Tuesday, September 8, 2009

Bridge vs Implant

Hey all,

Did you see Ric's post on Monday. It was like I was reading my own thoughts.
It was weird. I guess it was the same except for the fact that his was about 400 words and mine are 4000 (I don't want any comments on that). I think he is going to be very funny.

Hope everyone had a good weekend. Friday night my son was playing football and broke his pinkie finger on his left hand.
I keep telling Luke he is like a porcelain figurine.
It can't be because he is going through a growth spurt because he is short.
He does play hard though.

I am going to get right to it today. No fluff.
I was sitting in my office writing up charts, and my father was seeing a patient in the next room.
He came back into the office (we share office space) and showed me an x-ray of central incisal (non-dental people...tooth right in the front) that had internal resorption, and he had it bad.


The tooth could not be fixed. He put up the x-ray on the computer screen we have in the office, and we both knew what needed to happen to this tooth.
So I kind of listened in as he spoke to his patient. And then he recommended that this gentleman get a BRIDGE. I almost fell off my chair.
I would in almost every instance do an implant in this case.
I thought everyone felt the same way I did. At least everyone IN OUR OFFICE.
There would not be a single question on what I would do. I am trying to think of anyway if I lost
one tooth a reason why I wouldn't get an implant, and I can't think of one.
So my dad came back into our office and I said, "If you lost #8 you would tell me that you would want a bridge?"
He said, "Yes."
I was shocked. I said, "Why?"
He said a couple of reasons. He has just finished a case where the patient was trying to replace #8 and two implants failed in that spot. He eventually just went and did a bridge. So this jaded him.
Then he said he wouldn't want to wear a flipper for 6-8 months.
(I guess I have to preface all this by saying that we don't do immediate loading implants.
We don't trust them. Our periodontists don't trust them. I am not saying that immediate loading
implants are bad or wrong. I am just saying we don't do them. )
So these two thing, the flipper and past failures in this one patient, would be enough to have my dad prep #7, 9 and, 10.
I was speechless. I have always looked at the end result of NOT having to prep his virgin teeth and the ability to floss and the long standing success of implants as an overwhelming reason to go with the implant option. I have always looked past the misery of the first 6-9 months.

So my father told this patient the pros and cons of both. But most of the time they ultimately will ask, "Well, what do you think?"
Or in the way we present the pros and cons will sway the patient to your opinion (you know you do it). So basically it is going to be our decision.
This is kind of a harsh reality for me. I didn't think I ever thought much different than the majority. I make most of my decisions thinking that if 10 dentists were doing this 8 of them would agree with me. I know, I know, this is crazy thinking, but maybe it just makes me feel better.
The reality is for me that I have to educate myself. I have to know everything. I have to be armed with the knowledge of everything out there to better treat the person that says, "Well, what do you think?"
I have to think that I have. I have to think that I know most of the things going on out there.
I am not talking about doing all things that you know about.
I am not about hearing about a new thing and jumping in with both feet. I am about knowing about it, reading about it, and listening to the pulse of the dental community about it. That is what I am talking about.
Never has it been so clear.
We have a tendency to get in ruts.
You know you just go through the day practicing dentistry and the next thing you know you haven't been to a CE class in two years. Then you realize you have been using the same products for 5 years and don't even know what is out there.
I don't do this, but I can see how I could. I am using a product that really works. I hate changing. I hate using the "new" stuff and it not working. So I don't even want to know what is out there.

Okay back on track...
So my father's patient said, "Well, this has to be done so let's just schedule that extraction and bridge."
As he came back to the office, we talked about this point. The point that a patient is usually going to do what we think is best.
(My father said that he has recommended a bridge before and the patient still went with an implant. This brings up a whole other blog. What do you do if a patient wants to do something you don't recommend?)
I told him he should call his friends and see what they say.
I think I am in the majority on this one.
So I would like to hear what you would do. #8 internal resorption and the tooth can't be saved.
What would you do? Implant or bridge.

Let's end it here. If I get enough responses then we will talk about it.
But just don't say IMPLANT. Tell me your thoughts.
If you are a non-dental person, tell me what you would want and tell me your reasoning.

Have a great Wednesday,
john

ps Along the CE lines. I am going to the Florida Academy of Cosmetic Dentistry annual meeting
this weekend. Thursday is a photography lecture. Friday is John Kois all day. I am really jazzed about seeing him. I have probably seen him 4 times. One thing I hate is the first hour of this is the peridontium, to bring everyone up to speed. Then on Saturday, John Cranham all day. He is very good, also.

31 comments:

CAM said...

My practice is in Vaughan, Ontario,. About 1hr north of Toronto. I have a couple of thought. First, I agree with you that my first choice is alway the implant to conserve health tooth structure and indepently restore the tooth. Second, is like to look to a reason that I should not go with my first option. I the case of one or especially two centrals the reason would be extensive bone graft to allow support and improve cosmentic (support does not seem to be an issue). Cosmetics might be though depending on the smile line position. I would argue that in a highly demanding patient with a high lip line that the cosmetic outcome is more predictable with the bridge so that might sway me. Lastly, if a patient just cannot bare the thought of the implant process and understands the potential side effects of the bridge, I would do it (although with guilt.

No questions though, the implant option is always number 1 until proven otherwise.

Michael

Anonymous said...

I am a general dentist in KS. I graduated 8 yrs ago. I'd also go with an implant for the patient (and myself if I were in that situation).

Maybe you can post the results of your "survey" in a future blog to see where everyone stands.

Connie said...

You asked, "If you are a non-dental person, tell me what you would want and tell me your reasoning."

What the heck is a flipper? I'm not even entirely sure what a bridge is - does it stay in there always, or do you take it in and out like a partial denture?

Obviously I'm a non-dental person, I have no clue.

Overall, I would want a permanent result and a good cosmetic appearance. If implants "take" do they last forever or are they like veneers and need to be redone 10+ years out? I would rather have a "permanent" tooth than an appliance that has to be taken in and out and has metal on it.

I'm guessing I'd want an implant, but I'm pretty ignorant as to the pros and cons of the two choices.

toothdoc said...

Virgin teeth on either side, no bone loss or other implant contraindications, the patient is going to have to talk me into a bridge. That said, I always present both and the risks/short-term and long-term consequences of each decision.

Anonymous said...

I would definately recommend an Implant. I tell patients Natural tooth is best. Then Implant.Bridge is next. Partial. Then last is nothing. John Please tell your Dad That the standard of care to replace a missing tooth is an Implant According to The Florida Board of Dentistry. It Must be offered as an option. The patient can certainly decline the implant option, but it must be offered. There has been a case where an eighty year old person was not offered an implant as an option and the dentist was found negligent by the Florida State Board of Dentistry and discplined for it.

Over the last year I have been working with a periodontist and restoring the implants after 3-4 mths. So far so good. I have done more implants cases in the last year than my previous 14 combined.

Anonymous said...

Usually, when I go over the 3 options: Implant, bridge and partial, partial is usually rejected rather quickly by the patient because it is removable. They usually want the implant, because the other teeth will not be effected, UNTIL they find out that their insurance doesn't cover implants. Yes, the cost of a single implant is roughly the same cost as a 3 unit bridge. But 0% from the insurance company vs. 50% makes a big difference. Especially now.
Denise

Anonymous said...

I am a DDS, 2 years out of school and I would absolutely recommend an implant in this case. If this were my tooth, I would want an implant. Also, I didn't think that laterals were ideal abutments anyways. If this is a relatively young person and your bridge work last ~15 years, he could be looking at 4 + bridges in his lifetime. I would definately rather wear a flipper for 9 months and have an integrated implant in place forever. When you consider the lifetime of the respective restorative options, a successful implant would appear to be less in the long run.

sharpiemarker said...

[Question: When you say you guys don't load immediately, you still do place immediately and cover with healing abutment or whatnot? Or would you extract, socket graft (or not) and wait for bone and implant?]

[Connie: a "flipper" is what some people call a partial denture, or RPD. Basically you take it out pretty often to clean up, and they do get nasty. The bridge is cemented into place after the two teeth next to the space have been prepped.]

OK, what I think: (I'm gonna try to not write a dissertation on this, just a comment...) My background: well I'm down a lateral (10, but I have 7, its unilateral and congenital but I had the baby tooth) and today I am two weeks out from getting implanted there! I also LUV teeth and want to go to dental school. full disclosure on my blog.

My opinion: IMPLANT!

my reasoning and rebuttal to the bridge people (from both a patient and under/misinformed dental wannabe :D):
1--esthetics: what happens when you bridge that and later the bone just goes and you've got a pontic that is no longer ovate? wouldn't the tissue just melt away from the margin of the pontic in time, and if you wanted to keep things looking 100% you'd have to graft something there or make the pontic longer? (I may be 100% wrong here, but I would want the implant in there keeping the bone if it were me)
2--longevity. I think this is pretty much a given, I don't need to argue it, right? Implants WILL last longer once integrated, and integration is so easy nowadays (apparently, huh?). I'm sorry about your dad's past failures with this spot, but I think that has jaded him a bit much IMHO.
3--the flipper issue: yeah, wearing a flipper for like 8 months will kinda suck. I KNOW, I DID IT! I was wearing this: http://implant-adventure.blogspot.com/2009/04/some-pictures.html . Yes, it sucked. But I got over it, made some bad jokes when it broke and I had to be edentulous for a couple days when it got sent back to the lab, and I had a couple little mini heart-attacks when I dropped it in the bathroom, but I got over it for the greater good! It just takes willpower, really. heck, now that I have an open palate, things taste better, feel better, and I get a little reminder of being freaked out every time I got to brush and I don't pop out my retainer-- I think, "oh crap, wheres my tooth?" two nano-seconds later: "oh yeah, in my mouth... right *smile*" it's doable.
4-- the virgin teeth issue. I thought you guys thought they were way more sacred than that, huh? :)
5-- this guy looks like he has plenty of bone, no? So it would be as much of a slam-dunk as you can get in the anterior mandible, right?

Okay, that's just all I thought of off the top of my head, I'm sure other people can say more or rebut some of these reasons. I'm getting long so I'll end with a story:

Back in the '90s, when I had my very first pan at the pedo and they figured out I was down this guy, my pedo told my parents to start saving the money for the implant that I would need then. (They were expensive then) A bridge wasn't even part of the equation, and really hasn't ever been a viable treatment option for me. Just thought it was funny that in the '90s my pedo thought that. okay, enough from me. Thanks for asking this awesome question, Dr. G! Have an awesome time this weekend, I know you will learn a lot.

Anonymous said...

hey john,
quickly, i do agree with you that the implant option in most likely the "best"option, especially in this day and age of implants, and patient acceptance of implants. but, i do say that i end up doing plenty of bridges in areas that could be better served with implants, simply due to patients choices. my patient base does not have the highest dental IQ, and cost of treatment is very important to them. therefore, i don't lose too much sleep if they choose an option that is perhaps "second rate", i just concentrate on doing as good a job on the bridge as i can. also, realize that i DO present all patients with the OPTION, even if it is not likely that they will go for it.

jamie

gatordmd said...

Jamie,
In my town, usually the implant is a slam dunk, because the two fixed options are the same price. So I am interested to know why so many people in your practice choose bridges. Is it not the case in your town?
Let me know,
john

Anonymous said...

Most insurances dont cover the surgical implant placement or abutment. I believe that the portion the patient is responsible for is less with a 3 unit bridge than a single implant/abut/crown.

Anonymous said...

Hi I am just hoping that someone can help me out here. I had a root canal done about 16 years ago on my number 30 tooth, but about two years ago they realized that my root canal was done wrong. It wasn't completly filled and there was remaining pulp. I had a second root canal done about a year and a half ago, then a crown. I had just found out that there was another problem. Apperently my root canal was cracked right in the bottom almost center of the tooth, between the roots. Under that was a large hallow spot full of puss in my jaw. He told me that they would take care of fixing it but the tooth had to be removed. After he removed the tooth he told me that it would be best to get a bridge. He said that implants are hard to take care of and have no guarantee. He never told me that they have to grind down part of my other two teeth! I guess what I am asking is should my dentist have to give me a implant at his cost if he said that they would fix it? And since he never explained this in full detail the pro's and cons before extracting my tooth? Thank you!

gatordmd said...

I want to answer all your questions. I have to be careful to answer them with out throwing anyone under the bus.
You had a root canal that lasted 16 years. To me that is a successful root canal. It is also my experience that if a root canal is successful it is going to stay successful until something happens. What I am saying is root canals don't fail after 16 years. So something must have caused the root canal to fail. Like it cracked or decay got under your old crown.
That being said, when I see a long standing successful root canal fail, a red flag goes up. Have I tried to re do root canals that have failed? Yes. Do they all work out? Definitely not.
So the tooth is going to be lost or is lost.
If you read this post and the commnents you would know that the majority of dentists (at least the ones that read this blog) would recommend the implant.
As far as what your dentist should do...hmmm that is a tough one. I think if he does anything to help you pay for the next thing, whether an implant or a bridge he is doing over and above what others would do. Even if it is $50. He has done his best to help you with YOUR problem.

Last thing I would suggest is going to an education site likes the AGD's public site www.knowyourteeth.com which has a ton of patient information you can reference as well as a forum where you could ask these types of questions: http://www.knowyourteeth.com/dentaladvisor/forum.asp?FORUM_ID=4

I hope that helps.

Anonymous said...

I'll try to keep this brief. I'm a patient, not a dentist. But now know more about dentistry than I care to.

Lost my two front teeth in an accident in grade 3 - just after adult teeth had grown in.

Had many flippers - talk about embarrassing when you're in grade 5.

Finally, was able to progress to a bridge.

My dentist did not explain the pros/cons of bridge v. implant. He basically said, it's surgery and we put a screw in your jaw. OR .. you have something similar to your parial but it is fixed. That was it. We're talking 1994.

15 years later - right on schedule - the bridge failed b/c of resorption on one post. Of course now I am dealing with 4 teeth to replace, b/c of the bridge grinding down two good teeth on either side.

There's no question, in my mind, that implants would have been a better solution for me *if* I had been properly educated about it.

Was my dentist not an early adopter? Was he more comfortable doing bridges? I went with what he suggested and was delighted to have something permanent in my mouth and flipper-be-gone.

Now I am faced with dentures, implants or bridge-supported implants.

I met today with the dentist and surgeon and am choosing between 2 implants and 4-unit bridge, OR 4-implants and 4 separate crowns.

I will opt for the 4-implants and 4-separate crowns. I don't care what financial sacrifice will have to be made. I want something that will last me, a long time, and not risk more bone resorption in that area.

I do have a question:

The first perio I consulted wanted to do removable denture (fixed on implants) with gums portion (as part of denture) to support my upper lip.

Now I am using another perio and dentist and will have separate implants and crowns and minor gum surgery over the crowns (so they look more natural).

How important is the support for the upper lip - and how would I know if I am a candidate for it?

I just turned 50 and don't want to look old before my time by having my upper lip pinched and lined, especially after the expense of having multiple implants.

Thank you for any help/advice you can offer on this.

--- > The point of my post is to say that I was not well-served by being given a 4-unit bridge. It's likely two implants would still be in place, I would have lost fewer natural teeth and wouldn't be spending a year of my life researching, trying to find palatable options - not to mention the additional expense. Plus, the bone loss/resorption under the bridge where my two front teeth used to be.

I hope this doesn't sound angry. I am frustrated and disappointed but my comment is not meant as a rant against dental professionals, simply a view from the other side in terms of the bridge v. implant question.

gatordmd said...

Okay,
I feel your frustration.
A couple of things I was thinking when I was reading you comment.
#1)15 years ago implants were not really in vogue like they are today. In fact not many people were doing them. I think a dental practice back then would maybe see one or two implants a year and that certainly wouldn't be in the "esthetic zone".
Today we will see 50-100 implants a year in my practice.
So don't be so hard on your last dentist.
Here is the deal with the number of implants. In the esthetic zone it is very difficult to get the gum tissue to look natural with implants. The triangle of gum between teeth is like the "holy grail" of esthetics and lucky for you they say that if you do implants on the lateral spots and put pontics on the centrals or do central implants with cantilever pontics on the lateral, you have more of a likely hood of creating that gum triangle.
Now about the bone grafting...you do that not as much for lip support but to put the bone and tissue in the place it is suppose to be for esthetic reasons. Yes you can have a pretty good concavity up there if the teeth have been gone for such a long time and yes this does cause some issues. I would think you would need some bone there anyway to create enough thickness in your bone for an implant. That should be enough to support your lip.
Any other questions let me know.
John

wisepeppy said...

I lost my #8 when I was kid due to an incident with a bicycle and a curb. My dentist gave me a temporary bridge by simply cementing my old tooth between my adjacent teeth - this broke frequently and required numerous return visits to the dentist to repair. When I was old enough (~16?) my dentist gave me a "permanent" bridge, which I now realize wasn't a real bridge at all. He built a 'bridge' that had 'flaps' that cemented to the sides and back of my adjacent teeth, without ruining those teeth. This bridge lasted me over 10 years until I accidentally bit into something hard while chewing and it broke the 'tooth' free from the 'bridge' behind it. At that time I opted to receive orthodontia, and now have a retainer with a pontic attached to fill the void. My current dentist recommended an implant and referred me to a surgeon. He indicated that I'd need to start with a bone graft, followed by 4-months of healing, then the implant, followed by 4-months of healing, and finally a crown fitted by my dentist. All this, and I'm convinced this is the way to go. My insurance, however, won't cover one cent for an implant, but would cover 50% of bridges. Everything I've been told or read tells me that I don't want a bridge at age 30, and an implant is the way to go, but I really can't afford it - I'll probably end up wearing my retainer-with-pontic until I can save up enough for the implant. I'm disgusted that insurance won't cover even a portion of what is clearly the superiour solution to the problem.

Anonymous said...

Just recently down #8 myself, for reasons entirely unknown. It looked pretty much exactly like this - http://www.scielo.cl/fbpe/img/ijmorphol/v27n1/Pag228Fig_1.jpg - by the time the pink started creeping down below the gum line and alerted me to go get it checked out.

I elected to go with the implant, so right now I'm just beginning the bonegraft-wait-post-wait-crown plan.

For me, not having one of my front teeth for 8-12 months is unfortunate (certainly won't help me in job interviews), and paying every cent out of pocket even more so (although I am happily in position to be able to survive this)... but, being 24, and having my teeth in otherwise excellent condition, it is a small price to pay for the convenience of the ultimately more permanent solution of an implant.

For me, it really boiled down to, as you say, looking "at the end result of NOT having to prep [my] virgin teeth... past the misery of the first 6-9 months."

Heidi said...

I know this is an old blog post, but I just did a search on bridge vs. implant and this was the first hit.

I'm a patient, 43 year old female, healthy. Just had my first ever extraction (well other than wisdom teeth and others for braces as a kid) and I'm so upset about it! Apparently when I was 15 some dentist gave me a root canal (tooth #19) and used something called silver points or silver tips? Well, anyway, it went bad and a couple years ago my endodontist tried to save the tooth by redoing the root canal, but a year later it went all bad and had to be pulled.

Of course I want an implant!!! I don't want to ruin my one virgin tooth next to it, and the other one behind it is not virgin but just had a very nice new crown put on it last year. Also, I know implants, if successful, will last me forever! While a bridge lasts, what, 10 years?

But for me, a low-income person, the cost is a HUGE factor. I have to take out a loan to get this done. My insurance company (Aetna) will cover none of the implant, and none of the custom abutment and placement of the crown. They will only pay something like $400 toward a stupid GOLD crown!! So, for an implant and porcelain crown (and abutment, yada yada) the cost to me is somewhere around $5,200!!!!

While the cost to me for a bridge is only around $1,500 since my lame insurance company will pay half of a bridge.

I am devastated! I really don't want to get a bridge for all the reasons you all mention here. But paying off a $5,000 loan will take me a long time and what if more dental problems arise? Or other emergencies?

I guess I'm just venting. I don't know what to do. I hate being poor. And I hate that good medical care is so expensive and that lame insurance companies who make tons of money off of our premiums refuse to pay hardly anything!

Well, thanks for listening.
Heidi

gatordmd said...

$5000 sounds pretty steep.
Here in sunny central florida it would cost about $3800.
I have a couple of suggestions.
First, all the money doesn't have to be up front.
You can get a bone graft and then wait. I am talking you can wait years to get the implant. Then you can get an implant and then wait (once you get the implant you can wait years to get the tooth on it).
Then when you have save the money then you get the tooth on the implant.
But if this process is going to take over a couple of years, you don't want your teeth to shift.
I would get a "suck down" retainer to prevent your teeth from shifting.
So the teeth won't shift and you can take 3 years to pay for it....now doesn't that sound better.
Your dentist should have tried to find ways for you to afford it and talked you through it.
Talk to him or her and tell them your dilemma.
Hope that helps,
john

Mark said...

Great blog!!

I never received my permanent primary lower left, or right, second molars. I hung on to my right side baby tooth until the age of 23 and I promptly had a bridge put in (which I now regret having two "virgin" teeth prepped at such a young age, but hindsight is 20/20). I am now 33 and my baby tooth on the lower left side (#K) has 1 root left and a small infection. My dentist recommended that I have it removed by an oral surgeon because the teeth on either side have slightly leaned up against it and he's concerned that the baby tooth will need to be cut in half to be extracted. After reading this blog, I am not thrilled about another bridge at the age of 33, but do not want to go through the implant process for a tooth that can't even be seen when I smile. Are there any drawbacks to removing the baby tooth and leaving the space there? Will my teeth drift and look all crazy in 10 or 20 years? Money is not a factor in this decision as I can afford to get an implant. I am more concerned with the long-term outlook. Thanks in advance!

gatordmd said...

Mark,
Great comment and I will try to do your question justice.
The short answer is maybe.

Bridge or implant....A guy your age, to me, should always have an implant. Leave the adjacent teeth alone. "The process" you talked about is really not that big of a deal. If it is going to be a big deal then go get another opinion because it should be very simple.
Placing an implant should take about 20 minutes with almost no pain afterwards (unless there is bone grafting involved but still that is not that bad).
As far as not doing anything...
If you were my patient I would say that I would recommend you replace the missing baby teeth. Most of the time teeth will shift. The upper tooth is going to come down into the open space. The teeth adjacent to it will drift into the space (more like lean into the space).
This doesn't always happen but most of the time it does.

So IMHO....just do it.
john

Anonymous said...

I'm a 62-year-old female who just found out my upper right molar has to come out due to cracks. I believe it's #3. The endodontist and oral surgeon are recommending an implant. One tooth next to it is a virgin and the other has a small filling. I would also need grafts as my sinus cavity is large (who knew).

I am torn between an implant and a bridge - hearing pros and cons from friends about implants. Is my age a consideration? I have people tell me don't do it. I am a wreck thinking about this. Please advise.

gatordmd said...

Dear Anonymous,

Stop worrying. Implant is the way you should go.

You are right about the adjacent teeth, that is a big consideration. If it was my mouth I would not want to mess with them.

Look I am not going to get into all the pros of an implant.
Lets just say it is the best way and leave it at that.
Now saying that, it is the longer of the two processes.
Yes, the sinus lift/bone graft is going to be a pain but like I said it is the best.
Age, no, not an issue. You are 62, a dang spring chicken at my office. I had a 90 year old insist on implants a couple of years ago. So we did 5.

And with implants, with very few exceptions, they don't fail.

Now if you trust your dentist and your oral surgeon, then just do it.
Stop worrying.

And if you want to write personally, I'm at Jgammichia@aol.com

Anonymous said...

I had the upper left first molar #14 removed after infection and have decided on implant. I am 70 and don't have enough bone so i had one bone graft which supposedly is ok - or borderline - because the two quotes from my surgeon were for 1) sinus bone graft and specialized dental implant (the screw is longer and goes into the sinus?) done in only one visit or 2) 2-visit procedure also w/sinus bone graft but with a basic dental implant . Option 2) is $1,000 less - because the screw is shorter? Money is a big consideration but so is not having to do this again in 10 years or so. Also, i'm a bit wary of the longer screw going into my sinus cavity. Which option is better?

gatordmd said...

Anonymous,

Please email me because I have tons of questions for you and it would be much easier for us to communicate that way.
Jgammichia@aol.com

Robyn said...

I am a 55 year old women with non curable ovarian cancer. My top left front tooth has had a post and a crown for many years. Now the post won't stay in and keeps coming out with the tooth and I have it glued in for two weeks, then it comes out again.
Not knowing whether my life expectancy goes beyond another 12 months (unlikely), I wonder what to do about an implant verses a bridge, or just a denture, or just some new glue every few weeks?
My dentist seems to think an implant would be best, but it sounds like I might not even make it to the end of the procedure. The cost is a big factor too!
What do you think?
Robyn, Australia

Anonymous said...


Robyn,

This is John Gammichia. The writer of this blog. I would love for you to email me. My email is Jgammichia@aol.com.

I have some ideas that might save you a lot of time and money so also you can think about other things than your teeth.

Talk to you soon,
john

Anonymous said...

Robyn,

I am sorry to hear about your cancer and I am also sorry you are having an issue with your teeth.
I have some ideas I would like to talk to you about.
Can you please email me at Jgammichia@aol.com.

I have some ideas that might save you some money and some time.
So you can get back to thinking about other things more important.

Talk to you soon,
john

Anonymous said...

I would go with the implant. But there are financial issues for me. As everyone has said. Most insurances do not cover dental implants.

My #22 has been impacted since I was 13 and my general dentist wouldn't acknowledge it and my parents didn't believe me when I told them I had a lump in my gums. My #23 has had the root popped out of the jaw bone due to trying to pull up #22 with braces.

My orthodontist gave me the option of 2 implants or a bride, or a partial denture. Being faced with this option didn't help me. A dentist can offer implants as an option but if you told me it would cost up to 10,000 dollars. 2965 for teeth removal, sedation, and implant placement as well as a bonegraft. 5000 for the implants (titanium screws) and possibly 3000 for the crowns that attach to the abutments. Of course I'd love an implant, a ton of working class people would love an implant. But no one can afford it. If you want everyone to have this option, make it more affordable or advocate for insurances to start covering it. No one wants a bridge, I'm so scared about the detrimental effects it will have to the other teeth of mine... - Sincerely a broke dental assistant.

Anonymous said...

I'm a 48 year old man and had my molar on the lower left (2 in front of the wisdom tooth) removed almost a year ago. My dentist is recommending a bridge because the surrounding teeth are far from pristine. I don't have any medical issues so the implant option is available to me.

Is it better to go with the bridge since the surrounding teeth have several fillings or go with the implant and possibly have to have addtional implants on the surrounding teeth in the future?

The cost between the 2 options seems pretty close so I'm more concerned about the future.

Thanks,
Rich

gatordmd said...

Rich,

Sorry it took me so long to respond.
You are young and healthy and seem to have a High dental IQ (thats how we like to say it in the biz).
All I have to tell you is that I would be getting an implant.

Having a tooth adjacent to this area with a "several fillings" does not constitute a problem.

Now perio dz or a broken root...that is a problem.
Go with the implant.

Have a great Holiday,
Write me if you ever need anything else.

john

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