Poor, Good, Better or Best
Q: Dr. Crapo: Over the years I’ve had a lot of dental work. I’m not a regular patient but stuff happens and I need to get it fixed – so reluctantly I’ve gone. In the past six months I had a tooth get loose. The dentist said maybe it could be fixed by bonding it to the teeth beside it, so that’s what I had done. Three months later the bonding broke, so I had it done again. Then last week the bonding broke again and this time there was pain. I went to another dentist. An x-ray showed the root was broken in half. The tooth has to come out so the dentist said I could get a bridge that stays in the mouth like a crown, a flipper that comes in and out, or an implant. I’m not sure what to do and I couldn’t get much out of the dentist because he doesn’t do implants. He just said it was up to me. The tooth is the upper side tooth on the right, between the front tooth and the eyetooth. I need something done soon because this can only get worse – but what?
A: This tooth is a lateral incisor. It has obviously been under a great deal of stress. Usually this happens when the bite is a bit misaligned and the lower eye tooth, which is bigger and stronger, puts undo pressure on it every time you swallow or clench your teeth. You have several choices that are poor, good, better and best. The least expensive option is a flipper – it is also the poor option because the weight of your bite through the flipper, focuses on the space created when the tooth is extracted. This will create bone loss and hinder a more permanent solution should you choose one later on. The next solution is a bridge fixed like crowns to the teeth on either side. You should also have a bone graft so that there will be no healing defect. This is good conventional treatment but it does require trimming down the teeth on either side to act as anchors for the bridge. The next solution is to have the tooth extracted, a bone graft placed, so that an implant can be placed in six months from now. The only drawback is time. A tooth can be bonded into the gap while healing is taking place. The best solution is an immediate implant and temporary crown. This saves time and money. Now having given you these different solutions, they depend on your time, finances, the available bone and your tolerance of the procedures. The good, better and best solutions will all give you years and years of good service.
Based on actual patient cases
Calvin Ross Crapo