Hi Byranna,

I go for my appt with the implant dentist on Monday. Any questions I should specifically ask?

Thanks
Shelley

Hey Shelley!

Dental implants..... questions........

1)How healthy is the bone where the implants are going to be placed?

The bone needs to be VERY healthy and solid. A radiograph can help determine the bone health.

2)Will any of the areas require additional bone grafting and if so, what type of graft material would you recommend and what are my options?

Additional bone grafts are added during implant surgery when the existing bone is not adequate to hold the implant. This situation can occur from residual infection and/or periodontal disease. Choices range from cadaver, bovine, coral calcium or synthetic.

3)How healthy are the teeth and surrounding bone to where the implants are being placed?

If the implants are placed in bone where the tooth or teeth on either side of the implant is infected or diseased from periodontal disease, there is a strong possibility that the implant will eventually fail from a bone infection.


4)If the implants are going in your upper jaw, ask if there will be any sinus involvement and if so, how extensive will it be to repair the sinus?
Sinus lifts are done all of the time. However, the bone has to have enough room for the implant once the lift is done. Again, a radiograph will be helpful in determining that.

5)If the implants are going in the posterior region (back) of your lower jaw, ask if there is any concern about the implant being too near the mandibular canal?
This canal runs along the lower jawline and it holds the bundles of nerves that affect feeling in different parts of our face. Placing an implant in the canal could cause infection and permanent numbness. A radiograph is necessary to determine this also.

6)What type of implants are you using? Will they be screwed in or tapped in?
Most implants are made of titanium. Some are made of zirconium, but they are mostly used in Europe and have yet to become mainstream in the US. The ones that are screwed in are done so with a small ratchet. The ones that are tapped in are done so with a dental mallot. An access hole is first made in the bone for both types of implants. The reason for knowing this information is just to be better informed of what will occur ahead of time. Either way is fine and neither way has any advantage over the other.

7)How long is the healing phase?
Generally it is best to give about 4-6 months for the integration of the implant with the bone to occur before proceeding with any prosthetic work.

8)Ask what the steps are after the surgery to place the implant?
There is a sequence of appointments that follow this type of surgery and evey dentist has his own protocol.

I think that's it for now......... if I think of anything else, I'll let you know! Please let us know how the appointment goes!

By the way......... how is your TMJ and other dental issues going??

Bryanna

Byranna,

I wanted to follow-up now that I have had my appts and give you a status of where I stand.

I went to see the implant dentist 2.5 weeks ago. And boy was he impressed with my list of questions. He actually asked if he could copy them and give them to all his patients.

And he is the first dentist that agreed with you on root canals and that they are not perfect and there is bacteria and continued infection in there.

He said tell your friend she is super smart so

So we talked about the upper right teeth 2, 3 and 4 where I had the old bridge and a temp sits now. Tooth 3 is gone. And tooth 4 had the reroot canal and tooth 2 had a root canal.

First he checked over my whole mouth, every tooth. Said for the mount of crowns and root canals (old soccer accident were 8-10 front teeth broken in half) that my mouth was actually in pretty good shape.

He said he thought tooth 4 was good, that I likely could do an implant at tooth 3 and that even though tooth 2 had the root canal that it was on the fence in terms of lasting long. We talked about the cost benefit of doing an implant in that one now or 5 years from now if it fails.

I also have a space on the lower left jaw where some teeth were taken out 6 plus years ago.

So he sent me for a CT scan for both the uppper right and the lower left. For the upper right he wanted to see if there was a need for a sinus lift since it looked like my sinus dipped down between teeth 2 and 4 because of the lack of tooth 3. That explains some of the sinus infections since it is so close to that tooth.


So he called last night (what a nice guy) to go over all the results and he is sending my main and cosmetic dentist a note.

Here is his take...

The upper jaw implant is possible. He would have to do a sinus lift surgery at the same time. He still felt that tooth 2 is on the fence and I need to weight the cost benefit of having to retreat that tooth later. Is it better ot have him do a sinus lift or my ENT?

My inclination is to do an implant in teeth 2 and 3 and a crown on tooth 4. And then in a couple months do the crowns on 2 and 3.

ON the bottom left he says I have drastic bone reabsorption. And this guy will not touch that, its beyond his expertise. He is comfotable doing the upper right and the sinus surgery but not a surgery for I guess bone grafting?

So I would have to go to a oral surgeon that is a specialist that can take a piece of bone from my chin or hip or back jaw and graft it and then see if they can do the implant.

This doc did say that the specialist could also do the lower left and the upper right at the same time.

He also said that my main dentist would be able to make some prostetchic device with teeth that would fit like a retainer and that might be a better option.

So Thoughts?

Thanks
Shelley

Hey Shelley!!

I think I like your implant dentist :-)) I am SO glad that he was not intimidated by your questions and SO proud of you for asking them!!! It sounds like he gave you alot of his time to discuss your options and ordering the CT scan was a smart thing to do. I have to laugh that he wanted a copy of your questions.....I'm glad they were so helpful!

The reason he confidently talked to you about the downside of root canal therapy is because he is the one who replaces the infected root canaled teeth with dental implants. So he's well aware of the residual infection that is present in the jawbone as he deals with it all of the time.

With regard to the UR side:
If the implant dr is telling you #2 (which has been root canaled) is on the fence...... in dental jargon, this means it's bad and he probably wouldn't be comfortable placing an implant next to it in his own mouth. So I agree with you to have #2 removed and replaced with an implant.
Let's talk about tooth #4. Hear me when I tell you that in all probability this dr is looking at you and thinking ...... how do I tell this guy that #4 ain't that great either after he just paid to have a second root canal done on it. He knows it's just a matter of time before this tooth blows up, but thinks he'll lose you or you will lose interest if he tells you it should go too.

Shelley, at this point #4 is just a shell of a tooth and is not in a healthy state. Radiographically it may look "ok" at this particular time, but pathologically, it's a different story. This tooth (#4) can cause failure of any implants placed in that upper quadrant because of the residual bacteria that still remains in the tooth in spite of the root canal therapies.

About the sinus infections:
Many people have low sinuses that hover over the roots of their posterior teeth and never have a sinus infection. I am one of those people! Sinuses become infected becaue of a chronic bacterial irritant that sets up house in the lining of the sinus. The origin of the bacteria can come from many different things, but many times, it comes from an infected tooth!!

If you are going to have sinus lifts and dental implants placed in your UR quadrant please consider all of your options. I know the dr gave you one, here is another:

Remove #'s 2 and 4, ensuring yourself that the sinus lift and the implant surgeries will be done in cleaner, healthier tissue/bone allowing the areas to heal better and healthier. I cannot tell you how many people I've seen in your situaiton who undergo the implant surgery only to have the implants become infected because of that remaining root canaled tooth. It's alot to go through to only end up having to readdress the area all over again. Not to mention the burden that all this infection has on your immune system.

Do you have an opposing tooth under #2 in your lower right quadrant? If not or if the bottom tooth will be occluding with the implant in #3 space, then you may not need to replace tooth #2 with anything. Did the dr talk to you about that at all? Maybe I can make this clearer..... how many molars do you have in your lower right quadrant?

With regard to your LL..........
If you had the teeth removed 6 or so years ago and no bone graft material was placed in the sockets, then the bone loss is most likely severe and the ridge is too flat to hold an implant. This would require extensive oral surgery to replace the missing bone and it would be best to see an experience oral surgeon. These guys have different preferences to which donor sites they prefer to use and much of it depends on the health of the patient. There is no guarantee it will work or heal adequately to hold an implant. The younger we are when this type of surgery is done, the higher the success rate........ I know, but I just thought you should know that :-(

I think the more conservative approach to the issues on your LL are a removable appliance called a nesbitt (similar to a retainer with teeth). This is an acrylic half partial denture that replaces missing teeth in one quadrant of the mouth. If you also had missing teeth on your LR side, the partial denture could be made to replace all of the teeth on both sides of the jaw which is called a full lower partial.

With regard to the sinus lift surgery.......
Most dentists who do alot of implants or do alot of oral surgery are very familiar with sinus lift surgery. If he wasn't comfortable doing that, he would have told you without hesitation. There would be no need to have an ENT do the lift.

I hope I have not confused you...... please let me know if you have any other questions or I need to clarify something. I may not be able to get back to you until sunday/monday as I am going bridal gown shopping with my daughter this weekend!!!

Have a happy 4th!!

Bryanna ~'.'~

wow- i too thought that was a great list!

good luck with this, i am gonna try to follow your story here. just got a 25K estimate on `reconstructing' my mouth... can't do it, but still have plenty of bone.

peace

Hi JemmyRey,

I know to most people the sound of $25,000 for dental work is like one of the most profound things they could ever hear! I agree it's alot of money and it's not like you get any guarantee that the work will hold up!

Generally, there are dental treatment options for most every case. Has your dentist offered you any?

If you would like to share your story here, we would love to hear it! Many people have similar issues and are listening in here to learn as much as they can.

Have a great day and thanks for popping in!!

Bryanna

Hi Byranna,

Just an update. I went ot my cosmetic dentist and he agreed that we should do 3 implants on the upper right. I see the oral surgeon next week for the consultation and then the sinus lift and implants in September.

My doc also said he thought they could do the bone graft on the lower left. We'll see what the oral surgeon says but I still like the nesbitt device so we will see. My dentsist was like we can always find bone to make it work. He was a bit aggressive though so lets see what the oral surgeon says.

I have a coupel more questions for you.

1. How long after the sinus lift and implants should I have the crowns done? My dentists said he could do as early as 2 months but I thought it was more like 3 or 4?

2. I think I am having problems with my mouth guard. Its a bottom guard and I notice the last week that the inside of my bottom lip is irritated like it feels like one of those canker sores coming but it has not appeared. I also feel it a little on the fron inside bottom of the cheeks where the piece is against the cheek. I clean it with efferdent everyday but wondering if there is something else I should use or do. Someone suggested a vinegar soak. Also in two places some back marks have formed and even if I brish I cannot make it come clean.

3. After the implants should I have a new temp made? THis one has been on since April and has had to be reglued once.

Any thoughts?

Thanks
Shelley

Hi Shelley!

I'm embarrassed to say this........... but all of this time I thought you were a man!! I got confused with the picture of "Rod" in your posts.... thinking that was you for some reason........ but I guess that is your husband?? I'm not very involved in other forums on this site but I saw one that made me realize you were a woman! Anyway..............sorry for the confusion!!

Ok, so it sounds like there is a mutual agreement to remove teeth # 2 and 4 since neither of them are real healthy and they could jeopardize the life span of any implants placed in that quadrant. That makes ALOT of sense. My only question with this is....... do you really need to place an implant in the #2 site? Is there a tooth on the lower right that will be biting against it? If not, then there may be no reason to replace tooth #2 with anything.

If you are missing a tooth or two in your lower left, then it may be a viable option to at least temporarily fill in those gaps with a removable partial or nesbitt especially if you are unsure of having the bone grafting done there.

To answer your questions........

1) My office does ALOT of implants and we always allow the implant to integrate with the bone for 4-6 months before we put the implant crown on ..... actually closer to the 6 month point. The reason being is that the longer you can allow the dental implant to heal without any chewing or pressure on it the better. Once the crown is placed, then it will be used to chew on and that puts alot of stress on the implant if it has not completely integrated with the bone.

2)I'm not so sure your night guard is the problem with the irritation that you are feeling on the lip and cheeks. It could be that you have developed a fungal or lesion type irritation in your mouth and that would cause the symptoms you are describing. However, irrelevant of what it is, it would be a good idea to have your dentist take a look at those areas and give you a diagnosis before it gets worse and also adjust the nightguard if necessary. Sometimes people get different types of oral lesions for different reasons and they seem to pop up out of nowhere. Sometimes, the cleaning solution that is used to clean the appliance irritates the tissue and this can occur at the onset or later on day the road sometime. It's a good idea to brush your appliance with a hard toothbrush before and after you soak it in anything. It should always go into your mouth clean and any solution should be brushed off as much as possible.

3)With regard to a temporary bridge in the upper right after the implants are placed....... there will no teeth to anchor a temporary on. The dental implants will be covered by gum tissue during the initial healing phase. Then after several months there will be a second "quick" surgery to uncover the tip of the implants at the gum. A small, flat metal healing cap will be placed on the tip of the implant allowing the gum tissue to grow around it. The third stage is when the healing cap is removed and the crown is fitted onto the implant.


It sounds like you are moving right along!!! Good for you! Please keep us informed on how things are going........ ~'.'~

Bryanna

LOL Byranna....thats ok. Actually ROD is Coach Rodriguez, the new coach of the Michigan Woverines Football team. We are huge fans.

Thanks for all your advice.

Yes there is a tooth on the lower right so we are gonna do implants in #2, #3 and #4 on teh upper right. Thanks for the timeline that helps. NOt sure what my dentist was thinking saying he can put crowns on after two months. The timeline you mentioned is better for me financially to be able to pay the implant dentist and the cosmetic dentist.

Ah and good to know that the temporary goes away. I think it is nearing its life span so its good I am getting this done soon. Sometimes that #2 tooth aches a little even though it had a root canal and I wonder if that temp actualy covers everything well enough.

I'll be sure to ask about a temp nesbitt until I could afford to do the lower left next year.

Fungal infection What do you do to get rid of that?

My dentists instructions were to use efferdent and I do that the efferdent with listerine. I can absolutely brush it after each soak. I have not been doing that because the instructions did not call for it. The instrcutions did say to soak in vinegar if there is a build up. And those two black marks make me wonder if there is a fungus, although maybe its a stain because I tried to brush it off and it does not go away.

I'll let you know what the plan me and the implant guy craft next week.

Thanks
Shelley

Hi Shelley,

In most cases, it is definitely better to wait 6 months post healing of the dental implant surgery before placing the crowns. The last thing you want to do is chew on implant crowns before the actual implant has adequate time to integrate with the bone. Your dentist may be rushing it a bit because he knows it will be diffcult for you to eat without those teeth up there. However, better to play it safe rather than be sorry you didn't.................

Fungal infection of the oral tissue is quite common. Especially in people who have any autoimmune condition, diabetes, digestive disorders or other chronic health conditions that affect the immune system. It is also commonly seen in people who wear any type of dental appliance that covers the oral tissue for any length of time....... like a mouth guard, night guard, partial or complete denture or ortho retainers. Oral fungal infections are hard to get rid of and sometimes require medication. However, a person can keep reinfecting themselves if they don't figure out what the culprit is and change it. It would be best to let your dentist have a look and diganose it for you. There are other oral conditions that look similar and should not be ignored.

If you want to clean your appliance thoroughly, you can use a diluted bleach or hydrogen peroxide solution along with manually brushing it with a toothbrush. Efferdent and those similar to it are meant to clean the appliance but they are meant to be thoroughly rinsed off before wearing the thing. Listerine and those mouthwashes similar to it may kill some of the germs, but they are not healthy for the gum tissue. The ingredients in those mouthwashes are very harsh and irritating to the delicate gum tissue. The alcohol content in them acutally causes a reduction in saliva flow which predisposes the user to tooth decay. SO...... they are actually more of a risk than anything else.

The healthy mouth has over 400 different strains of bacteria, both good and bad. It is not meant to be a sterile place and there is no way to make it that way. When we attemtpt to "kill the germs" via harsh mouthwashes or toothpastes, all we are doing is setting up an environment for new strains of bacteria to develop to replace those that are being repeatedly killed off. Proper brushing and flossing with non harsh/toxic medicaments along with a balanced diet and plenty of drinking water is all that is needed to maintain a healthy bacterial balance in our mouths.

Ok Shelley...... keep us in the loop!!

Bryanna




QUOTE=shelley;352751]LOL Byranna....thats ok. Actually ROD is Coach Rodriguez, the new coach of the Michigan Woverines Football team. We are huge fans.

Thanks for all your advice.

Yes there is a tooth on the lower right so we are gonna do implants in #2, #3 and #4 on teh upper right. Thanks for the timeline that helps. NOt sure what my dentist was thinking saying he can put crowns on after two months. The timeline you mentioned is better for me financially to be able to pay the implant dentist and the cosmetic dentist.

Ah and good to know that the temporary goes away. I think it is nearing its life span so its good I am getting this done soon. Sometimes that #2 tooth aches a little even though it had a root canal and I wonder if that temp actualy covers everything well enough.

I'll be sure to ask about a temp nesbitt until I could afford to do the lower left next year.

Fungal infection What do you do to get rid of that?

My dentists instructions were to use efferdent and I do that the efferdent with listerine. I can absolutely brush it after each soak. I have not been doing that because the instructions did not call for it. The instrcutions did say to soak in vinegar if there is a build up. And those two black marks make me wonder if there is a fungus, although maybe its a stain because I tried to brush it off and it does not go away.

I'll let you know what the plan me and the implant guy craft next week.

Thanks
Shelley[/QUOTE]