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Question:
Mobile Tooth: I have been diagnosed with Peridontitis, however, it has not affected all my mouth.
I have a front tooth which has been badly affected. It has become rather mobile, and I have suffered from absesses in it. I have severe bone loss around that particular tooth. Would it not be
possible to have bone grafting, and save my own tooth?
I have been told that an implant would be best, but as my tooth is still very healthy, I believe that there is nothing better than keeping your own teeth where possible. ...Visitor from Republic of Malta, Maltese Islands
Answer:
I agree that when possible it is best to save your natural teeth. However, from the information that you provided it sounds like it may not be possible.
When periodontal disease progresses to the point of an abscess, much of the alveolar bone which supports the tooth has been destroyed. This exposes the root of the tooth to the bacteria which is normally present in your mouth.
The classification for describing the effects of bone loss falls in two categories. Horizontal bone loss and vertical bone loss.
Horizontal bone loss is present when a patient has generalized periodontal disease that affects all of the teeth. This is characterized by patients who look like they have "long teeth" where the roots are/may be exposed. Grafting will not work in these cases.
Vertical bone loss occurs surrounding an individual tooth. There are additional subcategories which involve the number of "walls" the defect has. For instance a "one wall defect" has a "crater positioned against the root.
One wall defects respond favorably to bone grafting procedures. The tooth root surface is meticulously debrided and cleaned. The bone graft material is mixed with platelet rich plasma. Next the grafting material is placed to fill in the "crater." Finally, a barrier covers the graft and the gums are closed over the site. The barrier helps to prevent the gums from growing into the bone graft.
In order for a bone graft to be successful, it needs two things. The first is a blood supply. The second is primary closure with no tension. This means that the gums have to come together without having to "pull" on them.
One walled defects are generally successful because the grafting material is receiving a blood supply from five sides (every where but the tooth). As the number of walls of the defect increase the success rate decreases.
If you would like to save your tooth you would need to have the following treatment performed:
- First, a root canal would be necessary to eliminate the abscess and allow th infection to heal.
- Next, the tooth would have to be splinted to the adjacent teeth to prevent mobility (grafts will not work if the tooth is moving).
- Finally, guided bone regeneration (the above described procedure) would be required by an experienced surgeon. Even if you went though all of the expense of these multiple procedures, it may fail.
If you elect to have the tooth extracted and an implant placed, be aware of the following. In order to have the height of both of the central incisors be the same a skilled implantologist should be involved. Otherwise the esthetic result will be compromised.
Chicago Metro Cosmetic Implant Dentist
Teeth In An Hour - USA
Daniel Marinic, DDS FICOI
2611 Broadway Avenue
Evanston, IL 60201
(847) 475-8700
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