Surgery Options

[Nuluvius]

I have lost:

• UR 4, 5 & 6
• UL 5 (which has recently sheared off post xray) & 6
• LL 6 (root remnant left behind)

I have a number of treatment options to choose from. I would appreciate some help in deciding which option to go with:

1. Dentist A (qualified with a diploma in implant dentistry):
   1. Alpha Bio X3 implant supported pink porcelain bridge of X3 crowns on the upper right with a sinus tent
   2. Alpha Bio X2 implant supported pink porcelain bridge of X2 crowns on the upper left with a full sinus lift
2. Dentist B (foreign qualifications):
   1. X3 implant supported bridge of X3 crowns on the upper right with a sinus tent (note no pink porcelain - just the crowns)
   2. X2 (linked) implant supported bridge of X2 crowns on the left with a sinus tent (also just the crowns)
3. Dentist C (masters in implant dentistry):
   1. Bredent X2 implant supported bridge of X3 crowns on the upper right with a sinus tent (just crowns and only 2 implants - gum would be 'crafted' around middle crown)
   2. Bredent X2 implant supported bridge of X2 crowns on the upper left with a sinus tent (just crowns)
   3. Displacement drilling techniques used meaning no need for large bone grafting

 

[MattKW]

• That implant system is unknown to me. It's not one of the larger players.
• I don't know what "displacement drilling" means.
• The use of pink porcelain suggests you will have a large gap to fill - this might make it harder to keep clean.
• Dentist C appears to be the most qualified.

 

[Nuluvius]

• That implant system is unknown to me. It's not one of the larger players.
• I don't know what "displacement drilling" means.
• The use of pink porcelain suggests you will have a large gap to fill - this might make it harder to keep clean.
• Dentist C appears to be the most qualified.

I was concerned that with only 2 implants that bone atrophy would occur in the space between them (underneath the 3rd mid crown). What do you think?

 

[MattKW]

No. It won't happen like that. Bone resorbs from direct pressure, so once you cover it up with a bridge, then it will not change.

 

[Nuluvius]

No. It won't happen like that. Bone resorbs from direct pressure, so once you cover it up with a bridge, then it will not change.

Interesting. I thought that bone atrophy was a function of preasure as well as the loss of mechanical stimulation at the site i.e. tooth loss.

 

[MattKW]

Teeth exert a pulling force through the periodontal ligament, thus preserving bone. Applying widespread and significant pressure by dentures causes bone to resorb. You won't cause significant pressure by eating with only your gums because you don't apply the same amount of force as dentures. It's not strictly bone atrophy as in osteoporosis.

 

[Nuluvius]

Teeth exert a pulling force through the periodontal ligament, thus preserving bone. Applying widespread and significant pressure by dentures causes bone to resorb. You won't cause significant pressure by eating with only your gums because you don't apply the same amount of force as dentures. It's not strictly bone atrophy as in osteoporosis.

On further conversations with that dentist, they clarify: There is 19 mm of space on the right. Given 2 planned implants there should be 5-6 mm of space between them and the recommended minimum space is 3 mm. They think that the implants will transmit forces over most of the area to help maintain the bone. Moreover the bridge will also cover it providing further protection.

 

[Nuluvius]

Update: Dentist A has dropped out of the running, it's now between Dentist B and C. I am having a really hard time choosing...