ddd,

Did your dentist inform you of your generalized bone loss in the upper right quadrant and possibly other areas? Did he measure your gum pockets? This is when they use a little probe to measure below the gum line in 6 places on every tooth. He would have called out these numbers to an assistant as she recorded them on your periodontal chart. If you have not had that done, then it's important for him to do it as it is helps to locate areas of possible periodontal disease and bone loss. Every comprehensive examination should include a full periodontal screening which includes measuring the pocket depths of every tooth.

Conventional dentistry will often push their patients to have dental implants because they are not taking into consideration the health of the existing jaw bone. Oral surgeons are also quick to push implants but it's best to discuss your concerns about the health of the bone and about placing an implant in bone that had a long standing infection 10+ years.

Here are some things to also bring up with the oral surgeon:

1) What is the health of the adjacent teeth #2 and 4 as they are looking suspicious on the xray regarding vitality. Also #2 the last molar may or may not have an area of pathology on the xray so ask him to check those teeth clinically and radio graphically.

2) Explain that you are concerned about long term post operative complications and want to minimize them as best as possible. So you want him to remove the entire tooth and any fragments of any stray root canal material ..... also the entire periodontal ligament .... and all other diseased tissue and bone during the surgery. You want that bone to be clean of all debris so it can heal healthfully.

3) Does he think the sinus will be involved with the extraction of #3? If so, will he go in and clean it up the best he can? Tell him you want to be informed if there is a sinus perforation or communication ... how severe it is... and what he did to repair it. It is always best to be thoroughly informed.

Sinus perforations vary in size and severity. However, if they need to be mended, then the surgeon is the one to do that at the time of the extraction. So just put a bug in his ear about your concern about a sinus involvement as that makes him aware that he needs to be on top of it.

Dental implants are a good tooth replacement when placed in healthy adequate bone in people who do not have periodontal disease.... who are relatively healthy and do not take medications that reduce their salivary output ... eat a nutritious diet with little to no sugar or processed foods .... and who have good at home oral hygiene care. People who are compromised in any of those ways, are not ideal candidates for dental implants. That does not meant they shouldn't have them, it's just not an ideal option.

Permanent bridgework.... if tooth #2 and 4 are healthy and you do not have periodontal disease, then you would be a candidate for a 3 unit bridge.

Removable partial denture... if you are already missing other teeth (other than wisdom teeth) in your upper arch and they have not been replaced, then you may be a candidate for a removable partial denture. This can be designed to accommodate any future teeth that may need to be extracted in your upper arch.

So you can see why it is important to know the health of your other teeth before you decide to replace #3.

Bryanna