Need Dental Advice...

[Gogar]

Originally Posted by Nostril Cheese

Wasnt the easiest thing. Had to dissect some of the gumline first with an Exacto. Been a few weeks, no infection.

smart!

[Joe Bob]

BTDT, still hurts 4 months later....

[Chocaholic]

You pulled your own too?

[abisel]

This might get you excited.



I had three implants from Dr. Cohen in St. Louis. First was molar #18 because of periodontal disease and we had to remove the tooth, build up the hole with grafting, sew up the gums and wait 3 months for healing. Then drill and tap for the implant, install implant, sew up the gums and let heal for another 3 months. Then install the abutment onto the implant and over to my regular dentist for the crown.

The last two implants (#29 and #30) were because of a failed bridge that cracked (after almost 40 years) and damaged a supporting tooth. Same thing. Build up the area with grafting, heal for 3 months, drill and tap, install implant, wait 3 months for healing, install abutment, install crowns.

Now you can get the implant, abutment and crown in the same day, but I am not convinced of that procedure. But that is up to the patient and doctor.

One thing is for sure. You will become friends with the nitrous oxide has it will relax you such that you can think about what to do next on your Porsche project and not that there is this guy with sharp instruments in your mouth.

[Nickshu]

Originally Posted by Chocaholic

Nick, or others....any familiarity with "mini-implants"? Searching a bit and it seems these can be completed in one session and useable immediately. Too good to be true?

No they don't work. 50% failure rate. They are OK to stabilize a denture in an 85 year old with 10% chewing function but that's about it. I have seen them bend under bite forces. I use them only as temporary implants while the "real" implant is integrating nearby.

[Nickshu]

Originally Posted by abisel

Now you can get the implant, abutment and crown in the same day, but I am not convinced of that procedure. But that is up to the patient and doctor.

Yes and no. This is site/patient/procedure specific. The "teeth in a day" protocol is for patients who have all their teeth missing or going to be removed. Multiple implants splinted together in a temporary bridge to control micromovement. For an implant to integrate it must have no micro-movement in the first 1-2 months. (Think similar to a broken bone). This is critical.

You can do the implant/abutment/crown in one day in other situations (single tooth or 1-2 teeth) IF and only IF the bite forces can be eliminated from the site and no chance of micro-movement occurs. If this cannot be achieved then it's a no go (or a for sure failure).

I do many "teeth in a day" cases in my practice but the patients/locations/situations have to be very carefully selected for success.

Don't be fooled by the advertisements making this seem like it's easier than it is...it's not. Best approach is just as Abisel said...trust your surgeon and GP's advice and go with what they recommend.

[cnielsen]

GP dentist here...

We do a lot of implants at my office so I will give you my opinion. Everything seems reasonable with the diagnosis and treatment plan. The first thing you need to decide is whether ou want to replace the tooth. If not, there are potential complications but nothing life threatening Many people are missing teeth and they do just fine but there are potential dental ramifications that you need to be aware of but then it is totally your decision.

That being said, if you want to replace the tooth, an implant is a great option in your case. And if you choose to replace it, I would highly recommend the bone graft.

Now for fees. These differ all over the country and even from one dentist to the next and they could be right next door to one another! And I will say that you do get what you pay for to some extent. I've seen some nightmare cases come into my office and the poor patients trusted their previous dentist because they had initials after their name and maybe lured in by a super low price...so be careful there.

The bone graft fee seems high. Mine is half of that. Might be worth a second opinion there. The extraction and implant prices are normal. I think it should be your choice of the sedation. You don't have to do it. We do a lot of implants without sedation and everyone says that the extraction was the worst part...implant was "easy".

The crown from your dentist will NOT cost $500. It is more likely to cost $1500-2000 with the abutment (connector piece to implant). There is no way around that but it is also done later after the implant heals so it spaces out your expensies and makes it easier to budget.

Lastly, don't delay too much. Dental decay and bone resorption from infection is very similar to rust on a car. Catch it early and it is a predictable restoration...wait and you may find that things become less predictable or cost more money.

Good luck! Oh...and get a CT to evaluate the nerve location and bone quality prior to getting the implant.

Chris

[nut11]

Due to poor brushing and flossing habits during my early years, I had to have installed 5 different implants including 3 bone grafts. These were completed between 10 and 15 years ago. I was a poster child for the procedure in my area. Perios and dentists came to see my results. Best thing I ever did for my oral and general health. Not cheap then and I can only imagine what it's costing now for a complete installation, but... Now, I'm a fanatic with Sonicare and flossing.

87 Blk Carrera
11 GTI

[Steve Carlton]

Wow- this is brutal.

Sonicare should advertise a free Porsche included later on with every brush and floss.

[creaturecat]

i have a permanent bridge. 1 tooth. It has been great. 25 yrs.

[Chocaholic]

Thanks again for the feedback. Just scheduled the extraction for next Tue. Chris...the "rust" analogy pushed me over the edge. Will have graft substrate done at same time. That way options are opened for down the road.

Something to look forward to over the weekend.......not!

[cnielsen]

Good call! Space it out and the financial burden won't be that bad....ext/bone graft now, implant next year sometime and then the crown/abutment 3-6 months after that.

[Nickshu]

I agree. Get it extracted and grafted, that way you leave your options open. Then when you are ready get the implant placed the bone should be well developed.

If it's going to be more than 1 year then consider having a retainer made for the second molar behind to keep it from tipping forward. While often times it does not tip at all, when it does it's a pain to deal with. If it even tips forward a little, while there may still space for the implant crown you end up with a food trap between the first molar (implant) and second molar due to the large "triangle" formed between the straight implant and the tipped second molar.

[cnielsen]

Yep...second that thought. Usually if done within a year you are fine.

[Crowbob]

Originally Posted by Nostril Cheese

I just yanked a wisdom tooth out with a pair of pliers.

Did the guy owe you some money or what?

[Chocaholic]

Thanks again to those who offered advice (and moral support). Perio used conscious sedation and novacaine, and I'm glad. Seems it took about 2 hours (!) to remove the tooth. He said it broke apart and was quite a challenge to completely remove...and I felt nothing. Woke up a few times during the tug-of-war but they knocked me back, probably to shut me up. Hurt like hell after the nova wore off at home. Endocet didn't help much.

Was packed with "graft substrate" and stitched up. Feel like I lost a fight with Mike Tyson. Cheek all swollen, jaw sore, etc. Actually, the tooth immediately adjacent is also sore when I press it with my tongue. I'm guessing it took a beating during the extraction. I suspect (hope) that as bone fills in and things heal, it will stabilize. Thoughts?

The event was about 30 hours ago and I'm certainly feeling better. Occasional Ibuprofen is all that is needed. Living on soup, yogurt and amoxicillin until things heal a bit more. Still look like Marlon Brando in the Godfather on my left side, but it seems to be slowly going down.

Will see how life is without ol #19 before deciding if an implant is in the cards. Looking forward to being healed and back to abnormal!

Thanks again!

[abisel]

Yep, you took a beating. Been there, done that and have two t-shirts.

But, it will get better and with the grafting, let it heal 3 months and then talk to the Perio about the implant. Go for it. You will be glad you did later on. Think about the upper arch and how number 14 will react to the loss of 19.



Implant will take about an hour. Same sedation and Novocain. He will most likely open gums to the area, drill to depth of implant (most likely a shorty or medium cause of the big nerve down in the mandible), install implant, sew up gums and heal for another 3 months. You will probably won't be as sore as the tooth extraction.

After healed, Perio will give a shot or two of Novocain so he can cut gum away at top of implant so as to install the abutment. Then it is off to your regular dentist to get impression for crown fitting. Two weeks later the crown is installed and your done.

Time frame will allow you to spread out the expense.

I got 3 implants and am glad I did. So will you.

I'll see if I can get the pictures my Perio took during my procedure and post them.

[Don Ro]

Wow! What a forum!
No wonder I come here.

[Hugh R]

Nice,

Three weeks ago, I had an infection of #31 root after a root canal/crown years ago. The endodontist drilled, filled with "medicine" let it sit a week, gave me other antibiotics as well. Last Wednesday he opened up, drilled out some more and two hours later I went to my regular dentist to "close". Still hurting like hell last night even biting on a French Fry. Going out of town on Friday to PA, called the regular dentist, he looked, sent me back to the endo guy who looked saw nothing amiss but prescribed generic Augmentin and generic Decadron and told me to come back the 1st week of January. Offered Vicadin, but I said ibuprofen was fine.

[Nickshu]

Glad it went well Mike. Sedation makes everything better. Good news is that the extraction is usually much harder than the implant placement. Especially if it's a big molar.

When you get to having the implant restored by your GP ask him to do a screw retained restoration instead of cemented. I would say 70% of the failing implants I treat are due to residual crown cement left behind below the gumline. It's very difficult to remove the residual cement on an implant. If a cemented must be used ask him to look up the Whadwani implant cementation technique.

Also if there's any chance your a clencher or grinder definitely get a night guard made after the implant is restored (and use it nightly). Implants really don't like grinding.