Hi John,

I received your PM, so I'm re-posting my reply here to you specifically. Hope you can find it this time!

Your situation is not uncommon. People loose their front teeth for various reasons most often due to some sort of trauma. The conventional standard of care treatment plan is to root canal the teeth that are said to be "salvageable", which is what you had done many years ago. However, since #9 was completely evulsed during the incident, it is likely that some portion of the roots of both #8 and #10 (perhaps even the jawbone) were at minimum fractured at that time. So at some point these "salvagable" root canaled teeth were going to show signs of infection and need to be removed. Just to clarify in case you were not previously informed ... #8 and 10 did not just become infected after 40 years....they were definitely in jeopardy at the time of the incident.

When there is an accident involving the front teeth.... treatment options should be discussed prior to any dental work being done. Some of the options may seem radical like removing the teeth rather than root canaling them... but all options should be discussed first. The common problem with the type of treatment that you had done is that by the time the symptoms of infection are evident and/or the dentist suggests to remove the teeth, the surrounding bone supporting the teeth is not very healthy which makes replacing the teeth a bit complicated.

You stated that tooth #9 has a cavitation. This condition can occur for several reasons, some of them are...... a long standing (initial low grade) infection resulting from an infected (frequently root canaled) or abscessed tooth and/or a long standing infection from trauma and/or a surgery that did not remove all of the diseased tooth and/or tissue. Inflammation sets in, the bone breaks down and the blood vessels can no longer supply blood to that area. Three major concerns with this condition are.... #1) it can be complicated to treat and eradicate completely so that site may not be a healthy place to put an implant ... #2) the bacteria can spread from one area of the bone to another which means the bone on either side of the cavitation may not be healthy sites to place implants ... #3) it can become (or contribute to) a systemic health concern if the bacteria travels to another location outside of the mouth so a cavitation should be taken seriously and treated properly.

To answer your questions...
Placing bone grafts in the area of #8 and 10 should only be done if the bone is healthy in those areas. If it's not healthy, then the grafts can become infected and this compromises the bone even further. It is true that without the grafts you will not grow adequate bone on your own to hold implants. The oral surgeons that I know recommend the placement of the implants no later than 6-9 months after the grafting because the bone will break down if there is nothing for it to support. An alternative to placing bone grafts immediately would be to remove the teeth, thoroughly debride the bone removing all disease tissue, then leave the sites to heal for several weeks. Then a second surgery can be done to place the graft material. A few months later, a third surgery can be done to place the implants. Several months after that, the crowns can be done. You would be wearing a partial denture during the healing phase of the three surgeries. The surgical areas are monitored a few times with xrays to see the progression of the healing and integration of the grafts. But it is important to keep in mind that even with all of this surgery, all of these sites are considered compromised due to the initial trauma, the long standing infection from the root canal therapy and the cavitation on neighboring missing tooth #9.

By the way.... I am in favor of Biological dentistry which embraces various forms of holistic dental treatment. My question is... if you are seeing a holistic dentist for the cavitation surgery on #9, why isn't he the one removing #8 and 10 ? What does he say about adding bone graft to all three of these areas? What does your oral surgeon say about the cavitation with #9?

The record on failure and/or infection with either zirconium or titanium dental implants consists of many factors. The biggest concern stems from the placement of either one of them in unhealthy bone and for all of the reasons I mentioned earlier. Which it sounds like your holistic dentist is concerned about and thus recommends the partial denture and possible bridge later on from 6-11. Both types of material are considered bio-compatible which means the majority of the population will not reject either material due to incompatible sensitivities. One material might be favored over another depending on the individual circumstances and the preference of the surgeon.

I hope this information is helpful to you.... please come back with some feedback and any other questions or concerns you might have.

Bryanna

Hi Bryanna,
Thank you so much for your reply. This does help. I am at work and just read this over quickly. I will read thoroughly later, and then am thankful I may ask you questions. To answer your question though, the holistic dentist is proposing to remove #8 and #10 as well as she will clean the cavitation in #9. The oral surgeon was going to do the same thing but wants to place bone graft (autologous or cadaver) immediately. I am uncomfortable with immediate placement of bone graft, and that the oral surgeon did not mention the cavitation in his treatment estimate, just the removal of #8 and #10. When I asked him about #9 he said of course he would clean it. But to me, if he didn't mention it in his treatment estimate, is he taking it seriously? Thanks so very much.
Steven
(I hope I entered this text in the right location, above your reply in the "Reply to Thread" text box.)