Infection?

[asdf1234]

Hello...

Male mid 40's Extensive dental work. (Several Implants, crowns, one bridge)

I had an implant placed in my lower left molar tooth 30 about 3-4 years ago. Last year the implant got infected(I forget the terminology here) and it had to be removed. This was very painful.

Several months later I elected to have a 3 unit cantilever bridge placed on tooth 28-29 which also covered missing tooth 30. All is great until last week. The tooth slowly started to feel uncomfortable, then it was very sensitive to hot and cold, then it started hurting BADLY! Yesterday I went to a dentist.(not the one who placed the bridge) The dentist took x-rays, and saw no signs of infection. Since I have not been flossing under tooth 29 I was educated about superfloss, and told my gums were severely inflamed. They bled badly when floss was run through.

The pain has since gotten better, but I cannot have anything touch 28, 29, or 30, or else I will scream in pain. I tried some salt water, and that HURT! I cannot put any pressure on any part of the bridge or it HURTS!

The way this has been hurting, throbbing, and cycles of severe pain I am thinking infection or abcess as I have been through this many times.

I am contemplating a root canal for 28, and 29 with my bridge intact. I thought about implants, but I simply don't have enough bone for an implant in 30, and what is the point of having implants placed for 2 teeth to end up with another cantilever bridge.

I dunno really. Thoughts? I need to make a decision soon.

 

[MattKW]

Cantilever bridge from 28 and 29 to make up for missing 30 is asking for trouble. Cut off 30 pontic, and hope that 28 and 29 recover. You can only replace the 30 with an implant, or not at all.

 

[honestdoc]

I agree with Dr. MattKw. If you can't have implant #30 due to past failure, consider partial denture or nothing. Partial dentures on lower arch may feel awkward and difficult to get used to.

 

[asdf1234]

Thanks for the Reply. I was mistaken about the numbers it is 19, 20, and 21, but your reply still stands valid. The pain has dropped significantly down to still hurting but I am sure to only mess with liquids at room temp.

I have been looking through my old previous xrays.

I did go back to the dentist today, and my options are steering me in one direction. Maybe some advice here would help some. I will upload some xrays if I can.

1.) I can have root canals done on 20, and 21 through my bridge. If there is anything going on under the bridge I could end up getting extractions.

2.) I can have the bridge removed in sections hopefully not damaging the teeth below, and then look at root canal treatment.

3.) I am not an expert but it looks to me like my failed implant on tooth 19 has healed up nicely. I don't see significant bone loss, but again I am not an expert maybe someone here can have a looksie.

This pic is from 2017 right before the implant was removed for I think this is the right term( peri-implantitis )

 

[asdf1234]

Here is my xrays from last week.
The half moon circle thing on 21 is something with their camera I seen it on all my xrays.

 

[MattKW]

1. The semicircle to the bottom left is some artifact of the Xray process and means nothing.
   
2. I am a little concerned about the dip below the crown (yellow arrow).
   
3. I would be pulp testing 20 and 21.
   
4. Then, cut off that false tooth. A cantilever bridge like that is going to cause damage to the supporting 20 and 21.
5. If that doesn't relieve the pain, remove the crowns on 20 and 21 and place temporary crowns.
6. If that doesn't reveal anything or relieve your pain, then maybe RCTs and single crowns. But I doubt if it's both teeth causing your problems.

 

[asdf1234]

The dentist I seen today who took xrays Friday mentioned the same spot as you.

What relieves the pain significantly is to push down on the last tooth number 19, and hold. Although I don't feel the bridge move at all when I do this.

Looking at the picture more. I wonder if the bridge has moved recently, and tooth a piece of number 20 with it.

I do appreciate the reply. I am happy to have some time not in agonizing pain to make a decision.

I am going to see an implant specialist tomorrow for xray and consultation. They only charge 1$ for the initial.
If I can have two extractions and three implants placed in one sitting I may just do that. They said very possible since the molar is already extracted/healed. They quoted me between $3,000 - $3,500 for the 3 implants, and healing abutments if I get my crowns somewhere else. $7,500 for 3 implants with crowns.

 

[MattKW]

So, you've already had 1 implant fail, and you are taking a big chance by taking out 2 salvageable teeth and placing more implants? Natural teeth are the best " implants" you'll ever get.
Also, there's no need to replace 3 teeth with 3 implants when 2 implants with a bridge may do the job with less risk. I don't know where you are, but 3 implants and 3 crowns for $7500 is ridiculously cheap.

 

[honestdoc]

I agree again with Dr. MattKW. I'm concerned there may be miscommunication and expectations may not be aligned. Getting the cantilever bridge especially with a molar pontic was a big mistake.

#20 has possible external root resorption on the root tip and #21 has bifurcated root canals at mid root that will be a challenge to instrument (clean & shape) if needed.

 

[asdf1234]

I appreciate the replies very much. It is really great to get different opinions from real dentists.

I visited the implant specialist today. They told me 20, and 21 are no problem. Implants are fine there.

19 however is risky because of the amount of bone. A short implant can be placed, but bone grafting and a longer implant would be ideal. I am ok with taking the risk using the short implant.

I am going Friday too see my regular dentist to have a bridge made up top for 12-14. I assume it will be better to have it made before having anything done to the bottom teeth?

 

[asdf1234]

20 and 21 came out rather easily...