Author: smokindok
Date: 2021-06-07 02:15
If Claudia is still following this, after the detour into yet another mouthpiece facing/embouchure pressure discourse...
Disclaimer: After 37 years of practice, I retired a bit over a year ago, to have more time for music... until Covid hit :-(
I am no longer licensed to practice dentistry. What I write below are just some things to consider, when making a decision, based on my experience placing many bridges, restoring many implants, and working with many musicians over the years.
First off, read carefully Hans' excellent comments above. His experience reflects the transition dentistry has gone through over the past few decades. As implant designs have been refined, and techniques for planning, placing, and restoring them have improved, the advantages of implants over bridges has, in most cases, made implants the first choice for replacing missing teeth.
One consideration is the health of the canine tooth on each side of the space where the teeth are missing. These canines have a much larger and stronger root than the incisors, so for decades they have been used to support a bridge to replace four missing incisors. Is the bone support for these canines sound, or has there been bone loss in this area also? If there is compromised bone support for the canines, the additional torqueing force of a bridge could accelerate breakdown of the supporting tissue, leading to mobility of the bridge and its eventual loss.
Do the canine teeth have existing restorations? If there are no existing restorations, it is a shame to unnecessarily strip all the healthy enamel off the tooth, weakening it and risking creating the need for root canal treatment, in order to make the clearance needed to place the bridge. On the other hand, if there are existing large restorations in the canines, the risk of fracture or restoration failure often increases.
That said, advanced bone loss can make implant restoration more complicated. This is where planning is critical! Modern 3D imaging techniques make planning the correct placement of implants much more manageable. Assuming the surgeon placing the implants and the restorative dentist constructing the replacement teeth are not the same person, communication between the two throughout the entire process IS CRITICAL. There can be situations where placing an implant in its "ideal" position in the bone puts the esthetics or function of the replacement teeth at risk. This needs to be resolved in the planning stages. When in practice, I always dreaded getting a call from an oral surgeon, after they had already placed implants, asking me to do the restorative work. At times, when multiple implants were placed, an implant would have to be "put to sleep" in the bone and not used to support the replacement teeth, because of the way it was positioned. PLANNING IS CRITICAL for a good result.
Examples of the details that need to be planned from the start: How much grafting needs to be done, using what technique? How long to wait after grafting before implant placement? What design and what manufacturer for the implant? What diameter implant? What length implant? How many implants? What is the best implant position in the bone for strength, function and esthetics? How long to allow for integration of the implant with the bone before any load on the implants? Will a temporary restoration be made for esthetics, while healing is taking place? What is the number and position of teeth in the final restoration? Will each implant be restored separately, or splinted together?
It is complicated, but done right, implants offer many advantages over traditional fixed bridges. If the implant route is chosen, understand that it may be a rather lengthy process. Feel free to contact me at the email in my profile, if you have any questions.
Hope all goes well with the treatment!
John
Edit: While writing this lengthy post, I see the discussion was already brought back on course!
Post Edited (2021-06-07 02:20)
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The Clarinet BBoard
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