Please propose a strategy for my mouth. Possible implants, crowns, denture? I'm a GRINDER!!!

I had vert-fract #19 pulled, bone graft added, 6 months ago. My bite changed from it and I broke #31. #31 may or may not need root canal, x-ray says no, pain says maybe. 30 also needs a crown. From my history (grinding, etc), I worry crowns destabilize rather than fixing things. If destabilized, it might delay implant past 1 year bone graft window. What would your strategy/order of work be for me? What kind of crowns? Gold? Does gold make teeth sensitive? How about removable partial for 19?

Doctor Answers 2

Strategy to correct current problems and prevent future problems.

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I would suggest to step back and evaluate actual cause of pain before proceeding.  Tooth pain is often referred from other areas, like jaw muscles especially in grinders and clenchers.  Avoid extracting 31.Gold is the kindest material for heavy grinders and actually self adjust over time.  Zirconia crowns are the least forgiving but strongest materials for crowns.    I would suggest minimally having a bruxism appliance to protect teeth at night.  A sleep study can rule out grinding related to sleep disorders.If I was treating you I might suggest starting with a neuromuscular orthotic to evaluate underlying physiology prior to doing a lot of dental work.

Possible implants, crowns, denture? I'm a GRINDER!!!

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Hi there,
I would do crowns 1st , using  gold or full contour zirconia (white) crowns, gold is the best but the most expensive ones, doesn't cause sensitivity however can cause that galvanic effect (metallic taste, light electric stimulus) if you have metal crowns or silver filling opposed to it on upper right jaw, the full contour zirconia are my 1st choice now days on grinder, because of  they white and are very strong like metal.After i do crowns i'll put you on lower night guard.
Because its already your due,  I would get a CT scan due to check how much bone structure you have for future dental implant, plan for implant surgery, for you i would do at  least 4.5 mm in diameter implant, not thinner than that considering your bruxism. I would do 2 stage surgery, it means implant  would stay under the gum for 4-5 months before making abutment & crown. Good LuckGeorge Sahakyan DDS

George Sahakyan, DDS
Glendale Dentist

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