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Question:
One year ago my front right tooth loosened. After surgery to scrape and clean under the gums I continue to experience problems. I am getting a conflicting opinion between 2 specialists and my family dentist. One recommends bone regeneration and implant, one recommends bone grafting and implant and one recommends a partial. All recommend pulling the tooth.
I have bone loss down 70% on the root surface. One stated that the supporting soft tissue has failed. The tooth is currently anchored to the other front tooth, which unfortunately has caused some loosening in that tooth also. I have asked why (if my tooth itself is ok) a bone grafting procedure cannot be performed around the existing tooth to stabilize it. I understand that I would need a tissue graft because of recession after this procedure.
I have read that a protective membrane can be placed around the graft to protect against infection. Why is this not a viable solution? It seems that I would have more area to be filled if the tooth was pulled. I am VERY concerned about esthetics after this procedure.
My teeth look great now and I know that implants while better than most still do not always look normal. In addition, I bleach my teeth every 6mos to a year. I do not want one tooth to always be a different shade. Are there any implants available that react to bleaching? Any information you can provide about why the tooth must be pulled would be appreciated. ...Visitor from OH
Answer:
With 70% of bone loss this is a large amount of bone loss and the problem with growing new bone around the tooth is that you must also grow the attachment of the periodontal ligaments to the tooth with it.
Also there is less surface to grow with as to the fact that the tooth will not regenerate bone on it's side. If the tooth is extracted then the bone will fill in and new bone can be grown or grafted to the existing site. The implant will then be placed in this new bone. Without the tooth the bone has
the ability to fill in within all of the sites 360 degrees around.
The bleaching process will not lighten the implant crown, I would recomend placing veneers on the adjacent teeth to match the porcelain and the look of the teeth. This will also have the added benefit of not having to bleach your teeth. You would be able to make the teeth any shade you like and can change the shape if you like.
John Purpura, DDS
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