Bridge or Implant with severe bone loss
 

Bryanna,

First, thanks for all the information that you've given on this site...I've learned so much from you and have become my own advocate! My problem is, firstly, I'm an American living in Spain so I'm dealing with a different dental system and trying to make the best decision. I lost tooth #9 over 10 years ago due to an accident as a child where all my baby teeth were knocked out. I've had a bridge since then. Fast forward, extreme pain 2 months ago and xrays reveal large infection above teeth #7 & 8. My dentist here did a root canal above #7 and said it would do it. It didn't. Immediately formed a fistula and went to seek different opinions - some said do an apico - which I've learned from you is useless - and now have to decide what to do. The Oral surgeon I have since come to trust, has now recommended not to do implants after the extractions of #7 -8 because of the massive bone loss. He said it would be difficult to rebuild all the lost bone and the esthetics would be bad. Another Oral Surgeon said to do implants but they may not look the best in time. I'm 42 years old and trying to think long term. The thought of getting implants is appealing but the Oral Surgeon I trust more says it's too difficult. He said if I went that route he'd want to use bone from my jaw as he doubts other bone sources would be enough. My intuition is to get the bridge but I'm concerned because it would be for three missing front teeth. Supposedly my canine teeth are healthy enough to hold the bridge. As well, if I go the bridge route he'd insert membrane into the gums as I'm concerned about the shrinkage. Am I making the right decision to go with a bridge instead of implants? And thanks once again for all the information you've given in the other posts as I'm now relatively calm about my situation and know I'll get through it. Information is truly power.

Hi Stephan,

Thank you for the kind words! Glad to hear that you are being your own adovcate!!!

I agree with the oral surgeon who told you that implants would not be a wise option due to the bone loss. The upper front area of the mouth has a thin cartilage of bone and any injury or chronic infection in that area will cause severe bone deterioration. The surgery to build bone in this area is extensive and the outcome is very unpredictable.

The first thing to do would be to have a temporary removable partial denture made to replace the missing teeth during the healing phase of the removal of those 2 teeth. Then have the teeth removed and the dentist would insert the partial at that time. You would wear this for several weeks to months as the site healed. You would remove it to clean it and before you went to sleep at night.

It is imperative to have the adjacent teeth clinically evaluated to be sure they are healthy as chronic infection in the jaw bone spreads fairly easily and you do not want to use unhealthy teeth as anchor teeth on this bridge.

You are going to end up with bone loss in those areas irrelevant of what you put in there because of the long term problem. The bridge may have to span from canine to canine. So it is imperative for the oral surgeon to make sure that the teeth and the jaw bone is healthy from the canine to the canine.

Bryanna

Bryanna,

Thanks for your advice. Now I feel confident that I'm making the right decision in going for the bridge. From the x-rays, the Oral Surgeon said the canine teeth were healthy enough to support the bridge.

My next question is would you suggest a bit of sedation with the extractions and cleaning of the infection/necrotic tissue? I feel much calmer about the procedure now that I've found a competent Oral Surgeon and understand the process, but I'm still a bit worried about discomfort and the length of time for the procedure. As well, all done in a country I'm still adjusting to!

Once again, thanks for all the advice and truth. I've learned a lot from you.

Stephan

Stephan,

You are very welcome!

It may be a good idea to have a little sedation for the oral surgery as there will be a lot of scraping going on. You should discuss the sedation options with your oral surgeon. You would also need to discuss the protocol for fabricating the removable partial denture so that you can have that ready for the day of the extractions.

I think the most concerning issue is being in a different country where you have to express your concerns in a way that they are understood. Having an oral surgeon that allows you to do that is imperative! If the general dentist is not that accommodating, then ask for a referral from the oral surgeon to a general dentist who is similar to himself in that demeanor.

Please check back with us!! Hope all goes well :)

Bryanna