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

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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

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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.

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