Not Enough Bone?! Really?

Question:

As a kid up till I was out of university I saw the dentist and hygienist faithfully. Mom insisted we all go regularly. Even in university, Mom made sure, when we got home from school, we saw the dentist. I had great teeth. Once I was off the plan and on my own it wasn’t a priority. I was just too busy for my teeth.

One day as I was home visiting, Mom asked, “how long has it been since you’ve seen the dentist?” It had been five years. I had started smoking on the job and even got into a marijuana habit. The money was good and I was having a good time. I promised I’d go… but didn’t. Then one day, for the first time, I had a toothache. I couldn’t believe it! It surprised me so I found a dentist. He said, “You’ve got a couple of molars that need root canals.” “Can’t you feel holes in your teeth when that happens,” I asked? “Your decay went straight through the top of your teeth into the nerve,” he explained. Well, I had to have the root canals so I did. “Those teeth should be crowned,” he said, “Next month, ok?” Next month turned into next year when one day I bit down and heard a great crack. “What was that,” I thought! I sifted through what I was eating and pulled out most of one of the root canaled teeth.

“Can’t fix it,” said the dentist when I went back, “and the other one is gone too. They’ll have to come out.” That was a shock! Out they came. “How will I chew on that side,” I asked? “Implants, except you don’t have much bone.”

That was ten years ago but I’ve been told implants can’t be put there. Is that right? I’ve cleaned up my act and go regularly to the dentist and hygienist but it’s the pits that I lost my teeth!. Anyway – no to implants? Really?

Answer:

You’ve experienced what some other patients have when upper teeth are extracted. That is – very little bone between the ridge where your teeth were to your sinus. Historically, bone thickness there needs to be at least five millimeters thick for the shortest of implants to be placed to avoid the sinus.

In the last five years, however, great breakthroughs have advanced in sinus bone grafting. New technologies let us place implants into the sinus cavity the same day as bone goes in. In effect, a pathway to the sinus is made, the delicate sinus membrane freed so that bone can be inserted then the implant placed. This bone becomes your own and holds your implant fast.

Final word, yes to implants and the crowns that follow.

Good Intentions Gone Wrong!

Question:

Dr. Crapo:  I was born about the time fluoride toothpaste hit Canada – late fifties, early sixties. When the T.V. ads hit the air, we couldn’t believe you’d go to the dentist and only have one cavity. Finally, it was the in thing by the time I was ten to make the switch to a fluoride toothpaste. By that time, I’d had teeth pulled because of decay and abscessing. Fortunately, they were only baby teeth, so when my permanents came in, I resolved to take better care. Well, like all good intentions, I’d get caught up in this or that and there would go my resolutions. I did make it to my adult years with all my teeth, albeit I have my share of root canals and huge fillings and crowns.

About two years ago I had a crown break off a root canaled tooth because of decay. I was just not careful and by the time I saw the dentist, the decay had completely spread under the crown. When the hygienist was cleaning my teeth, the crown was loose. She let me and the dentist know and before long he gave me the prognosis that the crown was lost. He had me come back but said he couldn’t promise that the tooth was strong enough to put a new crown on it. I went back hoping against hope but to my fears, the decay had travelled down the root too far to be strong enough for a new crown. He said the tooth would have to come out. Right there on the spot I couldn’t go through with it, so I said I can’t have it out – I’m just not prepared.

He said he could get rid of the decay and put a cap filling down the roots and just up to the gum line. I said ok because I wasn’t prepared to do anything at the time. It’s my lower left back tooth and chewing isn’t the same. He said I might be able to get an implant but wasn’t sure. I’d really like that tooth back, can an implant be put in?

Answer:

There are many things to be considered in answering your request. Why did the tooth start to decay when good procedures were put in place to save it i.e. crowning, root canaling? Is your bite causing stress that’s excessive, thus loosening the crown making it susceptible to bacterial invasion? Your diet, your cleaning – these are questions to be answered before you spend your money.

The answer is yes – the root can be removed and an implant placed immediately. In three months, you can start the process to have a new crown on that implant. This is a very predictable and successful procedure but answering the above questions will ensure that the procedure is not only successful but long lasting as well.