Dental Implant on Failing #8?

posted in Treatment Planning & Complications

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Joseph, a patient from New York, asks us?
I’m a 58 yr old MD, male, a non-smoker in good health. I had trauma to #8 50 years ago and since then have had orthodenture as a teen and a few root canal procedures and apicoectomies and 5 years ago a steel post to support the crown, all on #8. #9 is viable but crowned.

Recently, #8 seems to be a bit more mobile than others, with purulent gingival drainage (controlled with cefdinir) and pockets of 10 and 12 mm on buccal and palate surfaces. I’ve been advised the
tooth is failing, possibly fractured, and needs extraction followed by a dental implant or bridge. What’s your recommendation? Why? What kind of pain can I expect? What’s the cost range? What questions should I pose to my implant dentist? Thanks.

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5 Responses to “ Dental Implant on Failing #8? ”

  • Alejandro Berg May 9th, 2006

    Whithout the Xrays all is guessing but it is very probable that the root is fractured, which means you should loose the tooth as soon as possible to avoid a more severe bone loss.
    After some antibiotics and good infection control, and extraction and inmediate implant (with some grafting maybe) can be done and on top of that you can get a temporary maryland type bridge made of resin that will allow you to live your life pretty normally.
    In terms of pain, it should be mild. In terms on price it should be pretty painful,jajajaja, Actually I wont coment on that subject because I am outside the US so my north american colleagues would die if I told what we charge.
    Good Luck

  • Micki Gelb DDS May 9th, 2006

    Respectable Dr. Josef. At 58 having all the phases of dentistry on one single tooth is not bad. But let’s make one step behind the traditional frame of mind?!
    This is the victim-tooth for 50 years. But what about the opposite arch? or Cranio-Mandibular space? or neuro-muscular condition? or the bite and occlusion guidance?
    There is a lot involved before you can decide the capability of saving that tooth, recover bone and soft tissue or remove it and replaced with on implant.
    Give me a call 212.661.2542

  • Frank J. Palmaccio, DDS, MS May 9th, 2006

    As per your description, it certainly sounds as if tooth #8 is fractured. In any case, a mobile tooth #8, past endodontic treatment, 10 to 12mm pocketing on the palatal and facial surfaces with draining purulent exudate does not sound very promising. Strategic removal would be advised in conjunction with osseous grafting/GBR procedures. Following adequate healing, approximately 16 weeks, this site may be considered for surgical implant fixture placement. I would advise completing the osseous grafting/GBR procedure regardless of the final restorative treatment plan (implant vs. fixed bridge)to prevent a collaspse of the alveolar ridge once this tooth is removed. Cost range for this mode of treatment will vary depending upon the materials used and the different techniques used all which will alter associated costs. Multiple procedures may also be required depending upon the size of the residual defect once the tooth is lost. Needless to say, it is extremely difficult to give proposed costs without examining you. A conservative estimate in my office would be $3,000.00 to $3,500.00.(Surgical extraction, osseous grafting/GBR, eventual implant fixture placement) You will also incur additional fees during the restoration phase of the impant fixture. These fees would have to be provide by your restorative dentist. Post operative discomfort experienced by patients will vary patient to patient and within the same patient procedure to procedure and can usually be controlled without a problem.

  • Dr.Mohammed May 13th, 2006

    I’d rather think about traumatic bone cyst. which is the clear cause to me without an X-ray ,After the R.C.T. & apicoectomies he has through the Ages it seems that the bone has a defect… the Implant would be questionable because the bone didn’t form well around the root after apicoectomy ( how about the Implant ) may be we can use something to stimulate the bone formation like ( PDGF )
    I’d prefer the traditional bridge in such a case with all my respect to other opinions

  • David March 5th, 2008

    Tooth #8 is hopeless and nonrestorable. This is not the classic “when in doubt, take it out,” but it realy does appear hopeless. I would definately replace it with an implant. Statistical data indicates that an implant is a much more successful long-term option, particularly in the face of a compromized #9. Because of the long-term chronic infection and subsequent bone loss that you may have (or may not have) experienced, it may be necesary to perform a bone graft prior to implant placement. Discomfort will be experienced, but will not be remarkable. If done appropriately, it will be highly successful. The cost will be less in the long-term than any other treatment alternative. I also have an MD, as well as a DMD, and there would be no other treatment alternative that I would ever consider.

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