Hi CJ,

No bother at all

Just to clarify, anytime a dental implant is put in the jaw bone where an infected root canaled tooth use to be there is an elevated a risk for infection and failure of the implant. Especially when the tooth was infected for many years and when there was a fistula. No one can guarantee you that removing the infected tooth after that length of time is going to result in ideal or favorable bone health. Yes, it is imperative that when the tooth is extracted that the periodontal ligament and all visibly diseased bone is removed. However, the key term here is "visibly". No one can determine if there is laden bacteria microscopically or if it has traveled elsewhere. Many people have dental implants to replace root canaled teeth. Depending on the situation and the persons dental and medical health.... each case presents with its own individual results and complications. Most times the person does not even know a problem exists because either they have no symptoms or their dentist does not inform them until the problem has become severe. Similar misgivings with root canaled teeth. So with that said, it is not factual for a dentist to state that implants are done to replace rc teeth all the time therefore there are no problems or for a patient to say I have them and have no problems. It is unfortunate that all too often dental procedures are misrepresented or are offered with a major lack of information.

Regarding the bone loss after the tooth is removed. There is a 50% or more bone loss that occurs over a period of time when a tooth is extracted. This means that because there is no longer a tooth in the bone to hold the bone upright, the side of the bone collapse into the open socket causing a lowering and narrowing of the bone level. A dental implant serves the same purpose that the tooth did in that it holds up the sides of the bone. However, if the bone is diseased, the sides of the bone surrounding the implant will recede similar to if the tooth were not replaced by the implant. Recession of healthy bone differs from one person to another and can become a problem if other teeth are negatively affected by it as in shifting of teeth and/or the person decides years down the road to put in an implant.

To help reduce the overall amount of bone loss after a tooth is removed, a bone graft can be placed into the socket. There will still be bone loss, but not as much. Again each person will respond a bit differently.

If a nesbit is made properly and is worn every day (other than for eating) the adjacent teeth will not shift much. It will hold the space as long as it is worn regularly and replaced when it becomes worn down. He obviously does not feel comfortable making them or in my opinion he would suggest to give that a try based on your apprehensions about the dental implant.

A bridge does compromise the integrity of the adjacent teeth. So that needs to be a part of the decision for that replacement option.

My intention is not to frighten you or sway you in any particular direction. It is solely meant to inform you of the facts that are not being disclosed to you. Everyone has the right to be informed so they can decide if they want to gamble on having the dental implant or not. There is no right or wrong answer here... it is an individual choice that one makes based on their personal priorities.

Knowing what I know about oral and systemic health... I would not place a dental implant in an area of bone that had a long term infection. If the adjacent teeth to the infected tooth were already crowned or had large shallow fillings, I would opt for the permanent bridge because the adjacent teeth were not virgin teeth and would not require a lot more drilling than they have already had done to them. If the adjacent teeth were virgin teeth or had tiny fillings, I would opt for the nesbit.

I know this is a hard decision and you want to believe and trust your dentist. If you feel you can work with him and he is open to your concerns without hesitation, then fine. If he is not, then you may have to search for someone else. I wish this could be easier for you... I really do.

Bryanna