Bridge, implants or bone grafting?


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Already aware of the state of lower anteriors. Been told by several dentists both on and offline.

Posting cuz I want to know about the options my dentists laid out.

I just want a clear understanding of what:

bridges, [I think they said the center six on the bottom row would be bridged with crowns placed on the two in the middle]

bone grafts, [this is apparently possible if I want to keep my teeth. A dentist I spoke to online told me the bone loss was too far gone for that]

and implants entail. [No clue about these or how they work]

I'm wary about making any changes that alters the natural structure that's already there since I don't know what consequences might follow.

Everything I've learned about dentures leads me to relegate that as a non-option or potential last resort.
 
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Dr M

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Good day

Did you see a periodontist specialist regarding your case? I would also be wary of bridging the lower anterior teeth, with the amount of bone left. If you decide to go this course, I would consider getting the bone augmentation first, and then see if the procedure is successful. A lot of times the bone augmentation also gives issues and I would not consider crowning any teeth in that area until I know the situation is stable.
Best option would be to go see a periodontist. He will do a tooth by tooth evaluation in order to determine the long term prognosis of your teeth as well as address the underlying cause of periodontal disease, which lead up to the scenario you are currently in.
 

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Hello.

I've been advised to see a periodontist and there are plenty in my area but the only one available on my insurance has mediocre ratings. That hasn't stopped me from trying to book an appointment mind.

Several failed attempts both direct and indirect, of reaching them(no one picking up, inbox full, etc.) signaled to me a potential red flag of unprofessionalism suggesting that I was better off finding someone else.

So, I went to see a highly rated dentist that was available on my insurance instead. The current first step per their appraisal, is a deep cleaning which is pending my insurance's approval. I just wonder how loose my lower anteriors will be afterward given what I've been told about the calculus being the only thing currently holding them in place.

Your post is making me consider just paying out of pocket to see a high rated periodontist if only to get them to examine the teeth.
 

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Dr M

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There is a chance that the lower anterior teeth might become more mobile after the deep clean. It is best to go and see a periodontist. I agree.
 

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Oh. One other thing I've wondered about. Is the bone loss on the back teeth reversible at all? I've heard lots of people say bone can't grow back but not sure if they meant lesions or just any type of bone loss.
 

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Dr M

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Usually once bone is gone, it is gone. You get procedures like bone augmentation where they try and " build up" an area with artificial bone, although the success is dependent on a host of factors.
 

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Dr M

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It is basically the same concept. The bone can come from the donor, or it can be a mixture of artificial or animal bone
 

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I see. Something else I've wondered about:

Does teeth decay on its own over time regardless of diet? Like, do some people keep their natural teeth well into death from old age or is that impossible regardless of whatever measures are taken?

Essentially , I wonder if teeth age like the rest of the body or get worn down over the decades due to wear and tear from use.
 

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Dr M

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Teeth do undergo some wear and tear over time. The enamel wears away. This does not mean that you end up losing the teeth. You can still retain your own teeth until death.
 

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Interesting. So the enamel undergoes natural wear and tear.

Two last questions:

  • What about bone; does it also naturally erode over time or is that only ever due to gum cleaning neglect? I've been told that bone destruction is an effect of bacteria finding a path of invasion through a pocket in the gums.

  • Have you ever witnessed diet to have a strong distinguishing effect in patients? Say strict carnivores for instance; those that avoid all fermentable carbohydrates. I'm inclined to believe they would have very little gum or gum related issues.
 

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Dr M

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There is constant bone formation and degradation that takes place throughout your life time. Certain conditions such as osteoporosis or osteo-arthritis, does lead to bone loss however. The main reasons gum inflammation leads to bone loss, is due to the inflammatory cells that recruit other cells, such as osteoclasts, which lead to bone loss.

Carbohydrates, as well as other sugars, especially in modern diets, does have a direct effect on caries formation as well as other gum and periodontal issues. There are studies done on this.
 

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