Dr. Newitt removed an old, old crown that had failed (different dentist) and let the bone heal after the tooth was removed. After having a 3-D X-Ray it looked like I would be a good candidate for a dental implant to replace the failed molar. I have had lots of dental work with Dr Newitt but this was the most serious work. I booked the date for the work and had many questions which Dr Newitt answered very patiently. Going in for the work on the day of I was very nervous. Dr Newitt and his staff put me totally at ease with their professionalism and thoroughness. I assumed there would be lots of pain and swelling/bruising afterwards but was amazed to experience little to no pain and no swelling! I was astounded as the procedure not only included placing an implant for the tooth but a bone graft as well. Long story short the whole experience was painless and seamless, more than I could have imagined. I give the highest possible recommendation for Dr Newitt and his staff.
The options, as you pointed out, for missing 8 and 9 (upper front central Incisors) would be Implants, Bridge, or removable partial denture. It would help to see how much bone you have remaining, via a CBCT image, to determine how best to approach your treatment. If you have significant loss of bone the area of tooth #8 and #9 then a bridge may also have some issue in time, as the bone may possibly resorb even more. At 21 years old, if a bridge is placed, there is a good chance that that bridge will have to be replaced at some point in your life. At that time loss of more bone may make it even harder in terms of treating with Implants in the future. That being said Dental implants are not without complications both short and long term. As far as your question regarding Implants into the incisive canal - Yes, these canals are grafted on a regular basis and are successful. A large incisive canal would not be a contraindication to doing implants in that area if it is grafted properly. The biggest concern that arises in the area you need treated (#8 and #9) is not the incisive canal, but the aesthetic challenges of having Implants placed side by side. This would have to be determined by taking into account your specific Smile analysis. (your lip position at rest, when smiling, tooth length, Gum display, etc) Placing two implants, side by side, in the most visible area of your mouth can have challenges. The gingival tissue around implants does not respond the same way it does around teeth and you could, depending on your specific smile characteristics, have some issues with final aesthetics if your treatment is not planned out properly. Dealing with Implants in the central Incisor area are one of the most challenging in Implant dentistry and not the same as dealing with Implants in molar areas. Make sure you talk with a dentists with good experience dealing with Implants in Anterior aesthetic cases and get a good understanding of the possible outcome of such treatment. I do hope this information helps.
Great question and there is no one answer for every person. There are many factors that come into play when deciding between the two treatment options. While Implants will often provide the best alternative to replace missing teeth there may be circumstances where Implants are just not the best option. (anatomy, medical status, dental health, Hygiene maintenance, etc) Done properly, Implants can be a wonderful option for replacing your missing teeth. Bridges have their challenges too. To bridge, you need to have teeth to bridge to. In your case the missing 14 could be bridged but the missing 26 could not as you dont have a tooth behind it to anchor to. One of the biggest issues with bridges is that they can affect the teeth they are seated on (abutments). There is risk of blood supply/nerve issues, which could result in the need for root canals on those teeth (unless of course the abutment teeth are already root canal treated and devitalized), and due to the higher level of difficulty in maintaining hygiene under a bridge, they have a higher incidence of cavities (this is often why bridges fail on average after approx. 10 years) Bridges also, do not stabilize the bone where the missing tooth is located below the bridge. So, if in the future that bridge is lost due to cavities or fracture, for example, the bone may not be adequate for an implant without grafting. These situations, of course, are possible risks but not necessarily something that happens to everyone. Without Radiographs (X-Ray films) it is hard to say what your situation is in regards to Sinus grafting. I would assume that the Doctor was talking about grafting in the 26 site as this is the more likely site to have sinus space issues Vs. site 14. The 26 site is where a bridge is not an option for you, as pointed out there is no tooth further back to anchor to. So, your only options at the 26 site are , do nothing at all, an Implant , or a removable partial denture. As far as the sinus lift. Sinus lifts can be either simple or complex. They can be done at the same time as implant placement or done prior to Implants being placed. It depends on how much bone is available. Sinus lifts, when done properly, are the most successful and predictable grafting techniques we have and as long as the sinus has been diagnosed properly and examined with a CBCT (cone beam computer tomography) film (A must!) then complications are rare. At 28, you may still have a fair amount of bone available below the sinus (without a film I can't say for sure) but as time goes by the bone between your mouth and the sinus, at site 26, is likely to decrease. Again, without a film, I can't say what your current Sinus graft situation is but, in general, bone levels below the sinus will decrease (the sinus pushed down) with time and this may complicate Implant placement and increase costs in the future. I hope this is of some help.
Flippers are never the most comfortable thing you can have in your mouth. They are never that stable, strong or capable of providing any form of function (eating). but they should be adjusted so your back teeth do remain in contact during the healing phase. You should return to your doctor to get an adjustment to ensure your back teeth can come into contact. Another option that may be available, and this depends on your situation, is bonding a temporary tooth in the gap. The bond would be to the teeth on either side of the gap so those teeth would have to be healthy enough to bond too ( If there are crowns on the adjacent teeth the bonding won't be an option) A bonded temporary tooth can be a nice aesthetic option that is more comfortable than a flipper but can only be used in certain situations and like the flipper can't be used for biting on. It is meant as a temporary solution and has to be treated very carefully while you are waiting on the Implant treatment.
Once an upper molar tooth has been extracted a 3D CBCT scan is only necessary if you have decided to go ahead with an Implant treatment solution. Generally during time of extraction the doctor will gather enough information to determine the future need for bone augmentation or a sinus procedure. (not always) A simple 2D PeriApical Radiograph will provide enough information to at least get a preliminary idea of how much bone is available Vertically (to the sinus floor) and during the extraction procedure , visual confirmation of the amount of horizontal bone volume. In Implantology we often prefer to prevent the need for bigger grafts by preparing the site to best support an Implant at time of extraction. This cant always be done, especially if there is infection present but if not then ridge preservation procedures are recommended to keep the bone volume maximized until time of Implant. Depending on how the extraction site was prepared at the time of tooth removal (if a graft was placed, or not, and what type of graft) the wait time for a CBCT can range from 3-4 months to 6+ months. If it has been determined that a more significant Sinus grafting procedure is required you will generally end up getting a 3D CBCT scan prior that surgery and a follow up scan approximately 6+ months later. This second scan would be to assess the success of the Sinus graft and plan the proper positioning of the Implants. In dentistry we try to keep radiograph exposure to as little as possible to timing is important on CBCT scans so as to not have to redo them more than absolutely necessary. Hope this helps answer your question.
Since this is a recent treatment it would be best to return to the surgeon who placed the Implant for a solution. Since you have a radiograph specifically of that area, dated1/23/18, then someone has looked at it recently. Did they offer you any advice? The radiograph that you have presented appears to show a lack of bone, greater than 50% around the Implant. This radiographic appear could be due to a loss of bone and non-integration of the Implant or it could be that the Implant was placed in an immediate extraction socket and grafted. The graft material would not show up on the radiograph as dense as the surrounding bone, thus giving the appearance of bone loss. If the Implant is loose then that is a major concern. If it is the crown that is loose then it can be removed and the situation might be easier to deal with. Without all the history and treatment plan its hard to give you an absolute solution over the internet. It would be best to deal with the dentist that has been treating you. If that is bone loss then the Implant will beed to be removed asap as not to affect the bone around the adjacent teeth.
