Dental implant and sinus lift

tonyhamm

When I said regular scaling sessions would not be cheap I mixed up my terms - I have been using the Dentists Hygienst every 4 months for scaling and polishing, but to no avail. I should have said regular root plaining would not be cheap (£350 per quadrant). Other than root planing to remove calculus below the gunline (which my dentist like many doesn't offer) in no way have I neglected maintenance. Yet the periodontal disease has progressed again to where its affecting my health with this one tooth.

Gap: The Consultant Oral Surgeon who looked at the tooth said leaving a gap is an highly undesirable option. Teeth move forwards to close any gaps, and I would be risking my remaining teeth over the long term as they move position. Also the shape of my face may be affected, and I would be chewing only on one side of my mouth.

Denture: A single tooth denture (which was my idea) was surprisingly dismissed as infeasible by the Consultant as she said it would be highly uncomfortable and unlikely to help.

Bridge: She said a bridge is an option though, with the premolar and post molar ground down to support it.

I have checked private prices for root planing and debridement to remove calculus at the root. Its £350 for the molars (I would have to add £150 for x-rays etc), and that £500 would be obviously be a bargain if it lasted more than a year, but as there is so much bone loss its unlikely to be the case.

There may be an option to build up the supporting bone around the tooth, clean the disease out by oral surgery, and give maintenance another shot - thats something I will have to consult about.

tonyhamm

Just to update for anyone going through similar.

I saw a experenced implant dentist for a free consult about implants, because I believed I was better off just getting the thing whipped out and a implant in. But, he said the best approach was to try and keep the tooth, as (after looking at my panoramic x-ray) I would certainly (unless a root hidden from the x-ray had more bone) need a sinus lift + months of healing and complex work to get an implant fitted. Because I had lost a tooth the maxillary sinus floor had come right down (this was a faint white line on the panoramic x-ray) so there was maybe 5mm to work with.

He examined the gums around the tooth, which were tight because I keep them clean, and used a very small probe (not a williams (periodontal) probe) to get past the gumline and feel for calculus. He said he could definately feel something there on the mesial side which may be the cause of infections.

Looking at the bone and periodontal ligament loss on the x-ray, he said there was a new technique available using enamel matrix cells taken from baby pigs teethbuds (emdogain), that could now be used to build up the missing bone around the roots and even the periodontal ligament and is giving excellent results.

I would have to see periodontal dentist for a consult about that (£110 for the consult), but if I had gum surgery to clean out the roots with emdogain treatment to trick the body into building up the bone and periodontal ligament there was a reasonable chance I would keep the tooth as mobility was still less than 1mm. The rest of my teeth were excellent and didn't need any work.

However, I had already lined up a periodontal treatment (root planing) from a periodontal referral from my dentist, after Toothsmith and Brook2jack advised me above to look aggressively at maintenance rather than give up on it.

So, I saw a private periodontal hygenist/therapist (Diploma in Dental Hygiene), note NOT a periodontal dentist (who quoted me £350 per hour), for root plaining this one tooth. It came to about £40 (20mins).

After a pocket probing and bleed index of the teeth was mapped out with only minor pockets (2-3mm) scattered about, the tooth was looked at. The tooths periodontal pocket was only 4mm on the mesial, not the >7mm I feared and had normal 2-3mm pockets on the buccal, distal and lingual. She then root planed the tooth with curettes, and removed quite a difficult piece of calculus from under the gumline on the mesial side.
She explained although the pocket was only 4mm, small tears can occur between the gumseal and tooth which let in infection. And this is prob. where I have been suffering. Now the calculus was gone, hopefully the gums could tighten back.

Hopefully that will reduce the frequent infections etc... but gum surgery is still something I will have to look into. Anyway pretty pleased for now as its the first real treatment I have had in a long time.