Posts Tagged ‘bone graft’

What can you do if you can’t keep a denture in?

Tuesday, January 31st, 2012

I’ve had dentures for about 20 years. I’m having trouble keeping them in, even with adhesive. For some reason the ridge that holds them is disappearing. I’m afraid if this continues I won’t be able to wear my dentures at all. Can you give me some advice?

Lucille- Texas

Lucille,

You are in a difficult position. What you are experiencing is called facial collapse. It is inevitable with dentures worn over a long period of time. What happens is that, once all your teeth are removed, your body begins to re-absorb all the minerals in your jawbone. This is what is causing the loss of your ridge. And, you are right, at some point you won’t be able to wear your dentures any more.

When it gets to that point, you will need bone grafting, which builds back the bone. Not all dentists, or even oral surgeons, will perform this procedure because it is quite complicated. You will have to hunt around for an implant dentist who is qualified to do that. Dr. Thein is, but would be quite a distance for you to travel. Check around your area for implant dentists who are experienced in bone grafting.

Once that procedure is done, you have several options:

1. You could just get removable dentures again. Bear in mind that in 10-20 years, you will have the same problem with facial collapse and have to do the procedure all over again.

2. The ideal treatment is to get dental implants. These place titanium posts, that take the place of your tooth roots, in your jawbone and prosthetic teeth are attached. The implants signal to your body that the jawbone is still needed and no minerals are reabsorbed. You’ll have no problems with facial collapse.

3. The more implants you have the better, because it helps you retain more bone. But, implants are pricey, and out of reach for some people. If that is your case, you can get something called snap-on dentures (also called overdentures). These have just two implants and your dentures will snap on to them.

I hope this helps, and I sure wish your dentist had warned you about this 20 years ago.

This blog is brought to you by Los Angeles implant dentist Dr. Robert Thein.

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A dental implant horror story

Saturday, December 31st, 2011

Hi; I had two implants put in to replace 2 teeth that had abscessed and the root canals had failed as well. They are the back two molars on the lower left side of my jaw. The implants were put in 5 years ago. There was a small infection on the back one – that was cleared up – this was before the crowns were put on.

Everything was fine, crowns were put on and 6 months later the front crown came loose and there was a slight infection. The dentist gave me antibiotics and replaced the crown. Things were fine for another 4 months, then the gum on the outside of the front implant got very sensitive, pale and mushy. He had me take antibiotics and told me to wait and see.

It got worse and I went back to the oral surgeon. He had my dentist take the crown off, then the oral surgeon cleaned out the area. The implant was able to be saved, but needed a bone graft. It took 7 months to heal. My dentist decided to change to one crown that would go on both implants, hoping to avoid the issue of looseness. He put the crown on and things were fine for about 8 months. Now the same implant is getting infected again. There is pus coming out from under it and there are white “spots” on the outside of the gum that are also pockets of pus. The dentist blames me – says I must be doing something wrong, the oral surgeon blames the dentist. Believe me – I floss; then water pick, sometimes with Peridex; then brush; then antibacterial mouth wash and finish with an proxy brush dipped in Peridex in the area. The surgeries cost me thousands. I’m tired of the blame-game. I’m looking for a solution, an idea, some action to take. The oral surgeon is reluctant to take the implant out – he is the only oral surgeon in the area (I live on the island of Kauai). I don’t know of any good surgeons in Honolulu – they all claim to be expert. I don’t know if you know of anyone out this way or have any suggestions…..

Thanks for your time.
- Nicole from Hawaii

Nicole,
I don’t know what exactly to make of your situation – I can’t tell what is wrong – but I can be helpful.
Implant dentistry is a very unregulated field, and there are dentists doing implant work who quite frankly don’t know what they are doing well enough.

You had a dental implant failure. The implants became loose and were infected. Generally, when that happens, the implant needs to be removed, the area needs to heal, and possibly the bone needs to be bulked up with a bone graft. But only after it heals should a new implant be placed. The idea that your dentist would prescribe antibiotics for a failing, infected dental implant suggests to me that he doesn’t know what he is doing. Maybe I’m missing something, so forgive me, but at least from what you are telling me, something is very wrong here.

After this team has failed twice on this same project, I would definitely say it is time to try someone else.

What I would do to find an excellent implant dentist would be to go to the website of the International Congress of Oral Implantologists, or the website of the American Academy of Implant Dentistry. They award fellowship and diplomate status to dentists with strong expertise in implant dentistry. You can search their websites to find these dentists with these credentials, and they should be able to help you. Dr. Thein has achieved the highest level credential in both organizations as a way to assure his patients that he knows the field of implant dentistry.

This blog sponsored by La Crescenta implant dentist Dr. Robert Thein

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Replacing four front missing teeth.

Tuesday, November 15th, 2011

I had a car accident when I was in college and lost four of my teeth. They are the front two teeth and then two teeth to one side. I got a partial plate to replace them at the time, and I am kind of tired of it. My dentist says she can use a bridge to replace them, and it’s going to cost about $10,000. Before I spend that much money, I want to know if this is the right thing to do? How can I tell if this is the best way to fix this?
- Chad in Montana

Chad,
If you’re missing a tooth, there are two good ways to replace it and another way that is not as good. One is with a fixed bridge. A bridge involves placing crowns on the two adjacent teeth and suspending a false tooth between them. It is cemented as one solid unit, and it can last for years.

Another good way is with a dental implant. A root form is implanted in your jawbone, allowed to heal, and a false tooth is placed on this root form. This most nearly simulates a real tooth because it has both a root and a crown. It also helps keep the bone from sinking in. When a tooth is extracted, the bone that was supporting that tooth gradually resorbs and your body uses those minerals elsewhere.

Another method that isn’t as good but is usually quite a bit less expensive is with a removable partial denture. It clips onto the other teeth and it can be taken out to clean your teeth and at night. It is not as comfortable and can be annoying.

If you’re missing just one tooth, it’s kind of an even call, as far as which method is better – a dental implant or a fixed dental bridge. When you add more teeth, it tips the scales in favor of the dental implant. The more teeth that are missing, the more strain it puts on the adjacent teeth. If you are missing four teeth in a row, to be done properly the bridge should rest on four good teeth. So you are ending up with an eight-unit bridge. This is complicated to engineer, and if anything ever goes wrong with any one of the four teeth it rests on, you will likely need to replace the entire restoration. It addition, the way your missing teeth are configured, they go around a curve at the side of your mouth. The canine tooth, which when present is in the middle of that curve, is the tooth in your mouth with the longest root. The reason for that is that, because of its position, it has to take a lot of sideways stress. With a bridge, that tremendous stress will be taken by the teeth the bridge rests on, which could shorten their lives.

The ideal treatment for you would be to have the teeth replaced with dental implants. There may be reasons that your dentist hasn’t suggested that. She may not be that proficient with dental implants. Doing them well usually requires continuing education after graduating from dental school. It is only in the past few years that some dental schools have begun to include regular training in placing and restoring dental implants, so older dentists and even many young dentists may not be adequately trained in this area. And, if these teeth have been missing for some time, the bone could have shrunk where the teeth were. Some bone grafting may be required to provide enough bone support for the implant root forms.

This blog sponsored by California implant dentist Dr. Robert Thein.

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Do I have enough space for a dental implant?

Monday, September 26th, 2011

I recently had maxillary teeth 4 & 5 extracted along with bone grafting. My dentist told me that I only had 3 to 3.5 mm of space?bone? And therefore may never be a candidate for implants. If 2 teeth were removed, why with sufficient time to see if the grafting was successful, couldn’t I have implants?

Also, my teeth were corrected with braces and therefore are aligned, however he stated that my bite was “off”. He offered to correct my bite with full restoration. I do not want to cap every tooth in my mouth. Granted I do have fillings in many of the teeth the bands for braces were placed on.

I’m a 40 year old professional and want the best option for my appearance within financial reason. I’ve been researching my options. Wouldn’t a flipper be okay for the time being, especially since it’s so similar to a retainer, that I’m used to wearing anyway? Or a Nesbit? If they make 2 teeth Nesbits. Any input would be greatly appreciated. Thank you very much.
- Suzanne from New York

Suzanne,
This treatment plan makes me very suspicious of your dentist. A full mouth restoration based on a statement by the dentist that your bite is “off”? Such a radical treatment would be called for if there were major functional problems, but the complaint would originate from the patient, not by a simple statement of the bite being “off.” Almost everyone’s bite is “off” to one degree or another. It’s not clear what problem this dentist is proposing to solve.

A full-mouth reconstruction (putting a dental crown on every tooth) is called for in some situations when there is serious TMJ disorder accompanied, say, by debilitating headaches, or you have worn down all your teeth. But not just for your bite being off.

And as far as the dental implants, there are some cases where a single tooth is extracted and there really isn’t enough horizontal space to accommodate a dental implant. But when two teeth are extracted, you should be able to get a dental implant in there.

I would think a flipper would certainly work for now, and that would be a common temporary restoration as you are waiting for implants to osseointegrate. A nesbit is another possibility – this is a small removable clip-in tooth, and it could be fitted with two teeth. I would lean toward the flipper, because nesbits, being as small as they are and removable, have been known to be swallowed, or easily misplaced.

I’d recommend a second opinion. Find a reputable dentist who seems to have your best interests at heart. When dealing with dental implants, a dentist with credentials from the American Academy of Implant Dentistry, or from the International Congress of Oral Implantologists is a good bet.

This blog is sponsored by California implant dentist Dr. Robert Thein.

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Anything but a removable partial denture

Friday, May 13th, 2011

I had a 4 unit bridge spanning from tooth #6 (canine tooth) to #2 (second molar) for many years. I believe #5 had been taken out for braces when I was a kid. I am now in my 50s. After many years, tooth #6 (the canine) needed to be pulled. This was my support tooth for the bridge along with #2.

The dentist then placed a 6-unit bridge spanning from my front teeth (#8 and #7) all the way to #2. The bridge broke within a year and was replaced with a stronger bridge still spanning the same distance which was 3 missing teeth. The unit came loose at tooth #2. This is my current situation.

Second opinions tell me I need to remove this bridge immediately as it will ruin my front teeth (No. 8 &7) because of too much stress. I am considering this with crowns on 8 & 7 and an implant at 6. I have a ground down no.2 that was part of the bridge that will need a new crown. that still leaves me needing to replace no. 3&4 where there isn’t enough bone. They say i need a sinus lift and bone graft followed by 2 implants and crowns. the cost is about 30K which I can’t afford nor do I want a sinus lift and graft. What are my best options for replacing from 6 to 2 (minus 5). I was thinking of a bridge from the implant at 6 to the crown at 2 but was told it is not a good idea because one is flexible (2) and one is rigid(6) and it ultimately would fail. I don’t really want a removable unit or one with metal across the top of my mouth. Any thoughts?
- Ashley from New Hampshire

Ashley,
You really need to stay away from the fixed bridgework, if you have that many teeth missing in a row. You will gradually ruin all of your other teeth, and you’ll be left with nothing.

There are only three ways to support false teeth in the mouth:
1. With a dental bridge, which means you attach it to adjacent teeth. But there are limitations to how many teeth you can support this way. If there are more than two teeth in a row missing, it makes supporting them with a bridge highly risky. You discovered this when you had three teeth in a row missing and the bridge broke within a year. That was a bridge that never should have been placed. The longer span bridge flexes during function and puts an incredible amount of stress on the teeth it attaches to. And I agree with your second opinions that you need to remove this bridge immediately, as it appears that you are trying to support three missing teeth with two front teeth. This will fail and take those two front teeth with it, and it won’t take very long for this to happen.

2. You can support the teeth with a removable appliance that rests on your gums.

3. You can anchor them in the bone with dental implants.

Since the bridge is not an option in your case, you’re down to two remaining choices, and you have to make your decision based on their advantages and disadvantages. Wishing there were another option is counter-productive. And if you dither for long enough, you’ll have to have five or six teeth replaced instead of just three.

Yes, the removable partial denture will need to partly cover your palate. But this coverage can be minimized if you act before you lose those other two teeth. And yes, there are some discomforts and inconveniences associated with a removable partial denture. Weigh that in your decision process against the cost and trouble of getting dental implants, and come to a decision as quickly as you can. There are new plastic materials that are being used in removable partial dentures that are light, tough, and esthetic. If you haven’t yet been offered this option, you might get yet another opinion. Ask if the dentist does Valplast partials, or look up some information about them.

And the dental implants are nice – no question about that. But they are expensive. You could probably find a dentist to do them for less money by skipping the sinus lift and bone grafting, but then the implants will be at risk of early failure which will cost you even more money in the long run.

If you still have trouble making up your mind, I would invest a couple hundred dollars in a temporary dental flipper replacing those three missing teeth. That bridge is acting like a long crowbar prying at those two front teeth, and you simply cannot go on the way you are. Get the flipper and then take your time deciding between the implants and the removable partial denture.

This blog sponsored by California implant dentist Dr. Robert Thein.

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I can’t stand the temporary flipper partial

Tuesday, March 15th, 2011

I had my front tooth extracted and am waiting for a dental implant. I cannot stand using this flipper. Is there another solution for my situation. I had bone grafting done, then the implant will be placed. I am looking at close to a year before having the work completed. I am so unhappy with this flipper. It is so difficult to eat with and is so uncomfortable in my mouth.
- Donna from New Jersey

Donna,
We occasionally have this happen, where a patient has a problem with the dental flipper, and there is usually an easy answer, as there are several options for providing this temporary replacement tooth. But first let me address the need for healing time.

Bone grafting not only helps an implant on a front tooth to look more lifelike by filling in the natural contours of the bone and gums, but it also increases the stability of the dental implant and thus minimizes the long-term risks of the implant failing down the road. The downside of doing the bone grafting is that it requires longer healing times before your permanent tooth is finally placed, which is what you’re experiencing.

And while wearing a temporary tooth is never the same as having a tooth permanently placed, there are various ways to provide a temporary tooth. One of those is to use a dental flipper, which is the least expensive way to temporarily replace a tooth and which is what you have. But there are various designs of dental flippers. The simplest consists of a plastic tooth mounted on a plastic plate that snaps onto your palate and is held in place by pressing against the teeth. To increase the stability of the flipper, two or more wire clasps can be placed to clip over your teeth. I suspect, from your discomfort, that you may not have clasps on your flipper, and, if this is the case, adding clasps will increase the stability and comfort significantly.

You can also have a temporary bridge which is bonded to the two adjacent teeth. This is probably the most comfortable option, but it would be more expensive.

A third option is to have a Snap-On Smile made. This would snap over all of your existing front teeth. It is very secure and strong enough to eat on it.

I would encourage you to work with your dentist. Tell him or her about the problems you’re having. If you’re polite about it, I would think your dentist would want to work through this with you. If you encounter resistance, you might consider offering to pay a little bit more to upgrade to a better quality flipper or a different type of appliance.

This blog sponsored by Los Angeles implant dentist Dr. Robert Thein.

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