Thursday August 2, 2007 

Dear Dr. Mady: I got elbowed playing Volleyball about 20 years ago. A year later my front tooth turned dark and I had to have a root canal. The root canal failed about 3 years later and an abscess formed and I had to get the tooth pulled. Now I wear a device called a flipper and I am sick of it. I keep breaking it when I bite into things and I have fallen asleep on train rides and found it on the floor. I saw a dentist a few years ago and he wanted to shave down the teeth on either side of my missing one and make a bridge with a false tooth in the middle. He said this was a good option. I did not go for it and here I am still with this flipper and I wanted to know if there is anything else that can be done. Over the years I have heard about teeth being planted, but always thought it would be too expensive. Is this an option for me?—James in Manhattan


Dear James: This may certainly work for, but you have to see your dentist for a consultation. There are a lot of factors that have to be looked at. These include your overall health, the amount of bone left at that front tooth extraction site and the condition of the rest of your teeth. There are many other things also that your dentist will look at and evaluate.

I can understand what you are saying about wearing a prosthesis like a flipper. Even though flippers, removable partial dentures or complete dentures may be an inconvenience, the worst thins about them are not often perceived by those who wear them. Also, many still don’t have knowledge about other advanced treatment options that are now available.

As I see it, your options now are no treatment (stay the way you are), replace the flipper with a fixed bridge or an implant. If you researched the fixed bridge previously and declined that as a treatment choice, then the implant is definitely the way to go as long your dentist determines you to be a candidate. They are sensible and healthy because they can stimulate and maintain the bone in that area, just like natural teeth do. Chewing forces can be restored as time goes on, allowing you to chew much more naturally than with a removable device.

Because an implant is technically a root, when restored, they look and feel like regular teeth and can tremendously enhance one’s personal appearance, especially in the front of the mouth. An implant can give you the security to smile, eat and speak without shame. Some individuals can have an “immediate implant” placed at the time of the extraction as long as the surgeon can get sufficient torque in the bone to insert one. Many love this because they walk out of the office without a partial and the bone in the extraction site is maintained and does not get a chance to shrink through natural healing when no root is present.

In most implant cases, the implant is placed and after a sufficient healing period (today it is 3-6 months), the jaw bone goes through a biological union with the specially coated titanium threads. After that healing process, specially fabricated restorations are attached to the titanium posts. The restorative phase is quick and much simpler that a normal crown restoration on a tooth.

Dental implants cost more than a fixed bridge, but the gap between the prices has decreases tremendously over the past several years. There is not a lot of difference in cost today between the bridge and implant for replacing a single tooth, but people get scared when they hear the word implant. They are not just for the rich and famous anymore.

In addition to being reasonably priced, they have a success rate today of around 98 percent. Also if the implants are used to support dentures, the longevity is greater because implants help maintain bone density and strength. Without them, denture wearers experience shrinkage looseness and the need for costly relines.

As time goes on, there are there are fewer and fewer cases in which oral surgeons cannot place implants due to lack of bone in the desired location. This is because of newer techniques and materials and more experience with tissue buildup and bone reconstruction.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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