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Medical Forum / General / Dentistry / March 2005Are Implants my only Option?
I am in my thirties and missing my 9 and 10 teeth from an accident 25 years ago. My second Maryland bridge gave way last spring and I have been wearing a flipper since. My dentist, who I trust and am very happy with, sees implants as my best option. A visit to the Periodontiste assured me that I am a candidate(healthy, non smoker...) but due to significant loss of bone in the area I do need a fair amount of ridge augmentation. I realize implants are the way to go long term but being nervous about the augmentation and total cost($11,000 or $9500 after insurance), I just want to make sure I am making the right choice. This implant cost also includes crowns to 8 and 11 teeth. I understand that the failure rate for implants is very low but is one at increased risk if the location is in the upper front and if augmentation is needed? Since my 8 and 11 teeth need to be crowned anyway why not a fixed bridge? A second opinion gave me an estimate of $8200 or $5800 after insurance for a 4 unit bridge. This also included bone grafting and something called Tissue Guided Regeneration. Can a 4 unit bridge in the front last for any length of time? The dentist would not give me a direct answer. I would rather pay $400 after insurance every 6 or so years for a Maryland Bridge and avoid all the hassle but my dentist will not do another. Why are Maryland Bridges no longer recommended? I have been managing ok with my flipper for almost a year(except having to remove it to eat) so are dentures worth considering? Thanks for any suggestions and comments. Toothless in NY Remove NOSPAM to reply directly > I am in my thirties and missing my 9 and 10 teeth from an accident 25 years > ago. My second Maryland bridge gave way last spring and I have been wearing [quoted text clipped - 27 lines] > > Remove NOSPAM to reply directly Those are some hefty fees. Is this some well-known Manhattan dentist to the starzzz? Fixed bridge may be an option, but depending on only #8 and 11 is a bit of a risk. The periodontal risk may be acceptable, but a bridge like this has a significant risk of falling off. If #6 and 7 are beaten up and you can rationalize crowns on these teeth, I would have fewer reservations. The implant-supported prostheses will be easier to clean. Also, in the long run the periodontal risk is less with implants, and because the crowns #9 and 10 will be self-supporting, damage to one tooth will not doom the whole restoration. OTOH, surgery is surgery, and $11K is lotsa bling bling. Steve  SignatureCut the nonsense to reply >I am in my thirties and missing my 9 and 10 teeth from an accident 25 years >ago. My second Maryland bridge gave way last spring and I have been wearing [quoted text clipped - 10 lines] > >Since my 8 and 11 teeth need to be crowned anyway why not a fixed bridge? YUP we agree. Why not? Joel > A >second opinion gave me an estimate of $8200 or $5800 after insurance for a 4 [quoted text clipped - 14 lines] > >Remove NOSPAM to reply directly In response to the question "Why not" to the fixed bridge--I am concerned about shelling out 6k every 8 years or less for new bridge. Who knows the bridge might not even last that long, right? > >I am in my thirties and missing my 9 and 10 teeth from an accident 25 years > >ago. My second Maryland bridge gave way last spring and I have been wearing [quoted text clipped - 33 lines] > > > >Remove NOSPAM to reply directly > In response to the question "Why not" to the fixed bridge--I am concerned > about shelling out 6k every 8 years or > less for new bridge. Who knows the bridge might not even last that long, > right? Are surgeons now telling patients that bridges are temporary and implants are forever? I think that given good oral hygiene and a well-designed bridge, it should last far longer than that. Given bad hygiene and poor design, neither will last. Steve >>>I am in my thirties and missing my 9 and 10 teeth from an accident 25 >> [quoted text clipped - 72 lines] >>> >>>Remove NOSPAM to reply directly SignatureCut the nonsense to reply >> In response to the question "Why not" to the fixed bridge--I am concerned >> about shelling out 6k every 8 years or [quoted text clipped - 8 lines] > >Steve Wait a minute ........ there a number of implant cases that FAIL due to osseointegration and there are instances of implant breakage, just as bridges occasionally fail as well. Joel >>>>I am in my thirties and missing my 9 and 10 teeth from an accident 25 >>> [quoted text clipped - 72 lines] >>>> >>>>Remove NOSPAM to reply directly > Wait a minute ........ there a number of implant cases that FAIL due > to osseointegration and there are instances of implant breakage, just > as bridges occasionally fail as well. > > Joel Saw a patient yesterday morning. She had lost her upper left central incisor. A periodontist had placed an implant 3 times in the site, and the fixture failed to integrate 3 times. He was trying to convince her to try again. Steve >> Wait a minute ........ there a number of implant cases that FAIL due >> to osseointegration and there are instances of implant breakage, just [quoted text clipped - 8 lines] > >Steve It is an increasing problem ... the periodontists say one thing but I am not so sure ... I intend on looking into PubMed or something about it. OSSEOINTEGRATION or failure to achieve same. Joel >>> Wait a minute ........ there a number of implant cases that FAIL due >>> to osseointegration and there are instances of implant breakage, just [quoted text clipped - 16 lines] > >Joel It has to do with epithelial migration into the boney surgical site before OI can take place. Gore-Tex used to be the barrier of choice. Mine got infected and had to be removed after one month, however the implant correctly integrated. Had osseous graft at implant placement surgery. The actual margin of the gingiva suffered a few mm in height compared to the ideal, however the implant is rock solid and my lip doesn't elevate that high when I sneer. #8 -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >It has to do with epithelial migration into the boney surgical site >before OI can take place. Gore-Tex used to be the [quoted text clipped - 9 lines] > >#8 That describes it, but what factors cause it to happen or prevent it from happening? In other words, proposals for increased success. Joel >>It has to do with epithelial migration into the boney surgical site >>before OI can take place. Gore-Tex used to be the [quoted text clipped - 16 lines] > >Joel You would have to ask someone who regularly places implants. On this subject I am just the patient, ok, a well informed patient. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>It has to do with epithelial migration into the boney surgical site >>>before OI can take place. Gore-Tex used to be the [quoted text clipped - 19 lines] > You would have to ask someone who regularly places implants. > On this subject I am just the patient, ok, a well informed patient. The gum follows the bone. Here's what I know about papilla: The papilla will fill the embrasure space as long as the height from the crest of the bone to the most apical contact point of the crown and adjacent tooth is between 2 and 5mm. If the distance is 6mm, you only have a 60% chance of the papilla filling the space. If the distance is 7mm, then count on not having a papilla. One way to keep the gingiva from migrating apically on the straight facial is to undercountour the facial margin of the temporary crown (make it slightly concave). On anterior teeth, I place a temp crown for 2-3 months to sculpt the tissue prior to final impressions for the porcelain implant crown. Make sure that the temp crown puts slight pressure on the tissue mesial and distal (the tissue should blanche slightly) in order to form the papilla. Make sure to make the straight facial slightly concave. If the gingiva migrates too far coronolly while the patient is in the temp, then bulk out the facial margin a little. >>In other words, proposals for increased success. >> >>Joel >> >You would have to ask someone who regularly places implants. >On this subject I am just the patient, ok, a well informed patient. Well, its becoming an increasing problem around here anyway. Some say its due to the implant knock-offs that many are using but I am trying to dope it out ...... Joel >-- New patient exam 15 years ago where a guy had a mesio-lingual bony defect on his upper right central. He had been treated surgically by a periodontist 3 times without improvement (deep class II bite and clenching might have been a factor <G>). One extraction and a bridge between the lateral and the other central, and all is well to this day. Fawks > Saw a patient yesterday morning. She had lost her upper left > central incisor. A periodontist had placed an implant 3 times in the > site, and the fixture failed to integrate 3 times. He was trying to > convince her to try again. > > Steve > New patient exam 15 years ago where a guy had a mesio-lingual bony > defect on his upper right central. He had been treated surgically by a [quoted text clipped - 5 lines] > > Fawks See--and the textbooks don't like using laterals as terminal abutments. Good to know not all laterals read the textbooks! Steve >> Saw a patient yesterday morning. She had lost her upper left >> central incisor. A periodontist had placed an implant 3 times in the >> site, and the fixture failed to integrate 3 times. He was trying to >> convince her to try again. >> >> Steve SignatureCut the nonsense to reply Indeed! However, this lateral was larger than most. I didn't like the idea of also prepping the cuspid. I didn't like the idea of extracting the lateral and making a four unit bridge. The patient wasn't too wild about having a bone graft before an implant. If it looks this good after 15 years, I think it's likely to go another 10 or so. <G> Fawks >> New patient exam 15 years ago where a guy had a mesio-lingual bony >> defect on his upper right central. He had been treated surgically by [quoted text clipped - 17 lines] >>> >>> Steve >> Wait a minute ........ there a number of implant cases that FAIL due >> to osseointegration and there are instances of implant breakage, just [quoted text clipped - 8 lines] > >Steve Had a similar case but it was 9 and 10 significant bony defect (6-8+mm) hepC pt. Three grafts failed. Implants not an option. Solution: 8 X X 11,12 FPD with 'pink' porcelain to fill defect. Good esthetics. Has been in service over 10 yrs now. Pt is very happy. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE I think bridge longevity is more related to the presence or absence of parafunction. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> In response to the question "Why not" to the fixed bridge--I am concerned [quoted text clipped - 91 lines] >>>> >>>>Remove NOSPAM to reply directly > I think bridge longevity is more related to the presence or absence of > parafunction. Sure. I don't think implants would do well with parafunction either. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 I agree Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> I think bridge longevity is more related to the presence or absence of [quoted text clipped - 3 lines] > > Steve >I think bridge longevity is more related to the presence or absence of >parafunction. I got to add that word to my vocabulary ... I keep forgetting to ....... I might ask what you think was the reason that certain patients fracture teeth and restorations at an alarmingly high rate, and someone else can have an MODBL amalgam that last 30 years? Why do some paitents lose porcelain from crowns that you yourself had made with a quality lab? Why do some patients even develop holes in gold crowns? Why do some patients flatten teeth, and have incisors that are 2/3 their original length by the age of 50? Do you think that is 'normal function'? Maybe your patient base was so affluent and relaxed that this didn't happen? I see it every single day. Fawks >>I think bridge longevity is more related to the presence or absence of >>parafunction. > > I got to add that word to my vocabulary ... I keep forgetting to > ....... > I might ask what you think was the reason that certain patients fracture > teeth and restorations at an alarmingly high rate, and someone else can [quoted text clipped - 7 lines] > > Maybe your patient base was so affluent Affluent patients have the most wear. I think it's because they're constantly worrying about losing all of their money. The poor ones don't have that problem. >> Do you think that is 'normal function'? >> [quoted text clipped - 3 lines] >constantly worrying about losing all of their money. The poor ones don't >have that problem. Parafunction knows no economic boundaries. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>> Do you think that is 'normal function'? >>> [quoted text clipped - 5 lines] > > Parafunction knows no economic boundaries. Poor people worry about losing their money? >>>> Do you think that is 'normal function'? >>>> [quoted text clipped - 7 lines] > >Poor people worry about losing their money? Implants, explants, and eggplants ...... >>> Do you think that is 'normal function'? >>> [quoted text clipped - 5 lines] > >Parafunction knows no economic boundaries. I heard the Iraqi War was a result of parafunction ....... |
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