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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5788
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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The dentist told me I have to have my teeth 30 and 31 extracted.

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The dentist told me I have to have my teeth 30 and 31 extracted. I was told about Bone Replacement Graft after extraction. Is this necessary? Can I leave the empty space of the teeth like that? Is a bridge and crown necessary? I had 3 wisdom teeth pulled out in the past long time ago (Lower and Upper Left, Upper Right.) but I left it empty. Never had a bridge or crown or bone or anything. I seemed to have functioned ok all this time like that.The fourth wisdom tooth (lower right) is still in place and is not causing me any problem. The Dentist dint say anything about pulling that. Please help and advise. Thank you.

Rao
Submitted: 3 years ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 3 years ago.
Welcome to JustAnswer, and thank you for putting your trust in me!

The placement of a bone graft at the time of extraction can improve the suitability of that site to receive an implant in the future; this is the only benefit of graft placement under these circumstances. If you do not anticipate getting an implant, then there is no purpose served by grafting the extraction sites.

The utility of graft placement depends on your future prosthetic plans. The removal of the wisdom teeth does not require their replacement; wisdom teeth contribute little or nothing to the overall function of the mouth. The loss of teeth #30 and 21, however, will cause significantly more functional impairment, and may contribute to bite collapse, loss of facial height, with attendant cosmetic deformity and temporomandibular joint dysfunction. You should therefore plan on replacing these teeth after extraction before the unfavorable consequences of their loss begin to develop.

This area has particular restrictions when implants are considered, because there is a limited amount of bone available to accommodate implants above the jaw's main sensory nerve bundle-- hence the recommendation for a bone graft (to preserve as much bone as possible). You are not compelled to get implants, but they do offer your only option if you desire a fixed rather than a removable prosthesis. If the thought of wearing a removable partial denture is acceptable, you will not need those bone grafts.

Removable partial dentures provide a reasonable alternative to implants, and provide similar function at greatly reduced cost, faster treatment time, and elimination of the need for surgery. The trade-off is that removable denture prostheses place greater demands of accommodation, at least at first, because they are subjectively less similar to natural teeth than are fixed prostheses. However, most patients accommodate well to partial dentures, and their obvious advantages make them perfectly legitimate options, even though many dentists tend to promote implant service more forcefully.

Hope this helps...
Customer: replied 3 years ago.

Dr. Bornfeld:


 


Thank you for your answer. Part of it I did not understand. Pardon my ignorance.


 


1. The teeth that need to be extracted are 30 and 31, not 21.


2. From what you say I need to have the two teeth replaced because of consequences. I am not clear on what is an "implant". Is it the screw support type which is more expensive? Or Is a bridge/crown also considered an "implant"? Or are these two mean one and the same?


3. I feel I may not be comfortable with dentures.


4. Could you please educate me a little bit about "Implants"? Looks like Implant is my only option.


 


Thank you for your help.


 


Rao


 

Expert:  replied 3 years ago.
Sorry for the typo-- I knew you wrote #30 and 31, but my finger must have slipped...
This does not alter the substance of my answer-- you will miss those teeth, so they should be replaced if possible.

The term "implant" refers to a substitute for a natural tooth root that is surgically inserted into the bone. There are several different ways to replace a tooth using an implant, but the most mainstream way is to use a device known as an "abutment" to form a coupling with an implant, and to make a crown that fits that abutment. Most commonly, one implant fixture is used to replace one tooth.

A fixed bridge, which is a more time-honored way to make a "fixed" (rather than a removable) prosthesis, entails the placement of a crown on the natural tooth directly in front of the missing space, and a crown on the tooth directly behind the missing space, and suspending false tooth/teeth between these two crowns. In your case, unless you still have your lower right wisdom tooth and it has good position and long roots, a fixed bridge would not be feasible. (Wisdom teeth typically are not well-suited to providing anchorage for a fixed bridge due to their poor position and short root length, but there are exceptions to this rule.)

Implant service is provided in two stages, usually provided by two different dentists. The surgical phase is often implemented by a surgical specialist (usually either an oral surgeon or a periodontist), and involves the diagnostic phase (where various imaging techniques, including CT) are used to determine if there is sufficient bone in the right areas to accommodate an implant cylinder. This is followed by the surgical insertion of implant(s) into the jaw bone, after which time is allowed for bone to grow around and anchor the implant. After about 4 months, the implant is surgically exposed, and a "healing cap" is placed to allow a collar of gum tissue to heal. Treatment is then transferred to the prosthetic dentist, who takes impressions and has a dental laboratory create the abutments and crowns that will ultimately be attached to the implants. Overall time from start to finish may be as much as 7-10 months, although there are methodologies that (in my opinion, unwisely) skip some of the steps for the sake of expedience and time-saving.

You may not feel comfortable with dentures, but you will never know unless you try. Before the advent of implants, dentures were the only available option, and patients still manage very well with them. Dentists tend to favor implants for a variety of reasons that are irrelevant to patient satisfaction-- for example, some dentists favor treatment solely because it is more innovative and modern, which in itself is not a legitimate reason. You should discuss all your options with your dentist, and seek a second opinion if your dentist seems to be overly infatuated with the idea of implants, rather than their appropriateness for you.

Good luck!
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5788
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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