27 year old. Upper front tooth - gum and bone loss, right treatment choice? (Photos)

Question

Three years ago, I faced gum recession between front teeth, I went to a dentist and he put some filling (photo1). Two months ago, I felt pain with cold drinks and the gum swelled that I went to a periodontist. After CT scan, he said my bone loss is severe and gave me two options: a) toothextraction+implant or b) rootcanal+deepcleaning+splinting. Since I don't want to lose my tooth, I chose B. He mentioned due to severe bone loss, he wouldn't recommend a bone "powder" graft. Is my choice correct?

Kourosh Maddahi, DDS · Answer

Hi:The options that you were given by the periodontist seem to be the correct options.  I am wondering why do you have gum recession and severe bone loss mainly in the front tooth?  Secondly, is the bone loss continuing and effecting the adjacent teeth.  If the answer is yes, a more aggressive treatment such as extraction, bone grafting and implant might be a better long term choice.Best,Dr. Maddahi

Jonathan Shainhouse, DDS · Answer

A periodontist is a specialist of the gums and its surrounding bone structure whose opinion weighs great value. It's important that you recieve multiple treatment options with the risks and benefits of each procedure. With that information you can make an informed decision as to the best treatment for you. Recession alone would not cause the symptoms and bone loss you suggest. Did the tooth ever have exposure to trauma?  It is possible the filling to cover the root may have caused pupal damage leading to apical periodontitis and bone loss. A root canal would be the treatment of choice to save the tooth. The gum recession could be treated by removing the filling and performing a connective tissue graft to restore the lost gum tissue. Maintaining a tooth is often the best route. Single Implant placement in the anterior esthetic zone is often a difficult and challenging procedure to achieve great results.

Gary Braunstein, DDS · Answer

I think you made the right choice since you want to keep your tooth.   To make sure the bone loss remains under control, you should see your periodontist or general dentist every three months for periodontal maintenance  cleanings.  Unless your periodontist is able to regenerate bone around your tooth, you will continue to have a gum deciciency and a cosmetic problem.  Again,  if you are satisfied with the result that your periodontist  can achieve for you, then you have made the right choice. If at anytime you decide that you are unhappy with the result, you can always revisit the choice of extraction, bone and tissue graft, implant, abutment, and crown.

27 year old. Upper front tooth - gum and bone loss, right treatment choice? (Photos)

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27 year old. Upper front tooth - gum and bone loss, right treatment choice? (Photos)

Answers (3)

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