Dental Implant help needed

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nycpatient - 12 Dec 2005 09:41 GMT

My first molar on my bottom right jaw is loose and also has a
infection (currently taking antibiotics). I had a root canal done t
this tooth over 10 years ago. Last week, I went to 2 periodontist
to get their opinions. Here is what they told me

Periodontist #1: He said I have gum disease and require scaling an
root-planing (deep-cleaning). He also said I needed bone-grafting a
my bone line was too low for the implant. Therefore, his recommende
treatment plan was
(a) Tooth extracto
(b) Scaling of all 4 quadrants in my mout
(c) Bone-grafting
(d) After 6-9 months, perform dental implan
(e) After another 3-6 months, peform abutment and crowning
Total time: about 12-15 months

Periodontist #2: He did not mention that I needed scaling. I aske
him specifically if I needed bone-grafting and he said it looked lik
I had enough bone for the implant. But he would only be able to kno
definitively after he extracted the tooth and was able to see insid
the gums. Therefore, his recommended treatment pla
was
(a) Do just basic teeth cleaning with oral hygenis
since I had not cleaned them for over 2 years (n
scaling required)
(b) Tooth extraction and placement of implant on sam
day (said he liked to limit number of surgical procedures)
(c) After 3-6 months, perform abutment and crowning
Total time: about 3-6 months

I would consider my general oral hygiene and gum health as not good.
Bleeding gums, tartar buildup, etc. Hardly flossed on regular basis

I'm having difficulty deciding which of these two treatment plans
should go with.

It would seem that Perio #1 is taking a more conservative approach
get the tooth out, clean up any residual infection near site and res
of mouth, make sure I get enough bone in there (bone-graft), and the
do the actual implant afterwards, when the area has healed u
properly.

On the other hand, Perio #2 has alot quicker treatment time of 3-
months. However, is he being less careful (since I'm still takin
antibiotics for my infection) or just have more updated techniques o
maybe lower success rate by doing the implant without bone-graftin
first.

I guess my main issue is do I need bone-grafting or not? Why does on
tell me yes and the other no? Will the success rate for both be th
same, but it's just a matter of personal style in terms of th
treatment plan

I would appreciate any expert opinions on this, as I hope to decide i
the next couple days

Thanks in advance for your help

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George Chatzipetros - 12 Dec 2005 10:34 GMT

> I would consider my general oral hygiene and gum health as not good.
> Bleeding gums, tartar buildup, etc. Hardly flossed on regular basis.

I don't really know the details of your case (ie exactly how much bone
is left etc), but I think this is desicive point. Since yourself
describe your oral hygiene as unsatisfactory, I believe you first need
to give enough time to "train" yourself in establishing the excellent
oral hygiene required by implants. This can be accomplished with the
help and support of the periodontist while he's doing the root
planning. If your general oral hygiene problem is not tackled, there is
a good chance of the implant failing anyway.
My advice is to take it slow.

George

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Mark & Steven Bornfeld - 12 Dec 2005 14:55 GMT

> My first molar on my bottom right jaw is loose and also has an
> infection (currently taking antibiotics). I had a root canal done to
[quoted text clipped - 54 lines]
>
> Thanks in advance for your help.

    There obviously is no way to even give an opinion in any but the most
general sense. I refer to surgeons who are more or less conservative in
practice; I had a patient who wished multiple implants told he could
only get one or two, whom I subsequently sent to an OMF surgeon who
placed 4 without grafting and with no problems. It is also quite
possible if you are in NYC that I know one or both periodontists.
    I have found in general that OMF surgeons are somewhat more daring.
However, the Brooklyn OMFS who did my wife's implant took about a year
from start to finish.
    If there is significant periodontal bone loss it seems likely to me
that even if you don't absolutely NEED a bone graft, you will be able to
get a longer implant with superior support without getting near the
nerve in the jaw if you have a successful graft. Grafting at the time
of extraction or soon after is likely to be the best recourse. In my
wife's case the surgeon grafted at the time of extraction, which
surprised me as she had a substantian mid-facial infection. This was,
mind you, a very cautious surgeon.
    It is possible that severe periodontal problems in the area may
influence the final decision, but all other things being equal, you're
probably better off with the graft.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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