- Joined
- Jun 28, 2013
- Messages
- 1
I am 43, and have been missing teeth #9 and 10 for my entire life. I took a bad fall on my mouth as an infant and damaged both the deciduous and adult teeth—both sets of which had to be removed surgically. I had a Marilyn bridge put into place when I was 14 and this lasted until a cracked molar filling changed my bite at age 40 and I started tapping on it with occlusion. Then some minor facial fractures in the L maxilla moved teeth 11 and 12 lingually and the trusty Marilyn bridge had to be removed after 25 years.
There was a plan to move 11 and 12 outward, get a bone graft for a sizable defect in the superior ridge, and put in two implants for 9 and 10. After a CT of the anterior ridge, this plan of a graft with two implants was deemed not a viable option due to the amount of missing bone (a full-on A→P hole) and proximity of the bone gap to the central nerve foramen (~1mm). Canine tooth #11 is still out of place presently causing significant malocclusion after both Invisalign and Bioliner-Plus (with pegs and bands) failed to move it appreciably.
And so, I have stalled out at a crossroads on my restoration work for my missing #9 and #10 teeth, and would appreciate some perspective.
Presently, I'm still trying to decide about whether to proceed with or without a bone graft. Even with a graft, I would need to decide whether to go with: a single implant with cantilevered pontics, another Marilyn bridge, or a conventional 4-tooth bridge. Putting it all together, I've really got 5 sets of options.
1. Orthodontics, No graft, Marilyn bridge: Less expensive, saves teeth #8, 11 but less permanent and leaves misaligned #11 in place that may require prior orthodontics or major adjustments.
2. No graft, conventional 4-tooth bridge: Better outcome with matching #8 & 9, able to effectively move the misaligned #11 with the new bridge.
3. Orthodontics, Bone Graft, Marilyn bridge: Better alveolar ridge shape, less likely to show soft tissue gap with high smile, possible to do a single or pair of implants later(??), #11 requires othodontics or a major adjustment.
4. Bone Graft, conventional 4-tooth bridge: Matching #8 & 9, Better alveolar ridge shape, less likely to show gap with high smile, but later implants are not a good option, since teeth #8, 11 are reduced to pegs and would require crowns.
5. Orthodontics, Bone graft, single implant w/ 2-cantilvered pontics: Most expensive, teeth 8 & 9 do not match, leaves #7 in place that may require orthodontics.
I’m not made of money, and I’m not a fan of dental surgery. My feeling is to go with option #1, 2, or 3. I am concerned about whether the A-P hole in the maxilla above teeth #9, 10 is a problem in itself, so I’d put #3 on the table too. Anything’s possible.
Questions:
• What's my best option?
• Does leaving the boney gap there, pose more or different risks than filling it in with a graft? (e.g. Is it possible that it is a cyst harboring an infection?)
• Does letting the graft heal for a longer time make a two separate implants more likely to be possible later on?
Feel free to call me (20six.947.491five) or reply to this thread.
May we all be well!
~T.R. Morris, ND
Seattle, WA
There was a plan to move 11 and 12 outward, get a bone graft for a sizable defect in the superior ridge, and put in two implants for 9 and 10. After a CT of the anterior ridge, this plan of a graft with two implants was deemed not a viable option due to the amount of missing bone (a full-on A→P hole) and proximity of the bone gap to the central nerve foramen (~1mm). Canine tooth #11 is still out of place presently causing significant malocclusion after both Invisalign and Bioliner-Plus (with pegs and bands) failed to move it appreciably.
And so, I have stalled out at a crossroads on my restoration work for my missing #9 and #10 teeth, and would appreciate some perspective.
Presently, I'm still trying to decide about whether to proceed with or without a bone graft. Even with a graft, I would need to decide whether to go with: a single implant with cantilevered pontics, another Marilyn bridge, or a conventional 4-tooth bridge. Putting it all together, I've really got 5 sets of options.
1. Orthodontics, No graft, Marilyn bridge: Less expensive, saves teeth #8, 11 but less permanent and leaves misaligned #11 in place that may require prior orthodontics or major adjustments.
2. No graft, conventional 4-tooth bridge: Better outcome with matching #8 & 9, able to effectively move the misaligned #11 with the new bridge.
3. Orthodontics, Bone Graft, Marilyn bridge: Better alveolar ridge shape, less likely to show soft tissue gap with high smile, possible to do a single or pair of implants later(??), #11 requires othodontics or a major adjustment.
4. Bone Graft, conventional 4-tooth bridge: Matching #8 & 9, Better alveolar ridge shape, less likely to show gap with high smile, but later implants are not a good option, since teeth #8, 11 are reduced to pegs and would require crowns.
5. Orthodontics, Bone graft, single implant w/ 2-cantilvered pontics: Most expensive, teeth 8 & 9 do not match, leaves #7 in place that may require orthodontics.
I’m not made of money, and I’m not a fan of dental surgery. My feeling is to go with option #1, 2, or 3. I am concerned about whether the A-P hole in the maxilla above teeth #9, 10 is a problem in itself, so I’d put #3 on the table too. Anything’s possible.
Questions:
• What's my best option?
• Does leaving the boney gap there, pose more or different risks than filling it in with a graft? (e.g. Is it possible that it is a cyst harboring an infection?)
• Does letting the graft heal for a longer time make a two separate implants more likely to be possible later on?
Feel free to call me (20six.947.491five) or reply to this thread.
May we all be well!
~T.R. Morris, ND
Seattle, WA