NEED DENTAL ADVICE - SEE PICTURES

Discussion in 'Dental Archive' started by Atlantic965, Jun 26, 2004.

  1. Atlantic965

    Atlantic965 Guest

    Atlantic965, Jun 26, 2004
    #1
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  2. Atlantic965 wrote:
    Problem is that I can't really evaluate what is left of the teeth in
    your jaw. Clearly the two abutment teeth fractured off. Can't tell if
    there is still significant decay.
    I can't specifically see anything that is clinically wrong. Generally
    dentists don't like doing cantilever bridges (with the false tooth on
    the end), but we sometimes do them anyway--I did one this morning, and
    they frequently work out fine.
    I don't know how much dentistry you received--at a PPO I assume it is
    far more than this 4-unit bridge. The decision as to what the most
    appropriate course of treatment would require more info--posting x-rays
    would be a start.
    If you don't trust the dentist, go to another--even if just for a
    consultation. A consultation at a dentist you can trust would be money
    well spent.

    Good luck,
    Steve
     
    Steven Bornfeld, Jun 26, 2004
    #2
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  3. REPLY

    FULL TEXT followed by Annotated text.


    You wrote,

    Here is a run-down:, in 1997-1999 my teeth were all crowned and
    mostly root canalled by an incompetent dental clinic with a series of
    dentists. in 2001 My front BICUSPID? broke off and it was glued once
    but broke again, new dentist says a new post is needed. Shortly after
    the rear bridge next to the broken bicuspid collapsed. It was re-glued
    in 2001 and and came off today ( 6/25/2004) From what I see 2 of the
    teeth continued to rot away under the crown as it looks like tooth
    material is still in the crown. The last rear tooth is a fake. I am
    stuck with my current dentist due to my PPO and I am skeptical what he
    says, last time this happened he first wanted to extract teeth and put
    in implants, I cannot believe after spending almost $15000 + to have
    this problem fixed I am having this problem. Did I waste time and
    money crowning the teeth?. It broke me financially. But I was young
    and this was the 1st health crisis I ever had to deal with on my own.
    I am going to see the dentist Monday 6/28/2004, I know the pictures
    are a bit blurry I would appreciate any comments anyone would have to
    make as to what course of action I should take.





    ANNOTATED TEXT.



    Here is a run-down:, in 1997-1999 my teeth were all crowned and
    mostly root canalled by an incompetent dental clinic with a series of
    dentists. in 2001 My front BICUSPID?

    REPLY --> actually the lateral incisor, the one just behind the still
    existing front crown on the central incisor.


    broke off and it was glued once but broke again, new dentist says a
    new post is needed.

    REPLY ---> Yes, if its root canaled (IT IS) then it needs a solid
    post.


    Shortly after the rear bridge next to the broken bicuspid collapsed.
    It was re-glued in 2001 and and came off today ( 6/25/2004) From what
    I see 2 of the teeth continued to rot away under the crown as it looks
    like tooth material is still in the crown.

    REPLY ---> YES! This is the mystery of dentistry that people do not
    address. If you have a huge filling and then the dentist grinds away
    circumferentially to slip the crown over the tooth, there is not much
    attaching the crown (or bridge) to the tooth structure.


    The last rear tooth is a fake.


    REPLY --> technically its a "cantilevered pontic." This mean a
    free-end false tooth replacement.


    I am stuck with my current dentist due to my PPO and I am skeptical
    what he says, last time this happened he first wanted to extract teeth
    and put in implants, I cannot believe after spending almost $15000 +
    to have this problem fixed I am having this problem.

    REPLY ---> The Joelster's fix.


    1. A gingivectomy removing some of the superfluous gum tissue from the
    teeth. I believe you have some bone loss and some free-standing gum.
    This takes 5-10 minutes and is done when the other work is done. No
    biggie.

    2. THREE posts .... for the three teeth that are destined to hold this
    bridge. THREE GOOD POSTS.


    3. Using the old bridge, and first drilling out the busted off tooth
    structure, use the bridge as a form for creating three cores to
    attasch to the three posts. TECHNICALLY, create an intaglio- or
    reverse post core.

    4. Recement this here old bridge and it will be just great.

    FIRST, you have a beef with your old dentist/dental clinic/ whatever.

    Better settle that pronto.

    Joel M. Eichen DDS





    Did I waste time and money crowning the teeth?. It broke me
    financially. But I was young and this was the 1st health crisis I ever
    had to deal with on my own. I am going to see the dentist Monday
    6/28/2004, I know the pictures are a bit blurry I would appreciate any
    comments anyone would have to make as to what course of action I
    should take.




    On Sat, 26 Jun 2004 15:33:13 -0400, "Atlantic965"
     
    Joel M. Eichen, D.D.S., Jun 26, 2004
    #3
  4. Atlantic965

    StovePipe Guest

    So, JME, you'd do a root canal so as to get a good core to attach to?
    I assume you mean cast gold posts?
    You're going to fill the crowns with Duralay or other casting resin and
    then seat the bridge onto the abuttement teeth
     
    StovePipe, Jun 27, 2004
    #4
  5. Atlantic965

    jwndds Guest

    I'd start with brushing and floss and go from there.

    news:...
     
    jwndds, Jun 27, 2004
    #5
  6. I am a strong proponent of solid posts ,,,,, and crown lengthening to
    expose more ferrule. However, the post issue has fallen into disfavor
    in dentistry. Posts do split roots, even the best of them.

    I have some solutions, but it may be not of interest ....

    JOEL

     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #6
  7. Cast is always better as may root canal spaces are ovoid while
    pre-fabricated posts are round. In addittion, a cast post can also
    have a cast ferrule making the post itself plus the collar that
    prevents the tooth from splitting as ONE piece.

    If the ferrule is in the crown and the post is the post, then there is
    some flexure that over time may fail.

    JOEL


    PS- I am expert at casting .... (cerre perdu) .... its way fun. We
    used to do it in the office, years back.


     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #7
  8. Before or after photography?


     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #8
  9. Atlantic965

    jwndds Guest

    before and after cementation of the bridge.

     
    jwndds, Jun 27, 2004
    #9
  10. YUP, but there's nothing to cement to, if we are talking about the
    same case ...... he needs posts .....

     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #10
  11. Atlantic965

    jwndds Guest

    true. I was living in the past. I've seen it before. 1. People get a
    bridge (teeth initially lost because of poor homecare)... 2. bridge is lost
    due to decay from poor homecare... 3. people think it is the dentists fault.
    The only fault I see is the dentist recommended a treatment that he couldn't
    handle. Full dentures may have been better. Despite our best education
    efforts there are always a few patients who think crown and bridge is
    indestructible and there for life.

    jwn dds


     
    jwndds, Jun 27, 2004
    #11
  12. How can this be?

    The bridge covers the prepared tooth structure. How would poor home
    care cause a bridge to fall out?

    JOEL

    I say posts were necessary ......

     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #12
  13. Atlantic965

    StovePipe Guest

    I, for one, would be interested, as I do get walk ins with old stuff in
    their mouths and they often ask me to try and save them.

    FWIW, I just can't get my head around the concept of cutting an Endo
    treated tooth for a crown without putting a post in first. I know all
    you guys/gals say that posts do not reinforce teeth, etc. No body has
    yet clearly explained how reducing the thickness of a dried-out tooth
    (fragile+++) and covering it with PFM is supposed to strengthen it in
    the ferrule region, where, it seems to me, it is most likely to break.
    Even leaving the original tooth intact makes me sweat, as I know that
    sooner or later, the dried-out (Brittle+++) tooth will crack, and not in
    an advantageous way for restoration, whether or not there are large
    restorations on it. I know this, b/cs I have SEEN it. No stats, so I
    can't say what percentage of cases are likely to have this happen, but
    there ya go....

    I'm a bit less categoric about anteriors: If the tooth is intact, I
    don't think putting a veneer on it would weaken it appreciably,
    especially if the veneer is additive, with minimal reduction.

    If a post is likely to split a root, the guy should have been on an NTI
    or other protection well before the post was cemented in.

    JME, as I said, I'm interested in what you have to say re posts, etc,
    and who knows.... Maybe you could don a Master's in Endo-restored
    teeth...
     
    StovePipe, Jun 27, 2004
    #13
  14. Atlantic965

    StovePipe Guest

    I agree, especially for anteriors.
    Hmmm.... Don't know about this: we were taught to always have the finish
    line on natural tooth structure. Having the ferrule in cast material
    means the axial walls are made of metal. Is this what you mean? Are
    there pictures anywhere?
    You mean you wax-up the case in the mouth? Or do you use an indirect
    technique with Duralay?
     
    StovePipe, Jun 27, 2004
    #14
  15. ON your site you say: "I am stuck with my current dentist due to my
    PPO and I am skeptical what he says"

    You are not stuck with anyone or anything. Your PPO may only pay for
    you to see certain dentists, but you don't have to use your insurance
    or their dentists. You are not beholden to them for anything. Go
    elsewhere and pay more, but be happier.


    As for advice, I can't help you based on what I'm seeing in the photos
    or in your description. You must find a dentists that you trust to
    see this first hand. It is quite likely that you will end up paying
    even more than 15k to straighten this out.

    David Leader, DMD
    Massachusetts Dental Society Council on Dental Care and Reimbursement.
     
    Dr. David Leader, Jun 27, 2004
    #15
  16. Patients come in two types. The ones who simply chew up and down ,like
    my dog, and the ones who chew side to side like a cow.

    The side to side ones can cause a post to crack the root.

    The up and down guys, well they are a pleasure .......

    A cast post is far better in my opinion, and it should be cast with
    the ferrule as one piece. Deep is not as important as thick!

    This kind of mimics what Dr. Steve does with his Cerec restorations
    ......


    JOEL



    On Sun, 27 Jun 2004 17:05:24 GMT, (StovePipe) wrote:
     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #16
  17. On Sun, 27 Jun 2004 17:05:26 GMT, (StovePipe) wrote:
    I did lots of both types. I did direct inlays and onlays (blue wax)
    withdrew them and placed them on a sprue for investment and casting.

    A 3/4 crown could be direct/indirect technique. A wax pattern in the
    mouth makes for excellent occlusion, then repositioned on a die to
    touch up the subgingival areas, then cast.

    A post was made from plastic posts that were dipped in blue wax
    (Duralay) and fitted into the root canal space.

    The actual melting of the gold and casting takes 3-5 minutes.

    I also soldered in plenty of pontics (Steele's facings were cemented
    on afterwards).

    Again, 5 minutes!

    Some of these bridges lasted 20, 30 and more years!

    I saw a lady who had one made (NOT BY ME!) around 70 years ago! Still
    there .... cantilever bridge too!


    JOEL
     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #17
  18. On 27 Jun 2004 10:13:32 -0700, (Dr. David Leader)
    wrote:
    REPLY

    CORRECTION,

    You mean "pay less." The guy already paid $15,000.

    JOEL

     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #18
  19. On 27 Jun 2004 10:13:32 -0700, (Dr. David Leader)
    wrote:
    Fuzzy photo or not, work needs to be done!


     
    Joel M. Eichen, D.D.S., Jun 27, 2004
    #19
  20. Atlantic965

    jwndds Guest

    recession. exposed root structure. root caries.


     
    jwndds, Jun 27, 2004
    #20
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