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Cyst, tooth extraction, implant...

A

alphabetstreet

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Jul 11, 2019
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Hi, everyone, I am new here, but have been a lurker for a bit now. I have dealt with some crippling dental phobia for years and years now. Recently I have been dealing with a cyst on the root of a previously endodontically treated tooth that is eating away at my bone. Although not infected or painful, it apparently needs to come out soon to avoid more bone loss/teeth loss.

I have been told by 2 surgeons now that the best method will be to 1, remove the tooth (#7, a front tooth); 2, scrape out the cyst after extraction; and 3, immediately place a bone graft, sew that up, and come back later for an implant.
The thought of this entire procedure terrifies me. I am also incredibly terrified of any sedation methods. I know, it’s ridiculous, but I can’t help it, and it makes this whole thing much worse. The surgeons I have seen have been pretty insistent that I take some sort of anti-anxiety medication during, but I know it’s just not going to happen and is not an option for me, so it has to be LA only.

I also am being told that I must take antibiotics (Z-Pak) for the bone graft part of the procedure, that it is absolutely necessary and standard of care for bone grafting (not for the extraction or cyst removal, however). This is another thing that is pushing me away from the implant/bone graft route. I have a long history of stomach problems, and taking antibiotics for an elective procedure is not something I want to do. Apparently there is no alternative, though. I asked if there was a topical antibiotic that could be placed with the bone graft—no such thing.

At this point, I am quite unsure how to proceed. Part of me wants to just pull the tooth and get a Maryland bridge (especially since this would be the antibiotic-free route). But everyone is telling me that I’m young (37) and the best option is an implant, that I will lose facial structure if I don’t do an implant, and that I may actually have a divot in my face afterwards if no bone graft is done.

I guess I am looking to see if anyone has experienced this particular problem before, or something similar, and came through it without too much trauma. I am also curious what people’s opinions are for implant vs. Maryland bridge for a front tooth. Part of me feels like these surgeons are just pushing implants because that’s just what they do and maybe it’s a great money maker for them, I don’t know. No one has once suggested that I just get a bridge or wear a flipper—they seem incredibly shocked that I would even consider such a thing (maybe it’s my age). But I feel like implants are pushed everywhere; I once had a dentist want to pull my crowned teeth and replace with implants.

Any thoughts or feedback would be so greatly appreciated. And I apologize in advance if this is a topic that’s been covered extensively already. I also was unsure which discussion board to post this in (general, ask a dentist, etc.) so if it’s in the wrong place, I also apologize and will move it.
 
Enarete

Enarete

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Hi alphabetstreet :welcome:,

Lovely to have you as a member here. I don‘t know much about when antibiotics are necessary and when they aren‘t, but what I do now is this: your body is yours and you decide how you would like to replace your missing tooth. If flipper or a bridge is what you prefere, that‘s perfectly fine and I can only encourage you to find a surgeon/dentist who will be willing to fit one for you. The same thing applies for the way you would like to go about your treatment. If you wouldn‘t like to get any form of sedation then that‘s fine too, LA will work.

It seems that surgeons pushing sedation and of course implants happens very often, particularly in US and this can‘t be discouraging or even give you the feeling as if something was wrong with you, but it isn‘t. My only advice is, do not let anyone push you into anything but keep on looking until you find a place you feel comfortable at and that respects your wishes and preferences. The dentist/surgeon is supposed to give you options and you are supposed to decide. Right now it doesn‘t seem you have been given options.

All the best wishes and keep us posted
 
FearfulInMA

FearfulInMA

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Hi. I went through something similar a couple of years ago with a molar - it was the last one in the back, so a bridge wasn’t an option... but leaving it without any restoration might have been.

I also have serious fear of sedation and also refused oral anti-anxiety meds. However, I had been going to the same dentist for almost a decade at that point so I was able to convince him I would be able to manage (a specialist at the same practice did the extraction/graft/implant).

My rook has also been previously endodontically treated. I also required a graft. I was prescribed (and took) clindamycin, but had I been able to take amoxicillin (at the time I still thought I was allergic), that would have also been an option. I also have stomach issues with antibiotics. Could you ask if amoxicillin is an option (as this one seems to be easier on the stomach)?

After everything, I am very happy with my implant. Of course you can make whatever choice you deal is best for you. I would encourage you, however, to challenge yourself to base your decision on factors other than fear. I very much trust my dentist and though I’m sure there are dentists who push implants for financial or other reasons, at least in my case, I trusted that he was recommending an implant because it’s what he would have wanted for himself in a similar situation.

Best of luck with whatever decision you make. If you decide to go through with the implant, I’m happy to share any of my experience that might be helpful and/or answer any questions about my experience.
 
M

MountainMama

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Jul 1, 2018
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I am in a very similar situation right now. Mine is also the upper front tooth, but #8. I had an abscess from a childhood injury, and the infection did not go away after the root canal and an apicoectomy. My next step is also remove tooth, scrape out infection, and implant. I had a lot of bone loss from the abscess so bone graft as well.

I was given my options and an implant was not pushed on me, but strongly suggested. I am 39. I will have a flipper temporarily while the extraction and bone graft heal. I was also told that if I kept the flipper that eventually the bone would shrink, and could potentially cause a facial deformity at worst case scenario. It would cause gum recession on the teeth on either side as well. They told me a maryland bridge was a temporary deal, not meant to be permanent.

I have had one implant already, on a molar. I did not have antibiotics, and the surgeon said they were only needed if I ended up with an infection. Antibiotics also mess with my stomach, and I have had way too many in the past year due to dental infections. I finally told my endodontist I would not take any more, after a round of clindamycin messed my stomach up for months. I don't see why you would have to take antibiotics.

As far as sedation, I chose to have nitrous with my last implant, but I wasn't able to have any sedation with my apicoectomy on that front tooth and it wasn't as bad as I thought. The extraction and bone grafting could not possibly be as bad as an apicoectomy! If you think you would prefer to do it without sedation, they should respect that.
 
Judythecat

Judythecat

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643
Just to give a bit of balance to the implant situation, my colleague’s husband lost his two front upper teeth in a car accident in his early 20s, and has worn a partial denture since. He is now late 50s, has no issues, and definitely no facial deformity. Despite knowing him for years I had absolutely no idea he had it until my own dental woes started and my colleague told me. At the time he lost his teeth, implants weren’t around, and the partial denture was the best option. I wonder what the best option will be in ten or 20 years?
 
krlovesherkids777

krlovesherkids777

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Alphabetstreet,

Welcome to DFC and sounds like alot to think about and decisions to make. Sounds like you are really self aware and have alot of really valid concerns that your dentist should really listen to. I agree with Enarete that if you want to try something besides the implant option and the more invasive treatment you should maybe check a few options to see if someone more conservative will do this for you.. I know too alot of of dentists really are pushing implants and it can seem overwhelming , especially with the sedation fear and the antibiotics issues that is alot to think about at once for sure. I'd give it due dilgence if you have the time and energy and try a few consults. sometimes they will do them at no cost or low cost second opinions too.

I do want to encourage you though in a few areas..if you did decide to go the bonegraft and implant route or think about it.

I have done a bone graft just this past April, had an extraction. then about a month later bonegraft, implant and membrane same day.. I avoid sedation too due to trauma background , I feel comfortable with just local. and was fine, actually no pain at all and my dentist did it very calmly and peacefully. I did not have to take any antibiotics afterward either. Could be a dentist preference there too? maybe you could find one willing to not write for antibiotics. ? I had my first implant starting about 2 years ago and I can tell you I am glad I did it and although scary to go through (mostly in my mind) the first time, I'm going through a second time with a different dentist (only because my first left the practice ) but.. love my new dentist too :) they both did amazing and its been a really good experience from what I thought would be terribly scary and not sure how would turn out. I'm in the middle of my second. but I do encourage you if you go that route , I for one am glad I did it.

Really wishing the best for you whatever you decide , stay true to yourself and your needs and wishes . I know its hard to ask for your own needs sometimes when anxiety hits and in a dental office . I hope you can find a dentist who will work with your needs and desires and find a way to do what is best for you all the way around and you can be comfortable with!
 
A

alphabetstreet

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Jul 11, 2019
Messages
13
Location
United States
Thank you so much, everyone, for the thoughtful, kind, and thorough responses. I do really appreciate it. Just reading everyone else's experiences is so helpful. It's also nice to know that there are others out there who fear the same things as me (like sedation) and have been able to get through similar treatment with just local.

FearfulInMA, I would love to hear more about your implant experience.
 
A

alphabetstreet

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Jul 11, 2019
Messages
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Location
United States
Hi again, everyone, so I visited a pretty nice prosthodontist today, and I was hoping that he would tell me I am the perfect candidate for a Maryland bridge, but alas, he does not think that I am. I have fillings on both teeth that would need the resin bonding, and apparently this isn’t acceptable for Marylands ☹

He did mention, however, that a cantilever bridge attached to my canine (#7, I believe) would be a good alternative option, but this does involve shaving down a perfectly healthy tooth (well, healthy besides the filling).

I am so incredibly terrified of the implant process that I think I may just choose the bridge. Everyone around me thinks I am ridiculous for even considering something other than an implant. The prosthodontist also mentioned that for someone with a dental phobia, a bridge placement is not ideal because it involves many trips, numbing, wax casts of teeth, drilling the tooth down, etc. (I mean, no trip to the dentist is ideal for someone with dental phobia, but what can you do?) All I can think, though, is that it just sounds way less terrifying than the implant (the waiver that they made me sign for the implant was insane – I never knew so many things could go wrong!)

I really wish that I didn’t have to actually make this decision and could sit on it for a while, but I think the tooth needs to come out ASAP. I am just kind of hoping that maybe at some point, years down the road, I'll be brave enough to reconsider an implant.
 
B

Birmanclaws

Member
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Feb 18, 2018
Messages
50
I have had both my front teeth replaced with implants. The procedures were about 18 months apart. Both teeth required bone grafts (and no antibiotics were prescribed). Honestly, the implant procedures were much easier than getting a bridge or RCT. I just had LA (no sedation) as I needed to drive afterwards. During the treatment period I first had a cantilevered bridge on the remaining tooth, and later a cantilevered temporary bridge on the implant. I was too scared to use the cantilevered bridge for biting, but I have never regretted getting my implants
 
M

MountainMama

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Joined
Jul 1, 2018
Messages
2,598
Hi again, everyone, so I visited a pretty nice prosthodontist today, and I was hoping that he would tell me I am the perfect candidate for a Maryland bridge, but alas, he does not think that I am. I have fillings on both teeth that would need the resin bonding, and apparently this isn’t acceptable for Marylands ☹

He did mention, however, that a cantilever bridge attached to my canine (#7, I believe) would be a good alternative option, but this does involve shaving down a perfectly healthy tooth (well, healthy besides the filling).

I am so incredibly terrified of the implant process that I think I may just choose the bridge. Everyone around me thinks I am ridiculous for even considering something other than an implant. The prosthodontist also mentioned that for someone with a dental phobia, a bridge placement is not ideal because it involves many trips, numbing, wax casts of teeth, drilling the tooth down, etc. (I mean, no trip to the dentist is ideal for someone with dental phobia, but what can you do?) All I can think, though, is that it just sounds way less terrifying than the implant (the waiver that they made me sign for the implant was insane – I never knew so many things could go wrong!)

I really wish that I didn’t have to actually make this decision and could sit on it for a while, but I think the tooth needs to come out ASAP. I am just kind of hoping that maybe at some point, years down the road, I'll be brave enough to reconsider an implant.

I understand the fear. I am terribly fearful of all dental procedures, especially surgeries. I wanted to encourage you to think more about the implant. It sounds scary but it was honestly the easiest procedure I have had done...much easier than a root canal or apicoectomy. Each part of the process is so spread out, with months in between that you are not spending a lot of time at the dentist/oral surgeon.
I had nitrous oxide with mine. I was able to drive myself home after each step. The bone grafting is no big deal, as they do that at the same time as extraction and you won't even feel it. Putting in the actual implant seems scary, but it doesn't feel anything like what you imagine. You feel vibrations, like you do with a filling.

I completely understand your view but just wanted to share my experience. I seriously am petrified of dental surgeries, but a crown prep was harder for me to sit through than the implant procedure.

Whatever you decide, we will be here to support you!
 
A

alphabetstreet

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The vibrations during the implant procedure, when they actually insert the post, are they those really bad head-rattling vibrations? Or is it just like a high-speed cavity drill where you can't feel it but can hear it? How long does the insertion of the post take?
 
M

MountainMama

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The vibrations during the implant procedure, when they actually insert the post, are they those really bad head-rattling vibrations? Or is it just like a high-speed cavity drill where you can't feel it but can hear it? How long does the insertion of the post take?

It is not any worse than a filling. I heard it and just felt pressure from the surgeon's hand holding my jaw. It took minutes. In fact, I remember being surprised that it was done so fast.
 
FearfulInMA

FearfulInMA

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Sorry it’s taken me so long to respond. My experience was very similar to what was described my MountainMama. I had only local for all parts. For me, the extraction (which you’ll have regardless of your choice) was the very worst part. I’ve had awful extraction experiences prior to this, so all told, the one for my implant was not nearly as bad as any of the ones prior. I believe that I ended up having the graft at the time of the implant. I think the original plan was to do it during the extraction, but my bone structure looked good enough when the dentist was actually able to visualize it. I believe I had a small graft during the implant - but, honestly, I didn’t feel any of it, so I could be wrong. I found the implant itself was much easier than the extraction. Everyone told me it would be, but I didn’t believe them. It was relatively quick, very little bleeding, no pain, and I felt that it was a very gentle procedure. The recovery was also much, much easier than the extraction. As MountainaMama said, there is a lot of healing time between appointments where life returns to normal. For me, I had the extraction then the implant 3 or 4 months later. Then it was another 6 months before the crown for the implant was placed (to allow time for the implant post to fully heal to the bone before chewing on it).

I’ve had the implant over a year now and am very happy I was able to go through getting it done.

Do you have any specific questions about what it was like?
 
A

alphabetstreet

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Thank you so much for the responses! Just reading everyone's experiences is really helping me realize that implant will be the best option. I just hope I don't chicken out when I'm actually in the chair (there's a good chance of that).

What sort of temporary device did you guys use while your implant site was healing? I've been given a retainer; hoping that I will be able to talk with it in!
 
FearfulInMA

FearfulInMA

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Because mine was a back tooth, I didn’t have anything temporary in the site.

We’re all here for you and I will have my fingers crossed that all will go smoothly for you! When is your extraction scheduled for?
 
A

alphabetstreet

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Oh, thank you! You are so kind. The extraction is scheduled for next Tuesday. I am already nervous. Every time I think about it, I get this pang of fear and feel sick. But just knowing that so many other people have gone through it without a problem is so helpful.
 
M

MountainMama

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Thank you so much for the responses! Just reading everyone's experiences is really helping me realize that implant will be the best option. I just hope I don't chicken out when I'm actually in the chair (there's a good chance of that).

What sort of temporary device did you guys use while your implant site was healing? I've been given a retainer; hoping that I will be able to talk with it in!

Mine was also a back tooth, so no temp. I am getting number 8 out soon, though. Consult is scheduled for Aug 6th. I am getting a flipper for that (basically the retainer looking thing). I am not looking forward to that part. I think talking and eating will be a major adjustment. I had retainers as a kid, after braces, but on the top I had the clear one that looked like the invisalign braces. Getting used to something in the roof of my mouth will be hard.
 
krlovesherkids777

krlovesherkids777

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I had one on my upper right #5 and one lower left #20. Neither one had a temp anything on them. This tooth I had extracted before the implant placed was one that my partial attached to so right now I have the metal part of the partial sitting elevated on top the sight so its not totally an empty space. My dentist did offer to add a tooth to the denture for a few months but since it was so short term I didn't want to mess with my denture. and I made it so far ok. :).I think it is really worth it.
 
Aurora10

Aurora10

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Just to give a bit of balance to the implant situation, my colleague’s husband lost his two front upper teeth in a car accident in his early 20s, and has worn a partial denture since. He is now late 50s, has no issues, and definitely no facial deformity. Despite knowing him for years I had absolutely no idea he had it until my own dental woes started and my colleague told me. At the time he lost his teeth, implants weren’t around, and the partial denture was the best option. I wonder what the best option will be in ten or 20 years?

My dad has had a denture in the front for years after an accident when he was much younger and you would never know with him either. His tooth look perfectly natural and he hasn't got a sunken face at all.
 
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