Overdenture lower partial or seperate implants - many questions (detailed and long)

[Jane123]

Overdenture lower partial or seperate implants - many questions (detailed and long)

Hi there. A little history here, and please bear with me. I know there are a lot of details here, but my tooth history is extensive...and I want to give an accurate window into my dental world so someone can help me make a decision on what to do about my failing teeth.

Many years ago in the early 70's I had my first molar (lower left) removed because of an abscess. 10 years later, my 2nd molar broke and needed to be pulled. At that point a permanent bridge was put on with the anchor teeth being the premolar and the wisdom tooth (it had moved up considerably over the years). This lasted until 2004, when decay made the wisdom tooth unsuitable as an anchor, and the bridge was removed. The wisdom tooth was root canaled, a single crown was placed (in hopes of giving the new bridge in front of it some support), and a cantilever bridge was attached to the 2 premolars in front of the original 1st molar gap. (I believe the 2nd premolar was root canaled before the second bridge was put on). Eventually, the wisdom tooth crown came off and it was determined it couldn't be restored and it was extracted.

This left the cantilever bridge virtually unsupported on the back. A couple of years went by and the bridge started hurting. Nothing could be found wrong with the teeth supporting the bridge, but it would ache and hurt at night. We decided to chop off the cantilever tooth in hopes that the stress on the 2 premolars would lessen and the teeth would stop hurting. It didn't help...and finally after months of pain, a small fistula formed and the endodontist agreed (finally!) to do a root canal on the 1st premolar (this was last year). No cracks were found in the root under the microscope.

Fast forward to last week, and the 2 tooth bridge sheered off at the gumline. My dentist was able to temporarily glue it back in with no problem, but said that a new bridge is questionable and probably wouldn't last. He thinks I should either do implants, or a lower overdenture with 2 precision attachments on the root canaled teeth to hold the partial in place.

I am scared to death of implants...especially in that area since I know there is a bundle of nerves that exit by the bicuspid...not to mention the one that runs along the bottom of the jaw bone. I know there are CT Cone scans available now to give better details of the nerves, but the thought of a serious complication makes me very fearful!

So I am left with a decision of what to do. Implant risk or a partial. Neither seems like a good choice to me. I am tempted to ask him to perform heroics and restore the bridge knowing that it won't last, but 2 years with something is better than permanent numbness, or a partial I won't wear.

Besides the question of what to do.. I also have some questions about the partial:

1) Why does the partial denture have metal that extends to the other side of my mouth? Can't I just have 2 precision attachments on a small sideplate partial and call it good? If it matters, I also have another root canaled tooth in front of the canine. I'd be willing to sacrifice that tooth to another precision attachment if it meant I didn't have to have the metal bar go all the way around my mouth. I presume it has something to do with even pressure on the teeth...but I don't want all that metal in my mouth.

2) Has anyone ever went off protocol and snapped on an implant on top of a root that has a percision attachment? If the root is acting like an implant, why can't a tooth be restored on top of it...using a snap-on implant restoration?

3) Lastly, should I consider implants, or should I try the partial first? With the overdenture, the bone would be preserved ..so, no harm, no foul.... unless of course the stories I've read are true and a partial loosens other teeth and is the first step towards a full denture.

I am losing sleep over all of this. I feel so defeated since I have followed the advice of my dentists over the years with the bridges, etc.. only to end up here feeling like I have failed. I am fearful that my teeth will continue to fail, one by one and I will either have to ante up implants on a regular basis, or face the harsh reality of a denture.

Thank you for letting me vent. I am confused, depressed and in some kind of denial. I could really use some good advice at this point. I'm 56 years old.

 

[rob wain]

Re: Overdenture lower partial or seperate implants - many questions (detailed and long)

Hi,
First off, you haven't failed at all. You've had two bridges last you 40 years. That's a great success, well done.
To answer your questions-
1. The denture has to extend around the mouthotherwise it would pivot on the canine causing it to fail. There is unlikely to be much benefit from incorporating a lower incisor.
2. What you're describing here is effectively a crown on a post. If the premolars fractured at gum level then its not likely to bea good long term fix.
3. Partials doputstrain on other teeth, particularly the canine in your case, but short term wear wouldn't harm if its well designed and you have good gum health. On the other and, the optimal implant sites are first premolar and first molar - the bone will continue to be lost from the molar position. If you go for an over denture then consider placing an implant in the molar site now ready for the future.

General thoughts on over denture - the design you described is quite good but it will still feel quite bulky and alien, you may get used to this. You have to remove it for cleaning and overnight. It will move a little when you chew, food may get under it. Ask yourself what you'll do when the over denture fails.

Implants - risk of nerve damage is easy to assess with scan or X-ray
Betterchewing than an overdenture
Feels more like teeth
More expensive
Probably last longer.

My advice is get an assessment of the risk damage and bone quality- good implants are the best solution but it depends on your circumstances.
Rob

 

[comfortdentist]

Re: Overdenture lower partial or seperate implants - many questions (detailed and long)

I am a big fan of overdentures to the point that if you call my office and want a conventional lower denture without implants you won't be accepted as a patient.
The quality of life and satisfaction is vastly improved with implants.

 

[Jane123]

Re: Overdenture lower partial or seperate implants - many questions (detailed and long)

Thank you so much for replying so soon. I've decided to go for a consultation to the oral surgeon to find out if implants are an option. Maybe they can reassure me with x-rays that the chance of nerve damage is minimal. I need to know what I'm up against as far as genuine risks go (instead of my highly imaginative mind).

I've also called my dentist with a few questions and am waiting on him to call me back. We really didn't have much of a discussion about this when I was in last week because I think he could tell I was a little distraught and needed some time to think about it.

A partial seems like the end of the world to me, but implants make me so scared I get sick to my stomach. I suppose it is similar to the fear many on this site feel when they think of going to the dentist. I am not your typical patient. I have fear..but mostly my fear is that of losing my teeth...with the icing on the cake being that I have had so much work done over the years I am sick of it all. The pain, the money, the uncertainty of weather my teeth will 'behave' on vacation. Nothing in my life depresses me more than my teeth. When do you throw in the towel and say 'enough'.

Anyhow, thanks again. I thought I had posted a reply earlier today, but apparently I didn't hit enter or something. Sometimes I just wish I had become a dentist...since I have spent a good deal of my life worrying about my teeth. Temporary coming off? No problem...I'd just drive into the office and put it back on. Tooth hurting? No problem...I'll just go in and take an x-ray. Hmmm..maybe I should go to work for a dentist. That thought never occurred to me until just now....not a bad idea really.

 

[rob wain]

Re: Overdenture lower partial or seperate implants - many questions (detailed and long)

actually it's even harder to get treatment if you're a dentist- i don't trust anyone haha.
I think you've made a good call, implants will, probably be the better long term option but do get IDN checked forst.

 

[brit]

Re: Overdenture lower partial or seperate implants - many questions (detailed and long)

actually it's even harder to get treatment if you're a dentist- i don't trust anyone haha.

LOL I have long suspected this to be the case. I mean my last dentist did the most amazing slow painless injections (say 4 mins) - what would he do to get one for himself - well apparently Gordon would inject himself but surely sometimes that is not possible because of position?

Lincoln Hirst has said on here before that no one will clean his teeth as gently as he would for himself...etc etc ....it's probably really common for dentists to not trust other dentists.
How many dentists would happily go to just any random NHS dentist out of the phone book for say a crown? Yet the public are told by the NHS that all dentists are the same and equally good.

I do think dentists who have experienced dental treatment themselves i.e. dentists of a certain age are much better with the dentally anxious. They get it whilst also knowing it's not really a big deal...if you are in the right hands .

 

[comfortdentist]

Re: Overdenture lower partial or seperate implants - many questions (detailed and long)

LOL I have long suspected this to be the case. I mean my last dentist did the most amazing slow painless injections (say 4 mins) - what would he do to get one for himself - well apparently Gordon would inject himself but surely sometimes that is not possible because of position?

Lincoln Hirst has said on here before that no one will clean his teeth as gently as he would for himself...etc etc ....it's probably really common for dentists to not trust other dentists.
How many dentists would happily go to just any random NHS dentist out of the phone book for say a crown? Yet the public are told by the NHS that all dentists are the same and equally good.

I do think dentists who have experienced dental treatment themselves i.e. dentists of a certain age are much better with the dentally anxious. They get it whilst also knowing it's not really a big deal...if you are in the right hands .

I always give myself the first injection.
"How many dentists would happily go to just any random NHS dentist out of the phone book for say a crown? Yet the public are told by the NHS that all dentists are the same and equally good. "
That's easy NONE not even one!