Order of Events

[Thisbites]

I have a plethora of questions but would like to begin here.
Ive been in the process of getting restorative work, e.g. crowns fillings, and now am
trying to figure out how to go about my dental work.
Treatment plan suggests restorations, ortho, gum graft and implant and more
How does one know how to go about a could treatment plan?


6 yrs ago i had an extraction #19 due to failed root canal, and post rootcanal pain x 2mo that i couldnt deal with any longer hence no fist molar that i miss dearly everyday.
I loved dentists prior to the failed root canal and extracion, now the dentist and my teeth are a great source of stress.

Long story short, or short story long.
My bite is off, i have recession, bone loss, verrry short roots on front teeth from ortho at 14, missing tooth, super sensitive teeth and in need of a night guard asap. I take very good care of my teeth, rinsing after eating, tooth mouse, gum rinse, salt water rinse different tooth brushes for times of the day.. the list goes on.

Do my xrays show that i am a candidate for an implant on this first molar? Should i go the route of a partial?
The dentist i see now wants to do all of these things and then the night guard last.
Makes no sense to me as all l need is to get an impression of the upper teeth so i have at least a barrier between my teeth at night.

 

[Thisbites]

Any insight or suggestions as to how to go about plan of care in order of importance..
appreciated
(im not bipassing my dentist by any means but there are many variables here..thanks )

 

[DocT]

Can you specify : 1- where do you have recession? ( I see bone loss in upper right and upper left molar areas only) 2- why do you think your bite if off? What exactly is off? 3- why do you need ortho? What does need to be corrected? What are you trying to achieve with orthodox treatment?
And yes, implant is the best solution to restore missing tooth #19. I would definitely go for this

 

[Thisbites]

goodevening and thank you for the prompt response.
im also seeing that i duplicated some images

So when i say recession im referring the the receding gumlines on the molars especially the lower. Just exposed roots here and there, part of aging..
I moved from out of state and have seen two dentist since being back. One was the one who wanted to do on the spot implant at every visit
The new dentist i have now is basically giving me a snap shot treatment plan of what things should be taking place.
I believe he is suggesting ortho because i have no support in my bite (14 & 15) are not biting or connecting with the lowers, and the shifting continues due to the missing 19 x 6 yrs.
Honestly i would like
to focus on taking super care of my teeth while i have what i have, and then get my own night guard (send out lab) and then the implant as soon as i heal from the recent work i had done yesterday.
I heal slowly so i am ofcourse nervous about going down that route but believe its a great option..maybe a perio vs oral surgeon to do it?
Thanks

 

[DocT]

Well, it’s hard to recommend a treatment plan, based on the x-rays alone, without clinical evaluation. But based on the information given, there are some recommendations addressing your concerns.
I would be super careful considering second orthodontic involvement since you have many roots affected / shortened throughout your entire dentition as the result of your previous ortho treatment, not only the front ones. Your dentist can use different approaches to restore vertical contacts except braces.
You need implant or bridge on the bottom left to restore not only extracted tooth #19, but tooth #20 which probably was removed for your first ortho. Edentulous space is pretty big and will adversely affect any treatment. You need to have uninterrupted row of teeth not only to restore, but also preserve and keep proper achieved occlusal pattern.
NG is just a piece of plastic protecting something while you are sleeping. Before you go for it, you need to know, what exactly you want to guard in your mouth at night. Your dentist might postpone fabrication of this orthotic device because he is planning specific kind or design that requires properly restored bottom teeth. Just ask him, I’m sure he can explain.

 

[Thisbites]

Super reply
Can you be my dentist?
Although my current new dentist (recently moved from out of state) is definitely efficient, I wonder why he would suggest ortho
when ive had it prior and there are short roots (yes not just the front ones but many) I would think that he would not suggest that>
Im guessing to get the bite right and have as you say a proper occlusal pattern.
What approach could he use as a dentist to help with my malocclusion?

Yes 20 is missing is due to ortho and its a big space for sure. Does this mean that any work done wont matter?
I guess i would like any plastic between my teeth at night because its better than grinding and contact.
I want a barrier between my teeth, so as to preserve what i have.
You are right he does want to wait until everything gets completed before he takes an impression for the NG.
I still see it as a timing issue and for me personally Prevention is almost more important than having everything perfect as that could take months and months to complete a successful implant.
Another question i had was pertaining to a flipper to have in the interim for 19.
Like a valplast fitted thing i could use. I can say honestly that not having a first molar has been such a hard time.
thanks for your insight..your good!

 

[DocT]

Well, I definitely don’t want to interfere with your doctor’s plans. I’m sure he knows what he’s doing. Still regarding your questions.
Ortho treatment - If we are talking about limited ortho (3-4 month duration of treatment) just to upright teeth #18/17, you can place implant or implants ( if edentulous space is too big for one tooth) and use them as a fulcrum / pivot point for ortho leverage instead of your natural teeth in front of the defect. Root length of you molars #17,18 appears to be normal, and can survive another ortho treatment; premolar #21 and especially canine #22 look a little shorter than normal and probably not the best candidates.
Flipper for missing teeth - not a bad idea, especially as a temporary restoration. I’m not a big fan of dentures retaining by remaining teeth. There is nothing wrong about it, but your hygiene in this case must be flawless, immaculate. You always will accumulate excessive bacterial plaque b/w teeth surface and contacting denture parts. Just be sure you clean your teeth and denture at least 3 times a day or you become susceptible to demineralization of outward teeth layers followed by incipient caries and finally actual cavity that needs to be fixed. So, be careful.
NG - could be neutral device just guarding your teeth from wear and fracture, retainer-like trays to prevent teeth drifting, shifting, angulating as well as teeth surface protection from light occlusal forces; deprogrammed preventing TMJ misalignment due to parafunction triggered by excessive muscle movement; repositioning orthotics to correct muscle contraction and prevent spasm or stabilizers. Do you know which one you need? What kind of problem are you trying to solve with NG?
Occlusal alignment - without ortho, if you just need to bring you disoccluded teeth back into contact ( usually localized problem,Involves a few teeth) you can go with occlusal overlays ( composite chair side or lab fabricated ceramic restorations). They do not restore any teeth defects, but bonded on top of your teeth to fill the open space b/w top and bottom teeth. It’s not that simple and primitive as I described, but this is the idea.

 

[Thisbites]

Thanks so much for the information
I used to have a night guard in the past form grinding,and have woken up mornings with very sore teeth.
I think it comes and goes (grinding) but I simply want to be preventive, and a NG seems to be practical.
The dentist im seeing is new (just moved here) so hes not really privy to all that is with my teeth and has a practice that he manages
alon
After these xrays were taken ive had a few more restorative things done.
Nov 3 crownprep and seat on #21 as part of filling came out.
Dec 2 #18 was redone..the crown as i had intermittent dullpain with it.

Quite a bit for my taste, but prior dentist suggested it and i trust him so the new dentist confirmed it so i went with it. Now ive got dull pain in #30 after 29/30/31 were done.(december 27) composite filling on the buccal side of 30..kind of cracked and old.

id like to take a break and let things settle. I really do not enjoy going to the dentist but feel like its necessary if two dentists say the same thing and its prevenive.
A question for you
How long should i wait for this 30 to settle down? It just feels like pulp is inflamed mildy but not going anywhere as far as settling down.
This is why i really have anxiety about my teeth and dental work because you dont know what will happen to you, and if you will lose your teeth...very stressful.
Also why is it that people who literally take $#%^ care of their teeth have no pain? no nerve pain..minimal.
Yet those folks like myself perhaps..who are over the top careful (to the point of declining food)so as not to chew or deal with pain have so much sensitivity and pain?

 

[DocT]

Dull pain, mild discomfort, sensitivity to temperature after restorative work happen quite often, relate predominantly to the properties of dental material and usually take 6-8 weeks to disappear.
We all have our week spots - teeth, skin, joints,metabolism. We all have our challenges in life. Nobody’s perfect so do not be too upset about it.

 

[Thisbites]

Dull pain, mild discomfort, sensitivity to temperature after restorative work happen quite often, relate predominantly to the properties of dental material and usually take 6-8 weeks to disappear.
We all have our week spots - teeth, skin, joints,metabolism. We all have our challenges in life. Nobody’s perfect so do not be too upset about it.

 

[Thisbites]

Thanks Doc T
Very comforting to hear.
I guess I dont hear about other people complaining as I do..very few.. or having so many endless issues such as pain after dental work..or failed root canals.
Its like people go to the dentist, have work done and forget about it, like it didnt happen. Amazing.
Cut my arm, draw my blood, sutures, colonoscopy, whatever no big deal.
Teeth? different story.
Im mid 50's now and Im seeing the reality of our teeth and the road we go down, restorations that inevitably lead to tooth loss
dentures, etc. So when my teeth are dull nagging pain and not settling down, it stressful because it basically spells a waiting game of
pain that continues until the tooth is either gone unless you can get lucky to save your tooth with a rc or implant- another pandoras box..

I have so many questions and you are, very knowledgeable thank you again,

 

[Thisbites]

One thing i have learned along my dental journey is that our oral health is intimately tied with our well being. I dont care what anyone says.
Also
when going into dental work, one must really understand that its a roll of the dice as to whether or not your teeth are going to recover. The pulp is so sensitive and dental work is TRAumatic to teeth. I never underestimate this now, hence hesitation going in.

 

[DocT]

Ok, you do not heat people complaining about their teeth and dental work since you are not a dentist or any dental office team member. I see this situation often enough. Check dentists around, get word of mouth referral. Today we have a lot of really great dental materials available to eliminate post-treatment complications. If your dentist is up to date with his materials, you should not be uncomfortable after treatment. Dentist has a beautiful opportunities to combine material the way he wants to achieve certain goal; we have desensitizing bases, liners, surface sealants. You can discuss sensitivity issues with your dentist and he might try to solve the problem. It’s very doable.
Please do not hesitate to ask me a questions, if you have any - I would be happy to help, if I can.
By the way, your teeth are in a not bad condition at all. You are pretty far from dentures

 

[Thisbites]

Thanks Doc T

I will post the conebeam scan (that the other denstis is verrry reluctant to give me) and a few new xays when i get them done, perhaps it can give you more insight as to whether or not I could even handle an implant because of how crazy painful my gums get.


I believe that dentists do their best. I also have had poor luck with a few dentist who did not really make sure that
I was comfortable or ok..just sent me home.
It a hard profession im sure to deal with patients like myself.

But like you said, a pt shouldnt have to be uncomfortable weeks after treatment. I believe he did what he thought was correct for the fillings. Im not sure what material he could have used but you mention desensitizing bases? If he is aware of how sensitive my teeth are wouldnt he have used this material?

Maybe it was alot of work (29,30,31)and the tooth is not ready to settle down. Not dentist fault.
im 1 week tomorrow..post tx, inflamed sore gums, and dull mild ache on 31. oh well

 

[DocT]

I would definitely share my experience with the doctor and, if appropriate, ask him about desensitizing therapy. I’m sure he has an options. Do you see inflamed swollen bleeding gum? Or you only feel the discomfort but can’t see anything unusual?
CBCT images are very helpful. Let’s see what you have there

 

[Thisbites]

My gums never bleed really, but with this dental work on the composite filling on buccal side 30 its quite inflamed and very sore.
my gums and teeth are just sensitive no matter what.
will post ugly picture
my pano came in just early what a coincidence finally after a good wait and resistance
will send over

 

[Thisbites]

This might help ?

 

[Thisbites]

If everything settles down, then id like to see about doing the 19 implant.. maybe 3 months from now..I just am not sure if im a candidate being a worry wart and having slow healing gums.

 

[DocT]

On the buccal of tooth #30 you show gum recession. I'm not sure if you had this issue before restorative work was done or after. Most likely this is preexisted condition. You can try to rinse with salt water or backing soda warm solution.
As for conebeam, it is not the images that show you 3D for proper measurements and I did not get any additional information to be able to do so. Sorry

 

[Thisbites]

Thank you for the response. Yes this was before restorative work. This tooth has intermittent dull achy thing going on x 5 yrs.
What would it mean when you have a tooth (#30 crown) that spontaneously has naggy pain that comes and goes. Does this merit a root canal or should i simply deal with it? I dont believe that there is anything that is serious on the tooth other than the recession.
This nagging feeling isnt gummy its deep in the tooth.
The redo o the buccal composite didnt seem to help this although the
gums have healed ok. You were right, healing takes time. i turned the corner about 8 days post work.