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Re: Root Canal - Front Tooth
 

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Published: 16 y
 
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Re: Root Canal - Front Tooth


First, does it bother you to have little chewing capacity on the left? If it doesn't yet, it will later. Reason being, if you focus chewing on one side for long periods of time, you basically work out one muscle and atrophy the other. Your jaw will eventually start to deviate to one side and cause joint problems later. Now, this is NOT something that happens quickly, so do not let this information rush you in any way, just think of it for long term....it would be better to do something about the lack of a molar on the left (#14/15).

Partial Denture option (lifespan 4-5 years):
Pro- Cheapest, fastest, many patients handle a single partial fairly well
Con- A unilateral denture will never function perfectly well when chewing
Con- Hygiene, if you do not clean your denture every day, or if you wear it at night, you have a good chance of having fungal growths inside the acrylic base (such as candida)
Con- Bone loss*
Con- Will add more force to teeth supporting it (force is better balanced than bridge)

Bridge Option (lifespan 7-10 years):
Pro - Moderate cost, fast, esthetic, better function than partial
Con - Damage two adjacent teeth permanently
Con - does not include fixing the #14/15 space
Con - Bone loss*
Con - Extra force on the adjacent teeth

Implant Option (lifespan permanent):
Pro - Best esthetics, best function, does not damage other teeth, does not add additional force to other teeth
Pro - Looks and functions exactly like a natural tooth
Con - Cost (average implant w/ crown is 3500-4000, bone graft 2500, cost can increase with a specialist) Looking at ~10k for the front, and ~4k for the back
Con - Time (expect 6-12 months for completion)
Extra - Titanium is a metal, but there is no controversy with titanium in the body (unlike Amalgam or some base crown metals). Titanium is used for implants across the body such as hips, legs, arms, skull without problem.

**Bone loss - The bone in your body stays around when it is in function. Unused bone gets resorbed by the body. Losing a tooth starts this loss of bone. 5-10 years and your ridge will have lost half its height. This is more seen in the front top area due to the quality of bone. The main reason most dentists love implants is because they put function back into the bone and prevent bone loss just like a natural tooth would.

Overall, longterm implants are best. If cost is an issue, a partial denture would be better than a bridge because you can go back later and do the implant if the bone loss is not too great. Another way to do this would be to do implants in the front, and wait to replace #14 at a later date because bone loss in the posterior is not as severe and there is more bone to lose.
Note* realize I am only talking in ideal situations, I do know that time and money have a huge impact on dental treatment. Please do not think I am completely against the other options as they are both viable.

Your 9-11 you said were crowded. It does not seem like they are too overcrowded, so here are some options. You could veneer these or you could have braces. (more and more people over 20 are getting braces done than ever before).
Composite veneers: Basically a filling that covers the front part of the tooth.
Pro - cheap, fast
Con - Not as esthetic as porcelain, but a good dentist can make them look very good with multiple shades used (requires skill and a good eye for color)

Procelain veneers: Lab created coverings just like crowns
Pro - well done they last forever
Con - Cost

Traditional braces - many do not like the look and cleaning problems while they are on, however you can do amazing things with a full arch of braces
Invisiline - Clear plastic trays that are used in series to slowly move teeth. They take longer, but are esthetic, and cleaning is simple. They are limited to very simple movements (like you seem to have). I am currently having invisiline treatment on my teeth if that helps.

Going with braces if you can wait is sometimes better than veneers because you do not damage the surface of the teeth. I would highly suggest braces if you like the basic look of the teeth and just want them moved together and fix the crowding. Minor composite bonding can be used to fix chips and points after treatment.


Your case NEEDS to be done with a team of dentists. If a single dentist says he can do it all himself, RUN! (unless he is a licensed prosthedontist, they work on cases like yours exclusively) You need to find a dentist who is going to spend a least 1-2 (if not more) appointments just discussing with you what you want and planning out the end result. I would expect a diagnostic workup with wax teeth created so you can see what the end result will be and you can make minor changes to the end result look.
Any dentist trying to rush your decision in a few weeks is someone to avoid. However, expect them to rush you in 6+ months in order to prevent bone loss.

Schools - There are amazing schools (like Baylor in dallas) that pride themselves on well trained dentists and well trained specialists. Many schools have both an undergraduate and a graduate section (graduates are dentists who are specializing). While the people you know might have had issues with minor treatment, thats because they were dealing with an undergraduate who was still learning basic dentistry. Some undergrauates learn very quickly, and some not as fast so it depends on the student you are assigned. However, your case in particular would be sent to the graduate department, likely the grad prosthedontics section where licensed dentists are working under prosthedontists who have been in practice 15+ years. There is a general thought that getting treated by students is somehow lower quality, however, I would argue that old thought.
A good dental school, especially the graduate departments, you get not one dentist seeing your case, you have 2-3+. Treatment may move a little slower, but you can be assured a better end result because of multiple opinions on your case.

Now, I cannot say anything about specific dental schools, especially because I am doing confidential research comparisons. However, I would at least suggest going and seeing yourself what you think about what they can offer you. Several consult visits to a dental school will usually run you just as much as a single trip to a private dentist. If after you still do not feel comfortable at the school, great, you know you saw all the options before spending the amount of money you are about to spend. Find a very responsive dentist who is going to make you feel comfortable, who gives you several options, and who offers you that team approach (or is a prosthedontist).

I hope I did not hit you with too much of a brick wall of text. Feel free to ask any other questions you might have.
 

 
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