Hi elle,
I knew by your post that you have done lots of research and are not new to having dental work. I think it is wise to check out a dr as much as possible ahead of time. However, what I know about dentistry comes from the "other side of the chair" in addition to being a patient. Just like a nurse would know more about "the other side of hospital care" moreso than I would. Obviously you seek the best as much as you can and remain concerned because of conflicting things that you have read. Well the best informed patient is always skeptical because there is no such thing as perfect, IMO.
Endodontists who tell people that they only treat the teeth that should be treated are only telling part of the story. In other words, along with that statement they also, in my opinion, should be informing patients about the systemic connection between our teeth and overall health. It is only fair to tell the whole truth about the root canal procedure to the patient so that the patient can make an informed decision as to what they feel is in their own best interest. Treatment options should be given to every patient.
It's been my experience having worked in oral surgery, perio, prostho and general dentistry that periodontists and prosthodontists do the least amount of extractions. Periodontists, Prosthodontists and general dentists all have the exact same training in oral surgery. Their expertise is in other areas of dentistry. Like in any profession, some are better at certain things than others. Some perio or prostho's may be good at doing extractions, but more times than not tooth removal other than those considered "easy" are not their typical clincal experience. Now perhaps your periodontist does alot of extractions for some reason? If so, then why would she even entertain the idea of the root breaking off and tell you before it even happens that she's not going in to get it?
I know what I am saying is scaring the bageebers out of you and I am so sorry for doing that. But I have seen this situation too many times and it is not a good idea to leave a root tip in the jawbone. Especially when doing an implant there. As a matter of fact, if a root tip is left in the jawbone at an old extraction site........and the patient is now going to have an implant put there....... the surgeon removes the root tip before placing the implant. Why? Because that root tip is a potential source of infection. For a dentist to tell you any differently they are simply not telling you the truth.
Copied from your post...Here is what I have read and been told.
1. It is better to have the extraction, let it heal, then have the implant, but 3 perios have said they try to do it at the same time if possible.
YES, IT IS IDEAL TO HAVE THE EXTRACTION AND LET IT HEAL. THEN 3-6 MONTHS LATER GO IN AN PLACE THE IMPLANT.
2. Oral surgeons specialize in removing teeth, especially difficult ones, but perio's are the soft tissue guys.
OS'S SPECIALIZE IN OS ABSOLUTELY. SOME ARE A BIT TOO AGGRESSIVE AND THAT IS WHAT YOUR PROSTHO WAS TRYING TO SAY TO YOU WHEN HE SAID THE PERIODONTIST HAS A DIFFERENT APPROACH. HOWEVER, IF THE OS KNOWS THAT THE JAWBONE IS GOING TO BE RECEIVING AN IMPLANT, THEY TAKE BETTER CARE OF IT DURING THE EXTRACTION. PERIODDONTISTS ARE DEFINTIELY MORE CONCERNED ABOUT THE SOFT TISSUE AND TREAT IT VERY GINGERLY WHICH IS GOOD! BUT YOU NEED TO BE ABLE TO ELEVATE A TOOTH EFFECTIVELY AND HAVE THE PROPER INSTRUMENTS TO RETRIEVE ANY PEICES OF TOOTH THAT BREAK OFF. MY CONCERN WITH YOUR PERIO IS IF HER ATTITUDE IS I'M JUST GOING TO LEAVE IT THERE, THEN SHE MAY NOT HAVE THE SURGICAL INSTRUMENTS TO RETRIEVE IT.
3. Leaving a root tip in can cause an infection. And implanting on top of that can be disastrous. But, removing it can cause nerve damage.
YES, A RETAINED ROOT TIP IS A POTENTIAL SOURCE OF INFECTION. PLACING AN IMPLANT NEAR AN IRRITANT IS 100% AVOIDABLE. REMOVING A TOOTH WITH A CURVED ROOT TIP NEAR THE MANDIBULAR CANAL (THE NERVE SHE IS REFERRING TO) SHOULD ONLY BE DONE BY A DENTIST WHO HAS DONE MANY, MANY HUNDREDS +++ OF THEM. ANY DENTIST COULD BREAK THAT ROOT TIP OFF..... BUT THERE ARE INSTRUMENTS AND TECHNIQUIES USED TO RETRIEVE IT WITHOUT CAUSING NERVE DAMAGE. USING AN IMPROPER INSTRUMENT CAN ACTUALLY PUSH THE ROOT TIP FURTHER INTO THE NERVE CANAL AND THEN THE DAMAGE AS OCCURED WHETHER IT IS REMOVED OR NOT.
With reagrd to your pain question...... everyone is different. Depending on how difficult the extraction is can determine the soreness. Implant placement generally does not cause throbbing pain. Various degress of achiness, soreness, and swelling can occur.
Again, I think you are doing an awesome job of doing your homework!!! I so encourage people to do what you are doing! But some people are more comfortable with just putting their trust in the dr and don't want to think about the what if's and that's fine. But the dr should still inform the patient as much as tolerable. Me...... I'm a what if person because I have seen and experienced too much to know better.
Let us know what you decide to do...... I think it would be wise to go with your gut instint on this one.
Bryanna
Quote:
Originally Posted by ellem8
Hi Bryanna,
Everything you have mentioned are things I did consider and were concerns of mine, and actually still are. I did research both, the dentist and implants.
Let me give you a little background. I take very good care of my teeth and gums. My gums are in great shape but I do clench my teeth so they have taken a little bit of a beating from that but I have worn a flat plane night guard for the last 10 years. I have a prosthodontist that handles all my restorations, an endotontist that has done my root canals, (I know how you feel about those and it has me scared to death) and a periodontist. I do have a high amount of respect for my endo though. He is actually very against doing any procedure unless it is absolutely necessary. Even root canals which is his job.
I did interview 3 perio's before I chose the one I am using. I also considered an oral surgeon but I was told (by my endo) that since perio's specialize in soft tissue they are the best to use for the extraction and implant. I was told by all three perio's that they try to do the implant at the time of extraction depending on the patient. I did also check with my prosthodontist about the removal of this tooth and asked him how difficult it would be, since he has done a lot of extractions and he thought she would be able to remove it no problem.
When she mentioned the root to me this is what she said. "If the root tip breaks off we may have to leave it. In my opinion I feel it is too much of a risk and could cause damage to the nerve, trying to retrieve it." she also said she will really take her time with the extraction, but the problem is that with the resorption, the teeth tend to "pop" while you are trying to remove them, since they are hollow inside. She does 200 implants a year. I didn't ask how many extractions she does, I didn't think to. I just assumed she did a fair amount. I can call her on Monday and she will answer any questions I have. She is very good about that. My surgery is scheduled for Tuesday.
Here is what I have read and been told.
1. It is better to have the extraction, let it heal, then have the implant, but 3 perios have said they try to do it at the same time if possible.
2. Oral surgeons specialize in removing teeth, especially difficult ones, but perio's are the soft tissue guys.
3. Leaving a root tip in can cause an infection. And implanting on top of that can be disastrous. But, removing it can cause nerve damage.
So should I just plan on talking to her on Monday and depending on her answers consider postponing and getting an opinion from an Oral Surgeon? The tip is very close to the nerve. I have an x ray that I was going to attach but I guess I cant until I get to 10 posts. 
Thank you so much for all your help. I just want to make sure I do everything the best way possible and I get the best treatment out there. It can just be very confusing when you get conflicting answers sometimes and when dentists are trying to make money! lol
One last question about the pain. Can I expect it to be really sore, or more throbbing? I just want to be as prepared as possible. I have all my soft foods ready to go and filled all my prescriptions today. I plan to follow all the directions I am told so hopefully I will heal fast!
Elle |