What are my options for having 2 missing lower teeth with lots of bone loss?

Teeth 20 and 19 were pulled in my early 20s (now 37). The Dentist I went to did a ct scan showing there not enough bone to do implants there. Number 21 is missing bone near the adjacent missing tooth making it unstable. My uppers were re-crowned with zirconia last year and am in the process of crowning 9 lowers, # 29-21. Is it wise to remove 21 and 18 and replace with an implant that connect a 4 crown bridge? Would bone grafting give enough support for #21? I don't want anything removable.

Doctor Answers 2

Bridge options

The way I look at it, you have 3 options.  

1. Bone grafting in the #19, 20 areas, followed by 2 implants. Do not remove #21.   

2.  Same as option 1, but remove #21.  Place 2 or 3 implants depending on whether or not you would like individual teeth or a bridge placed on implants.  

3. Do not extract #21, place a 4 tooth bridge from #18-21.  

If that fails at some point down the road (potentially not for quite a while) you can always place implants at that point.

Implants and crowns or bridge

Since #21 is missing bone and is "unstable" it should be evaluated completely for removal.  You say nothing about the condition of #18, so I can not recommend removal of it. Bone grafting by an experienced surgeon can create a suitable site for implants to be placed.  This would possibly allow for a 3 unit fixed bridge to be placed on two implants, or better, 3 separate units could be placed on three separate implants if it is possible to place three separate implants.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.