Bryanna,

Good to see you're still around and offering helpful advice. Earlier in this thread you gave me lots of info about an implant I was getting for a tooth that had already had a couple of root canals and a couple of apicoectomies.

I'd like to give you the update if I may...

You may recall that the sinus was perforated when the extraction was done. Unfortunately it was perforated again when he place the implant. But the follow-ups over the next months showed good progress and the torque test on the implant suggested it was good to go for an abutment and crown.

The day I got the crown I noticed that tooth was sensitive to bight on. I assumed this might be normal since I hadn't been able to chew on that side of my mouth for the better part of a year. But after a few days with no improvement I called the doctor that did the implant. He told me the sensitivity was not to be expected. He suggested I come in and let him look at it.

When I saw him, he noted that the tooth/implant was wobbly (and still sensitive - particularly to side pressure). He asked me to come back in two weeks. That takes us to Monday (two days ago). He had hoped it was simply the crown rocking on the abutment. He drilled into the crown and removed the screw so that he could remove the crown. Unfortunately, he confirmed it was the implant that was wobbly - not the crown. He proceeded to remove the implant (leaving me with a sinus perforation for a third time). He then placed a collagen disk in the hole to seal the sinus perforation and promote bone growth. He suspected that the sinus perforation at the time of the original implant placement could be the cause of the bone not grafting to the implant as the soft tissue from the sinus might have grown down into the hole.

So now he has inserted the colllagen disk, ground away some more bone, added some fake bone to promote bone growth, and sutured the gums. I have an appointment to see him again on Monday.

The thing I want to do least of all is repeat this whole process over the next 9 months or so to end up with another failed implant. Is it time for me to give up on teeth all together and live on soft foods for my few remaining years? :(

Thanks again.

Hi Spork,

Sorry I didn't see your post sooner. I am on the east coast and have been hit hard with the tropical storm Sandy. Just got power back last night after 6 days!! But things are looking brighter for now .. so that is good ;)

I do not recall what tooth you were replacing or if that tooth had been previously root canaled. Could you just update me on that?

If it is in an area that you can live without a tooth, that would be your best bet. When the bone is compromised and/or there is a sinus perforation ... the placement of a dental implant is very risky. Repetitive tries will also be risky and can be compromising to the health of your jawbone and sinuses.

I am surprised that the restorative dentist, the one who put the crown on, did not notice any movement during the placement of the crown. What is the update from your implant dentist today?

Bryanna

No worries. Sorry to hear you got caught in the storm. Glad you came out OK.

This is the number 3 tooth. It's had two root canals, two apicoectomies, and we're headed for two dental implants. :(

Well, it was right there in my mouth with all the other teeth. I had really grown very attached to it. During the 9 months I went without due to the implant I wasn't really able to chew on that side at all. What do people do when they're missing teeth?

That's bad news. He perforated the sinus during the sinus lift, and perforated it again when placing the implant. He seemed to feel there was no cause for concern. When he removed the implant a week ago today it left me with a perforated sinus for a third time. Although actually I don't recall whether removing the implant left me with the sinus perforation or whether that happened when he further prepped the hole for new bone grafting. In any event - I left with one more hole than when I arrived.

Assuming the bone and sinus perforation heals nicely, and a new implant can be placed without causing yet another perforation, do you still give it low odds of success? He gave it a 98% likelihood of success. But then he also told me the sinus perforations were nothing to worry about.

How does an implant typically fail? This one came out with no bone fragments attached to it.

I don't know whether it was loose at that time. But it was certainly sensitive from the first time I tried to chew on it.

The stitches came loose over the weekend on their own. So I trimmed the loose ends, took pics and emailed them to the implant dentist. I asked if I should just go ahead and remove the one little sliver of suture that remained. He said I should do so if I could do it carefully. So I removed the last tiny suture with a pair of tweezers, sent him another photo, and he told me I could put off the appointment for a week. I'm scheduled to see him next monday.

Thanks again for all your advice.

Rick

Hi Rick

My answers are in BOLD lettering.
This is the number 3 tooth. It's had two root canals, two apicoectomies, and we're headed for two dental implants. :(

TOOTH #3 IS THE FIRST MOLAR AND IT IS USED FOR CHEWING. HOWEVER, THE HISTORY OF THIS TOOTH AND JAWBONE HAS LEFT THIS AREA OF YOUR MOUTH VERY COMPROMISED DUE TO THE LONG TERM INFECTION, INFLAMMATION AND TRAUMA FROM ALL OF THE INVASIVE DENTAL PROCEDURES. I WOULD NOT MESS WITH THIS BONE ANY FURTHER, IF IT WERE ME.


Well, it was right there in my mouth with all the other teeth. I had really grown very attached to it. During the 9 months I went without due to the implant I wasn't really able to chew on that side at all. What do people do when they're missing teeth?

IN CASES SUCH AS YOURS, THE HEALTHIEST REPLACEMENT OPTION WOULD BE EITHER A 3 UNIT BRIDGE OR A REMOVABLE PARTIAL. I WOULD DISCUSS THOSE OPTIONS WITH YOUR DENTIST IN DETAIL.


That's bad news. He perforated the sinus during the sinus lift, and perforated it again when placing the implant.

THIS INDICATES A LACK OF SOLID BONE WHICH IS NOT A SURPRISE GIVEN THE LONG TERM INFECTIONS AND REPETITIVE DENTAL WORK DONE IN THIS AREA.

He seemed to feel there was no cause for concern. HE WOULD IF IT WERE IN HIS OWN MOUTH!

When he removed the implant a week ago today it left me with a perforated sinus for a third time. Although actually I don't recall whether removing the implant left me with the sinus perforation or whether that happened when he further prepped the hole for new bone grafting. In any event - I left with one more hole than when I arrived.

AGAIN, THIS IS DUE TO THE POOR QUALITY OF BONE. IF THE SINUS CAN REPETITIVELY BE PERFORATED WITH EVERY PROCEDURE .... WHY NOT LOOK FOR A LESS INVASIVE OPTION?

Assuming the bone and sinus perforation heals nicely, and a new implant can be placed without causing yet another perforation, do you still give it low odds of success? He gave it a 98% likelihood of success. But then he also told me the sinus perforations were nothing to worry about.

WITHOUT A DOUBT, THIS AREA OF YOUR MOUTH IS HIGHLY COMPROMISED. FROM A LOOK AT THE OTHER SIDE OF THE DENTAL CHAIR .... I DON'T KNOW OF ONE DENTIST THAT WOULD CONTINUE ON THIS PATH IF IT WERE HIS OWN MOUTH.

How does an implant typically fail? This one came out with no bone fragments attached to it.

IMPLANTS FAIL DUE TO INFECTION AND/OR COMPROMISED BONE. IT CAME OUT EASILY BECAUSE THE BONE IS NOT HEALTHY ENOUGH TO INTEGRATE WITH THE BONE GRAFT MATERIAL OR THE IMPLANT. THEREFORE, THE IMPLANT WAS BASICALLY SITTING IN MUSHY BONE GRAFT AND TISSUE.

I don't know whether it was loose at that time. But it was certainly sensitive from the first time I tried to chew on it.

CHANCES ARE... IT WAS LOOSE AT THE TIME OF THE DELIVERY OF THE CROWN AND YOU WERE NOT INFORMED. I HAVE WITNESSED THIS MANY TIMES AND THE OUTCOME IS ALWAYS THE SAME.... EVENTUAL IMPLANT FAILURE.


Thanks again for all your advice.
YOUR WELCOME. PLEASE DISCUSS OTHER REPLACEMENT OPTIONS WITH YOUR DENTIST.

Bryanna

Once again - thanks for all the good advice - and bad news :(

I will definitely talk to the oral surgeon about those options - and I very much like the idea of asking what he'd do if it were his mouth.

Hi Spork
 

I have a removeable bridge, just fantastic. No worries about bone loss or grafting, or implants. I didn't want to take a chance, and I was told the truth by the oral surgeon. I came into the dentiest armed with information, and got the truth of my situation. i do wish for you the same good outcome. the bridge is no big deal, looks great, and works just fine. Implants cost a heck of alot more, and the failure rate is high with bone loss and infections. ginnie

Thanks very much for that. I'm not familiar with the concept of a removable bridge. Do they not have to grind down the neighboring teeth to accommodate it? What holds it in?

Thanks.

ETA: a Google search turns this up: http://denturesolutions.org/removable_bridge_work Is this what you're talking about? It looks like it covers all the teeth - not just the missing one and its neighbors. Is that right?

Thanks again.

Re: laugh at me
 

Hi spork, I have something called a besnit, or a nesbit, I get confused at the way it is spelled!!!!! or pronounced!!!!!! Bryanna I know will laugh over this, as I do this every time!!! It holds two teeth, and wraps around the ajoining teeth, no grinding needed on teeth infront or in back. This is comfortable, and not that expensive to do. I think having one depends on what teeth are missing. I didn't even know about them until my dentist recommened this to me. Better than bone grafts and inplants where I can't afford that anyway. Hope you will look into it. Sorry for my confusion!!! That is why I didn't test well in school. I knew the answer, what it meant, just couldn't spell right! ginnie:hug:

Hi Bryanna
 

You will laugh at my post to Spork, I did it again!!!! This woman gets so confused!!!! ginnie:hug:

Thanks very much Ginnie. I will very definitely look into it. I have an appt for a consultation with a local oral surgeon on Monday, and I want to discuss all options with him.

ETA: Just found this http://en.allexperts.com/q/Dentistry...uestion-12.htm Looks like you got it right to me.

ginnie,

You have a NESBIT.... lol :)

Bryanna

Can I have one?

Rick,

What ginnie has is called a nesbit. This is a very small appliance that resembles teeth on an acrylic base and it replaces one to two teeth that are next to each other. You need to have "anchor teeth" on each side of the space to hold the nesbit in place. This appliance is easily removed just like a denture. It is not recommended that you eat with this because it is so small that you could swallow it. And it is not meant to stay in when you sleep, again because it can be swallowed. You may be a candidate for a nesbit if you are just going to replace tooth #3. Some dentists do not recommend these because they are small and can be a choking hazard. Others make them all the time and their patients love them! I've known many patients who do really well with them!

A removable bridge is very different than a nesbit. The bridge is fabricated to fit over existing teeth to make the teeth look better esthetically. This appliance is removable to clean. Your case does not warrant this type of appliance.

A removable partial denture is basically a larger nesbit. It can replace missing teeth on one or both sides of the arch at the same time. Here is a link with good pictures ...
http://doctorspiller.com/partial_dentures.htm

Hope this helps!
Bryanna

Rick,

Yes, you could have a nesbit to replace #3. But it's important to understand the limitations of this type of appliance. The website I provided you shows a good picture of a nesbit.

Bryanna


QUOTE=spork;935403]Can I have one?[/QUOTE]

Hmmm... unfortunately, the only reason I want a tooth there is for chewing. The missing tooth is far enough back that you don't notice it's missing.

In the link you provided I see:

"The design of the new flexible plastic framework takes the danger out of an accidental swallowing of the appliance. In the event that someone did swallow one, it is unlikely that any damage could be done to the lining of the digestive system."

So it sounds like maybe the swallowing hazard has become less of an issue.

It also says:

"Dentists used to build Nesbits for their patients all the time. They were composed of a single denture tooth (usually a back tooth) between two cast metal clasps which attached onto the teeth on either side of the missing one."

I would have thought it was intended for chewing if it's typically used on a back tooth, but then I've never even heard of one until today.

Given the root canals on the two neighboring teeth, it sounds like the best bet is to leave a hole there - right?

Hi Bryanna
 

Yep I knew you would get a kick out of my once again mis-spelling....ginnie:hug:

Hi Spork
 

Hi, in my case the dentist, said I could eat just fine with the nesbit. I have two teeth replaced, and firmly anchored in front and in back of the two missing teelth. I am careful however, lets say reasonable with its use. I do take it out at night. My dentist uses these all the time, and said at one time dentists did use them more. She is a firm believer in them. Her father, and two brothers are also dentists. I can't see anything negative about them at all. No carmel apples, steak, hard stuff to chew are the only draw backs I can tell. I sure hope it all works out for you. ginnie

Rick,

Nesbits are not meant to be used for chewing because food can get stuck on them, pop them out and that's when you could choke on it. If swallowed, the acrylic ones are more likely to pass through the digestive tract without getting caught as with the metal ones. Also, they have to fit snug or that too cause them to fall out and it's the choking thing that could be a problem. However, if you only eat soft foods while you have it in and you try not to chew on that side, you could leave it in with some confidence. Most of the patients that I know who have nesbits remove them during eating and then just pop them back in when they are done.

Chewing is not the real reason for a nesbit because you can usually chew most foods okay without one. The reason to have this appliance is to prevent the adjacent teeth from tilting in towards that open space which can mess up your bite and also to prevent the biting tooth (the tooth directly above or below this space) from drifting up or down into this space. Nesbits are space holders, for lack of a better definition, and for esthetics.

Removable partial dentures are designed for chewing as well as space holders and esthetic reasons.

Given the two other root canaled teeth, #2 and 4 in your case, it is not ideal to put an implant in between these two compromised teeth. It is also not ideal to put a three unit bridge there which would mean grinding down the two root canaled teeth. The trauma from the drilling on these guarded and fragile teeth could set off a huge problem. Also, when one or both of these teeth needs to be removed, the entire bridge becomes useless. It's usually not recommended because it's just not stable.

Bryanna

Thanks for that detailed explanation. I now understand why one would use a nesbit - even though it's not good for chewing. I understand that it's probably not a good idea to choose any of the options that involve grinding the neighboring teeth.

Looking at Wikipedia it appears that a removable partial denture does not require grinding my existing teeth. Would that make it a good option in my case?

Rick,

In your case based on the photos and xrays that you have sent to me.... you may not be a candidate for a conventional partial denture because you do not need to replace any teeth on the opposite side of the upper arch. Partial dentures replace teeth on both sides of the arch.

You may be a candidate for a unilateral partial which is designed to replace a tooth or teeth on one side of the arch. Some dentists are comfortable making these, others are not. You would have to discuss this with your dentist.

The basic idea is to avoid putting implants in areas that had root canaled teeth due to the consequences of the long term infection from those teeth. And also avoid using root canaled teeth as anchor teeth for a bridge.... for the same exact reasons. So ask your dentist what your other options are.... every case is different and not all dentists are comfortable doing all things.

Does that sound reasonable to you?
Bryanna

Thanks. On the one hand it sounds reasonable - on the other hand, I'm now pretty surprised and disappointed with what my current dentist seemed comfortable with. I'm pretty keen on avoiding another case of a specialist finding me to be a perfect candidate for whatever his/her specialty happens to be. :(