Q: Dr. Crapo: When is enough, enough? I have practically lived
in dental offices all my adult life. As a teenager, it was big silver fillings
– yes, I had lots of decay – my fault. Then it was crowns, sore teeth, then
root canals, broken crowns, cracked teeth and roots, then extractions. After that came bridges fixed onto my teeth, which I broke, at least that’s what the
dentists said. I tried several different dentists who had good reputations and
all said I had a killer bite. I’ve been told now that I’ll have to have
implants. Can you break implants? I’ve got one back tooth left on my right side
(all the porcelain has chipped off), one lower right bicuspid and the rest of
my lower front teeth, two bicuspids on the left, but no molars on that side. My
upper front teeth are gone. I now wear a denture and I hate it. It’s not fair
that I spent a fortune only to be left with an upper plate. I have “tons” of
bone, so I’m told, and they want to put in implants. How can I be sure that I
won’t break everything again? I’m fifty-five and I can’t imagine living with
this plastic plate (which I cracked down the center last week)! Will implants
work? How can I be sure?
A: Not many can do what you’ve done. Destroying a dentition (your teeth) as you have done
and still having a lot of bone remaining for implants, suggests at least
nocturnal grinding (grinding in your sleep), functional grinding (chewing
through your food and gnashing your teeth with each stroke) and bone that has a
genetic quality that makes it stronger than your teeth.
Yes, you could have implants successfully placed and your mouth completely restored, and
no breakage if the bite is constructed so that all nocturnal grinding is
controlled (this requires a special bite guard called an E-splint) and your
functional grinding is limited by a construction that does not allow “interlocking
of the cusps” (the spikes on back teeth). The biting surfaces of your new posterior
crowns should be made of metal not porcelain, though porcelain is fine on the
sides (so your flashing smile doesn’t look like a ‘55 Chevy bumper).
In your case, implants should be placed at each tooth site; twelve implants placed in
the upper jaw, so you have back teeth to your six year molars. Your lower teeth
will probably need crowning, and you’ll need two implants on the lower right
side and one on the left. You will also need a checkup with the person who does
this reconstruction every three months to ensure no bite changes are occurring.
A very detailed discussion should occur with the doctor(s) who will perform this work for you – before you start!