Unusual case-will an implant help?

[squarebull]

Hey, Ok I will try my best to explain the case, as I need advice from an Implantologit/dentist...

I have had two teeth missing at the left side for year, and had a bridge fitted years after the teeth came out. The gum has receded inward but not upward, so there is a crevace/ dip across the gum o the cheek side where the roots would have been. The problem I have with the bridge is that it seals this dip / crevace and when I talk it creates a suction/air bubble situation with the inside of my cheek and the crevace. I have tried making a gap beteen the bridge and the gum to release air, with limited results. I am really tired of this problem as every solution to it seems to present other problems. I have had a cat scan and there is enough bone for implants. But my issue is, two implants would no doubt produce the same result as the bridge. But I do wonder whether one implant would help - I mean take out the bridge and only replace one tooth (nearest the front so my smile isnt unsightly) and have the other as a gap, and so not sealing the dip in the gum and creating an air pocket. However, I know this is probably not the done thing as a gap allows for the teeth to migrate towards it. I would see this however as a lesser evil.

So my question is, is this a viable solution, is there another solution? I have tried a removable gingival mask, it was great, but didnt stay put long enough. adding to the bridge with gradia or whatever its called (sorry) presents problems with cleaning, so thats off the menu. Im running out of ideas really. If there is no solution im seriously considering having the bridge removed and living with the gap.

Sorry for the looooong message, but it is quite a difficult problem to explain. I hope I have been able to!
Many thanks for your thoughts on this

cheers

Chris

[prosman]

I have had two teeth missing at the left side for year, and had a bridge fitted years after the teeth came out.

which teeth exactly?

The gum has receded inward but not upward, so there is a crevace/ dip across the gum o the cheek side where the roots would have been. The problem I have with the bridge is that it seals this dip / crevace and when I talk it creates a suction/air bubble situation with the inside of my cheek and the crevace. I have tried making a gap beteen the bridge and the gum to release air, with limited results. I am really tired of this problem as every solution to it seems to present other problems.

did you initially have this problem with the bridge before you had the bone resorption/ gum recession?

I have had a cat scan and there is enough bone for implants. But my issue is, two implants would no doubt produce the same result as the bridge.

why?

But I do wonder whether one implant would help - I mean take out the bridge and only replace one tooth (nearest the front so my smile isnt unsightly) and have the other as a gap, and so not sealing the dip in the gum and creating an air pocket. However, I know this is probably not the done thing as a gap allows for the teeth to migrate towards it. I would see this however as a lesser evil.

So my question is, is this a viable solution, is there another solution? I have tried a removable gingival mask, it was great, but didnt stay put long enough. adding to the bridge with gradia or whatever its called (sorry) presents problems with cleaning, so thats off the menu. Im running out of ideas really. If there is no solution im seriously considering having the bridge removed and living with the gap.

Sorry for the looooong message, but it is quite a difficult problem to explain. I hope I have been able to!
Many thanks for your thoughts on this

cheers

Chris

it sounds like your best option is placement of an implant (or 2) with a silmultaneous bone graft to build out the missing tissue.

i am presuming you did not have a problem when you had teeth ?

[squarebull]

Hi,

see x-ray here for location of larger two teeth bridge on my left/your right...

http://www.photobox.co.uk/album/43683206

I need to explain, I had lost the teeth for a number of years before the bridge was fitted, so resorption had already happened. There was no real problem except aesthetically before the bridge was added. The bridge seemed to seal the crevace and create the air pocket, wheras before air was free to come and go down.

I feel implants will do the same as I have been told implants will no doubt increase the size of the dip/ decrease the bone. And aside from the implant teeth not being stuck together as a bridge is, Im not sure it will be much different? I guess its experimental but a very expensive experiment.
I went to get the bridge replaced with two implants, but when I explained the reason, he refused to do it as he didnt know as it would resolve this problem, and I had expected him to say there isnt enough bone for an implant and to suggest a graft. But the cat scan showed enough bone to have them.

With regard to gum grafts or bone grafts, yes I have read extensively about this, but whenever im in the chair with an implantologist or dentist, they express real doubt as to whether it would help. Infact I have been told by several different sources that it just wouldnt work and would take an awful lot of work and money! I also dont want to go through this procedure.

I would be willing to have 1 implant, nearest the front, to see how it changes the problem, then decide if two are needed or if two would make it better. But I would be unwilling to spend money on two at once in case it made it worse or had no affect at all. BUT I have never been able to establish whether implantologists would place a single implant where there is a tooth on one side and a space on the other! would it be a bigger risk of failure? would it migrate into the gap?

Thanks for the reply I hope I have bee able to answer your questions, and I hope the x-ray pic adds clarity.


Regards

Chris

[prosman]

[FONT="Century Gothic"][COLOR="Navy"]Hi,

see x-ray here for location of larger two teeth bridge on my left/your right...

My First Album - Shared photo album - PhotoBox

I need to explain, I had lost the teeth for a number of years before the bridge was fitted, so resorption had already happened.

So did you have a problem when you had teeth there originally? If no then why would implants cause the same problem as a bridge?

There was no real problem except aesthetically before the bridge was added. The bridge seemed to seal the crevace and create the air pocket, wheras before air was free to come and go down.

have you tried a better constructed bridge?

I feel implants will do the same as I have been told implants will no doubt increase the size of the dip/ decrease the bone. And aside from the implant teeth not being stuck together as a bridge is, Im not sure it will be much different?

this would be a big advantage as there would be a space, and therefore no seal

With regard to gum grafts or bone grafts, yes I have read extensively about this, but whenever im in the chair with an implantologist or dentist, they express real doubt as to whether it would help. Infact I have been told by several different sources that it just wouldnt work and would take an awful lot of work and money! I also dont want to go through this procedure.

i can understand if you don't want to go through with the procedure, but i would question the advice you have been given. if they don't want to treat you it is likely they are maybe scared of this rather unusual problem. i have placed in excess of 1500 dental implants and have never had anyone complain about air getting trapped, i have had several people complain about air getting under their bridges, through their implant restorations. if the crowns are shaped correctly you should have no problem

I would be willing to have 1 implant, nearest the front, to see how it changes the problem, then decide if two are needed or if two would make it better. But I would be unwilling to spend money on two at once in case it made it worse or had no affect at all.

if i was you i would either get your dentist to cut the 2nd premolar unit off the bridge. this may fix your problem and solve the need for an implant or if you can get a decent sized implant placed in the 1st premolar site, try a temporary cantilever bridge, if it solves you problem copy it into the final restoration. if it doesn't then just restore as a single unit.

BUT I have never been able to establish whether implantologists would place a single implant where there is a tooth on one side and a space on the other! would it be a bigger risk of failure? would it migrate into the gap?

implants don't migrate and it is not at any increased risk of failure.

[squarebull]

"if i was you i would either get your dentist to cut the 2nd premolar unit off the bridge. this may fix your problem and solve the need for an implant or if you can get a decent sized implant placed in the 1st premolar site, try a temporary cantilever bridge, if it solves you problem copy it into the final restoration. if it doesn't then just restore as a single unit."

Do you mean cut the bridge? Cutting off one of the centre teeth? I didnt think that was possible, as the weight on the remaining one would then not be equally distributed? But if it is possible then yeah I think it would solve the issue of the air pocket. I just thought a false tooth i.e one on a bridge, needs to be anchored at both sides?

thanks again

Chris

[prosman]

"if i was you i would either get your dentist to cut the 2nd premolar unit off the bridge. this may fix your problem and solve the need for an implant or if you can get a decent sized implant placed in the 1st premolar site, try a temporary cantilever bridge, if it solves you problem copy it into the final restoration. if it doesn't then just restore as a single unit."

Do you mean cut the bridge?

Yes exactly!

Cutting off one of the centre teeth? I didnt think that was possible, as the weight on the remaining one would then not be equally distributed?

this is not always important and if your dentist makes sure the occlusion is managed, then it will be fine.

But if it is possible then yeah I think it would solve the issue of the air pocket. I just thought a false tooth i.e one on a bridge, needs to be anchored at both sides?

what do you have to lose if you are currently unhappy.

thanks again

Chris

Your welcome Sorry I could not answer this earlier as I was on my way to Auz for xmas