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Re: Root Canal - Front Tooth
 
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Published: 16 y
 
This is a reply to # 1,318,166

Re: Root Canal - Front Tooth


First of all, I would like to commend you for doing outside research, I try to push all my patients to educate themselves about what they are doing to their mouth/body.

Unfortuantly, many dentists focus on production and lose sight of educating patients so they can make a fully informed decision. Its not your fault you did not know about root canals if they never mentioned anything about it to you or your parents.

Did you mention earlier you already had a temporary in the front? Is this a temporary bridge, or partial denture? If its a bridge and you already have #5 and 8 prepped, you might as well stay with that treatment plan. If its a temporary partial, there are some other questions I would ask before specifically giving you an opinion.

First, your bone levels are most important when looking at implants as a choice. How long have you had your teeth out? Have you had a diagnostic cast made of your mouth? (we always do before doing ANY anterior case because of the huge esthetic zone).
Just in general, you need 5.5mm of bone from tongue to lip dimension, 6.5 from tooth to tooth, and 8-10mm from the top of the ridge. The final number is most important. A bone graft is easy to add bone to the lip side, but vertical height is difficult to add.

Next, what is wrong with your other teeth? Do you have most of your back teeth? Do #5 and #8 need crowns? (not talking about veneers). If you need crowns on #5 and #8, a bridge might be a good option IF you still have decent bone levels. If you lost a lot of bone, a partial will give you better esthetics due to the loss of gumline unless you have a low smile line. (I know I am throwing out a lot of terms, please feel free to ask about anything I mention).

My other main reason to avoid a bridge, especially in your case, is functional load. Every tooth in your mouth is designed for specific loads due to how much root structure you have. Canines (#6) have the longest roots in the mouth because they function as a cornerstone tooth that take a lot of forces. If you have a #5-8 bridge, you are asking teeth with smaller roots to take the load of 2 extra teeth, plus a canine). This could lead to excess bone loss and you eventually losing #5 and 8. Most anterior bridges are done with the canine as one of the abutment teeth because it is designed to take much more force.

Titanium in an implant is just as biocompatable as gold, if not more so. Gold is the base metal used by "biologic" dentists.

Lastly, comes down to cost. Implants are the most expensive, dentures the least. I would also caution you that many dentists do implants who do not have enough training, and anterior implants are the MOST difficult to plan because they are in the esthetic zone. If you have a dental school near you, thats where I would go to get implants done (if they have an implant program), multiple doctors looking at the case leads to more reliable outcomes. Secondly, I would suggest finding a prosthedontist because they get extra training doing more difficult cases such as multiple teeth replacements and advanced implants. However, the good news is, once an implant is CORRECTLY placed, it will last your entire lifetime (unlike bridges and crowns). Implants are long-term the best and sometimes overall cheaper option (if you look at cost over 30 years).

Again, without seeing your specific case, I can only give you information, not a recommendation. However, for few patients are implants not a good option if you can afford them.


Since you mentioned lumineers, I will say I do not really like them. The material and idea behind a veneer is great, however many people who do lumineers say they do it as a "pain free" experience. This is because they do minimal prepping of the teeth and basically add a layer of porcelain over the original tooth, which looks bulky. More conventional veneers will take off 0.4-0.7mm of tooth (you have 1-1.5mm of enamel). This provides room for the porcelain that makes up the veneer and provides a more natural shape, as well as preserving the enamel. Because of this enamel still being there, a well done veneer can last virtually forever as well if taken care of. It is harder to find a dentist who knows how to do a good veneer, I have no specific recommendations on how to find one other than by looking at previous results from EVERY angle. Do not be satisfied with just frontal shots, ask for incisal shots (this is where you will see if the tooth is bulky). Again, veneers require diagnostic casts in order to effectively evaluate your occlusion.
 

 
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