Andrew Currie, DMD, MS

Hillery,

    Sorry to hear you're having some pain. I would go ahead and call the oral surgeon's office to report what you're feeling. The surgeon may have x-rays from during the procedure where they know they were safely away from a nerve, but it can be hard to tell for sure sometimes. A new CT scan will show a 3-D image that makes evaluating the implant position easy to do. If a nerve was involved, the sooner it's diagnosed the better. If the implant was close to the nerve (which is typically the case), there may be some swelling present within the bone that compresses on the nerve causing the tingling sensation. If that's the cause, then it will subside as the swelling goes away and will be of no long-term consequence.  Another possibility is that what you're feeling is a result of having to strip the muscle off the bone in order to do the procedure. As the muscle is trying to reattach, it can cause odd nerve sensations. Once the muscle has healed back to the bone, the nerve sensations go away as well. 

    All that being said, there's no down side to seeing your surgeon right away to be on the safe side -- report what you're feeling, and request that they take an updated CT scan to be sure the implants are safe. As a surgeon, it's always handy to have a post-operative scan anyway just to know for certain how the implants look. 

Best of luck.

WorriedOne, you can certainly get bone or gum grafts independent of dental implants. From what you describe, it sounds like you'd be best suited to see a periodontist, who is a specialist of the gums and bone that support our teeth. Periodontists are trained in grafting of both bone and gums, and much of what they do is based around saving a protecting teeth. 

While you're there, you should also ask about the best ways to maintain your periodontal health going forward. Although there is no "getting better" from periodontal disease, we don't look at it as the point of no return that we used to. There are treatment modalities: lasers, PerioProtect Trays, localized delivery of antibiotics like Vibromycin, and bone defect repair materials (Emdogain) that can improve areas that are tough to graft. 

Hope that helps!

Teeth can absolutely shift over time when there are spaces, but typically 2-3 weeks won't be long enough for much to happen, especially if your teeth are in contact with the opposing teeth which help them stay put. If you had to put off placing the final crowns, then you should take your retainer to your dentist who can hollow out the portion of your retainer that is touching the implant healing caps (what is preventing it from properly seating into place). Once hollowed out, the retainer will likely fit like normal and you can wear it until the the crowns are placed. 

At that time I recommend switching to a hard acrylic bite guard instead of a retainer  -- the bite guard functions as an excellent retainer (better than a traditional orthodontic retainer), and it protects your teeth and new implant crowns. Most of us clench or grind occasionally, and protecting the investment of your new implants is always a smart idea. Plus, our natural teeth have ligaments, so they can actually compress into the bone a little when we bite hard or grind. Implants don't have ligaments, so when you bite forcefully against them there is no give and you can fracture the crown, hurt the implant, or injure the opposing tooth. A bite guard protects against those things and functions as a retainer as well. 



Hope that helps!

Depending on your budget and your willingness to complete any needed bone grafting, implants are likely still an option. When teeth are removed and dentures are worn for years, the bone that used to support the teeth will shrink away -- how much depends very much on the person and the amount of time the teeth have been gone. 

There are a variety of ways implants can help: Two or more implants with snaps can help retain the denture and give more biting force and comfort (the same can be done with mini-implants if there is not enough bone to support normal sized ones, but those should be a last alternative). If you can fit four or more normal sized implants in the correct positions then you may be eligible for a prosthesis that you don't take in and out, which would be a huge quality of life upgrade for most patients. This style of treatment is known as a hybrid denture, but often referred to as an All-on-Four prosthesis. 

If your budget limits your options to something smaller, you can improve what you have by adding in one or two implants to provide extra support and retention so that your partial denture doesn't rely completely on the remaining teeth. Our patients often incrementally work towards a better plan by adding an implant or two every year or so until they can change the prosthesis to a better one once enough implants are in place. 

To find out which options you're eligible for you will need to see a dentist who is familiar with restoring implants and has a cone beam CT scan which will show your bone in 3-D so they can evaluate if you the correct amount of bone in the right positions to place implants and properly support whatever style of prosthesis you want. 

If you don't have enough bone, there are a variety of styles of bone grafts available that can often convert someone who is ineligible into a good candidate, but again, you must be evaluated with a CT scan to determine what you need. If bone grafting is required, you may need to see a specialist like an oral surgeon or a periodontist, and it may add time (4-7 months depending on the graft) to your treatment plan. 

Best of luck!

Edward,

    Sorry to hear about your tooth. That's unfortunate, but it certainly happens. If there is a vertical root fracture, your dentist is correct that they are usually impossible to repair, even with a root canal. Where we disagree though is the 50% failure rate of anterior implants. I'm not sure why he said that, as we do anterior implants all the time and they work just as well as everywhere else in the mouth, but under the same guidelines -- there has to be adequate bone, the design of the tooth has to be correct, your bite should be considered to avoid detrimental forces to the implant crown, and of course patient compliance with good hygiene and avoiding harmful habits is required. 

   Implants typically have around a 95% success rate, so if your dentist is giving you a 50% chance, go talk to someone else be sure. The CT scan will be crucial to determine the correct approach, but if you show that CT to an oral surgeon or a periodontist that places implants routinely, then they should be able to help you. Granted, it is often a process that requires multiple steps such as grafting the extracted tooth socket and allowing it to heal for 3-4 months prior to implant placement. After implant placement you may have to wait another 3-4 months before they're willing to place a tooth on it. If all the stars align then you may be eligible for an immediate implant, which is an implant placed immediately after extracting the tooth. If that goes perfectly, then you can often immediately place a temporary tooth on it as well. All of these things require good planning and well executed surgical technique. I highly recommend a CT guided surgery which forces our drills and implants into the correct position. In the past 7 days I've done two immediate implants with immediately placed provisional teeth because I used guided surgery and spent plenty of time planning the surgery. I am no exception, as there are surgeons doing the same thing every day in every city, so if your guy says it's a 50% chance, I'd say it's time to ask someone else BEFORE you let him pull the tooth. 

   Best of luck with everything!