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Questions in the Dental Health forum are answered by Dr. Jerome Tsang. Topics covered include bridges, cavities, crowns, and x-rays.

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I was told by my dentist that tooth 14 and 15 needed a root canal.  In 11/2010 had the root canal done on tooth 15.  The roots were calcified but the RC worked.  It was never crowned yet.  That tooth broke off in half and is only half of a tooth (going up and down).

I went to get the other RC on tooth 14 in 01.2011 and the Endo started it but said that the roots were very small and he wasn't sure if it would turn out very good and told me to ask my dentist if he should continue.  

I asked my dentist and he referred me to another place (a dental school).  They said that my tooth had mobility and that it wouldn't be worth doing a RC on and they said that it had some bone loss.  I looked at the X-Rays and couldn't see any bone loss that they were talking about.  They told me that I should get an implant.

I told my dentist and he wondered the Endo had told me to get an implant and not a bridge.   He said that I might not have enough bone to get an implant.  

My dentist also said that since my tooth #15 already needs a crown, and tooth 14 needs to be extracted because it's moving, that the solution would be to get a bridge for  tooth 15,14 and 13.

I'm so confused because I've been to 3 different Endodontists throughout this ordeal and also my dentist and they've all said different things.

My tooth #13 has nothing wrong with it so I'm concerned about ruining it to make a bridge, so I wanted to know which option is best.

The reason that I'm concerned about ruining my good tooth (#13) is because most of the teeth in my mouth are crowns and bridges or huge fillings and I have so few good teeth left.  I'm always in such fear of someone who ends up losing my teeth.

Can anyone help me with what to do?  Thank you.
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That's a tough situation because you're getting alot of information that's conflicting.  

If #15 is fine and the root canal is stable, I would suggest to put a crown on that individual tooth.  As for #13, I would always favor not treating a tooth that's not needed.  Plus, the life span of a bridge isn't that great so there's always the possibility that the bridge will fail and may jeopardize either #13, 15 or possibly both.  I would suggest to try to deal with #14 individually with either an implant or a root canal.  If the success rate of the root canal is low as it seems to indicate, then extracting it would be better because any further bone loss could create an even less ideal situation for a dental implant.  You may need a sinus graft/bump to create more bone before placing an implant which is what they seem to implying.  

Hope that helps some.
7 Comments
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Avatar_m_tn
They can't do a RC on tooth 14.  It's loose and needs to be extracted, so needs an implant or bridge but I'm not sure if there's enough bone for an implant.

I'm guessing that an implant PLUS a bone graft is even MORE expensive than just an implant right?

Then I have the cost of extraction, two crowns, a buildup and who knows what else.  I'm not sure what all this could come up to.  My insurance won't pay for implants.  For a bridge it would cost $2,400 and my insurance pays 1/2 up to $1000 per year.  

For a crown it would cost 1/2 of what the amount is and then I'd have to pay the total implant out of pocket and then get another crown and they'd pay 1/2, again up to $1000.  I'd still have to pay for extraction and buildup and I don't know how much my insurance charges for that.  I think they said for a simple extraction it would be $120.

I'm confused at figuring the math out on what's the difference in cost between getting one done vs. the other.  Can anyone else figure this out?

Thank you.
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540545_tn?1377626518
Well, if its a bridge vs implant, then the implant would be the more expensive alternative due to the lack of insurance coverage.  Unfortunately most policies with dental insurance don't cover dental implants.  

Still, a dental implant should last longer than a bridge and it would preserve #13 as well.  As a long term investment, a dental implant is more ideal.  It may cost more upfront but it should, in theory, last longer as well although no one can guarantee that.
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Avatar_m_tn
I've heard from some others though that their implant didn't work and they had to end up getting a bridge and so it concerns me that I'd end up having to pay for both.  But it also concerns me to ruin tooth 13.  

I've had so many problems with my teeth thanks to genetics and also because my parents didn't take me to a dentist until some of my molars were large craters.  

I also had a bad malaclusion but didn't get braces until my 20's and my 1rst ortho pulled 4 teeth.  After 1 1/2 years when nothing was improving I switched to another ortho that said that the other ortho shouldn't have pulled those teeth because the spaces wouldn't close, so then I had to get 2 bridges.  I had those bridges put done in the 80's and they've lasted.  That's why I wondered why you said that they don't last.  

In also had to have surgery to get my jaws re-aligned to help fix my bite.

I've had so many things done and that was just some of them.  And new things just keep coming.  I can't keep affording all of these things all of the time.  I just don't know what to do anymore.

btw, can you please fix my subject line.  Thank you.
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540545_tn?1377626518
I don't know how to change the subject line.  I just post like you do.

Well, according to research that I was taught in school, the average lifespan of a bridge is lower than an implant but its not to say that for your particular case, the implant will last longer.  Its hard to answer cause each case is different and its all probability how things turn out, not a definitive answer so you play the odds so to speak.  

If you get the implant and it fails, you get a bridge.

If you get a bridge and it fails, then you may lose one or more teeth.  Then you're looking at more implants or a denture.  

Its a tough situation.  My personal opinion is the implant but unfortunately I can't guarantee anything.
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Avatar_m_tn
I'm wondering if the fact that I'm grinding my teeth at night could have recently loosened tooth 14, the one they want to extract.  I have an appliance for it, but the side where tooth 14 is on it was sort of crushed down a little.  It's still there, but that side of the appliance is now thinner.

I  wanted to get a new appliance to see if it would help tighten up the tooth, but I guess now I can't since it would end up having to be replaced once I get the crown for tooth 15 and also possible tooth 14.

Is this making any sense?

Do you have any ideas?  

Thank you.
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540545_tn?1377626518
If the appliance is still intact and you're using it, most likely not.  

A new appliance probably won't help either and won't fit properly once you get a new crown on #15.
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Jerome Tsang, DDSBlank
Irvine Modern Dentistry
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