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Medical Forum / General / Dentistry / October 2007Problem with bridge prep
Back in January 2007 I had number 31 extracted. It broke, got an inlay, inlay broke, got infected, root cracked, got extracted. On September 25 2007 (9 months later) I went to my dentist to start the preparation for a bridge for 30,31,and 32. Tooth 30 and 32 would be prepped for a crown. I was told a bridge would be ideal because 30 has fractures and needs a crown anyway. I expected some pain after 30 and 32 were prepped simply because of the nature of the prep. The level of pain turned out to be way more than I expected. I am in very intense pain, especially with 32 which was normal tooth with no sign of decay or infection prior to the prep. After just 3 days the temporary bridge came out. I tried to replace it myself but the pain was so intense that I ended up going back to the dentist. The dentist fixed it but the pain continued. I'm taking ibuprofen 600 every 5 hours for the pain. The ibuprofen resolves the pain totally. On Monday October 15 I went in to get the metal part of the bridge fitted. The dentist took x-rays but did not report any abnormal findings. He told me that when the bridge is placed he will use a temporary cement. He said that the metal fused to porcellan should help stabilize the teeth and resolve the pain. If after a few weeks the pain is still present he will recommend a procedure to resolve it. He didn't say what but I imagine it would be a root canal on 32. My question is this - how much pain and for how long is a "normal" bridge prep ? I expected some pain but not this much for this long. Is it possible that the dentist messed up the prep ? Should I seek another opinion ? The dentist put a crown on 19 for me and did an excellent job so I trusted him to do the bridge. I have ZERO problems with 19. Maybe a little sensitivity to hot/cold but nothing intense. > Back in January 2007 I had number 31 extracted. It broke, got an > inlay, inlay broke, got infected, root cracked, got extracted. On [quoted text clipped - 23 lines] > excellent job so I trusted him to do the bridge. I have ZERO problems > with 19. Maybe a little sensitivity to hot/cold but nothing intense. Transient sensitivity to hot and cold would be normal. Pain of the severity you describe strongly suggests a problem with the pulp. While it is of course possible he "messed up" the prep, there is always a chance of pulpal involvement with a crown prep. Wisdom teeth also tend to have short clinical crowns (the part of the tooth above the gumline) and an adequate preparation with enough space between the prepared tooth and the one it normally bites against is often difficult without getting close to the tooth. The shape of wisdom teeth and their pulps are also variable, which increases the chances of running into trouble. They are tough root canals to do sometimes, because of both access issues (being so far back) and the tendency to have funky canals with lots of twists and turns. So if root canal is planned, make sure it is a good candidate for success before committing to rely on this tooth as an abutment (holding tooth) for a bridge. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Oct 18, 2:19 pm, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > > Back in January 2007 I had number 31 extracted. It broke, got an > > inlay, inlay broke, got infected, root cracked, got extracted. On [quoted text clipped - 47 lines] > > - Show quoted text - wow ! an actual dentist ! Thanks for the reply ! It sounds like my dentist is taking a conservative approach in that he is using a temporary bond in case the pain continues after placement of the bridge. If I do experience pain after the bridge it sounds like the consensus is RCT for 32. If 32 is not a good candidate for abutment for the bridge, what options other than an implant would I have ? My insurance does not cover the cost for implant surgery. They will cover the post-implant crown installation. I've already paid out of pocket $2,500 for the bridge and that's exactly HALF the cost ! Thanks again ! > wow ! an actual dentist ! Thanks for the reply ! He may be a dentist, but he plays the guitar :-) Now if he played a "real string instrument" tuned in fifths, that would be better. :-))) Hey Steve, I found out what a temporary is on my trips to the "Thumb". :-( Weird part is that, the longer I work there, the more crowns I convert to CEREC, bring the impressions home and mill during my lunch breaks, had to remember how to put a temporary on again. > > wow ! an actual dentist ! Thanks for the reply ! > [quoted text clipped - 5 lines] > to CEREC, bring the impressions home and mill during my lunch breaks, had to > remember how to put a temporary on again. CEREC, that's the inlay that was installed on my #31 which BROKE !! The dentist who installed it moved and he no longer accepted my insurance so he referred me out. The new dentist didn't know how to repair it since it was CEREC which he wasn't familiar with. In the meantime, I developed an infection in #31 which sent me to the oral surgeon because the dentist nor the periodontist could discover the source of the infection. The oral surgeon performed gum flap and observed that the root on #31 was fractured and recommended extraction. When it healed I went back and had it extracted. BTW - I play the guitar... ;-) Proves you are a clencher. Keep Strumming Signature/ Amatus / >> > wow ! an actual dentist ! Thanks for the reply ! >> [quoted text clipped - 19 lines] > extraction. When it healed I went back and had it extracted. BTW - I > play the guitar... ;-) >> wow ! an actual dentist ! Thanks for the reply ! > > He may be a dentist, but he plays the guitar :-) Now if he played a "real > string instrument" tuned in fifths, that would be better. :-))) FOURTHS ROOOOLLLL!!! > Hey Steve, I found out what a temporary is on my trips to the "Thumb". > :-( Weird part is that, the longer I work there, the more crowns I convert > to CEREC, bring the impressions home and mill during my lunch breaks, had to > remember how to put a temporary on again. So...very...sorry. Steve No way to tell specifically without seeing you in person. No pain is normal. Some discomfort is expected for this procedure (very mild, and short lasting). Constant pain probably means RCT. The fact that the dentist is planning on temporary cement at first is good sign that he cares and understands. I suspect you could have fractures in the roots judging by your total description. You need to control your night-time clenching so as not to keep fracturing teeth. Signature/ Amatus / > Back in January 2007 I had number 31 extracted. It broke, got an > inlay, inlay broke, got infected, root cracked, got extracted. On [quoted text clipped - 23 lines] > excellent job so I trusted him to do the bridge. I have ZERO problems > with 19. Maybe a little sensitivity to hot/cold but nothing intense. > No way to tell specifically without seeing you in person. > [quoted text clipped - 40 lines] > > - Show quoted text - Very astute reply. The dentist recognized signs of night time clenching and took an impression for a night guard. I've been wearing it religiously since I got it (a few weeks ago). Will the night guard prevent further fractures ? Thanks ! Assuming you have a "Horseshoe" appliance,,,,, yes it will protect teeth. It will not keep you from clenching hard during sleep, though. Signature/ Amatus / >> No way to tell specifically without seeing you in person. >> [quoted text clipped - 50 lines] > > Thanks ! > Assuming you have a "Horseshoe" appliance,,,,, yes it will protect teeth. > It will not keep you from clenching hard during sleep, though. [quoted text clipped - 64 lines] > > - Show quoted text - Yes, it's a horseshoe appliance and fits over the maxillary teeth. IME, clenchers need more anesthetic and have more pain after treatment (especially if any treatment alters the occlusion, which often happens). They will also destroy natural teeth and dental restorations. NTIs are much better than 'horseshoes' to treat the condition. Steve > Yes, it's a horseshoe appliance and fits over the maxillary teeth. > IME, clenchers need more anesthetic and have more pain after treatment > (especially if any treatment alters the occlusion, which often [quoted text clipped - 9 lines] > > - Show quoted text - Thanks Steve ! Over the last two days the pain from 32 has subsided almost entirely. I have not had to take any advil. I am still avoiding eating on that side since I'm still wearing a temp bridge and I don't want it to come out. Hopefully no pain is a good sign. I go back the 2nd week of Nov to get the final bridge installed. |
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