|
Question:
I have had a fixed 8-tooth upper front bridge due to a car accident in 1975. It took 4 years to get to that point, trying in vain to save the front teeth.
The bone loss has continued over the years and I now have only 7 natural upper teeth remaining, 4 of which are holding the bridge. The bridge no longer meets the gum line, either. My oral hygene is excellent and I have professional cleanings every 4 months. Still, bone loss and pockets around the teeth continue to plague me.
The Periodontist and the Dentist want to do a gingivectomy and disagree on how to then replace the teeth, but both agree it would be quite a construction. I have only a 50% chance of any of this working at all, though the odds may go up a little if I heal very well after the gum surgery.
This sounds expensive, painful and chancey...I have no insurance. Would an upper denture be a better, simpler solution? I am 52 and look 15 years younger. Will this age me? My Dr.s are appalled that I would do this. Please help...I am so confused. ...Visitor from CA
Answer:
I feel for you and I personally must deal with these issues with my own patients on a regular schedule. These choices are never easy and it is important that you have all your choices presented.
Under my care, I would look closly at your present support system (bone level, pocket depth, mobility of existing teeth, etc.) before recommending treatment. I will assume for the moment that your anterior bridge comes from your first bicuspid tooth on the right across to the first bicuspid tooth on the left (8 unit fixed bridge) and that there is some type of problem with the bridge (decay, open margins, loose teeth, compromised esthetics - you said space under brg.).
If you have stable teeth with 50% or more of the roots firmly in bone, I would advise you to invest in saving the teeth and doing a new bridge with
precision attachments in the back to support a removable partial denture or even consider implants in the back if the bone density is sufficient.
If you do not have adequate support bone or they are talking about aggressive surgery and bone grafting to save these teeth, then I would consider an "over denture". In this case, you would save the canine teeth
(longest "I" teeth) by doing root canals on them and placing a small dome over the root to aid in support for a full denture.
This is a preferred choice over taking all the teeth out because by saving these two roots, you will preserve the upper ridge bone and help prevent your midface from collapse. I would construct a "healing denture" to be placed at he time of surgery to give you teeth while you heal. 4-6 months later, I would construct a custom, cosmetic denture to give you the most natural smile possible. These can often be made beautiful and very realistic but be careful to work with your dentist on the cosmetics. Early photos really help.
The cost factor is a reality for most patients and surgery and new fixed work can run over 10 -15K and implants go up from there. The removable
option is often a reality for most patients who live in the real world but I don't want to discourage you in any way from making this investment.
I can assure you that I do many large cases on patients who have modest means and they always feel the investment was worth it. This is a very personal decision for you and your family and you may want to ask their opinion also.
At any rate, if it is predictable, saving teeth is the way to go. If they are giving you a 50% chance of success, I would advise against advanced surgical options. I hope this has helped.
Editorial Staff
Return to Dentures FAQ
Return to FAQ Index
You also have the option of using Google search technology to conduct a specific search within our databases to find more specific information. Use key words or short phrases:
|
|
