Dental Implant vs Cantilevered Bridge?

mary_228June 7, 2006

Sadly, I twisted one of my teeth loose(the one next to my front tooth)while eating something and my dentist is convinced that it will not tighten up because I stretched the ligaments (or tendons?)

He is recommending an implant because it would preserve the "virgin" tooth next to it. It would also be stronger than bridge work. I know the oral surgeon is recommending and believe he is excellent.

I'm wondering about your experience with the discomfort of the oral surgery and recovery. It seems particularly gruesome to me as opposed to crown and bridgework, of which I have more than I care to count.

A complicating factor is that the implant is not covered by dental insurance, whereas the crown/bridge would be partially covered. I estimate the out of pocket difference to be $1500. We can afford this, but I'm trying to weigh the ordeal factor with the perceived benefits and added expense.

What would you do?

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I've never had either so I can't speak to the pain and agony but I used to be a dental hygienist so I'm a bit familiar with the options. I haven't worked in this field for a long time but I still maintain my license and attend continuing education - took a class on implants a couple years ago. I'm sort of in the loop but not exactly an expert on the latest technology.

It is generally accepted though that a bridge adds stress to the adjacent teeth and supporting structures - especially a cantilevered bridge which puts all the stress on one tooth vs. two. I agree an implant sounds rather gruesome but they seem to be quite common now. If it were me I'd have the implant but I'd check very carefully into the person doing it. I'd want someone with ALOT of implant experience - not just someone who is a good oral surgeon. I'd also want to know specifics about that particular dentist's long term outcome/success with implants.

The greater concern to me would be why your dentist feels you cannot save this tooth. Do you have some deterioration of the supporting tissue in that area - gums, bone, etc? If so I'd want to be seeing a periodontist to ensure everything possible is being done to ensure the remaining teeth can be retained long term. I've never heard of someone dislodging a tooth from eating unless there was something else going on.

Good luck!

    Bookmark   June 7, 2006 at 10:08AM
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mary: Have you considered getting a second opinion from a periodontal surgeon? I had to have oral surgery because of gum disease. I had two teeth that were "mobile". I had surgery about three years ago and those teeth that were mobile three years ago are as solid and stationary as any of my other teeth now. In fact, I am still in disbelief about this.

Regarding the discomfort of oral surgery, I had absolutely none whatsoever. I didn't feel a thing. Although I was given a prescription for Vicodin, I didn't even have to take an aspirin. I suspect this varies depending on the patient.

    Bookmark   June 7, 2006 at 10:42AM
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Mary - I've had major dental work my entire life, thanks to genes and a childhood accident. Root canals, crowns, bridges, implants - I've had 'em all ;)

I have two implants, and will probably end up with at least one more. I knocked teeth loose as a kid, they lasted for years, but eventually deteriorated. I originally had a bridge, but had to move to implants. Unfortunately, implants weren't a common thing earlier.

It's all about the ability of the surgeon, so as gibby suggests, you need someone with lots of experience. The specialist I use in Maryland (I'm moving to NJ and will continue to drive down for him) is known as an expert, teaches at the dental school, and is very into pain control. I remember the assistants in my general dentist's office talking about his hands. Sounds weird, but they said he was incredibly gifted.

The procedure it lengthly, but should not be painful. Honestly, it was not any worse than bridgework/crownwork I've had. It's a little gross, because there's pressure involved, but it doesn't hurt. I had prescription pain meds, but ended up needing only 600-800 mg of ibuprofin at regular intervals for a couple of days.

What *did* hurt was an infection I got from followup surgery to try and build up bone that I had lost over the years. But that had nothing to do with the implant part.

I wouldn't be afraid of implants, but agree with gibby that you should only go that root if the tooth truly can't be saved. You might even get a second opinion. Losing one tooth can have a domino effect, so make sure it happens only if there's no other option.

    Bookmark   June 7, 2006 at 10:45AM
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What others said, plus my own experience: Despite the surgeons' (I consulted two who were recommended by my dentist) warnings about all possible pain and complications, I decided on an implant because it's independent of the other teeth. It turned out to be an easy procedure for me, no problem at all. I took one Vicodin, that's it, and I probably could have gotten by without it. The only unpleasant - though not painful - part was when he drilled the initial hole for the little screw thingy. They use a very verrrryyy sloooowwww drill in order to prevent heat buildup in your bone, so it takes a long time and you have to listen to the whole thing. I didn't use the gas, but if you do, maybe you wouldn't even mind this part.

Good luck, whatever you decide.

    Bookmark   June 7, 2006 at 11:38AM
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Gibby: You asked why this tooth will need to be replaced.
I guess I should have said that it is a peg tooth (really a baby tooth?) that has a crown on it. It has a very short root (as do my front teeth) which has always been a concern for my dentist. There is lots of bone for the implant to fit into to, so at least that's not a concern.

goldgirl mentioned the domino effect which worries me, as I already have a cantileverd bridge on the other side of my front teeth to fill in the gap where an adult tooth never formed, and the gum line has seriously receded. Good thing I don't have a big, high smile!
Some of you mentioned periodontists, so maybe I should consult with one that I know in the area.

I guess with the surgery, I'll need 6 months before the crown can be made and will have to endure the discomfort (?) and expense of a temporary (since this is in the front of my mouth). I wonder how the temporary would be attached?

    Bookmark   June 7, 2006 at 11:48AM
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Mary - I think it's a good idea to have an evaluation by a periodontist - just as part of gathering comprehensive info about your oral health as you decide what to do in this situation. I worked for a periodontist early in my dental hygiene career (along with some general dentists) and I can tell you more than a few general dentists overlook periodontal needs. In fact I still get my teeth cleaned by a friend who works for a periodontist - and get an exam by the periodontist periodically as well.

    Bookmark   June 7, 2006 at 1:18PM
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Mary - I've never heard of having to wait six months for a temporary. I think I had to wait perhaps three weeks - that allowed time to make sure everything was okay, and to get the tooth produced. A practice that does lots of implants/crowns/bridges will have an in-house lab that can produce a high-quality temporary, much better than what you may be used to from a general practice.

    Bookmark   June 7, 2006 at 1:32PM
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I've paid for tremendous dental work for my son that had his front tooth knocked out when he was about 10. The next time that tooth needs to be fixed, it will be an implant. I hate the way these last two porcelain veneers look. They're too 'sheer' looking and the tooth looks grey. He's not had any problems with it now that he's had a root canal. I just know that having friends with implants, I wish we went ahead and did one for my almost 26 year old son. The costs for the root canal and all of the multiple "fixes" (nothing seems to last), has bee three fold to what one implant would have cost.

I'm also facing four crowns with my own teeth. I'm wondering what I should do.

    Bookmark   June 7, 2006 at 2:34PM
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Sherilynn: That's interesting about the cost of multiple fixes. I 've been so lucky with my crowns (25 yrs so far) that I never realized how often people need to have them replaced!

Goldgirl: As I understand it, it takes six months for the bone to grow around the implant (or whatever happens in the bone) and then the final crown can be attached. So in the meantime, I'll have to have a temporary.

    Bookmark   June 7, 2006 at 3:08PM
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Like Sherilynn's son, I knocked out my front (permanent) tooth when I was 8. Running down the hallway upstairs, my foot caught on the stair railing, sending me crashing face first into the bathroom door post. Oh, how I wish I could take back that moment in time.

It's been a nightmare ever since.

I've had it all - the old tooth (that fell out) implanted (which then died), crowns, bridges, and right now I'm on my 2nd set of porcelain veneers. We eventually pulled out the 2nd front tooth so that the situation would match, then they moved my two side teeth to the front and first put crowns on them then porcelain veneers. They are smaller than most normal front teeth, and I've never been fond of them. I have a permanent retainer behind them to keep them from moving apart.

Next time around, it will be implants.

Don't let your kids run in the house.

    Bookmark   June 7, 2006 at 4:48PM
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I also agree with the implants. Especially if you can afford them.

The only caveat I foresee, is if you have osteoporosis--your jaw bone might be too soft and the implant won't take.

Make sure your perio and oral surgeon due a CAT scan on your jaw to determine if there is enough bone.

My mother had implants despite her osteoporosis and they had to do a tremendous amount of bone grafting. That was a nightmare. She really shouldn't have been a candidate for implants, but she insisted.

So, if you are healthy- implants are ideal.

    Bookmark   June 7, 2006 at 5:53PM
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snookums - I know just how you feel. As kids, we used to walk across the old fashioned bike racks. I did this one day and fell - ordinarily, I probably would have been fine, but at the time I had an orthodontic spacer on the my back upper teeth to spread out my bite. So, my front teeth were slightly loose :(

Every time I'm at the dentist I wish I could take back that moment! My next wish is that I could have had all the progressive dental options available back then ;)

    Bookmark   June 7, 2006 at 6:41PM
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I've had gum surgeries done and also a full mouth of bridges and crowns; I am sensitive to mouth pain so although I could function pretty normally, it took days for me to feel top shape after each procedure. A precaution for you would be to not book any activity or event that is too taxing in case you are in pain; nicer if you can pop the codeine and not do too much. It's just a question of forseeing when your appointments are and allowing yourself to recuperate well.

Even when I was in pain and could not chew, I would leave smarties on my tongue and let them melt.
It's all worth it to have perfect teeth.

    Bookmark   June 7, 2006 at 8:50PM
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I've had to fork over 20,000 for my bottoms to be crowned and one bridge as well as some gum trimming done to put those dang things in. The pain was more like nagging afterwards. Advil every 3 hrs (yes I was taking more than I ought to) and a few days of warm water rinses especially after food. I found that warm green tea swished around my mouth seemed to soothe me.

Take mitchdesj's advice you don't want to have to deal with polite chit chat and socializing when you're in discomfort or pain.

I have to fork over another 20,000 for the top teeth this September, ugh. That's what happens when you have bad genes and a Pepsi addiction.

    Bookmark   June 8, 2006 at 12:51AM
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Wow! It's been a revelation reading about all the dental work that people have been through. And I thought I had problems!

I spent some time at my oral surgeon's website and watched a video presentation with tons of information and various restorations using implants. I'm not so freaked out now, and the thought of the extra $1500 seems a small price to pay for good looking, longlasting results.

The video showed a "flipper" I'd probably have made for me to fill the space while the bone forms around the post, so at least I won't look grotesque for six months!

However, I did just make a periodontist appt ($125 consult) to see if there's anything less invasive that can be done. Thanks for all the advice. You guys are great!


    Bookmark   June 8, 2006 at 2:05PM
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Does an implant mean that your tooth will die? Or can they preserve the root in spite of the screw? And I think that a peg tooth is a full sized tooth that has been shaved/drilled down so that a crown can fit snuggly over it. A peg tooth is a livng tooth, but all of the enamel is gone and it is somewhat pointed. I do have a crown on a peg tooth. Do not look in the mirror when they are mounting your crown. The peg tooth, which is in fact the size of a baby tooth, is really, really different looking. The word that best describes it is scary. I try to avoid looking into my dentist and his assistant's glasses/eye protectors when that tooth is exposed. Because my mouth looks like something out of a horror movie with the exposed peg tooth in the open gum of a full sized tooth. I lost my two front teeth in a bicycle accident when I was about nine, one tooth finally died when I was in my twenties, and now I have beautiful crowns in front.

I just got back today from having two old crowns removed, decay cleaned out along the gum line, and am awaiting two new crowns. My teeth have posts in them (does that make them implants?) already, so I am only paying for new crowns. Between our insurance and our medical reimbursement account, I'm not paying for this work directly. Our medical reimbursement account gave us a "credit card" to pay for our health care expenses. It's extremely convenient.

It seems like you've gotten great advice Mary. Save that tooth. Unless you love eating firm or highly sticky foods (like those suckers, what are they called? "something daddies" that are perfect for removing certain types of dental work), give this tooth time. Keep your mouth cleaned and floss gently to prevent decay around the base of the tooth. If you can keep your mouth clean and healthy, and avoid hitting your mouth or eating difficult to chew foods (or biting pens, apples, nuts, hard candy, nails etc), I would think that you could wait a half a year. Because we are on a tight budget, we have to alternate my DHs and my dental work with orthodonture for seven kids, I have postponed dental work for years (not root canals but cavities) but just keeping my mouth clean and maintaining twice a year check ups. Finally, if you want to whiten your teeth, pick a nice bright shade for your crown. I didn't choose the ultra white "A" grade that everyone who works in my dentists office has, but sort of a soft, mellow white, the "B" grade. Still white, but not the "you need your sunglasses to look at my smile" white.

I really wish God had given us three sets of teeth.

    Bookmark   June 8, 2006 at 3:10PM
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Thanks for the clarification about the peg shaped tooth. Mine was peg shaped to begin with (a deformity), so there was really precious little to hang a crown off of, although that is what I have had for the past 25 yrs. The root on this tooth is very short, and it has always a bit wiggly and subject to injury.

It sounds like you have implants that the crowns are attached to. My crowns are attached to chiseled teeth and are pretty ugly, too. Not quite the Frankenstein look you've described so well. I can appreciate your warning about not looking in the mirror after the pics I've seen on the docs website. An informed patient is what they're going for I think!

I like your idea about three sets of teeth. Perhaps God never meant us to live so long!

    Bookmark   June 8, 2006 at 4:29PM
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Glad to know I'm not alone in dental hell.

Braces, lots of molar extractions, root canals, veneers, crowns. Then serial gum surgeries. Latest: a bizarre infection tunneling through my soft tissue from a fractured root in my front tooth. Inaccessible for surgery through the side. No option for an implant. So...Extraction and crowns either side to hold the bridge. Fourth crown done for symmetry. (You do *not* want to look at an extraction gap flanked by peg teeth. Yikes, now I've got that seared into my brain!) Waiting now for gum line to normalize before permanent cement of the bridge and adjacent single crown.

Of course on Sunday AM of Memorial weekend 300 miles from home on a motorcycle trip, that single crown went flying off when I flossed- I caught it a centimeter before the sink drain got it...cripes. What's next?

    Bookmark   June 8, 2006 at 6:57PM
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OMG, maybe we should start a Dental He** support group?!

    Bookmark   June 8, 2006 at 7:12PM
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I have a crown on a lower front tooth that has lasted 38 years.

My brother and I were both grounded to our rooms (at opposite ends of a hall) and entertained ourselves by seeing if we could throw gumballs into each other's mouths. Oh boy. We were our parents' nightmare idiot spawn.

    Bookmark   June 8, 2006 at 11:30PM
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I have done it all and started with implants several years ago. It is a long process and not always comfortable but if you have the money go for it. I have three implants and they look and feel great. The only thing what bothers me at times is when I have a cold. They had to do a sinus lift at the right and left side in order to fit the screw for the implant (bone loss) and my sinuses hurt pretty bad when I have a cold.

    Bookmark   June 14, 2006 at 2:08PM
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Just back from a consult ($125!) from the periodonist who would do the extraction, implant and bone graft for $3600!

I'm shocked. The oral surgeon I was previously referred to charges $1800 for the implant (extra for the other stuff, don't know yet how much!)

Have to wait till July 1 to see him. Luckily, the tooth is tightening up a bit, although I have a bit of pain.

    Bookmark   June 15, 2006 at 11:56AM
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I liked the oral surgeon's recommendations MUCH better. I've got great bone there, they can extract the tooth and put in the implant and abutment in one visit. That same day, under the same anaesthesia, I rush over to the dentists office to have the temporary made and put on the abutment. Voila!

Then no eating on that part of my mouth for six months (this may well be the hardest part!) and I'll be all set for the crown.

I must admit that I am nervous about the drilling for the implant. Like wooderlander said, the slow drill and noises will probably get to me. Only (!) another $500 to be put to sleep. Hmmm. We're doing a new roof, gutters, $$$ chimney repair. I think I'll try to tough it out. Wonder if they can prescribe a Xanax (sp) or something to help me chill....

Wish me luck!

    Bookmark   July 7, 2006 at 12:32PM
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Hello all!

Just wanted to say the it's now two weeks post implant and everything went well. The oral surgeon prescribed a valium type drug that I took prior to the procedure which calmed my nerves and saved $400 worth of anesthsia if I had to be put out. He also harvested my bone to use for grafting around the implant.

After a short recovery, my general dentist put a tooth colored abutment on the implant and made a temporary which he then attached. They call this procedure "Immediate Temporary Implant". So this also saved me the cost of a "flipper"! The reason he chose a tooth colored abutment is to eliminate any problems with the abutment showing through the crown or, ultimately, at the gumline when the gums recede over time. In about six months they will be able to make the permanent crown.

Thanks for all the encouragement and war stories!

    Bookmark   August 3, 2006 at 7:35PM
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Mary - thanks for giving an update - good to hear it went well!

    Bookmark   August 4, 2006 at 12:10AM
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