Implant supported bridge or single implants?

[Jane123]

Second try at getting a dentist to answer

Oral surgeon suggests 2 implants (21,19) and an implant supported bridge to replace a failing cantilever fixed bridge on teeth 21,20. Tooth #19 has been missing for over 30 years but OS says there is enough bone for an implant. He said individual implants are 'just extra money' and he didn't see any reason for 3 individual implants. Teeth #18,17,16,15 are already gone.

I have read the pros and cons for the implant supported bridge.... it does a better job of dispersing the pressure on the bite than individual implants, but is harder to keep clean and much more expensive if something goes wrong in the future (replace whole bridge instead of one implant).

Any opinions on which is best? Implant supported bridge or individual implants?

Also, teeth 20 and 21 currently have root canals, and it has been suggested that precision attachments could be used for a partial instead of implants (I have a deep fear of implants that are placed near the nerves). Since I do have many root canals and possible tooth failures down the road, maybe a partial is best????

I am confused and stressed out to the point that I'm having a hard time living my life. I realize that this decision is mine to make, but I can't seem to make it. The depression and failure I feel concerning my teeth is hard to describe....not to mention that this is a ticking time bomb that has to be done sooner instead of later.

So again, my main question is.. assuming adequate bone and space, which is better... implant bridge or individual implants?

Thank you.

 

[comfortdentist]

Honestly I do both and as much as I love to do implants I love to do the right treatment even more. It is impossible to recommend one over the other based on the information provided. Some of the other considerations are your age, smoking, periodontal disease, caries history, bone and tissue at the implants site, occusal forces, space, hygiene, general health, conditions of support teeth and expectations.

 

[Jane123]

Thank you for responding. Can I ask one more question? Am I being overly concerned about nerve damage? I will be getting a CT Cone scan...does this virtually eliminate the possibility of nerve damage? I can't find any statistics on how many lower jaw implants result in permanent numbness or pain. I don't tolerate pain well, so if it were to happen to me, I'm fairly certain I wouldn't be able to go on.

 

[comfortdentist]

Ask:
1. Can you clearly see the nerve on the scan ?
2. How much spare room to you have?
3. Can you just numb the surface so that I would lnow if you are close?
4. Will you use drill stops to virtually prevent accidently "dropping" too deep?

If the above guidelines are followed then your risk is very low.

 

[jellyfish]

Ask:
1. Can you clearly see the nerve on the scan ?
2. How much spare room to you have?
3. Can you just numb the surface so that I would lnow if you are close?
4. Will you use drill stops to virtually prevent accidently "dropping" too deep?

Not to hijack this thread, but I have similar concerns. I am congentially missing both second mandibular premolars (20, 29) and will need implants soonish because the retained primary molars have severe root resorption - several dentists have told me I am an "ideal case" for implants. I also recently had injectional lingual paresthesia, which "only" lasted four months, but I had dysesthesia and was in constant, intractable pain - I couldn't stand to go through that again.

I started reading implant case studies (osseonews) and dental journal articles when I had the paresthesia, so I have some idea of the protocol for avoiding and dealing with paresthesia from implants. I would also want to ask if the dentist would remove the implant immediately (within ~24 hours) if there were any signs of paresthesia, because I would rather have a complete do-over than risk permanent damage from wait-and-see. Does your question #3 translate to using infiltration only rather than an IAN block?

Also - what should you do if the dentist does not want to follow this protocol? Is it possible to get a copy of the CBCT on a memory stick and bring it to a different office, or do CBCTs use proprietary software that isn't easily transferable? I can screen for whether an office uses CBCT in treatment planning over the phone before scheduling an appointment, but I'm not sure how far along the process things get before there is a chance to ask these more detailed kinds of questions...

TIA!

 

[rob wain]

Jane123 - I agree with comfortdentist that there isn't a definitive answer to the choice between individual implant crowns and an implant bridge.
Advantage of extra implant is that it's easier to deal with future implant loss BUT implant loss is pretty rare anyway.
Having multiple adjacent implants makes it harder to achieve a good gum contour which may effect appearance, speech or cleaning.
Personally when we are planning implant cases we recommend the number of implants needed as a minimum and only increase this is we feel there is a significant chance of an implant failing in the future. So my starting point would be to opt for an implant bridge unless there was a reason to want/need the extra implant.

Jellyfish, your points about la infiltration and potentially backing a fixture out are well made. The CBCT is very easily shared between different dentists - most come with software built in to allow anyone to view the images.
I would suggest that if you had your own copy of the CBCT then you would be able to discuss your case quickly with any prospective dentist and ask about their protocols without needing to commit yourself.

 

[comfortdentist]

I started reading implant case studies (osseonews) and dental journal articles when I had the paresthesia, so I have some idea of the protocol for avoiding and dealing with paresthesia from implants. I would also want to ask if the dentist would remove the implant immediately (within ~24 hours) if there were any signs of paresthesia, because I would rather have a complete do-over than risk permanent damage from wait-and-see. Does your question #3 translate to using infiltration only rather than an IAN block?

YES that is my protocol.

 

[Jane123]

Thank you for those questions to ask Unfortunately, this OS insists on giving IV sedation, so the answer to #3 would be no. I do have an appointment with a younger OS (less experience) this week for a second opinion. I have been to this office before for a previous consultation and know they leave sedation options up to the patient. I'm thinking nitrous oxide would be good enough for me.

Thank you again. I am leaning towards the partial with precision attachments added to the existing root canals....then if I can't stand it, I can always do the implants. I wish I didn't have this implant fear, but I do... and since I'm not sleeping well these days, I need to move forward.

Oh and thanks Jellyfish for your response. I know that pain and numbness do occur, and you have reminded me that it is indeed 'real'. When I talk to my friends about complications, they look at me like I'm crazy. Most people are unsuspecting of the problems that can occur. I get comments like "well, you could get killed in your car today, but you still drive". Yes, that is true, but driving is not necessarily optional..but implants are.

 

[jellyfish]

Jane123, I certainly don't want to discourage you from getting implants if they would be a good solution for you! I had what was probably pretty far toward the worse end of temporary paresthesias, and I am definitely planning to go ahead with implants for myself (assuming the CBCT doesn't show anything bad). I just want to take careful measures to minimize the risk of nerve damage.

BTW, I did at some point read a technical journal article on the prevalence of long-term or permanent paresthesia from mandibular implants. I forget the details, but IIRC the results were that a small but significant percentage of people had some form of lasting paresthesia, but for most of these people it was extremely minor (like a small patch of their chin that had reduced sensation) and the majority of those with permanent effects were still glad that they had had the implants and were not bothered by the paresthesia.

 

[comfortdentist]

Thank you for those questions to ask Unfortunately, this OS insists on giving IV sedation, so the answer to #3 would be no. I do have an appointment with a younger OS (less experience) this week for a second opinion. I have been to this office before for a previous consultation and know they leave sedation options up to the patient. I'm thinking nitrous oxide would be good enough for me.

Thank you again. I am leaning towards the partial with precision attachments added to the existing root canals....then if I can't stand it, I can always do the implants. I wish I didn't have this implant fear, but I do... and since I'm not sleeping well these days, I need to move forward.

Oh and thanks Jellyfish for your response. I know that pain and numbness do occur, and you have reminded me that it is indeed 'real'. When I talk to my friends about complications, they look at me like I'm crazy. Most people are unsuspecting of the problems that can occur. I get comments like "well, you could get killed in your car today, but you still drive". Yes, that is true, but driving is not necessarily optional..but implants are.

That is not correct. You can and I have sedated soneone and still know if they have any painor sensation when you get close to the nerve utilizing local infiltration only.