Dear Dr. Crapo: Two years ago I was in a terrible accident where my back was broken in three places. Fortunately I survived the accident with no physical impairments – it was quite miraculous. As time has gone by other problems have cropped up, the most recent being a broken eyetooth. At first, because I was dealing with other things, I just left it – a space at the upper right corner of my mouth seemed no big thing but last night the tooth began to ache. It was bad most of the night. I saw an emergency service but was told that it was a difficult type of extraction and because it was infected it might get worse if freezing was put in and an effort made to get it out. I asked them about options and they said get it out and then see what could be done. I didn’t think about it much because I was in pain. They gave me antibiotics and thankfully the pain is gone but now what to do. My approach is to not spend a lot of money and get a flipper. My regular dentist said that would be okay but I should think about a bridge or implant. I know that is going to be expensive so now I’m stuck – what to do?
The eyeteeth are the most important teeth in our dentition as far as mechanical guiding function is concerned. They characteristically have the largest and longest roots of all the teeth and take the greatest shear forces placed on the teeth. When necessity forces us to remove an eyetooth, important provisions must be made. The best solution is to remove the root a-traumatically and place a large, long implant. That is the best treatment. If a bridge is contemplated it is important to graft the eyetooth socket and place a temporary bridge until healing is complete. If this is done the teeth on either side of the missing eyetooth must be very strong because these bridge supporting teeth must withstand the shear forces normally carried by the eyetooth.
It is very important that the bone be preserved, I can’t overstate that and the least expensive way of doing that is to have the root that’s left, filled with root canal filling material. This treated root will maintain the bone until you can afford an implant. A flipper (a removable tooth, friction-fitted to a pink “plate”) will serve for cosmetic purposes but know it will not provide good function and the teeth in that area may suffer damage or breakage themselves.
This information, underpinned by preserving bone, will allow you and your dentist to develop a long term plan that will produce an excellent result.
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