Post or crown or something else?
September 20, 2013 11:04 AM   Subscribe

My partner (28 years old) had, on the same upper back-ish tooth, two failed root canals followed by a tooth extraction. They're still waiting for the extraction to heal. But they told us that a post is impossible since his bone is too thin. I hear a crown requires root canalling neighboring teeth, which we really don't want. Can we just leave it as is without teeth shifting significantly? Is there another option that doesn't requiring destroying MORE teeth?

As a bonus question, my 79 year old grandma is in a similar situation: failed root canal, extraction, bone too thin for a post, and does not want to go with a crown. Would you recommend the same for her?

I really don't know much and the literature on the internet is sparse. I apologize in advance if I've mixed up the terminology. Thanks.
posted by ethidda to Health & Fitness (18 answers total) 1 user marked this as a favorite
Husbunny grew up in Kentucky. 'Nuff said? He's missing some teeth in the back and he's fine.

Just keep an eye peeled for shifting.

The best thing is to discuss options with your partner's dentist. ASK what a crown would entail, or even if it's recommended. ASK what the consequences would be if you chose to do nothing.

Expert opinions are why experts cost so much.
posted by Ruthless Bunny at 11:07 AM on September 20, 2013

Is a bone graft not an option? Probably pricey, but better than damaging neighboring teeth, though I've never heard that you need to root canal neighboring teeth for a crown.
posted by yasaman at 11:11 AM on September 20, 2013

The option usually taken is a bone graft, either from (sorry) powdered dead people or autologous bone (sourced from elsewhere on the patient's body). Sometimes the former doesn't take and you try the latter. In the gramma case, age and bone density might be a factor but I don't really know.
posted by elizardbits at 11:21 AM on September 20, 2013

Maybe things are different for the back teeth, but I've got crowns on a couple of molars and there was no root canal.
posted by dismas at 11:22 AM on September 20, 2013 [1 favorite]

(the option usually taken when the bone is too thin for an implanted post, I mean)
posted by elizardbits at 11:24 AM on September 20, 2013 [1 favorite]

Just another vote for investigating a bone graft for your partner - a 28 year old should be more aggressive about other options than a 79 year old.

And, a suggestion to get at least one more opinion on the matter if your current dentist didn't suggest a bone graft (a fairly standard procedure) and has 2 failed root canals under their belt.
posted by quince at 11:31 AM on September 20, 2013

If the tooth is gone gone then "crown" in this situation most likely refers to a bridge, which is a fake tooth supported by the two neighboring teeth. A root canal is only done when there is damage to the tooth. Which may be the case in the mouth that we are discussing. But maybe not. A bridge without root canal can be done. In fact, a tooth may need a crown but NOT need a root canal.

Some people's teeth shift more readily than others. By the time the change is noticeable to the person whose face it is, the fix may be more involved. A dentist is trained in figuring out how likely a given set of teeth is to drift, and to keep an eye out for when it's beginning to happen. Don't count on anyone else's experience to match yours.

If you are not comfortable with what you have heard from your dentist (whether it's price, or necesity of treatment, or anything else!) please seek a qualified second or third opinion.

Not only because the only person who can give you advice about your mouth is someone who has seen your mouth, and your radiographs, but also because the pricing structures for dentistry do have some geographic considerations, even within particular cities.
posted by bilabial at 11:36 AM on September 20, 2013 [1 favorite]

Thank you for the information.

Just for clarification, the current dentist only had one failed root canal. My partner likes this dentist fine. This dentist said the previous dentist (who my partner did not like) was not good, and did the root canal "too wide". (My partner believes that he was recommended to do a root canal on the tooth by the dentist, as a cover up for some other dental malpractice.)

My partner's considering leaving it open for now, if it's okay. I will bring up bone graft if his dentist doesn't just to see what they say. Price is not really an issue. (I don't really want to pay $10k for it, for example, but we have decent insurance and can set money aside in an FSA.)

yasaman, I might be mixing up my terminology. Maybe I meant a "bridge" instead of a "crown"? I know that there is a fairly invasive but standard procedure to replace the missing tooth from an extraction.
posted by ethidda at 11:36 AM on September 20, 2013

Oh! And who did these root canals? Was it an endodontist? Or a dentist?

They are different jobs and if he hasn't yet seen an endodontist, he needs to do that as soon as possible. Also, if he opts to look into a bone graft, that is the territory of an oral surgeon. Because that's what oral surgeons do all day long, surgery. Dentists see everything, maybe doing one or two grafts a week if they're super agressive about it. Oral surgeons will probably do one or two a day. But ask about their numbers.
posted by bilabial at 11:38 AM on September 20, 2013

Yes, the root canals were done by endodontists. The first one was a referral, from a dentist he didn't like to an endodontist he didn't like. The second one is the one he's working with right now, and in the same office as his new dentist.
posted by ethidda at 11:41 AM on September 20, 2013

I know that there is a fairly invasive but standard procedure to replace the missing tooth from an extraction.

You might be thinking of an implant.
posted by yohko at 12:01 PM on September 20, 2013

Your partner (28 yo) - yes, a bone graft/augmentation, done by a specialist, and then an implant. A sinus lift may be involved. Pricy, but worth it. Doing a bridge is better than doing nothing, but a bridge has some drawbacks - it usually lasts a shorter time than an implant, and requires compromising adjoining teeth to various degrees (to support the bridge). Doing nothing: bad; not only will adjoining teeth shift, but s/he will eventually lose the opposing tooth (or teeth) as well; further, there will be bone loss where the tooth was extracted and then more bone loss when the opposing tooth is lost as well. Bottom line: best - implant, second best - bridge, worst - doing nothing. There are some caveats with implants as well - is your partner a smoker? Is s/he a diabetic or have high blood sugar? How conscientious is s/he about dental hygiene? Also, an implant with bone graft is a lengthy undertaking - can take 1-2 years. IMPORTANT: an implant should be done by a specialist who does implants and has lengthy experience and good reviews, not a regular dentist, no matter how well-liked and enthusiastic.

Granny - given the age (79), doing nothing is a reasonable option, though a few points need to be considered - how good is her general health? How much longer is she going to last? Does she have enough teeth left so that her food intake is not compromised? Otherwise, one may consider some kind of partial with dentures, but that's a situation that needs to be carefully considered on a case by case basis by a specialist who can take all factors into consideration.
posted by VikingSword at 12:05 PM on September 20, 2013

Be aware that implants have a life expectancy just as partial plates, and crowns do. Flossing is mandated with implants, but there is no problem of "seeds getting under the appliance" as there is with a partial. No smile in a glass overnight. No driving halfway to work and then remembering that you did not replace your partial. Your teeth can only be removed by a dentist.
posted by Cranberry at 12:38 PM on September 20, 2013

I'd have him get a few additional opinions. At 28, at minimum he should be able to do a bone graft, if not a regular implant without a bone graft. Teeth are drop dead critical. I think anything that undermines the structure of additional teeth, other than the compromised tooth, should be avoided if there is any financial way to avoid it. More opinions. Most people get three estimates for major work on their house -- it seems reasonable to get three (expert) opinions on something like this.
posted by A Terrible Llama at 1:10 PM on September 20, 2013

(I had an implant at a tough economic time for me, when it was fairly sketchy whether it was a thing I should be doing. It cost three times what I would have paid for the bridge. I cannot tell you how many times I've looked back and felt great about that decision, even though at the time I felt queasy as hell about it.)
posted by A Terrible Llama at 1:12 PM on September 20, 2013

Implants are composed of three elements - the implant screw itself, the abutment and the implant crown. Abutment failures are rare, as are implant (screw) failures. Some considerations that influence longevity of the implant: the experience and skill of the person who places the implant, the technology utilized and the health and periodontal care of the patient. Newer implants - as of the last 5 years or so - have features that should make them even more successful, though obviously we don't have track records for these, so it will remain speculation until the data is in. Some older implant techniques were suboptimal resulting in slightly higher failure rates. If the patient is diabetic, a smoker and doesn't take care of their mouth health, it may impact how long the implant lasts.

However, even with all these caveats, the life span of implants is excellent and unsurpassed by any competing restorative techniques. The effective life span of a properly placed and adequately cared for implant is the life span of the patient:

"Data from 5 to 15 years demonstrate success rates from 88 percent to 100 percent for single-tooth implants, with expected lifetime success rates approaching 97 percent."

Unfortunately, some patients might not be able to care for their implants for whatever reason and/or develop other health problems such as diabetes and this will severely impact how long lasting the implant might be. With adverse conditions, the failure of implants might be as high as 18% at some point. Natural teeth are superior to any implant, (though the natural tooth in this case is gone, so the point is moot), but a meta study comparing tooth loss to implant loss found little difference in well-cared for natural teeth and implants, and comparable rates of loss in badly cared for teeth and badly cared for implants:

"The incidence of tooth loss among subjects with a follow-up period of 10-30 years varied from 1.3% to 5% in the majority of studies, while in two epidemiological studies on rural Chinese populations the incidences of tooth loss were 14% and 20%. The percentage of implants reported as lost during the follow-up period varied between 1% and 18%."

Revisiting the composition of implants, the implant screw itself fails very rarely. Abutment failure can come from screw loosening (inside the abutment). The biggest potential failure point is the implant crown itself, which might happen in a 10 year span. Therefore for the patient the cost factor going forward after an implant over a life time is potential crown failure(s), not the implant itself.

The lifespans of bridges are more difficult to assess globally, because there is such a huge variety of bridges and techniques, but in general the life span is pegged at 10-15 years, with many exceptions on either side. But the bottom line, is that those statistics are materially worse than in the case of dental implants.
posted by VikingSword at 1:30 PM on September 20, 2013 [2 favorites]

I have an implant with a bone graft, replacing a molar with multiple root canals and crowns and gum surgeries and tooth breaking and so on. My bone graft was cow bone chips. It was a long process, but now all is fine.
posted by gingerbeer at 4:23 PM on September 20, 2013

We brush with a sonic toothbrush and floss daily. No family history of diabetes on his side. And at the latest visit, his dentist brought up bone grafts. We did some research, and he is actually experienced and well rated for doing bone grafts specifically. The bone may have to come from my partner's hip to reduce the possibility of rejection, if the extraction site doesn't heal ideally.

I actually misunderstood my grandma's situation. The root canal was declared successful, and she is getting her crown(s) fitted.

Thank you for all your answers. They made me understand the different options a lot better and much more comfortable supporting my partner's decision with his tooth.
posted by ethidda at 11:35 AM on September 25, 2013 [1 favorite]

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