Q: I haven’t always had the best teeth but over all my adult life I kept most of them. Six months ago I had a tooth go bad. It had been worked on many times and had responded well to treatment but this last time it broke in the root and had to come out. I had it out after much consultation and it left a gap behind my eye tooth. I’ve seen a number of dentists about bridging and also about implants. I think my husband and I agree that implant is the way to go but when the tooth was extracted two dentists said there wasn’t much bone left. They thought that a bridge might be better. The problem is that my teeth that would be used, already have crowns on them so they would have to come off before a bridge could be made. It feels like three steps forward and two steps back. I then saw another fellow and he did a bunch of measurements and molds of my teeth. We came back and he explained a lot about forces on my teeth, how my teeth were wearing and why some were breaking. He showed me how teeth should work and told me that my front teeth weren’t guiding my chewing to say nothing of the fact that I’m a tooth grinder. He said bite was important to the success of the implant. It’s a bigger job than we expected but I’ve always known my bite was off. Does all this seem logical? He showed us how a bone graft could be avoided, is that the best way?
A: When a tooth is lost because of bone breakdown caused by disease or trauma a bone graft is the way to ensure you have the needed boney structure for an implant. It is best to do it at the time of the extraction. Usually six months is necessary for good bone stability. Some bone grafting materials take longer so ask questions about optimal healing before the implant is placed.
If that hasn’t been done, bone can be added later following several tried and true techniques. Again, a five to six month waiting period is needed.
Sometimes bony expansion can eliminate grafting but careful analysis of the bone is necessary before attempting the procedure. Bone expansion is best done in the upper jaw but can be done the lower jaw as well.
Once you’ve settled the implant issue in your mind do not forget your bite. It is the most important factor for success of all dentistry in people who grind their teeth. Implants do well most of the time but if they get too much pushing and grinding they may eventually fail. You’ve had some good advice. Go for it.