Implants To Replace Front Missing Teeth

Question:

Dear Dr. Crapo: I’m a forty-five year old man with an upper partial denture that’s been there for fifteen years. I lost my front teeth in a bar when a guy going for someone else, planted his fist between my front teeth. Three of the teeth were beyond repair and I never did find the fourth tooth. I was in the military at the time and they made me a partial which I’ve worn since. Two years ago, just before I got out, they talked of placing implants because they said they didn’t want to cut down my good eyeteeth to make a permanent bridge. It didn’t happen, so I’m investigating what to do. I’ve learned that dental plans will only cover the crowns on the implants and not the implants themselves, and that’s only about 15% of the whole cost. The plan will pay much more for a bridge. It’s frustrating because the implants are best, right? I’m fed up with the partial, in and out...in and out...sometimes I forget it’s not in, then I’m in my car halfway down the street, look in the rear view mirror, only to see a big black hole. I can’t tell you how many times I’ve had to turn back for that blasted thing. Anyway, can you suggest something? I think I want implants and be done with it.

Answer:

About three months ago, I saw a man with a similar problem. He’d been told that implants to replace his four front missing teeth were the answer. When I examined him carefully, I found that he had a slight underbite between his upper and lower right eyeteeth and first bicuspids (the teeth behind his eyeteeth). It was significant enough that excessive forces would have been placed on the new implant crowns causing wear and perhaps breakage of the porcelain on those crowns. He had the choice of braces to move the teeth into a better bite, to use crowns and a bridge to correct his bite and give him a permanent set of front teeth, or to correct the crossbite on his right side with crowns and place the implants. To him, braces were going to take too long, so crowning two lower teeth and two upper teeth to straighten out a crossbite (like an underbite), then doing the implants was the answer for him. Because four implants placed in dense bone can be splinted (linked) together with temporary crowns, he had immediate teeth. When everything is finished, he’ll have a very well balanced bite and implant teeth that will give him a lifetime of service.

If your bite is right and you have adequate bone, you may be able to go directly to the implants. Be careful though, your bite must be right. The gentleman I mentioned had been told that he only needed the implants. If we can help, we’d like to. Call 778-410-2080 for a consultation. Back to the column

My Worst Nightmare

Q:I’m terrified going to the dentist because of a nightmare surgery. My eye teeth were sideways – fangs under my lips. My front teeth were in and out. One forward, one pushed back like someone knocked it there. My dentist sent me to the orthodontist who said, “take out her eye teeth and I’ll straighten the rest of them.” He sent me back to my dentist who took out my eye teeth… all four of them. O my goodness, ninety minutes of hell! It remains to this day my worst nightmare. The orthodontist got my teeth straight but I have receding gums on the teeth that were pushed into the eye tooth spots. The recession gets worse all the time. It started not long after my braces and is getting worse every year. I was told I need gum grafting to stop it. Also, why is it happening? If I get gum grafting, will it stop the recession? I need this to stop and I need to know I won’t go through another terrible surgery.

A: Your story is unfortunate on many levels but going forward excellent records of your bite, your bone support and gum support can show us the primary cause of your recession. There may be root size differences between your eye teeth and the teeth moved into those spots. If the moved teeth are wider than the eye teeth, your recession may be due to inadequate bone width i.e., root wider than the bone. As well, bone could have been taken away to get the eye teeth out and reformation of your bone was not complete. Another cause may be functional; that is chewing forces pushing outwardly on the teeth with every stroke. Bicuspids don’t do well with forces that eye teeth are made to take. Over time these forces stress the bone by pushing the replacement teeth (bicuspids) until bone resorbs (dissolves) away. Recession is about bone loss in one form or another. It is a maxim that eye teeth not be removed. No other tooth has the size or stability of the eye tooth. Its job is to deflect lateral (sideways), or shear forces for all your teeth. At the time your treatment was done, much discussion was circulating that taking out bicuspid teeth would produce midfacial esthetic problems. The thought that keeping both bicuspids produces a more pleasing appearance is not really evident. Losing the eye teeth has far reaching functional/working and appearance ramifications. Your situation can be addressed. Careful planning and execution can resolve your recession and bone loss.

If we can help, we’d like to. Call 778-410-2080 for a consultation or visit us today.

Based on actual patient cases

 Calvin Ross Crapo

Victoria Implant Centre

778-410-2080

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