posterior region of the mouth even if they are just single implants with crowns. However, you might be able to sneak one in behind #6 in the #5 area. Depending on the health of the bone in the #3 area, you may be able to sneak one in there also. But these would be single mini implants with crowns on them, not to be used for a permanent bridge.