One final question if you don't mind Bryanna. You have been such a terrific help.

My general dentist suggested an implant at #19 in order to close the upcoming gap somewhat, leaving #18 vacant.

#20 is a sound tooth not root canaled.

What do you think?

Poilj,

Regarding your question about placement of the dental implant to replace tooth #19 ....

There are some significant issues to consider or address before placing any dental implant simply because of the fact that it is a foreign material, usually titanium or zirconium, which can be rejected at the site or contribute to poor oral or physical health of the recipient. Things to consider:

1) The overall health of your mouth irrelevant of where the dental implant is proposed to be placed. Any chronic area of infection or inflammation compromises oral health. Root canaled teeth, periodontal disease, poor oral hygiene, ill fitting restorations/crowns/partial dentures are areas of concern for infection and inflammation.

2) The overall health of the patient. Smoker, alcohol drinker, poor eating habits, and many medications compromise a persons health. Acute or long term inflammatory disorders or infections of the digestive tract or elsewhere compromise the health of the immune system. Any of these issues can prevent, slow down, or even cause a rejection of the implant.

3) The jaw bone at the site where the implant is to be placed as well as the surrounding bone or teeth should be healthy. If there are or were neighboring teeth that were infected or root canaled, the health of the bone in the area of the proposed implant may be compromised. The jaw bone must also be sufficient in height, width and thickness to hold the implant.

4) The dental history with tooth #19 is important. If it had been root canaled and the infection had spread to the bone prior to it being extracted, then the bone may not be ideally healthy as it can be difficult for the surgeon to eradicate the bacteria completely from the bone from a root canaled tooth.
If #19 were periodontally involved and there was moderate bone loss due to the infection, then the amount of bone will be compromised and it's health in question.
If #19 had been extracted more than a year ago, bone loss has occurred with each passing year. Depending on the circumstances, the existing ridge may be too flat to hold a bone graft prior to the implant. Bone grafting is done to help encourage new bone to grow and to help stabilize the dental implant. However, the graft cannot do those things if the bony ridge is inadequate or not healthy. The graft would either be rejected or just sit on top of the existing ridge without much, if any retention.

It is important to consult with an oral surgeon. Make sure he knows your full medical and dental history as well as any medications that you take, even decongestants or other OTC meds. He should know the history of tooth #18 and tooth #19. He should take a panoramic xray and possibly single xrays to view all of your teeth, especially those that are root canaled. Of course, unless there is a blatant abscess with any teeth, he will likely dismiss the chronic bacterial infection in your other root canaled teeth.

Depending on what the oral surgeon finds and recommends to you then you can decide whether or not to proceed with the dental implant. He may suggest to remove #18 and place the implant in #19 site at the same visit. On one hand this is usually done in one oral surgery. On the other hand since #18 is root canaled, it may be wise to extract #18, let it heal for 3 months and then place the implant in the #19 site providing it is a good recipient site.

Many times in my professional experience and even with people who have written in here, the surgeon convinces the patient to "get it all done" and do both procedures in the one appointment. In an ideal situation where there was no concern about root canaled or infected teeth, this could work out great. But anytime you had or have infection, the post op complications can be worse than if it had been done separately.

I know this is not an easy thing to deal with or think about. It is best if you consult with at least one if not two oral surgeons about the things I have informed you about here. It is not wise to let your general dentist extract #18 or place the implant in #19 site as he more than likely has very limited experience with surgical cases like yours.

Bryanna

Thank you once more for your help.

Just an FYI tooth #19 was extracted possibly 35 yrs ago and the bridge covering 18-19-20 is probably 32/33 yrs old. Probably the only thing the dentists did right by me yrs ago. As I said earlier the dental visits I had early in life were brutal at times. it scared me away for years