Decision time - could I have your opinions please??

[sharon]

Tooth # 10 has a root canal, two crowns and now decay under the crown, ugh!! I have been given a choice between an 1) exatraction/implant or 2) redoing the root canal, lengthening the crown of the tooth and then having a new crown put on. The first option is about $4500 after insurance and the other is about $600 after insurance. I was all set for option #1, then I received the pre-treatment estimate from my insurance company and am now giving that major rethinking. I really can't afford $4500 at this time.

My biggest fear in the dental chair is gagging/vomiting. I had a cerec crown done earlier this month and it was a great experience because I did not have to have the big impression. I thought tooth #10 would be equally easy but then he said I would need to redo th rc and lenghten the crown (I don't even know what that means) and after all that it may not be successful and I will still end up needing the extraction/implant.

I was sort of ok with the implant until I looked at youtube videos and I see they have to use some sort of guard in the mouth when doing the surgery. This really freaked my out because it looks like I willl surely need to have a major/big impression taken and also because it looks like the guard will be in my mouth during the surgery and I am afraid that will make me gag. And also, if it isn't a cerec crown then I will probably need a big impression for that. All in all that sounds like a like of impressions. All work will be done by the same dentist in his office over several visits no matter which option I go with so having ga isn't an option.

I need you input and opinions - what would you do?

And does anyone have any implant experience? What kind of impressions does one need and what is the guard like? I'm going to the dentist tomorrow so he can explain both procedures to me but am looking for advice/help so I can be better informed. and what the heck is crown lengthing?

thanks, Sharon

 

[coolin]

Hi Sharon
Maybe by the time you read this you will already have been to the dentist and he will have explained it all to you but here goes my input anyway
I have had 2 implants placed. By the US numbering system they are teeth numbers 20 and 29 (or lower left and lower right 5)
Number 10 looks like upper left 2? So quite a visible tooth.
To be honest I don't remember any kind of guard being used when I got the implants but I did get impressions once the implant had integrated for the 'crown' part of the implant.

Have you had a look at the information on gagging on the website?

How can I prevent gagging in the dentist's chair?

Our readers share their tips for preventing gagging at the dentist's: coping with X-rays, impressions, brushing teeth, dental treatment, dentures, and more.

www.dentalfearcentral.org

Let us know how it goes today?
Cheers
Coolin

 

[2sleepy]

I have a similar situation, I have a crown on one of my lower canines that has decay at the gum line. My dentist told me that the tooth does not have a huge amount of bone support so an implant would be the optimal solution, but he can repair the tooth and fabricate a new crown. The cost of the implant would be $3,000 (my insurance would pay 1/2) the new crown $880 of which my insurance will pay 1/2. I have a horrible fear of having teeth extracted so I asked him what the 'worst case' was if I opted for a new crown. He said "I like to guarantee crowns for 30 years, this one I can only feel comfortable about for 8-10 years at which point you will most likely need an implant" It was a no brainer, I am getting the new crown and will face the situation of getting an implant several years from now..who knows they might develop an easier way to do implants by then =)

 

[comfortdentist]

I have had a patient that I had to sedate to do an implant on a maxillary incisor(12,11,21,22 or 7,8,9,10) because he gagged so bad. I think that I was more worried than him because his arms were the size of my thighs and he was an ex-boxer.
In general a number 10(22) is pretty easy from a patient's view as long as you have enough bone. As to the impression here it is possible to use a very small tray that most gaggers are fine with.

I just finished a 6 veneer case on a very strong gagger. Perhaps I'll post her pictures.

 

[sharon]

Hi, thank you for your responses. Yes, it is the upper front tooth, very visible, so just extracting and leaving it be is not an option.

I saw the dentist yesterday and after insurance the extraction and implant will be about $4700 (lousy insurance will only pay about $200) and for the redo of the root canal, some gum surgery and new crown my cost will be about $800. The better option he said would be the first but financially I am just not in a position to do that so I will go for the RC and crown and hope it works. We talked about impressions and he said either way he can probably get away with little ones, no biggies. I asked him about the guard and he said, yes, there will be one, but I forgot to ask about the size of it. I am afraid he will take the old crown off and see that saving what little is left of the tooth is not an option and I will have to have the implant. At that point, I won't have any choice but to do it, but I am so not emotionally ready for that.

Besides gagging/vomiting I am also afraid of getting a vertigo attack in the chair (I have a vestibular disorder) and lying way back only makes things worse. I was in a comfortable position for the cerec crown and hope he can do this front tooth in the same position, and if he can't I don't know what I will do. Yesterday he lay me all the way back, head lower than feet, and when the chair stopped moving, I still felt like I was moving. It was a horrible feeling and I had to sit up immediately. So I will not be able to tolerate it if I have to lie back. I am so distressed by this and can't wait until it is over.

Honestly, how can anyone be comfortable in that position?

 

[sharon]

I think that I was more worried than him because his arms were the size of my thighs and he was an ex-boxer.

I love dentists with a sense of humor . Now that I have read you saying a #10 is pretty easy I wish I went with that option. Oh, no, just remembed the cost! Well, at least if it does come to a point where I have to have an implant I'm glad to hear you say that, and the money, well, I'll pay for it somehow.

Sharon

 

[2sleepy]

If the impressions bother you, why not ask your dentist if he can do the root canal and refer you to someone who does Cerec crowns?

CEREC and Digital Dentistry

What is CEREC? Find out about the pros and cons of CEREC and digital dentistry, and how they compare to a normal crown process.

www.dentalfearcentral.org

There are no impressions, they just take some pictures and then they put the data into a machine and it makes your crown in less than an hour. When I was hunting for a new dentist I pretty much knew I would need a new crown so I made sure that they use this technology, impressions don't bother me so much but I hate having to go back and have the temporary crown removed and the permanent crown put on

 

[sharon]

2sleepy - I just had a cerec crown on another tooth and it was a very good experience. In fact that is why I am going to this dentist instead of my usual one. I'm supposedly just going so he can do the two teeth that need crowns and then return to my old dentist but I think I may stick with this one because 1) he takes my insurance and 2) I feel comfortable with him and 3) he does cerec crowns. One crown done and one more to go.

But evenso, I did have to have a small impression with the first cerec, it was very doable but still made me nervous. Because this next one he is working on has already had a root canal and 2 crowns he may find when he takes the crown off that the tooth can't be saved. That is the point I get nervous at because I am afraid with the iimplant and all that I will need a big impression even though the told me I "probably" won't. PROBABLY, being a very scary word. Hopefully, I will not have to go that route, and if he can successfully save the tooth and do a rc and crown I still will have to do a little impression he said, even with cerec.

Aren't CEREC crowns great? I never even heard of them until I came here a month or two ago very nervous about my upcoming crown appt. And lo and behold someone mentioned them. I had a hard time finding a local dentist who both does this and who I felt comfortable with. In the end it was well worth it, both from not having the big impression and from having it all done in one appointment.

 

[2sleepy]

2sleepy - I just had a cerec crown on another tooth and it was a very good experience. In fact that is why I am going to this dentist instead of my usual one. I'm supposedly just going so he can do the two teeth that need crowns and then return to my old dentist but I think I may stick with this one because 1) he takes my insurance and 2) I feel comfortable with him and 3) he does cerec crowns. One crown done and one more to go.

But evenso, I did have to have a small impression with the first cerec, it was very doable but still made me nervous. Because this next one he is working on has already had a root canal and 2 crowns he may find when he takes the crown off that the tooth can't be saved. That is the point I get nervous at because I am afraid with the iimplant and all that I will need a big impression even though the told me I "probably" won't. PROBABLY, being a very scary word. Hopefully, I will not have to go that route, and if he can successfully save the tooth and do a rc and crown I still will have to do a little impression he said, even with cerec.

Aren't CEREC crowns great? I never even heard of them until I came here a month or two ago very nervous about my upcoming crown appt. And lo and behold someone mentioned them. I had a hard time finding a local dentist who both does this and who I felt comfortable with. In the end it was well worth it, both from not having the big impression and from having it all done in one appointment.

Yep, Cerec crowns are amazing! My dentist told me he's about 95% sure a new crown will work on my tooth, but did warn me that once he takes off the old crown, if he's not comfortable that he can save the tooth and re-crown it, he wants to extract it during that visit and do an implant. He said he would then use the same exact process as making a cerec crown for my tooth, put a little impression material on (I think he said that is to establish your bite) then take pictures and the crown would be ready less than an hour later. So, according to him, there are no big impressions or having to come back for a second visit even with the implant.

 

[blackhound]

Tooth # 10 has a root canal, two crowns and now decay under the crown, ugh!! I have been given a choice between an 1) exatraction/implant or 2) redoing the root canal, lengthening the crown of the tooth and then having a new crown put on. The first option is about $4500 after insurance and the other is about $600 after insurance. I was all set for option #1, then I received the pre-treatment estimate from my insurance company and am now giving that major rethinking. I really can't afford $4500 at this time.

I'm going to the dentist tomorrow so he can explain both procedures to me but am looking for advice/help so I can be better informed. and what the heck is crown lengthing?

thanks, Sharon

Hi Sharon,

I had a crown lengthening procedure on a tooth this summer so I can tell you a bit about my experience and what to expect. Each one of these cases is different so your mileage may vary.

In my situation I was faced with the same decision -- extraction/implant or RCT, crown lengthening and CEREC crown. My tooth in question was #4. It had a large amalgam filling and a piece of the back of the tooth snapped off just below the gum line (which was the reason a crown lengthening would be needed). The dentist needs to have enough tooth to place a crown. I think they call it the biologic width/margin. If the crown is jammed too far under the gumline then you produce another set of problems with the gum tissue. They get there by removing bone and gum tissue around the tooth in question.

The factors which led me to the crown lengthening procedure are particular to my situation. 1) I have perio disease and already have a bone defect in the area where the crown lengthening needed to be done so the dentist didn't have to remove bone as the bone was already gone. 2) the bulk of my tooth was intact and I really wanted to maintain my natural tooth. 3) the piece that broke was on the back side so the bit of gum contouring is invisible and the front of the tooth was able to retain its natural gum line.

By now the dentist has explained the procedure? He will have to chip away some bone to place the crown properly and then recontour your gum line. Since this is a front tooth I would ask about the impact on the esthetics on your front tooth in regards to the necessary gum contouring.

Also realize that you are removing bone. In my case the decision wasn't that awful because I wasn't removing anything that wasn't already gone in the spot. It seemed like it was a no harm, no foul sort of decision.

BH