How to replace a tooth - implants?

[grace11]

I'm having a nightmare with a tooth - after two root canals the remaining tooth broke. I was hoping the dentist could 'peg' the crown on but the gum is inflamed and he's saying best option is to extract it and have an implant. It's near the front - a premolar - and I'm pregnant - hopefully all this work will be done after the baby is born. I really need some advice from people who have been through this and weighed up the options. An implant seems very expensive (no idea where I'll find the money) and there's the risk attached to it - found some horror stories online. What have people done in a similar situation? Surely people have teeth taken out and replaced all the time?? Any advice/shared experience would be much appreciated, feel very confused x

[MatildaTheCat]

I've had a premolar implant this year. It is a lot of work and appointments. First the extraction. I was advised to have a small denture to keep the other teeth from wandering, so more expense. Then several interim appointments to check the bone healing. At last the post was drilled in which was lengthy though not painful due to the injections. More waiting for bone formation. Then after six months the impressions were taken and a few weeks more I had my new tooth fitted. I have to say it's excellent. I cannot tell the difference.

So yes, lots of work and a lot of money but I'm glad I did it. I asked heaps of questions including:
A) how many have you done?
B) what is you success/failure rate?
C) what went wrong and why?

My dentist was very thorough in his explanations and I think he was a little bit scared of me after the quiz. That's ok, he did a good job.

[grace11]

That's really helpful, thank you. If you don't mind me asking, how much did you end up paying? Was it more than £2000? Did you weigh up other options? The dentist has basically said an implant only to me but what about a single denture or bridge? Although a bridge sounds expensive too. I'm wondering whether to chance another root canal but that would be three on this tooth... I can't believe no dental insurance covers implants either - not that I have any but have been desperately scrambling around trying to get some but it's all useless!

[BikeRunSki]

I had a molar out a couple of days ago, and started a similar thread a week or two ago. There was a really thorough reply from a dental nurse, I'll see if I can find it.

My gap is out of my "smile line" and so far hasn't felt too odd. I've thought about implants, but as it's not visible I will leave it for now. If it were visible though, I'd look into how to fund and implant, or dentures.

[BikeRunSki]

Here's my thread Grace11

[grace11]

Just had a look at your thread and that's really helpful, thank you. Think the general consensus is an implant. My dentist happens to be a specialist and I suspiciously thought he was pushing this approach on me as it's his 'thing'. I totally relate to the getting old thing - felt irrationally depressed last week when the dentist said the crown couldn't go back on. I blame myself too - if only I'd been more careful maybe the crown would still be on. Think I'll go with a big list of questions next week so I don't just sit there stunned and depressed again!

[MatildaTheCat]

Grace, it cost 2k plus a staggering £500 for the one tooth denture. That could probably be left out but as I say the dentist said the surrounding teeth could start to move into the gap. The gap was just visible if I smiled. Having the single denture could be an option but it was expensive and also quite fragile. It felt ok but did slip around a bit as the day went on.

I fear finding insurance for an implant after losing a tooth might, indeed be difficult , a bit like calling up and saying! 'I had a burglary last night, can I get some home contents insurance?' However it is common to get a payment plan, I think and I paid in stages even without that.

There is no rush. You could simply have the extraction and see how you feel about it in a few months. Do some research but I would beware anywhere that offers quick or suspiciously cheap treatment. It is a lot of work and visits but I'm glad I did it.

[elizabethpatterson]

Even I am planning to do my tooth implant this month in New York. I heard from my aunty about her dentist in Long Island is experienced one so I am thinking of doing it in that clinic . I read about that clinic in New York Magazine as well , check here if anybody wants more information lipulse.com/category/wellness/ .

[grace11]

Thanks MatildaTheCat, I guess I've got a bit of time to save some of it as it won't happen until after the baby is born - although I can't quite imagine managing a newborn and coping with all this dental work. I spent most of last year in out of the dentist, thought I was behind this for a while! Yes the insurance thing makes sense but why does no one insure for implants if they are the best solution?! The dentist said I'd have about four months after the extraction before the bone starts shrinking so he wants to do it fairly fast, probably using a £500 denture!

Good luck going to NY Elizabeth - I read on another thread about someone going to Spain to get implants done.

[Mrsmorton]

I often replace premolars with resin retained bridges if the tooth in front/behind is in good condition. These require no drilling at all to the adjacent tooth (some dentists do a slight amount to remove big lumps and bumps but not more than 0.2mm).

Regarding health tourism, when I do my OOH job I will categorically not provide any treatment to patients who have had implants either in the UK or abroad unless they have systemic infection (temperature and swelling). In the UK at least they can see whoever did the implants on the next Monday. I'm not sure popping over to spain/eastern Europe is so easy. Or even if the clinic would still exist by the time you got there. Dentistry in the UK is the most highly regulated in the world, just food for thought.

[Laska42]

mrs morton what if losing a tooth means you end up with three missing?

I had my wisdom teeth out as a teen, but in my 40s i ended up losing the 2nd to last molar after much over drilling/filling im told which weakened the tooth.. anyway its gone,

I eventually had root canal on the back molar and a 'floating bridge' connected just to the back tooth to filll the gap..(this cost £££! even on the nhs) Ive had it about 15 years now and for thelast few years my dentist has said i will have to loose my last molar which has the bridge attached because its wobbly.. ( it is wobbly but doesnt seem to be wanting to come out and i live with it ).

Result ive avoided the dentist for the last few years , but i suppose im going to have to go back sometime soon, ( luckily my other teeth are all pretty good ) and they are going to want to take it out.. This means il either have to get two implants ( which i cant afford) or have a 3 tooth gap.... Earlier this year i had an abcess, which i cured with hydrogen peroxide .. this was under the wobbly tooth, ) so I suppose the time has come when i cant avoid the dentist any more

If i go with the gap , will my gums and the bone underneath shrink? i have heard it does.. im late 50s .. every time i think ill go back to the dentist about it I veer toward keeping the wobbler.. if it hurt id definately have it out.. Ilook aftre my other teeth and luckily they are all in good nick enetist has said they are very good previously)

[Mrsmorton]

The tooth is chronically infected and is releasing a large amount of bacteria as well as inflammatory markers into your bloodstream. It's not good to keep it and you definitely can't cure an abscess with anything other than dentistry.

An implant would be an excellent choice there if you could afford it. Dentures are tough to do where lower molars are missing and an implant will maintain the bone levels.

You need to go to the dentist and discuss it. Hard line there I'm afraid.

[Mrsmorton]

I don't want to answer millions of questions, I tried to write a whole dental thread a while ago but got harassed and abused by pm so I'm loathed to do it again.

Essentially there's two types of bone in your jaw. Your skeleton and what we call the alveolus which exists purely to hold your teeth in. If the teeth go, the alveolus resorbs and gives people with no teeth that classic crumpled, closed face look. Losing a few teeth doesn't have the same effect, it's possible three teeth will cause that but impossible to say via the inter web.

[grace11]

Thanks Mrsmorton - I'll ask the dentist about the resin retained bridges. Wonder why he didn't mention...

[Mrsmorton]

It may be that you're not suitable? Lots and lots of factors to take into account!

[RoosterCogburn]

I don't want to hijack the thread but I just wanted to say Mrsmoton you always give such detailed advice and are so helpful - thank you.
I remember a thread where you and other dentists were treated really badly and I thought you handled the whole thing in a dignified manner

[Laska42]

Please can you explain why it cant be cured any other way? and why dentistry does , if all they do u is take out the tooth,? which doesnt seem infected . i can bite down in it ,,

ive been told that you cant cure abcesses before, but its not sore , or leaking as far as I an tell and the Hp wash seemed to knock it on the head.. I am so loathe to have it out and end up with a 3 tooth gap!

[Mrsmorton]

[blushing]

[GandalfsOtherHat]

Grace would you mind a slight hijack to ask mrsmorten something?

Mrs
For some reason every single root canal I've had has had to be re-done. I'm due to see the endodontist next Tues for the next one :( I know the tooth next to it is next in line for a root canal. The costs are adding up!! Currently I have severe pain due to the failed rct, I really just want this tooth (molar) out! I'd rather put the money towards an implant. Why does my dentist recoil in horror every time I mention this? i'm 38, have a filling in almost every tooth and cavitate extremely fast. I don't think my dentist believe me when I say I really try and look after my teeth! Neither of my sisters nor my husband or his siblings (we all grew up together) have even ONE filling :(

[Laska42]

mrs Morton thanks I posted again before I read your last . I respect what you say about writng lots of advice ,, thanks for your help .. looks like ill have to 'bite' the bullet then ..

[Foreverconfused]

Im in the process of having a implant in a gap where 2 teeth were extracted about 15 years ago. Never affected my eating or speech but because it was 2 lower teeth , my opposing upper tooth was over erupting due to no support.
Initially I was going to have two tooth implants but was quoted £7000 !! I did need a bone graft as well because the bone was very thin due to not being used for so long. This was out my price range so I spoke to dentist and he agreed to do the one directly under the erupted tooth. Had my bone graft in March (cost £1500) and just waiting for bone to grow. I have my follow up appointment beginning of August and should hopefully get my implant post September
I'm then having a temporary crown which will be adjusted every month to slowly move the upper tooth out the way and make room for the permanent crown (costing £400)
All in all , it's costing about £4500 and taking a year to do. I did try and look for cheaper quotes at different surgeries but in all honestly when you're sat there with your mouth wide open ,with tools drilling ,screwing ,sawing etc... you want to know you're in safe ,professional hands (I chose to have the free local as opposed to paying an additional £800 for a general ).

[Walnutpie]

Is it the case then, that if we lose teeth, we need to wear a denture regularly in that space, if not all the time, then at least some of the time, to keep the other teeth in their correct places?

Forever what does 'over erupting' mean? Falling sideways?

[Foreverconfused]

Yes , basically even having the one tooth out can cause teeth to move about ,not always noticeable.
Over eruption is when a upper tooth doesn't have a bottom tooth as support so will carry on growing until it finds that tooth. In my case my tooth would've kept growing until it met the gum of where my bottom teeth were. This obviously exposes the sensitive part of the tooth of which would usually be under gum tissue and is more prone to cavities.
If you have just the one tooth out then the opposing tooth will use the teeth either side of the gap for support usually. I didn't have that as I had 2 teeth out ,so there was no way it could find another tooth.

[Walnutpie]

Wow. Thanks for explaining. I didn't know a tooth would 'search' for another tooth like that.

What you're having done is marvellous, isn't it. Sophisticated dentistry, indeed. Good luck, I'm sure it will go well.
I have an implant and am sometimes rather surprised by it, because it feels stronger than my other teeth. But most of the time I don't notice it. Marvellous thing, implants. I see that there are now dentures that are attached to implants in stead of using polygrip or whichever denture fixative. Much more stable and comfortable.

[Foreverconfused]

I know. My family think I'm nuts spending so much on a tooth , a back one at that ,but I've always believed teeth are your main feature. I've got a baby tooth upper canine which I'm getting replaced if it falls out. I was going to have it pulled out and then have a implant but would need a sinus graft , and after the bone graft I'd just dealt with I wasn't ready to go through it again !

I'm ridiculously excited

[Walnutpie]

Good for you. I've spent a lot of cash on dentistry too. I think in this country there is a general attitude that dentistry 'shouldn't' be expensive or complex. We are a bit behind the times.

The upcoming generation seems more dental aware, with the prevalence of smile clinics now, and so many different kinds of braces. Eventually the English will lose their reputation as the nation with awful teeth.