Q: Dear Dr. Crapo: I'm nearly 80. I'm in excellent health. My teeth are quite functional despite missing three back teeth on my upper right side. I've been seeing a gum specialist and my gums are good, though they've dropped down a bit. Then I broke a tooth and had to have a root canal. That went well but then another tooth broke and my regular dentist who did the first root canal said “you have some complex things going on; I'm going to send you to a specialist”. So I went and the specialist told me things were really not good and I'd need about ten implants.
That kind of scared me, so I saw another dentist, who said that while the ten implants were an option, that my teeth could be restored nicely if all the teeth were treated so that impeccable balance and alignment was achieved. I asked him about the way my gums had dropped, and that was my concern, that the teeth would get loose and fall out. He showed me how all my teeth were relatively tight except one and that by fusing teeth together, I could achieve a very good balance and alignment, plus the tightness would not only be attained but regained, as the strength of the whole would benefit the one tooth that wasn't really tight and that the bone would tighten up around the root. He also showed me that the gum around all my teeth was very sound and healthy.
Now I'm confused. I don't know what to do. The implant option is more expensive than fixing my teeth, but the implants will be stronger and not susceptible to decay. I really can't afford either treatment. What about dentures?
A: Let me answer your last question first. People over 60, generally speaking, have a miserable time adjusting to dentures, in place of their own teeth. It'll take a year of misery getting used to dentures. If you were 30 or younger, I'd tell you that you could accommodate the drastic change more readily. Also, chewing efficiency with dentures and biting force is between 10-20 percent of your natural teeth. Think about eating a roast beef sandwich – with a denture – not easy.
You can never go wrong with well-placed and well restored implants. You sound like your general health makes you a good candidate. You'd be very happy with the function of them and if done correctly, you'd have teeth the same day that your teeth were extracted to clear the area for implants.
Having said that, if your own teeth are generally solid, if the gums are healthy and you don't show signs of decay generally, you should consider keeping your teeth and have them totally rebuilt. A great functioning result can be made and they'll look great. The transformation will also feel more natural.