[james pierson]

First of all I want to think Bryanna for the great service she provides to the large population of patients that are taking their health seriously and responsibly learning to be able to make an educated decision and not just blindly follow someone else's here say.

You are an ASSETT to this forum and I bless you for helping so many that are desperately in pain and totally uninformed of what is happening. And hopefully new patients will learn enough to become part of their health team and not leave their welfare in the hands of one individual as well as know enough to select the correct and best professional to treat their malady.

Having said that here is my case and a few questions to help me on my decision,

I have tooth #4 which is an anchor to a 5 tooth bridge ( anchored in #'s 2, 4 & 6 with 3&5 pontics) that according to dentist has a large cavity under the crown and quickly says it needs to be extracted. Needless to say I do not want to extract it unless there is no other way. The Xray shows a slight gray in the bone at the root end (which concerns me as a possible infection). Its not inflamed and does not hurt unless I floss it or brush it.

I find this disturbing because I complained of a slight pain in this area a year ago and the dentist said there was nothing there after checking. I came back 3 months later and told him still had the pain he took another periapical X-ray and said all is well. I later went to my perio and he said the same. Then 4 months later when I go for the cleaning the hygienist says I have a cavity on this tooth which the dentist confirmed. I asked, but you said there was nothing there less than 4 mo ago? His reply was you can't see the cavity under a crown and it spreads quickly. I wonder if it really can spread so quickly as to rot the tooth and Apparently reach the bone?

I would like to see if there is ANYWAY to save it. I mentioned root canal (even though I understand how bad this is but may last my lifetime) and he said no since he says he can insert his probe through the teeth now and extraction is the ONLY solution.
So the 1st question: Do you see anyway to save it?

Assuming I have to extract it a Perio (which also agrees with extraction) has offered me he could extract it (in pieces) w/o removing the bridge leaving me with a working set of teeth. Of course this would leave the bridge anchored only in tooth #2 and 6 with 3&5 pundits and the extracted #4 socket making it less sturdy and more prone to failure. He says we can then see how long it will hold up. Question # 2: Will Taking it out this way involve additional trauma or the same as normal extraction. He mentioned he would extract it in pieces? Can he do this effectively and clean the socket under the bridge?

The other choice he gave me was to cut the bridge, extract 4 and place an implant in 3 and 5 with a 3 teeth bridge anchored in the implants in 3 & 5 and 4 as a pundit.
He mentioned he would need to do a sinus lift in # 3 which I'm not too happy to hear. My 3D Xray ( 3D ConeBeam scan) shows I have up to 5 mm of bone depth in 3 up to the sinus membrane.
Question #3:
Can I not have a 5 mm Bicon implant in there (in 3) w/o the sinus lift?

Question #4:
Can I have instead an implant in 4 (after extraction) and replace the bridge with 4 6 &2 as anchors as before? This will entail only one implant and the bridge can be done with Bicon Trinia fiber re-inforced composite material by Bicom (or similar) that is strong and somewhat flexible that will help on the minor movement of the natural teeth. I know most professionals don't like to do this but some do.
Of course the implant could be done at same time as extraction assuming the bone is not infected. Also I'm concerned with the darker area in the bone shown on the Xray. Will the doctor need to debride the bone to get the infection (if there is one) so he can do the bone graft or can he do it w/o debriding and rely on the antibiotic?

I'm a senior citizen and trying to use the less invasive procedure with the lesser trauma possible and minimum or no drugs although I'm in good health and take no medicines.
Question #5
Ultimately what would your recommendation be if you were treating me?

Thanks

[Bryanna]

Hi james pierson,

Thank you for the kind words I do try to be of help to people even though the information I offer is not always what someone wants to hear.

I have read your post and looked at your xrays and scan photo...thank you for sharing those.

To sum up the dental situation based on these xrays, the scan and your dental history ... the jaw bone in your upper right quadrant is less than ideal in all areas of the bridge. The scan clearly shows infection in the bone above tooth #4. The last molar appears to have decay and extensive bone loss. So that last molar would not be ideal for an anchor tooth for any bridge. There would be no longevity there. The bone area above extracted #3 (indicated as #5 on the scan) shows extensive bone loss and possibly incomplete healing of the bone. Not a great place to put a dental implant.

To be very honest with you, any measures that are taken to try and rebuild the bone, do a sinus lift, etc in this quadrant are heroic at best. The health of the bone concerning #3 site, tooth #4, and possibly even tooth #2 is very questionable. Your dentist should be explaining to you the high rate of failure with performing any invasive dental work in that quadrant.

To surgically remove tooth #4 while keeping the bridge in will only be addressing a part of the problem. It can be done, but access is difficult and visibility is limited. This would still leave you will a questionable #2 and a very unstable bridge which will contribute to additional bone loss as the pressure upon #2 and #6 anchor teeth will be very hard on the bone and periodontal ligaments. Chances are the bridge will fracture #2 and 6 and fall out.

Are you missing teeth on the other side of your upper arch? Have you considered removing #2 and #4, keep #6 crowned and have a removable partial denture?

Bryanna

Originally Posted by james pierson

First of all I want to think Bryanna for the great service she provides to the large population of patients that are taking their health seriously and responsibly learning to be able to make an educated decision and not just blindly follow someone else's here say.

You are an ASSETT to this forum and I bless you for helping so many that are desperately in pain and totally uninformed of what is happening. And hopefully new patients will learn enough to become part of their health team and not leave their welfare in the hands of one individual as well as know enough to select the correct and best professional to treat their malady.

Having said that here is my case and a few questions to help me on my decision,

I have tooth #4 which is an anchor to a 5 tooth bridge ( anchored in #'s 2, 4 & 6 with 3&5 pontics) that according to dentist has a large cavity under the crown and quickly says it needs to be extracted. Needless to say I do not want to extract it unless there is no other way. The Xray shows a slight gray in the bone at the root end (which concerns me as a possible infection). Its not inflamed and does not hurt unless I floss it or brush it.

I find this disturbing because I complained of a slight pain in this area a year ago and the dentist said there was nothing there after checking. I came back 3 months later and told him still had the pain he took another periapical X-ray and said all is well. I later went to my perio and he said the same. Then 4 months later when I go for the cleaning the hygienist says I have a cavity on this tooth which the dentist confirmed. I asked, but you said there was nothing there less than 4 mo ago? His reply was you can't see the cavity under a crown and it spreads quickly. I wonder if it really can spread so quickly as to rot the tooth and Apparently reach the bone?

I would like to see if there is ANYWAY to save it. I mentioned root canal (even though I understand how bad this is but may last my lifetime) and he said no since he says he can insert his probe through the teeth now and extraction is the ONLY solution.
So the 1st question: Do you see anyway to save it?

Assuming I have to extract it a Perio (which also agrees with extraction) has offered me he could extract it (in pieces) w/o removing the bridge leaving me with a working set of teeth. Of course this would leave the bridge anchored only in tooth #2 and 6 with 3&5 pundits and the extracted #4 socket making it less sturdy and more prone to failure. He says we can then see how long it will hold up. Question # 2: Will Taking it out this way involve additional trauma or the same as normal extraction. He mentioned he would extract it in pieces? Can he do this effectively and clean the socket under the bridge?

The other choice he gave me was to cut the bridge, extract 4 and place an implant in 3 and 5 with a 3 teeth bridge anchored in the implants in 3 & 5 and 4 as a pundit.
He mentioned he would need to do a sinus lift in # 3 which I'm not too happy to hear. My 3D Xray ( 3D ConeBeam scan) shows I have up to 5 mm of bone depth in 3 up to the sinus membrane.
Question #3:
Can I not have a 5 mm Bicon implant in there (in 3) w/o the sinus lift?

Question #4:
Can I have instead an implant in 4 (after extraction) and replace the bridge with 4 6 &2 as anchors as before? This will entail only one implant and the bridge can be done with Bicon Trinia fiber re-inforced composite material by Bicom (or similar) that is strong and somewhat flexible that will help on the minor movement of the natural teeth. I know most professionals don't like to do this but some do.
Of course the implant could be done at same time as extraction assuming the bone is not infected. Also I'm concerned with the darker area in the bone shown on the Xray. Will the doctor need to debride the bone to get the infection (if there is one) so he can do the bone graft or can he do it w/o debriding and rely on the antibiotic?

I'm a senior citizen and trying to use the less invasive procedure with the lesser trauma possible and minimum or no drugs although I'm in good health and take no medicines.
Question #5
Ultimately what would your recommendation be if you were treating me?

Thanks

[james pierson]

Originally Posted by Bryanna

Hi james pierson,

Thank you for the kind words I do try to be of help to people even though the information I offer is not always what someone wants to hear.

I have read your post and looked at your xrays and scan photo...thank you for sharing those.

To sum up the dental situation based on these xrays, the scan and your dental history ... the jaw bone in your upper right quadrant is less than ideal in all areas of the bridge. The scan clearly shows infection in the bone above tooth #4. The last molar appears to have decay and extensive bone loss. So that last molar would not be ideal for an anchor tooth for any bridge. There would be no longevity there. The bone area above extracted #3 (indicated as #5 on the scan) shows extensive bone loss and possibly incomplete healing of the bone. Not a great place to put a dental implant.

To be very honest with you, any measures that are taken to try and rebuild the bone, do a sinus life, etc in this quadrant are heroic at best. The health of the bone concerning #3 site, tooth #4, and possibly even tooth #2 is very questionable. Your dentist should be explaining to you the high rate of failure with performing any invasive dental work in that quadrant.

To surgically remove tooth #4 while keeping the bridge in will only be addressing a part of the problem. It can be done, but access is difficult and visibility is limited. This would still leave you will a questionable #2 and a very unstable bridge which will contribute to additional bone loss as the pressure upon #2 and #6 anchor teeth will be very hard on the bone and periodontal ligaments. Chances are the bridge will fracture #2 and 6 and fall out.

Are you missing teeth on the other side of your upper arch? Have you considered removing #2 and #4, keep #6 crowned and have a removable partial denture?

Bryanna




The problems you have cannot be managed properly

Thank you Bryanna for the fast response. You are right sometimes we get the answer that is not what we wanted to hear but on the other hand that is why we are here because of so many people giving you answers that do not reflect your reality. Sometimes because conflict of intereest, sometimes because lack of knowledge or experience but nevertheless either the incorrect solution to your problem or not all the available options to allow you to make the correct educated solution for your case.

No matter how harsh we want to hear the truth and the possible solutions. We are tired of being misled and kept in the dark that is why problems arise.

Anyway based on your response I want to make sure I understand clearly your opinion and advise.
Since your answer was short I assume you meann the following:
1. You see infection on the bone above #4 and agree with others that has to come out and see no way of saving it.

2. You have also detected on the X-Rays that #2 may also have a cavity . Is that under the crown or externally bellow it?

3. If I extract #2 can I not place an implant the lenght of the root on the same bone holding the root?

4. Bone above #3 is small and possibly not healed well. Can I not place a 5 mm Bicon implant and bone graft with some of that bone stimulating protein? Seems like I have close to the 5 mm.

5. the bone in this quadrant is questionable because its small or because you believe its not healthy?

6. I agree with you dentist should be more up front and explain the rate of failure instead of saying all is fine and grafting would resolve the depth. I have been asking this question from the get go and they all say the only important thing to be a candidate for implant is your health noth the bone depth. I also feel uncomfortable with implants in this quadrant and need to be well informed to make an educated decision and not be surprised if it fails or worse.

7.Removing #4 w/o removing bridge would be more involved and poor visibility. Does a dentist have visual contact with the bone on a normal extraction to be able to diagnose its health?

8. leaving the bridge after extracting 4 would contribute to bone loss. Where under a specific tooth?

9. I would prefer to leave 2 if it can be restored to health (I assume you mean a cavity) and have it continue holding the bridge till it falls rather than extraxcting it assuming it will not cause any infection or other problems.

10. If I extraxt #2 & #4 that would leave me with missing 2, 3, 4, &5 and not have a back tooh to clip a removable denture? I have not thought of this because no one has given me this option. I guess I need to understand better how this would be done.
To answer your question I have #15 & 16 missing from the left side of the Maxila.
I'm attaching ascreen shot of the 3d of MY whole mouth as well as tooth 5 and 3 so you can see approximate bone height.

[Bryanna]

Hi james p,

First let me say that dentists are in the business to sell dentistry. This does not mean dentists intentionally want to bring harm to anyone. It just means that if the patient is willing to allow extreme measures involving invasive procedures to be done in areas of the mouth that are not ideal for those procedures and there may be limited longevity to the work, many dentists will go along with that plan. So unless you are someone who is comfortable with going along with that sort of thing, then it is best to come up with a less risky plan that has some longevity to it.

I am going to re post your questions and answer you in bold type.

<<1. You see infection on the bone above #4 and agree with others that has to come out and see no way of saving it.>>

THAT IS CORRECT. WHEN THIS TOOTH IS EXTRACTED, THE BONE WILL NEED TO BE THOROUGHLY DEBRIDED OF ALL DISEASED TISSUE AND BONE. THAT AREA ABOVE THE ROOT OF THE TOOTH IS A CYST OF BACTERIA AND GENERALLY THESE CYSTS ARE VERY ATTACHED TO THE BONE. SO EXTRA CARE NEEDS TO BE DONE TO REMOVE THE CYST AND ALL REMNANTS OF IT WHEN THE TOOTH IS EXTRACTED.

<<2. You have also detected on the X-Rays that #2 may also have a cavity . Is that under the crown or externally bellow it?>>

ON THE SCAN THERE IS A LARGE AREA OF RADIOLUCENCY (BLACK) THAT STARTS AT THE MARGIN OF THE CROWN AND MOVES UP INTO THE FUR-CATION AND ROOT AREA OF THE TOOTH. THIS TYPE OF RADIOLUCENCY GENERALLY INDICATES DECAY. IF THAT IS WHAT IT IS, THIS TOOTH IS NOT SALVAGEABLE. ADDITIONALLY, A TOOTH THAT HAS EXTENSIVE DECAY CAN ALSO MEAN THAT THE BACTERIA FROM THE DECAY HAS INVADED THE BONE. SO WHEN THE TOOTH IS REMOVED, THE BONE WILL ALSO NEED TO BE THOROUGHLY DEBRIDED OF ALL DISEASED TISSUE AND BONE. THEREFORE THE AMOUNT OF BONE THAT IS BEING MEASURED NOW, WILL BE LESS AFTER THE TOOTH IS REMOVED.

<<3. If I extract #2 can I not place an implant the lenght of the root on the same bone holding the root?>>

NOT REALLY AS THERE IS ALWAYS LOSS OF BONE WHEN A TOOTH IS EXTRACTED. THE MORE BACTERIA THERE IS IN THE BONE, THE MORE EXTENSIVE THE BONE LOSS WILL BE. YOU NEED TO HAVE HEALTHY BONE TO PLACE AN IMPLANT PROPERLY.

<<4. Bone above #3 is small and possibly not healed well. Can I not place a 5 mm Bicon implant and bone graft with some of that bone stimulating protein? Seems like I have close to the 5 mm.>>

THE DENTAL WORK NEEDED TO PLACE AN IMPLANT IN THE AREA OF #3 WOULD BE EXTENSIVE AND THE LONGEVITY WOULD BE QUESTIONABLE IF THE EXISTING BONE IS NOT REAL HEALTHY. YOU COULD HAVE THEM TRY IT, BUT UNDERSTAND THAT THERE WOULD BE A LOT INVOLVED IN DOING THAT. SO MAKE SURE YOU ARE CLEAR AS TO WHAT THEIR PLANS AHEAD OF TIME.

<<5. the bone in this quadrant is questionable because its small or because you believe its not healthy? >>

THE INTEGRITY AND HEALTH OF YOUR JAW BONE IN THE UPPER RIGHT QUADRANT MAY BE QUESTIONABLE FOR DENTAL IMPLANTS IN ALL ASPECTS. THE 3D SCAN TELLS PART OF THE STORY. BUT IT'S WHEN A SURGEON ACTUALLY GOES INTO THE BONE, THAT IS WHEN THE HEALTH AND INTEGRITY OF THE BONE BECOMES TRULY APPARENT. MY OFFERING TO YOU IS THAT IS THE BONE IS FOUND TO BE SO SO..... DENTISTS WILL TAKE INVASIVE MEASURES TO PUT IMPLANTS IN AND YOU HAVE TO DECIDE IF THAT IS WHAT YOU ARE COMFORTABLE WITH DOING.

<<6. I agree with you dentist should be more up front and explain the rate of failure instead of saying all is fine and grafting would resolve the depth. I have been asking this question from the get go and they all say the only important thing to be a candidate for implant is your health noth the bone depth. I also feel uncomfortable with implants in this quadrant and need to be well informed to make an educated decision and not be surprised if it fails or worse.>>

IT IS UNFORTUNATE THAT PATIENTS ARE RARELY PROPERLY INFORMED OF THE EXTENSIVENESS AND RISKS WITH SOME INVASIVE DENTAL PROCEDURES. FOR THOSE PATIENTS WHO DO NOT WANT TO KNOW ANYTHING, THIS IS FINE. BUT FOR THOSE WHO WANT TO BE INFORMED, IT CAN BE LIKE PULLING TEETH TO GET THE INFORMATION!!
IT IS TRUE THAT A PATIENTS HEALTH IS IMPORTANT CONCERNING BONE GRAFTING AND DENTAL IMPLANTS. HOWEVER, OTHER ISSUES THAT ARE EQUALLY IMPORTANT ARE THE PATIENTS: LIFESTYLE, DIET, HEALTH OF OTHER TEETH/GUMS/JAW BONE, STRESS LEVEL, MEDICATIONS..... SO ON.

<<7.Removing #4 w/o removing bridge would be more involved and poor visibility. Does a dentist have visual contact with the bone on a normal extraction to be able to diagnose its health?>>

WITHOUT THE BRIDGE BEING PRESENT, WHEN A TOOTH IS EXTRACTED THE DENTIST HAS ROOM TO MANEUVER THE INSTRUMENTS IN BETWEEN THE TOOTH AND THE BONE TO LOOSEN THE TOOTH FROM THE LIGAMENT. ONCE THE TOOTH IS OUT, HE CAN VISIBLY SEE INTO THE SOCKET AND ALSO FEEL WITH HIS SURGICAL INSTRUMENTS THE INTERIOR OF THE SOCKET. THIS VISUAL AND TACTILE SENSE GIVES HIM A GOOD SENSE OF WHAT IS IN THERE AND HOW FAR HE NEEDS TO GO TO CLEAN IT OUT PROPERLY. WHEN THE BRIDGE IS INTACT, THE VISIBILITY OF THE SOCKET AND TACTILE SENSE IS LIMITED. ALSO, THE ROOT OF THE TOOTH IS THE ONLY PORTION OF THE TOOTH THAT WOULD BE REMOVED. YOU WOULD STILL HAVE A DEAD PIECE OF TOOTH INSIDE OF THE CROWN OF THAT BRIDGE. WHICH CAN GET PRETTY STINKY :/

<<8. leaving the bridge after extracting 4 would contribute to bone loss. Where under a specific tooth?>>

THE STABILITY OF THE BRIDGE DEPENDS ON HOW WELL THE ANCHOR TEETH ARE HOLDING THAT BRIDGE IN PLACE. IDEALLY, A 5 UNIT BRIDGE SHOULD HAVE 3 ANCHOR TEETH. THE LESS STABLE THE BRIDGE IS, THE MORE PRESSURE AND WEIGHT IS PUT ON THE ANCHOR TEETH. THIS PRESSURE WEARS DOWN THE LIGAMENTS AND CAUSING THE BONE SURROUNDING THE ANCHOR TEETH TO BREAK DOWN.

<<9. I would prefer to leave 2 if it can be restored to health (I assume you mean a cavity) and have it continue holding the bridge till it falls rather than extraxcting it assuming it will not cause any infection or other problems.>>

THE RADIOLUCENCY ON THE SCAN WITH #2 IS LARGE. IF THAT IS ALL DECAY, THE TOOTH IS LIKELY NON VITAL AND NOT SALVAGEABLE. TOOTH DECAY IS A BACTERIAL INFECTION AND IT PROGRESSES BEYOND THE TOOTH. THAT AREA NEEDS TO BE DIAGNOSED TO DETERMINE IF IT IS DECAY.

<<10. If I extraxt #2 & #4 that would leave me with missing 2, 3, 4, &5 and not have a back tooh to clip a removable denture? I have not thought of this because no one has given me this option. I guess I need to understand better how this would be done.>>

LOOKING AT YOUR PANORAMIC XRAY, YOU ARE NOT A CANDIDATE FOR A CONVENTIONAL REMOVABLE PARTIAL DENTURE BECAUSE THE TEETH YOU ARE MISSING ON THE UPPER LEFT WOULD NOT BE INCLUDED IN THE PARTIAL. YOU MAY BE A CANDIDATE FOR A UNILATERAL PARTIAL DENTURE WHICH IS ONE THAT REPLACES MISSING TEETH ON JUST ONE SIDE OF THE ARCH. BUT IT MAY NOT REALLY BE THE IDEAL REPLACEMENT IN YOUR CASE. PLACING MINI IMPLANTS INTO AREAS THAT ARE GOING TO HOLD THE CLASPS OF A PARTIAL DENTURE WOULD BE RISKY AS THE MINI IMPLANTS ARE NOT INTENDED TO SUPPORT THE WEIGHT OF PARTIAL DENTURES OR PERMANENT BRIDGEWORK.

Keep in mind that the bone height is only one aspect of what is needed to place dental implants successfully. The health, width and thickness of the bone are also important dental factors. Mini implants are not ideal in the posterior region of the mouth even if they are just single implants with crowns. However, you might be able to sneak one in behind #6 in the #5 area. Depending on the health of the bone in the #3 area, you may be able to sneak one in there also. But these would be single mini implants with crowns on them, not to be used for a permanent bridge.

[james pierson]

Originally Posted by Bryanna

Hi james p,
Hi Bryanna,
First let me thank you for the invaluable help and education you have given me in a couple of posts. You have given me the tools to defend myself and also hopefully make an educated decision that will be right for ME and avoid some of the horrible side effects others have suffered in the hands of uneducated professionals as posted on this site. My heart goes out to them understanding how horrible is pain in your teeth or anywhere in the mouth.

I also want to apologize for all the questions. Its not that I doubt anything you say on the contrary its just that I'm so concerned and totally dedicated to get every piece of information I can get on this matter that I try to fine tune to every detail to make sure I don't miss anything. You are God sent to all of us who are suffering and can't get straight answers from our professionals.

I WILL ASK QUESTIONS IN italics UNDER YOUR ANSWERS. tHIS DOES NOT WORK SO i WILL USE SMALL FONTS.


First let me say that dentists are in the business to sell dentistry. This does not mean dentists intentionally want to bring harm to anyone. It just means that if the patient is willing to allow extreme measures involving invasive procedures to be done in areas of the mouth that are not ideal for those procedures and there may be limited longevity to the work, many dentists will go along with that plan. So unless you are someone who is comfortable with going along with that sort of thing, then it is best to come up with a less risky plan that has some longevity to it.



AGREE TOTALLY THAT IS WHERE I BELIEVE THERE IS A MAJOR CONFLICT OF INTEREST THAT MAKES IT VERY DIFFICULT FOR THEM TO BE TOTALLY CANDID AND OFFER ALL THE OPTIONS AND EXPLAIN ALL THE NEGATIVES. iF THEY EDUCATE YOU ABOUT ALL THE RISKS YOU MAY DECLINE THE PROCEDURE AND CUT INTO THEIR EXCESSIVE INCOME. ($2400 AN IMPLANT AND $1800 A CROWN NOT TO MENTION THE GRAFTING OR SEDATION ETC) I PERSONALLY DO NOT GO ALONG WITH ANYTHING I DON'T UNDERSTAND AND HAVE ALL THE FACTS THAT IS WHY I STILL HAVE THIS INFECTED TOOTH IN MY MOUTH THAT MAY EXPLODE ANY DAY WITH A CYST AND PAIN!


I am going to re post your questions and answer you in bold type.

<<1. You see infection on the bone above #4 and agree with others that has to come out and see no way of saving it.>>

THAT IS CORRECT. WHEN THIS TOOTH IS EXTRACTED, THE BONE WILL NEED TO BE THOROUGHLY DEBRIDED OF ALL DISEASED TISSUE AND BONE. THAT AREA ABOVE THE ROOT OF THE TOOTH IS A CYST OF BACTERIA AND GENERALLY THESE CYSTS ARE VERY ATTACHED TO THE BONE. SO EXTRA CARE NEEDS TO BE DONE TO REMOVE THE CYST AND ALL REMNANTS OF IT WHEN THE TOOTH IS EXTRACTED.

I'm afraid if I don't find the proper dentist soon this cyst may start acting up requiring antibiotics. I assume that the bridge would have to be removed in order for the periodontist to be able to extract in an a traumatic manner and be able to sanitize and clean for proper healing which may not be possible with the bridge in place. Once the extraction is healed would this site not be a good candidate for an implant with grafting? It seems to have close to 8 mm in height now. See attachment

<<2. You have also detected on the X-Rays that #2 may also have a cavity . Is that under the crown or externally bellow it?>>

ON THE SCAN THERE IS A LARGE AREA OF RADIOLUCENCY (BLACK) THAT STARTS AT THE MARGIN OF THE CROWN AND MOVES UP INTO THE FUR-CATION AND ROOT AREA OF THE TOOTH. THIS TYPE OF RADIOLUCENCY GENERALLY INDICATES DECAY. IF THAT IS WHAT IT IS, THIS TOOTH IS NOT SALVAGEABLE. ADDITIONALLY, A TOOTH THAT HAS EXTENSIVE DECAY CAN ALSO MEAN THAT THE BACTERIA FROM THE DECAY HAS INVADED THE BONE. SO WHEN THE TOOTH IS REMOVED, THE BONE WILL ALSO NEED TO BE THOROUGHLY DEBRIDED OF ALL DISEASED TISSUE AND BONE. THEREFORE THE AMOUNT OF BONE THAT IS BEING MEASURED NOW, WILL BE LESS AFTER THE TOOTH IS REMOVED.

You are super! I do see that area and can only be surprised the Dr ( a maxilofacial surgeon who took the 3d) did not see it or neglected to mention to make my case more hopeful and hoped I would decide to all this complicated surgery. I do see the area you mention but do not see anything in the bone as I do in #4. Could it be the tooh is decayed but it has not yet reached the bone and its still healthy? Is there a way of knowing the bone health w/o extraction? If in fact the tooth is extracted and bone debrided can it not be a possible site for implant later with grafting with a good prognosis? See attachments.


<<3. If I extract #2 can I not place an implant the lenght of the root on the same bone holding the root?>>

NOT REALLY AS THERE IS ALWAYS LOSS OF BONE WHEN A TOOTH IS EXTRACTED. THE MORE BACTERIA THERE IS IN THE BONE, THE MORE EXTENSIVE THE BONE LOSS WILL BE. YOU NEED TO HAVE HEALTHY BONE TO PLACE AN IMPLANT PROPERLY.

I agree but once bone is cleaned and healed healthy can't an implant be placed with grafting and some high degree of success?


<<4. Bone above #3 is small and possibly not healed well. Can I not place a 5 mm Bicon implant and bone graft with some of that bone stimulating protein? Seems like I have close to the 5 mm.>>

THE DENTAL WORK NEEDED TO PLACE AN IMPLANT IN THE AREA OF #3 WOULD BE EXTENSIVE AND THE LONGEVITY WOULD BE QUESTIONABLE IF THE EXISTING BONE IS NOT REAL HEALTHY. YOU COULD HAVE THEM TRY IT, BUT UNDERSTAND THAT THERE WOULD BE A LOT INVOLVED IN DOING THAT. SO MAKE SURE YOU ARE CLEAR AS TO WHAT THEIR PLANS AHEAD OF TIME.

Assuming no sinus lift I see the implant placement with grafting same as the one I had done in the jaw on teeth's 30 & 19 not more complicated. I'm I missing something? I agree the health of the bone is the key. Is there a test or someway of testing the health of the bone before even planning on any procedure in this quadrant?


<<5. the bone in this quadrant is questionable because its small or because you believe its not healthy? >>

THE INTEGRITY AND HEALTH OF YOUR JAW BONE IN THE UPPER RIGHT QUADRANT MAY BE QUESTIONABLE FOR DENTAL IMPLANTS IN ALL ASPECTS. THE 3D SCAN TELLS PART OF THE STORY. BUT IT'S WHEN A SURGEON ACTUALLY GOES INTO THE BONE, THAT IS WHEN THE HEALTH AND INTEGRITY OF THE BONE BECOMES TRULY APPARENT. MY OFFERING TO YOU IS THAT IS THE BONE IS FOUND TO BE SO SO..... DENTISTS WILL TAKE INVASIVE MEASURES TO PUT IMPLANTS IN AND YOU HAVE TO DECIDE IF THAT IS WHAT YOU ARE COMFORTABLE WITH DOING.


It seems you are saying that the only way to know the bone health and integrity is by actually going into the bone? I would not even consider any implants or treatment unless I was sure the bone was healthy and adequate. Whatever adequate means? (height, width, integrity ?)

<<6. I agree with you dentist should be more up front and explain the rate of failure instead of saying all is fine and grafting would resolve the depth. I have been asking this question from the get go and they all say the only important thing to be a candidate for implant is your health noth the bone depth. I also feel uncomfortable with implants in this quadrant and need to be well informed to make an educated decision and not be surprised if it fails or worse.>>

IT IS UNFORTUNATE THAT PATIENTS ARE RARELY PROPERLY INFORMED OF THE EXTENSIVENESS AND RISKS WITH SOME INVASIVE DENTAL PROCEDURES. FOR THOSE PATIENTS WHO DO NOT WANT TO KNOW ANYTHING, THIS IS FINE. BUT FOR THOSE WHO WANT TO BE INFORMED, IT CAN BE LIKE PULLING TEETH TO GET THE INFORMATION!!
IT IS TRUE THAT A PATIENTS HEALTH IS IMPORTANT CONCERNING BONE GRAFTING AND DENTAL IMPLANTS. HOWEVER, OTHER ISSUES THAT ARE EQUALLY IMPORTANT ARE THE PATIENTS: LIFESTYLE, DIET, HEALTH OF OTHER TEETH/GUMS/JAW BONE, STRESS LEVEL, MEDICATIONS..... SO ON.

You are totally right that is why I'm here to educate myself enough to not only be able to make an educated decision but fight off the implant peddlers that know it will not last. And again you are right its like pulling teeth and to add insult to injury if you are educated and question the procedures they get upset and very confrontational. I had to fire a couple of dentist because of this. The last thing you need is to have a procedure done with a dentist or perio that wants to keep you in the dark

<<7.Removing #4 w/o removing bridge would be more involved and poor visibility. Does a dentist have visual contact with the bone on a normal extraction to be able to diagnose its health?>>

WITHOUT THE BRIDGE BEING PRESENT, WHEN A TOOTH IS EXTRACTED THE DENTIST HAS ROOM TO MANEUVER THE INSTRUMENTS IN BETWEEN THE TOOTH AND THE BONE TO LOOSEN THE TOOTH FROM THE LIGAMENT. ONCE THE TOOTH IS OUT, HE CAN VISIBLY SEE INTO THE SOCKET AND ALSO FEEL WITH HIS SURGICAL INSTRUMENTS THE INTERIOR OF THE SOCKET. THIS VISUAL AND TACTILE SENSE GIVES HIM A GOOD SENSE OF WHAT IS IN THERE AND HOW FAR HE NEEDS TO GO TO CLEAN IT OUT PROPERLY. WHEN THE BRIDGE IS INTACT, THE VISIBILITY OF THE SOCKET AND TACTILE SENSE IS LIMITED. ALSO, THE ROOT OF THE TOOTH IS THE ONLY PORTION OF THE TOOTH THAT WOULD BE REMOVED. YOU WOULD STILL HAVE A DEAD PIECE OF TOOTH INSIDE OF THE CROWN OF THAT BRIDGE. WHICH CAN GET PRETTY STINKY :/

STINKY :/
I hear you you are totally right. I'm surprised my periodontist would suggest this. But then again he is totally dedicated to implants that generate a tremendous income. Base on the # of implant patients I see there daily I estimate over $1.5 Million. Can you believe this? No wonder people go to south America for implants and crowns.

<<8. leaving the bridge after extracting 4 would contribute to bone loss. Where under a specific tooth?>>

THE STABILITY OF THE BRIDGE DEPENDS ON HOW WELL THE ANCHOR TEETH ARE HOLDING THAT BRIDGE IN PLACE. IDEALLY, A 5 UNIT BRIDGE SHOULD HAVE 3 ANCHOR TEETH. THE LESS STABLE THE BRIDGE IS, THE MORE PRESSURE AND WEIGHT IS PUT ON THE ANCHOR TEETH. THIS PRESSURE WEARS DOWN THE LIGAMENTS AND CAUSING THE BONE SURROUNDING THE ANCHOR TEETH TO BREAK DOWN.

I totally agree with you. But if leaving the bridge is an option I can live with that till it happens.


<<9. I would prefer to leave 2 if it can be restored to health (I assume you mean a cavity) and have it continue holding the bridge till it falls rather than extraxcting it assuming it will not cause any infection or other problems.>>

THE RADIOLUCENCY ON THE SCAN WITH #2 IS LARGE. IF THAT IS ALL DECAY, THE TOOTH IS LIKELY NON VITAL AND NOT SALVAGEABLE. TOOTH DECAY IS A BACTERIAL INFECTION AND IT PROGRESSES BEYOND THE TOOTH. THAT AREA NEEDS TO BE DIAGNOSED TO DETERMINE IF IT IS DECAY.

You are totally right. But if its alive and has not affected the bone may it still be salvageable?see attachment for height. Could it not also be bone recession between roots?


<<10. If I extraxt #2 & #4 that would leave me with missing 2, 3, 4, &5 and not have a back tooh to clip a removable denture? I have not thought of this because no one has given me this option. I guess I need to understand better how this would be done.>>

LOOKING AT YOUR PANORAMIC XRAY, YOU ARE NOT A CANDIDATE FOR A CONVENTIONAL REMOVABLE PARTIAL DENTURE BECAUSE THE TEETH YOU ARE MISSING ON THE UPPER LEFT WOULD NOT BE INCLUDED IN THE PARTIAL. YOU MAY BE A CANDIDATE FOR A UNILATERAL PARTIAL DENTURE WHICH IS ONE THAT REPLACES MISSING TEETH ON JUST ONE SIDE OF THE ARCH. BUT IT MAY NOT REALLY BE THE IDEAL REPLACEMENT IN YOUR CASE. PLACING MINI IMPLANTS INTO AREAS THAT ARE GOING TO HOLD THE CLASPS OF A PARTIAL DENTURE WOULD BE RISKY AS THE MINI IMPLANTS ARE NOT INTENDED TO SUPPORT THE WEIGHT OF PARTIAL DENTURES OR PERMANENT BRIDGEWORK.

I don't need to replace the missing teeth on the upper left. How is a conventional partial installed or attached? How about a unilateral partial denture? How will it be supported?


Keep in mind that the bone height is only one aspect of what is needed to place dental implants successfully. The health, width and thickness of the bone are also important dental factors. Mini implants are not ideal in the posterior region of the mouth even if they are just single implants with crowns. However, you might be able to sneak one in behind #6 in the #5 area. Depending on the health of the bone in the #3 area, you may be able to sneak one in there also. But these would be single mini implants with crowns on them, not to be used for a permanent bridge.

I did think of this expensive solution but as you have expressed before you need to make sure you have adequate bone before even considering this option. And I have no idea how you would determine if the bone is healthy, wide enough or thick enough to make an educated decision on this option.

I did notice that in your previous answer to my original post at the end you said and I quote "The problems you have cannot be managed properly" What did you mean by that? That my case is hopeless? I hope not and I also hope there is a rational solution for my problem because I need to chew to eat.

[Bryanna]

James,

You are great with those xrays and that painter thing!!

I copied your panoramic xray on my word so I could enlarge it. In doing so I think there may be a concern on tooth #6. This also seems likely in the new photos you shared here.

The area you circled on #2, yes that sure looks like decay into the furcation (the junction where the roots meet in the center of the top of the root system) and up into the mesial (front) root. This tooth also appears to be non vital.

Also, on the enlarged panoramic view, tooth #4 infection, may have perforated the sinus. It sure is close.

I don't want to open up another can of worms but I think it would behoove you to not just focus on this one area of your mouth as you may have some other things going on that could help determine the replacement option for the upper right. The last 3 teeth on your upper left appear to be not so healthy and may even be non vital or partially non vital. What does your dentist say about those teeth?

The reason I bring the upper left into the picture is because:

#1) The longevity of them is most likely limited.
#2) Taking that into consideration along with the bacteria that is associated with non vital teeth, if those teeth were removed and the upper right posterior were removed, you would be a candidate for a removable partial denture.

Yes, what I am saying at first sounds extreme. However I'm suggesting that you take a look at the whole picture. If it's decided that both the upper right and the upper left existing teeth are in hopeless condition, then the least invasive replacement option to take care of both sides would be a removable partial denture. Based on everything you have shared here, I think this should be considered carefully before you get involved in dental implants.

My statement about problems cannot be managed properly.... disregard. It was me thinking out loud as I was trying to put my reply together. I edited that statement out of my original post.

The photos of the mini implants that you posted.... whose mouth was that? I ask because your lower implants are average size and I don't see those mini ones in your panoramic xray.

Bryanna

Originally Posted by james pierson

I did think of this expensive solution but as you have expressed before you need to make sure you have adequate bone before even considering this option. And I have no idea how you would determine if the bone is healthy, wide enough or thick enough to make an educated decision on this option.

I did notice that in your previous answer to my original post at the end you said and I quote "The problems you have cannot be managed properly" What did you mean by that? That my case is hopeless? I hope not and I also hope there is a rational solution for my problem because I need to chew to eat.

[james pierson]

You are great with those xrays and that painter thing!!

I have an ICat copy of my 3D scan and in my Windows computer I can slice, move position, measure etc. since you also get a copy of a viewer with the copy of the X-ray. And I try to give you as much info as possible so you will have something more than words. I always ask for copies of all X-Rays and the Dr's files as soon as I leave their offices. You would be surprised in how many arguments that has gotten me into. The painter is just a simple editor that are in the net free at a dime a dozen . You have one free in windows called Paint that is easy to use.


I copied your panoramic xray on my word so I could enlarge it. In doing so I think there may be a concern on tooth #6. This also seems likely in the new photos you shared here.

YOU DON'T HAVE TO DO THAT WINDOWS HAS" WINDOWS PHOTO VIEWER" THAT ALLOWS YOU TO ZOOM AS LARGE AS YOU WISH. BOY NOW THAT HAS TAKEN ME BY SURPRISE. WHAT DO YOU SEE IN THE X-RAY THAT MIGHT INDICATE 6 IS A CONCERN? SHOULD I GO TO A ORAL MAXILLOFACIAL RADIOLOGIST (OMR) TO HAVE A FULL INTERPRETATION AND STUDY? tHESE omr'S ARE HARD TO FIND i GOOGLED THEM IN MY AREA AND FOUND NONE ONLY A HOSPITAL THAT ONLY CATERS TO PRACTITIONERS. aS USUAL THE PATIENT IS NOT IMPORTANT OR OF ANY CONCERN. DO YOU KNOW HOE TO FIND ONE OF THESE GUYS?


The area you circled on #2, yes that sure looks like decay into the furcation (the junction where the roots meet in the center of the top of the root system) and up into the mesial (front) root. This tooth also appears to be non vital.

THIS TOOTH HAS A CROWN THAT IS MISSING A PIECE OF THE PORCELAIN THAT IS WHY YOU SEE THE WHITE WITH A MISSING PIECE. AS YOU SAY I WILL NEED TO HAVE THAT LOOKED AT CAREFULLY. IT MAY ALSO BE A BONE RECESSION SINCE THAT LOOKS DARK ON AN X-RAY. HOW CAN VITALITY BE CHECKED? BY HITTING OR PLACING HOT AND COLD?


Also, on the enlarged panoramic view, tooth #4 infection, may have perforated the sinus. It sure is close.

I AGREE. AS A MATTER OF FACT I HAVE BEEN FEELING ON MY RIGHT NOSTRIL RECENTLY LIKE I HAVE SOMETHING INSIDE DEEP UP IN THE NOSTRIL WHICH I TRY TO REMOVE BY BLOWING MY NOSE. THIS MAY BE DUE TO THE PERFORATION. I HOPE NOT. IF SO DOES THAT NEED A MEMBRANE OR SOME OTHER FIX? HOW WOULD THE DR DEBRIDLE THE BONE AND CLEAN THE SOCKET? SCARY


I don't want to open up another can of worms but I think it would behoove you to not just focus on this one area of your mouth as you may have some other things going on that could help determine the replacement option for the upper right. The last 3 teeth on your upper left appear to be not so healthy and may even be non vital or partially non vital. What does your dentist say about those teeth?

I AGREE BUT THE DENTIST OR THE PERIO HAVE NEVER SAID ANYTHING ABOUT THEM AND THEY DON'T BOTHER ME. NOW THIS IS REALLY DEVASTATING NEWS BUT I APPRECIATE YOUR INPUT BECAUSE I WOULD CERTAINLY HAVE THEM LOOKED AT WITH A MICROSCOPE. i AGREE THAT IF IN FACT THEY ARE DEAD THIS WOULD AFFECT HOW I WOULD RESOLVE MY ISSUE BECAUSE I WOULD HAVE TO EXTRACT THEM. THE ONLY WAY I WOULD EXTRACT A TOOTH IS IF ITS DEAD OR ROTTEN WITH INFECTION OTHERWISE I WOULD TRY TO SAVE. SEE ATTACHMENT OF PANORAMIC WITH MORE CONTRAST.


The reason I bring the upper left into the picture is because:

#1) The longevity of them is most likely limited.
#2) Taking that into consideration along with the bacteria that is associated with non vital teeth, if those teeth were removed and the upper right posterior were removed, you would be a candidate for a removable partial denture.

I AGREE AND APPRECIATE YOUR THINKING AHEAD BUT AS I SAID UNLESS THEY ARE DEAD OR IRREPARABLY INFECTED I WILL NOT REMOVE. NOW PLEASE EXPLAIN TO ME WHAT IS A PARTIAL DENTURE AND HOW WOULD IT BE ATTACHED IN MY MAXILLA? i HOPE YOU ARE NOT TALKING ABOUT ONE OF THOSE GLUED TO THE CELING OF THE MOUTH. FOR NOW I NEED TO FOCUS ON EXTRACTING #4 BEFORE IT EXPLODES ON A PAINFUL CYST AND A SWOLLEN FACE! I'M ON BORROWED TIME TRYING TO GET EDUCATED AND INTERVIEWING DENTISTS. TOMORROW I HAVE AN APPOINTMENT LETS SEE WHAT HE SAYS. I DON'T EXPECT MUCH FROM WHAT I SEE ON HIS SITE BUT AT LEAST IS AN OPINION OTHER THAN MY TRADITIONAL CONVENTIONAL DENTIST.


Yes, what I am saying at first sounds extreme. However I'm suggesting that you take a look at the whole picture. If it's decided that both the upper right and the upper left existing teeth are in hopeless condition, then the least invasive replacement option to take care of both sides would be a removable partial denture. Based on everything you have shared here, I think this should be considered carefully before you get involved in dental implants.


HECK IS VERY EXTREME AND HAS ME MADE MORE ANXIOUS AND CONCERNED OF HOW WE HAVE NO WHERE TO FALL ON EXCEPT THESE DUBIOUS PROFESSIONALS WITH NO CREDENTIALS OR DATA ON THEIR WORK, SUCH AS FAILURES AND REASONS. NO REFERRALS EITHER TO THEIR CUSTOMERS SAYING ITS PRIVATE. SO YOU EVENTUALLY HAVE TO GIVE IN TO ONE OF THESE PEOPLE THAT IS WHY YOU HAVE TO KNOW MORE THAN THEM TO DIRECT YOUR OWN CASE.
ITS LIKE YOU SAY SAME AS EXTRACTING TEETH. I HATE TO TURN MY HEALTH INTO SOMEONE GOING IN BLIND AS TO THEIR ABILITIES AND KNOWING HOW MUCH IT VARIES FOR THE SAME PROCEDURE FROM ONE PROFESSIONAL TO THE OTHER BASED ON EDUCATION, EXPERIENCE, ABILITY, CONTINUOUS EDUCATION, GOOD ASSISTANTS, PROPHYLAXIS, EXPERIENCE WITH X-RAYS, MODERN EQUIPMENT, HONESTY ETC. AND THE LIST GOES ON. BOTTOM LINE ONE MAY FIX THE PROBLEM WITH EXCELLENT HEALING AND NO PAIN EVER AGAIN BUT THE OTHER CAN RUIN YOUR LIFE AS WE HAVE SEEN HERE IN THIS BLOG. THAT IS WHY WE NEED TO BE AWAKE AND EDUCATED. THANK YOU, THANK YOU, THANK YOU. I'M CONVINCED YOU HAVE BEEN HEAVENLY SENT TO ASSIST US IN OUR BLINDNESS.
My statement about problems cannot be managed properly.... disregard. It was me thinking out loud as I was trying to put my reply together. I edited that statement out of my original post.

I HOPE IT WAS NOT ME YOU WERE THINKING OUT LOUD . IT KNOCKED ME FOR A LOOP.

The photos of the mini implants that you posted.... whose mouth was that? I ask because your lower implants are average size and I don't see those mini ones in your panoramic xray.

YOU ARE 100% RIGHT. MINE ARE HUGE AND W/O KNOWING HE INSTALLED ONE BONE LEVEL #19 AND #30 STATE FLAT? THIS #30 HURTS WHEN I FLOSS SO I ASSUME HE INSTALLED A LITTLE OUTSIDE OF BONE AND THEN AFTER i BRUSH THE WHOLE QUADRANT HAS A SMALL PAIN AND IMPLANT AREA IS SENSITIVE. i HAVE HAD THEM FOR 2 YEARS AND THE PERIO SAYS THEY ARE STRONG . HAD I KNOWN AS MUCH AS i KNOW NOW i WOULD HAVE ASKED THE BRAND AND SIZE OF THE IMPLANT AND HOW HE WAS TO INSTALL. BECAUSE DEPENDING ON YOUR PROBLEMS DIFFERENT MANUFACTURERS HAVE A SOLUTION BUT PROFESSIONALS LEARN ONE BRAND SYSTEM INSTALL AND ARE TOO LAZY TO LEARN OTHERS THAT MAY APPLY TO YOUR CASE. THAT IS WHY I FOUND BICON BECAUSE ITS THE ONLY MANUFACTURER THAT MAKES IMPLANTS 5 MM LONG AND HAS BEEN AROUND FOR OVER 30 YRS, ALSO THEY DO NOT USE A SCREW FOR THE ABUTMENT BUT A LOCKING TAPER BACTERIALLY SEAL SO YOU DON'T NEED SCREWS AND TORQUE DRIVERS AND ALSO HAVE THE IAC AN INTEGRATED CEMENTLESS , SCREWLESS ABUTMENT CROWN WITH REDUCED TIME AND COST. NOW HOW MANY PEOPLE OR EVEN DENTIST KNOW THIS???? UNLESS YOU DO YOU MAY HAVE THE WRONG IMPLANT PLACED IN YOU!
ANYWAY TO ANSWER YOUR QUESTION THAT IS AN ADVERTISING X-RAY FROM BICON SHOWING HOW MUCH LESS SPACE TIER 5 MM IMPLANT TAKE. JUST FOR COMPARISON MINE IS 12 MM. NO WONDER THE DR IS THINKING OF SINUS LIFTS.


Bryanna[/QUOTE]

[james pierson]

Originally Posted by james pierson

you are great with those xrays and that painter thing!!

I have an icat copy of my 3d scan and in my windows computer i can slice, move position, measure etc. Since you also get a copy of a viewer with the copy of the x-ray. And i try to give you as much info as possible so you will have something more than words. I always ask for copies of all x-rays and the dr's files as soon as i leave their offices. You would be surprised in how many arguments that has gotten me into. The painter is just a simple editor that are in the net free at a dime a dozen . You have one free in windows called paint that is easy to use.


I copied your panoramic xray on my word so i could enlarge it. In doing so i think there may be a concern on tooth #6. This also seems likely in the new photos you shared here.

You don't have to do that windows has" windows photo viewer" that allows you to zoom as large as you wish. Boy now that has taken me by surprise. What do you see in the x-ray that might indicate 6 is a concern? Should i go to a oral maxillofacial radiologist (omr) to have a full interpretation and study? These omr's are hard to find i googled them in my area and found none only a hospital that only caters to practitioners. As usual the patient is not important or of any concern. Do you know hoe to find one of these guys?


The area you circled on #2, yes that sure looks like decay into the furcation (the junction where the roots meet in the center of the top of the root system) and up into the mesial (front) root. This tooth also appears to be non vital.

This tooth has a crown that is missing a piece of the porcelain that is why you see the white with a missing piece. As you say i will need to have that looked at carefully. It may also be a bone recession since that looks dark on an x-ray. How can vitality be checked? By hitting or placing hot and cold?


Also, on the enlarged panoramic view, tooth #4 infection, may have perforated the sinus. It sure is close.

I agree. As a matter of fact i have been feeling on my right nostril recently like i have something inside deep up in the nostril which i try to remove by blowing my nose. This may be due to the perforation. I hope not. If so does that need a membrane or some other fix? How would the dr debridle the bone and clean the socket? Scary


i don't want to open up another can of worms but i think it would behoove you to not just focus on this one area of your mouth as you may have some other things going on that could help determine the replacement option for the upper right. The last 3 teeth on your upper left appear to be not so healthy and may even be non vital or partially non vital. What does your dentist say about those teeth?

I agree but the dentist or the perio have never said anything about them and they don't bother me. Now this is really devastating news but i appreciate your input because i would certainly have them looked at with a microscope. I agree that if in fact they are dead this would affect how i would resolve my issue because i would have to extract them. The only way i would extract a tooth is if its dead or rotten with infection otherwise i would try to save. See attachment of panoramic with more contrast.


The reason i bring the upper left into the picture is because:

#1) the longevity of them is most likely limited.
#2) taking that into consideration along with the bacteria that is associated with non vital teeth, if those teeth were removed and the upper right posterior were removed, you would be a candidate for a removable partial denture.

I agree and appreciate your thinking ahead but as i said unless they are dead or irreparably infected i will not remove. Now please explain to me what is a partial denture and how would it be attached in my maxilla? I hope you are not talking about one of those glued to the celing of the mouth. For now i need to focus on extracting #4 before it explodes on a painful cyst and a swollen face! I'm on borrowed time trying to get educated and interviewing dentists. Tomorrow i have an appointment lets see what he says. I don't expect much from what i see on his site but at least is an opinion other than my traditional conventional dentist.


Yes, what i am saying at first sounds extreme. However i'm suggesting that you take a look at the whole picture. If it's decided that both the upper right and the upper left existing teeth are in hopeless condition, then the least invasive replacement option to take care of both sides would be a removable partial denture. Based on everything you have shared here, i think this should be considered carefully before you get involved in dental implants.


Heck is very extreme and has me made more anxious and concerned of how we have no where to fall on except these dubious professionals with no credentials or data on their work, such as failures and reasons. No referrals either to their customers saying its private. So you eventually have to give in to one of these people that is why you have to know more than them to direct your own case.
Its like you say same as extracting teeth. I hate to turn my health into someone going in blind as to their abilities and knowing how much it varies for the same procedure from one professional to the other based on education, experience, ability, continuous education, good assistants, prophylaxis, experience with x-rays, modern equipment, honesty etc. And the list goes on. Bottom line one may fix the problem with excellent healing and no pain ever again but the other can ruin your life as we have seen here in this blog. That is why we need to be awake and educated. Thank you, thank you, thank you. I'm convinced you have been heavenly sent to assist us in our blindness.
My statement about problems cannot be managed properly.... Disregard. It was me thinking out loud as i was trying to put my reply together. I edited that statement out of my original post.

I hope it was not me you were thinking out loud . It knocked me for a loop.

The photos of the mini implants that you posted.... Whose mouth was that? I ask because your lower implants are average size and i don't see those mini ones in your panoramic xray.

You are 100% right. Mine are huge and w/o knowing he installed one bone level #19 and #30 state flat? This #30 hurts when i floss so i assume he installed a little outside of bone and then after i brush the whole quadrant has a small pain and implant area is sensitive. I have had them for 2 years and the perio says they are strong . Had i known as much as i know now i would have asked the brand and size of the implant and how he was to install. Because depending on your problems different manufacturers have a solution but professionals learn one brand system install and are too lazy to learn others that may apply to your case. That is why i found bicon because its the only manufacturer that makes implants 5 mm long and has been around for over 30 yrs, also they do not use a screw for the abutment but a locking taper bacterially seal so you don't need screws and torque drivers and also have the iac an integrated cementless , screwless abutment crown with reduced time and cost. Now how many people or even dentist know this???? Unless you do you may have the wrong implant placed in you!
Anyway to answer your question that is an advertising x-ray from bicon showing how much less space tier 5 mm implant take. Just for comparison mine is 12 mm. No wonder the dr is thinking of sinus lifts.


Bryanna

[/quote]
have not heard from you on this post? Please give me your valuable input.
Thanks!

[Bryanna]

James,
Just so you know... I am a volunteer here. So that means I'm here in between work, family, school, and life.... I do the best that I can to get to everyone in a timely manner. Sometimes it's not as quick as one would like, but this is the best that I can do. I'm sure you understand.

I will re post your questions as you have written them and place them within these symbols << >> and then answer you in regular type.

<<WHAT DO YOU SEE IN THE X-RAY THAT MIGHT INDICATE 6 IS A CONCERN? SHOULD I GO TO A ORAL MAXILLOFACIAL RADIOLOGIST (OMR) TO HAVE A FULL INTERPRETATION AND STUDY? tHESE omr'S ARE HARD TO FIND i GOOGLED THEM IN MY AREA AND FOUND NONE ONLY A HOSPITAL THAT ONLY CATERS TO PRACTITIONERS. aS USUAL THE PATIENT IS NOT IMPORTANT OR OF ANY CONCERN. DO YOU KNOW HOE TO FIND ONE OF THESE GUYS?>>

Tooth #6 appears to have decay or some sort of absorption on the lingual (palate) side of the tooth above the crown margin into the root. You can see it in several shots but here's one...
http://neurotalk.psychcentral.com/at...6&d=1443506031
You do not need a specialist to diagnose the deterioration of your teeth. A general dentist, any dentist, is educated in reading xrays and diagnosing tooth decay. Your tooth problems are not invisible to an educated professional.

<<THIS TOOTH #2 HAS A CROWN THAT IS MISSING A PIECE OF THE PORCELAIN THAT IS WHY YOU SEE THE WHITE WITH A MISSING PIECE. AS YOU SAY I WILL NEED TO HAVE THAT LOOKED AT CAREFULLY. IT MAY ALSO BE A BONE RECESSION SINCE THAT LOOKS DARK ON AN X-RAY. HOW CAN VITALITY BE CHECKED? BY HITTING OR PLACING HOT AND COLD?>>

Tooth #2 crown may be missing some porcelain but the likelihood of decay on this tooth is pretty certain and there is definitely an abnormal division of the root system in the root trunk area. Abnormal meaning the joining of root system is no longer in tact, it is separated. This occurs from a disease process like periodontal disease or tooth decay where bacteria is able to collect resulting in bone loss. When the loss is severe enough to deteriorate the root trunk, the tooth becomes very fragile and often fractures.
Vitality can be checked with hot or cold temps but it can also be diagnosed by the xrays that would show calcified canals, root/tooth resorption or some other deterioration in the root system. Teeth #2, 4, 12, 13, and 14 in your upper arch show radio graphic signs of reduced vitality if not non vital.

<<TOOTH #4 SINUS PERF: I AGREE. AS A MATTER OF FACT I HAVE BEEN FEELING ON MY RIGHT NOSTRIL RECENTLY LIKE I HAVE SOMETHING INSIDE DEEP UP IN THE NOSTRIL WHICH I TRY TO REMOVE BY BLOWING MY NOSE. THIS MAY BE DUE TO THE PERFORATION. I HOPE NOT. IF SO DOES THAT NEED A MEMBRANE OR SOME OTHER FIX? HOW WOULD THE DR DEBRIDLE THE BONE AND CLEAN THE SOCKET? SCARY>>

There is a cyst in the bone attached to tooth #4. It is common to see this on infected teeth. If the cyst has not perforated the sinus, then it is certainly putting pressure and causing inflammation on the sinus membrane. That would give you the nasal symptoms. The only way to determine the exact location, depth and size of the cyst is to remove the tooth and explore that area with surgical instruments. Chances are the sinus will be perforated when this tooth and cyst is removed. The size of the perforation depends on the extent of the bacteria and deterioration it has caused. Most small sinus perforations will heal on their own if there is no lingering infection. Some perforations need to be mended closed. This procedure depends on the size, location and depth of the perforation and how healthy the surrounding tissue and bone is after the tooth is removed.

<<Regarding the upper left teeth: I agree and appreciate your thinking ahead but as i said unless they are dead or irreparably infected i will not remove. Now please explain to me what is a partial denture and how would it be attached in my maxilla? I hope you are not talking about one of those glued to the celing of the mouth. For now i need to focus on extracting #4 before it explodes on a painful cyst and a swollen face! I'm on borrowed time trying to get educated and interviewing dentists. Tomorrow i have an appointment lets see what he says. I don't expect much from what i see on his site but at least is an opinion other than my traditional conventional dentist.>>

Those teeth are not healthy and possibly non vital. Therefore their longevity is limited and there is bacteria brewing around each one of them. Ideally this area of your mouth should be taken into consideration when deciding on replacement options for the upper right.

A removable partial denture is... removable, it is not cemented to anything. It is like a full denture but it's smaller and only replaces the missing teeth.

What did this new dentist have to say??