Q: Dr. Crapo: I have lived in Canada for fifteen years. I’m
from Eastern Europe and have a lot of problems in my mouth. I had most of my teeth fixed there, but now a bridge came loose on my upper right side and it had to be cut off. The dentist found decay under the back molar but the front part of the bridge was still good, so when he cut the bridge off, he cut it so the front part was left. I now have a crown (left from the bridge) on the tooth
in front of the space, then I have a space and then I have a back molar that
had a root canal where the bridge came loose. I think I want an implant in the
space and a new crown on the back tooth. When I asked the dentist, he said the
x-ray showed I didn’t have enough bone and he said that when the tooth was
taken many years ago it must have been a hard extraction because too much bone
was gone on the side. I don’t know what that means, but that’s what he said. I
have a friend who is a dental assistant and she says anything I want can be
done, so I’m asking for a new crown and an implant because I don’t want another
bridge. Can you help me?
A: When a bridge comes loose there is always a
reason. Sometimes it is operator (the dentist) fault; other times it’s an
anatomic problem that is not discovered before the procedure (i.e. a bad bite).
Most of the time it is the latter, but careful analysis before the bridge is
made, prevents your kind of problem most of the time.
When you’re told that too much bone was removed from the side, it means that one of
the four sides of the socket was broken away as the tooth was removed. Most of
the time, it is the cheek side portion. This inevitably makes the ridge of bone
narrower than is ideal or too narrow for implant placement. On upper teeth, the
ridge may have also shrunk to the point that it is too close to the sinus. Your
problem is a narrow ridge and not enough room between the ridge and the sinus.
A bone graft of the ridge and the sinus will give you enough bone to place the
implant. This grafting can be done together so that six to eight months later
an implant can be placed.
The root canal should be reassessed. Decay means leakage and leakage may compromise
your root canal. Have that done and then place the crown while the bone graft
is maturing. Lastly, be sure that your bite is not going to place excessive
force on the new dentistry.