my mouth is a mess. i need around 5 extractions and implants.
here are some of the issues that i am trying to resolve.
apicoectomy vs. implant
titanium vs zirconium implants
if titantium should it be conical or not; and should it be done with platform switching.
can extraction and implant be done at same time if there is infection. i will be going to nyc and dentist says it can be done in one day with second day after osseointegration. is this possible given that there is infection present.

i can send xrays and dentists assesments and suggestions for treatments via email if that would help.

any help will be much appreciated. thank you in advance.

rev. bren

Hi brenjacob,

Your questions are logical and to the layperson even simple to answer. However, there are so many factors to be considered prior to undertaking extensive dental work. Every case regarding replacement of several teeth is complicated and all of the pertinent facts of the individual should be considered.

Factors include:
Do you have periodontal disease?
Have you ever had periodontal surgery?
Do you have root canaled teeth that you are retaining?
Are you already missing other teeth?
Does this treatment plan include all of your dental problems or are there some that are not going to be addressed at this time?

Do you have any chronic health conditions or auto immune disorders?
Do you take any medications on a daily basis?
Did you or do you smoke or drink alcohol excessively?
Do you eat a diet of processed foods, soda, etc?
Your age, health and stress are all factors.

I will re post your questions and just give you my straight forward opinion on those procedures in general. I will reply in bold type.

<<apicoectomy vs. implant>>

AN APICOECTOMY IS A SURGICAL ROOT CANAL. THE MAIN DIFFERENCE BETWEEN A CONVENTIONAL ROOT CANAL AND A SURGICAL ONE IS THE POINT OF ENTRY. BOTH PROCEDURES UTILIZE TOXIC CHEMICALS AND FILLING MATERIALS. NEITHER PROCEDURE GAINS ACCESS TO THE HUNDREDS OF TINY CANALS THAT CONTAIN INFECTED NERVE TISSUE. THEREFORE THE TOOTH REMAINS CHRONICALLY TOXIC AND INFECTED. SO NO SOLUTION TO A PROBLEM THERE.

IMPLANTS WERE INTENDED TO REPLACE TEETH THAT DID NOT INFECT THE BONE TO THE POINT OF OSTEOMYELITIS. IT IS A HUGE DENTAL AND SYSTEMIC RISK TO PLACE DENTAL IMPLANT IN AN AREA OF JAW BONE THAT HAS HAD A CHRONIC INFECTION AND/OR HAS AN INFECTION THAT CANNOT FOR CERTAIN BE ERADICATED.

<<titanium vs zirconium implants>>

BOTH OF THESE MATERIALS ARE CONSIDERED BIO COMPATIBLE WITH HUMAN TISSUE. MEANING UNLESS THE INDIVIDUAL IS SENSITIVE OR ALLERGIC TO EITHER OF THEM, THE MATERIAL IS BASICALLY CHEMICALLY INACTIVE. THERE IS SOME CONCERN ABOUT TITANIUM BEING ABLE TO FORM A WALL OF
BACTERIAL BIOFILM AROUND ITS CIRCUMFERENCE. HOWEVER, THIS OCCURRENCE MAY OR MAY NOT POSE A PROBLEM FOR SOME PEOPLE.
ZIRCONIUM SUPPOSEDLY DOES NOT FORM THAT SAME BIOFILM AROUND ITS CIRCUMFERENCE. HOWEVER, THE TRUE BIO COMPATIBLITY DIFFERS FROM ONE PERSON TO ANOTHER BASED ON THEIR OWN CHEMICAL MAKE UP.

<<if titantium should it be conical or not; and should it be done with platform switching.>>

THE SHAPE, SIZE AND ATTACHMENTS OF A DENTAL IMPLANT ARE DETERMINED ACCORDING TO WHAT THE INDIVIDUAL CASE PRESENTS IN EACH AREA WHERE A DENTAL IMPLANT IS TO BE PLACED. FACTORS SUCH AS HEALTH OF THE BONE; WIDTH, LENGTH AND HEIGHT OF NATURAL BONE; RELATION TO THE LOCATION OF THE SINUS OR MANDIBULAR CANAL; TYPE OF BONE GRAFTING USED; WHAT TYPE OF CROWNS THE IMPLANTS ARE GOING TO BE COVERED WITH ARE THEY INDIVIDUAL UNITS OR ARE THEY GOING TO BE CONNECTED; WHAT ELSE IS GOING TO BE SUPPORTING THEM.

<<can extraction and implant be done at same time if there is infection. i will be going to nyc and dentist says it can be done in one day with second day after osseointegration. is this possible given that there is infection present.>>

THERE ARE MANY DENTISTS WHO REMOVE INFECTED TEETH, PLACE BONE GRAFTS AND PLACE THE DENTAL IMPLANT WITHIN A DAY OR TWO OF EACH OTHER. THERE ARE TWO TRUTHFUL REASONS THIS IS DONE. ONE IS SO THE PATIENT DOESN'T LOOSE INTEREST IN GETTING THE IMPLANTS AFTER THE TEETH ARE EXTRACTED. ANOTHER IS FOR THE CONVENIENCE OF THE PATIENT
NOT HAVING TO SIT THROUGH SEPARATE SURGERIES.

WITH ALL THAT SAID.... DENTAL IMPLANTS WERE NEVER INTENDED TO BE PLACED IN INFECTED BONE. ARTIFICIAL JOINTS ANYPLACE IN THE BODY ARE SELDOM PLACED IN BONE THAT IS INFECTED BECAUSE IT IS NOT IDEAL TO DO THAT. SO I BELIEVE THE JAW BONE SHOULD BE IN THAT SAME CATEGORY.

THE PROBLEMS WITH INFECTED BONE IN THE JAW OR ANYPLACE ELSE IS THAT IT CAN BE DIFFICULT TO ERADICATE THE INFECTION COMPLETELY ESPECIALLY IF THE INFECTION WAS LONG STANDING AND/OR WIDESPREAD. THE HEALING FROM EXTENSIVE ORAL SURGERY CAN BE COMPLICATED AND EVEN MORE SO WHEN THE BONE IS NOT IDEAL.

<< i can send xrays and dentists assesments and suggestions for treatments via email if that would help.>>

YOUR CASE NEEDS TO BE EVALUATED CLINICALLY AS WELL AS RADIO-GRAPHICALLY AND THE OTHER FACTORS THAT I MENTIONED EARLIER SHOULD BE CONSIDERED AS WELL. IT WOULD BEHOOVE YOU TO GET A SECOND, EVEN THIRD OPINION FROM ORAL SURGEONS SO YOU CAN MAKE AN INFORMED DECISION. DISCUSS ALL OPTIONS AVAILABLE TO YOU, WITH OR WITHOUT IMMEDIATE DENTAL IMPLANT PLACEMENT.

IF YOU LOOK AT THIS UNDERTAKING FROM NOT JUST A DENTAL BUT AN OVERALL HEALTH PERSPECTIVE, AND A LONGEVITY PERSPECTIVE, YOU WILL GET A BROADER PERSPECTIVE OF WHAT YOU NEED TO DISCUSS WITH YOUR SURGEONS. IF YOU DON'T WANT TO LOOK AT IT FROM THAT ANGLE THEN IT REALLY WON'T MATTER WHICH DIRECTION YOU CHOOSE TO GO IN.

<<any help will be much appreciated. thank you in advance.>>

YOU ARE WELCOME. I HOPE IT WAS HELPFUL TO YOU.

<<rev. bren>>

ARE YOU A REVEREND BY ANY CHANCE...?