Tooth Implant

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Hi there.. !

I would be really grateful for some advice.

My dentist has told me I will need to have my front tooth taken out and my ideal solution would be an implant.

However I notice to have 1 tooth implant is very expensive. My thinking is could I just have the tooth extracted via NHS and just see how I get on without tooth?

I have had some advice that varies. one dentist says say for my budget I can just have the tooth extracted by a NHS dentist. My understanding was if I do intend to go down the implant root at a later date I should get a specialist implant dentist who knows how to preserve the bone. The dentist says if there is not much bone I can always have a bone graft anyway.

The dentist also says if I don't want to I don't need to have dentures to "fill" the gap. (I was told by other dentist that if I don't "fill the gap" with dentures my other teeth will "grow over into the gap". The dentist said the other teeth will grow over into gap eventually but this will take 10s of years!

So my plan for now is just to have tooth extracted on NHS and see how things go before I do anything els. Does this sound like a good plan?

Hope to talk soon and thanks for reading.


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  • Posted

    Tooth movement can happen literally before you know it. (It's actually not movement of the tooth, but rather old bone cellls in the area of the removed tooth dying and being sent to "meet their maker" by the osteoclasts, while at the same time osteoblast "storks" bring new baby bone cells to the other side.  It's actually a little more complicated, but this is easy to visualize.

    Bone grafts will be changing soon.  Techniques for 3-D printing of replacement bone parts has been demonstrated.  Some of the "inks" currently used are based on hydroxyapatite.  Newer ones are based on calcium phosphate. The idea is to print a 3D lattice with the chosen ink.  The lattice  has the size and shape needed, appears solid, but is functionally sparse,  allowing  it to be impregnated with stem cells and allowing other parts of the DNA map (nerves, capillaries, etc) to grow into place where they belong.

    A newly discovered growth factor (Nell1) that helps “jumpstart” stem cell division is showing promise in reversing osteoporosis.  The two techniques may be used together for rapid creation of replacement bone parts.

    Other new advances promise to eventually make implants a thing of the past.  One such technique has been used to trigger the stem cells in the roots of a tooth to begin rebuilding the tooth from the inside out, discarding bad tooth in the process.

     If the tooth is dead, a transplant of root cells and supporting tissue might one day be transplanted from another tooth.  Amazingly, DNA maps are location independent, so stem cells transplanted from the "wrong" kind of teeth will sort of "recognize" where they are and produce the "right kind" of tooth. 

    An understanding of how such location independence works  is one of many things explained wonderfully expained in the book "Your Inner Fish", without requiring any prior exposure to jargon.

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    • Posted

      I was just reading what I said in the last paragraph of what wrote, and realized that my glowing words about "Your Inner Fish" could be construed as being somewhat spammish.  It was not intended that way.

      Just so you know, I have no financial ties to the book, I don't know the author,   and I do not stand to gain anything from recommending it other than the satisfaction that comes from sharing a good read. 

      It is just a book that has the rare quality of being able to clearly explain a wide range of related topics, both individually and collectively, tying them together in such a way that it all makes sense, from the big picture down to many of the very smallest details.

      I forget her exact words, but the friend who recommended it to me jokingly said it could be called something like "Everything you always wanted to know about what we're made of and how we got here but were afraid to ask"(**)   (**) and want real answers of substance, not a sex manual. 

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    • Posted

      My mother had dentures and absolutely hated them.  So does everybody I have ever met who had them.  That's not saying you couldn't be an exception.

      Did your dentist say why the tooth needs to come out?  Different dentists have different thresholds for making that decision.  It could come down to there being a tooth saving proceedure that he does not perform in his practice, but another dentist might..

      For example, at around the time I moved a while back, I had gotten written estimates for work to be done on the same teeth from my old dentist, and one in my new neighborhood.  They were similar, except where my old dentist specified inlays, the new one just wanted to give me crowns.

      One dentist might use veneers to make an irregular looking tooth appear smooth, while another might just plop a crown on top of the whole thing,  even though more tooth may have to be sacrificed when doing a crown,  which might end up causing more expensive dental work to be needed years later.

      If you are willing to commit to a time frame for making a decision, your dentist might be amenable to keeping the tooth (stub) in place for a while, canal filled with gp, sealed against bacteria, and a temporary "crown" on top.  It would still be a temporary,  but with today's techniques (at least in the US, I don't know about elsewhere) he can make you a durable temporary crown that looks as good as a permanent one, has a margin as  tight as one he gets with a permanent crown made by a decent lab, won't trap food, and won't come loose without using a chemical release agent.

      You could use the time it gives you to save up for a down payment.

      You could also look at the online versions of dental maazines.  Things seem to be changing more rapidly than was once the case, and what was considered gospel years ago is becoming foklore.

      If a dentist is using a new technology that costs him less, and he is sympathetic to your situation he might be willing to offer you a cost break (some dental procedures have enormous markups, but remember too that the equipment they must own is also quite expensive)

      Although a dentist I've known for 30 years will tell you that using temporary crowns while an implant heals will cause osseointegration failure and for that reason you cannot have temporaries with implants,  at this very moment, I'm reading a dental journal paper in another window showing how careful evaluation of  four dimensional geometry , intra-oral forces, and occlusal contact issues (for starters)can lead to at least as good or better osseointegration of implants fitted with with provisional crowns  than "traditional" implants without them.

      Key points emphasised: Patient selection ("100%overbite? Just Say No!"wink

      Avoid flap to retain bone vascularization;Careful, atraumatic extraction essential;buccal and palatal walls are preserved via careful coring; use of surgical guide for proper positioning "should go without saying", placement must consider four dimensions:mesial/distal, buccal/palatal,  apical/coronal, and motion;once osteotomy prepared, then implant inserted;angulation carefully adjusted; height set relative to adjacent teeth; implant diameter should “fill” the extraction socket to maintain planned 3D (ignore the fourth, here) geometry;If any voids,fill with bone from prior drilling and/or burring;line and adjust temporary crown so that there is no centric or protrusive contact; because recession of approximately 0.6mm to 1.0mm generally occurs within three months after implantation, final restoration should not be crafted until after that time. During provisional period there should be no occlusal contact in centric occlusion or excursive movements.


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    • Posted

      Urgg.  That's the second time this week that punctuation I've used got turned into a smiley-face.  I wish this site had an "edit" option

      Double Urgg.  I really didn't realize that I'd typed so much into that tiny input box

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    • Posted

      If I were in the position right now of having to choose for myself,  I would (A) get the implant and have it done by a competent implant specialist, (In the US, however, work is often divided between an implant specialist who does the planning and surgery and your own dentist who does the final crown - I would never let a general dentist, no matter how skilled he might be overall, place an implant in my mouth)  (B) stay very far away from any dentist who says he is so good that he can place (some, or even any) implants with no need to bother with 3D (or conical) imaging (that statement alone should tell you that he is not an implant specialist, no matter what else his shingle might say) or who performs extractions that are not atraumatic. (Even in America, there are still a few of both)
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