Tooth implant/bridge or nothing?

[cleansun]

Hoping lollygaggle is about maybe!

I just had my lower first molar extracted today, and have also had the wisdom tooth out on that side so there’s one lonely tooth with a gap either side

issue is, I had the upper tooth above it extracted years ago and I’m wondering if there is a point doing an implant if there’s nothing above it? My dentist has quoted £2800 for bridge or £3500 implant

Watching with interest

The reason many say to replace a molar is there is a possibility the tooth above it may keep on growing up and “over erupt” however if there is no tooth opposing this is not a problem .

A bridge means cutting down two teeth which results in a 20% chance of the tooth dying, needing root treatment and becoming more brittle .

An implant is the gold standard but you also have to budget for maintainance and replacement of parts over the years. Also smoking, diabetes, gum disease affect the failure rates for implants . You don’t want to leave it too long after having a tooth removed to have an implant as it needs a good amount of bone to be successful

Some people will hate having a tooth missing and will want to replace it , others can live happily without most of their teeth. You only need 20 teeth to be dentally fit and able to eat.

So the questions are

Are you willing to make the diet and cleaning changes (and possibly lifestyle changes) so that you not only don’t lose more teeth but also give the expensive dentistry the best chance of sucess

Can you budget for maintainance and replacement of implants as no dentistry lasts for life

Are you likely to lose more teeth soon

Does the missing tooth bother you

The prices are around what I would expect .

I would think that if there is nothing above it then a replacement would be for purely cosmetic reasons.

I have teeth missing in all four parts of my mouth (through dentists as a child filling every nook and cranny, I'm sure for money as never had toothache or local anaesthetic which saved them money🙄). Consequently as an adult a lot have broken. The gaps at the backs have caused no problems and some are 30 years old.. When my front tooth broke I've had a maryland bridge which doesn't require the teeth either side to be crowned, so far all is well but it's less than a year for that one.🙏

Maryland bridges are not suitable for back teeth , except as a temporary measure, as the forces involved in eating will dislodge them .

If you were a child before the early 70s there was no fluoride in toothpaste and decay rates were much higher . Also materials and understanding of decay has moved on so fillings were done at that time , according to best practice , that might not have been done in the same way today .

I’m not expecting to lose more - this was a failed root canal and crown and it turned out the tooth was cracked all the way down
I sleep in a Michigan splint and use tepe brushes, floss, fluoride, electric toothbrush etc and I also put toothpaste on the tepe brushes to get it in between my teeth. I don’t drink any alcohol

I did smoke for 20 years (I’m 42 now and haven’t smoked for 8 years)

I have the money for implant or bridge and also denplan which covers my hygienist appointments and check ups

Should add I believe my lost ones are due to grinding, genetically awful teeth (parents and grandparents) and also the history of smoking of course. I have xylitol after every meal as well
I haven’t had much decay, they just seem to crack/break. The upper one was removed as it had a filling after it broke which then fell out, after 5 more filling attempts my dentist said extraction

I spoke to the dentist today who said my mouth is immaculate and it’s up to me basically

If you are a strong bruxer (grinder) and wear a Michigan splint this can be a problem with implants as they have no “feel” the same as a real tooth and can be prone to fracturing . This is something to discuss if you are thinking of an implant , in particular .

I suspect my dentist is leaning towards implant as he said the teeth either side haven’t been restored in any way so he’s reluctant to say a bridge
I won’t be able to grind on the implant as no tooth above it!
but yes heavy grinder since I was 11/12, no idea why

If you grind the other thing to bear in mind is are your other teeth worn down , particularly at the front?

If there is damage apparent in other teeth then rather than repairing things piecemeal it may be better to look at what is going on in your mouth as a whole . Bear in mind this will be expensive .

It may be there is no tooth directly above but often when you are grinding your tooth will make contact with other teeth either side of the gap.

I would be very loath to drill two healthy teeth for a bridge .

@Lollygaggle thank you, you are correct, most of fillings were done when I was a young teenager in very early 70s. I did have a lovely dentist for 30 years who cured me of my dentist phobia (many horrible experiences as a very young child such as physically being grabbed and forced into the chair with black gas mask forced on my face) who told me that fluoride wasn't put in toothpaste until mid 70s and that dentists used to be paid per filling, unfortunately he retired and I'm now at the mercy of a different one every time I go and back to being very anxious and, therefore, a bit obsessed by all dental threads🤷‍♀️🤦‍♀️

Please ignore the horrendous lighting but no wear (I can’t smile properly as still numb!)
Had a full check up, X-rays and the mouth scan thing where it goes round your head? said loads of really good bone

I have worn a soft mouthguard since I was 12, to the point I woke up from anaesthetic and demanded it, I won’t even nap as a passenger in a car without wearing one. Changed to the splint a few months ago

I wonder if you are a clencher rather than a grinder. With someone who clenches soft bite guards tend to make things worse as they act a bit like a chew toy . Michigan splints tend to be better for this.

There’s not much evidence from this photo for damage from grinding/clenching , so in the end whether or not you replace this tooth is down to personal preference. Why not live with it for a few months and see how you feel.

Forgot to say vaping is also not good for gums or implants , particularly vapes with nicotine in the juice .

I do clench as I wake up hanging onto the splint like it’s a chew toy and consciously try to relax my jaw every time I can! So yes quite possibly more a clencher

he said they won’t touch it for 4 months anyway but if I want an implant it’s best done in the first year

Botox might be a thought for the clenching (from a dentist or doctor who knows what they are doing , not a nurse or heaven help us a beautician) .

I did briefly look at it a while ago but I’ll have another look, I wanted to make sure it was someone really experienced in it for clenching

honestly I do so much for my teeth and they’re “nope”

Sorry to hijack the thread but would welcome @Lollygaggle 's opinion.

I had a dental implant in February with a bovine bone graft. This was to replace a Maryland bridge that had failed after 20 years. I have the top two front teeth missing.
I decided not to go for a fixed bridge as this damages healthy teeth either side. However, the metal post has failed to integrate with the bone. The dentist thinks because I did not have sufficient bone there.
I have been offered another try using bone taken from my bottom jaw. I don't yet know what this entails but it sounds painful. I found the procedure pretty unpleasant the first time with the 5 injections which were very painful and the gum swelling etc. I am gutted at the thought of going through it all again with no certainty it will work. Also, another 8 months with no teeth! My only other option is the bridge which will damage my healthy teeth. I don't know how long that will last either. I suppose a bridge might outlive me ( 63) but it might break in 5 years.

Hijack away, I’ve got dry socket so I’m sulking now and on antibiotics!

There are so many variables here it’s impossible to tell you what the right thing to do is but there are a few factors to consider

implants and bone grafts have a much higher failure rate in those who smoke, vape , have poorly controlled diabetes , are on certain medications eg bisphosphonates (for osteoporosis ) . If any of these apply to you then you may want to consider sorting these factors out , or where medications are taken that can’t be changed this might affect your decision .

Bone grafting at the front of the mouth tends to be more problematic than grafts at the back because of the type of bone defect. As your dentist has said there is no guarantee of success of this or indeed any dental treatment , so you need to be sure that you are happy to undergo treatment knowing this. After 20 years I would imagine there is quite a bone deficit where the teeth are missing . If you do go down the graft route I would consider asking for sedation which will add a bit to the cost but will make the proceedure much more pleasant for you.

Have you any other teeth missing at the top? Many people have plastic dentures as a temporary solution to missing teeth and have huge problems getting on with them. Metal framework part dentures, chrome cobalt , are much better fitting , thinner, don’t normally have a palate in and are much better tolerated. They might well be worth considering even as a medium term solution , and if you have other teeth missing will solve that problem as well. They can last many years before needing replacing .

When you drill teeth down eg for a bridge or crown , there is a 20% chance that the nerve will die off , which means the tooth would need root treatment . A tooth that is root filled is a much more brittle tooth and potentially has a much shorter life span . On average a bridge has a 10 year lifespan although they can last decades longer . A Maryland lasting 20 years is very,very good so it sounds as if your bite and cleaning will not be a problem. The other factor is how good the roots are on the supporting teeth and how good your gum health is.

In the end it’s down to what your attitude to risk is , as , apart from the chrome cobalt denture option, both graft and bridge carry an element of risk of failure/complications .

@Lollygagglecan I ask implant wise, is it an issue if you’re immunocompromised? I’m neutropenic
I have decided against a bridge so it’s whether to do an implant or just leave it

Thanks @Lollygaggle . I have never smoked, not on any medication and not diabetic. Luckily, no other teeth missing at the top.

Neutropaenia does affect gum healing , although the evidence for implant success is divided (level of neutropaenia is a factor) , as is effect on bone grafting. However the reason behind the neutropenia may also be a factor in graft success eg lupus etc.

In short it’s not going to help and you are certainly as higher risk of infection.

I can use an injection to boost my neutrophils, I hate doing it but short term wise it means I would be normal level
its autoimmune so nothing underlying, I just kill them lff