Two bad dental options (bone graft or bridge). Help me choose.

December 14, 2018 6:16 PM

This was me in August. I did as advised and had the tooth pulled before my hiking trip and all was well. I've just gone back to the dentist to arrange my implant and have been told it can't be done without more invasive surgery. Two terrible and expensive choices are in front of me. You are not my dentist.

As it turns out, I do not have enough bone to do the implant, so if I want an implant I need to do a bone graft with dental lift. I've seen two highly regarded specialists so far and walked away with two very different options. Both are eye wateringly expensive.

Option 1-- Do a bone graft with sinus lift and implant. This is, probably unsurprisingly, the option recommended by the implant. The costs in Hong Kong range from 4-5K US for this procedure. Some brief research on the Internet talks about long recovery times, inability to fly, etc.

Option 2-- Cap the two teeth around the missing tooth and put a bridge in place. One of the teeth next to it already has a cap from an old root canal but somehow this cap has to be made differently? I am not a dentist and there was a reason for this somehow. The other tooth has a filling, but is still healthy. This is what the non-surgical dental specialist recommended, again-- probably unsurprisingly. This procedure runs 3.5K-4.5K

To complicate things further, I lived most of my life in the Netherlands, and one of the pieces of advice from my old dentist there-- I called him-- is never cap a living tooth. When I asked my dentist here, he acknowledged that many believe this, but it isn't the standard of care in Hong Kong.

I have a couple more specialists to call for a second opinion, but I'm starting to conclude glumly that they will all have a different point of view.

1) Has anyone had this choice? What did you do?
2) Has anyone had the sinus lift and bone graft? Can you share your experience?
3) Bonus Question: Has anyone had dental surgery in Thailand at a clinic they can recommend? This is what many of the expats in greater China do to reduce cost, but I do not know how to choose a reputable clinic.

If you have another perspective that you think might be helpful, I would appreciate that too.

posted by frumiousb to Health & Fitness (12 answers total)

Check your memail.
posted by TWinbrook8 at 6:36 PM on December 14, 2018

This is second hand. My sister needed an implant but didn't have enough bone. Her dentist took some blood and used the serum to somehow use it to stimulate bone growth. He then did a successful implant.
posted by H21 at 7:31 PM on December 14, 2018

If you have a crowned tooth next to the implant site a possibility might be to position the implant across the site of two teeth.

I had this done in Australia in a multi part process because of a failed implant and bone loss. There was mostly sufficient bone around the crowned tooth site to situate the implant post to support two teeth. I did have a bone graft and yes, you need to leave it for six months before proceeding with implantation. Then another six months to let the implant set into the bone. My bone has since grown well around the implant site and it was the best outcome for a difficult case.
posted by honey-barbara at 7:55 PM on December 14, 2018

I had an implant in my lower jaw fail a few years ago and had the bone graft + new implant vs bridge choice. I got the same never cap a living tooth advice from my US dentist. I can't tell from a quick google how much added risk of complication the sinus lift adds vs doing this in the lower jaw. You do have to do the bone graft (and in my case, removing the failed implant) and then place the implant four to six months later, but the actual inconvenience is a couple of days each time. (I probably took two days off work each time, but I don't remember for sure. And then a few more days of eating cautiously) I didn't have cause to fly, but I don't recall being told not to. YMMV with the sinus lift, of course.
posted by hoyland at 8:00 PM on December 14, 2018

I had a root canal failure followed by an extraction, and I ended up doing the graft plus implant because there was just no way I was going to carve up 2 perfectly healthy teeth to do a bridge. The graft failed 3 times from donor bone but held very well from autodonor bone elsewhere in my mouth, and I believe it would still be functional today had I not had an extremely severe case of anemia which preceded my hysterectomy. This caused a horrible failure of the implant and it was eventually pulled out quite easily by hand by the dentist doing a different bridge for me. That was 4 years ago and I haven't done anything to replace it, as it's a lower back molar, but I will probably get another graft/implant when money and overall health allow.

I don't know what a sinus lift is and it sounds horrible, sorry.

I do know a few people who have had dental surgery in Thailand and I will see if they actually remember any useful details.
posted by poffin boffin at 8:03 PM on December 14, 2018

I have had neither of these procedures. Based only on the information you've provided here, I would personally go for the bridge, as it seems much less invasive. Yeah there might be a chance of complications down the road, but worst case scenario with the bridge, you lose all three teeth and get a partial denture—not the end of the world. Worst case scenario with a sinus lift or bone graft I dursn't contemplate. Either way, they're going to have to carve you up—if it were me I'd try to keep it at teeth-level rather than bone-level or deeper. I would definitely inquire further of both dentists re:complications, next steps should the procedure fail, etc. but right now I'd be leaning strongly toward Option 2.

Best of luck with whatever you choose, I'm sorry you have to deal with this bullshit situation.
posted by Anticipation Of A New Lover's Arrival, The at 8:26 PM on December 14, 2018 [1 favorite]

I simply couldn't afford an implant, so I went with a bridge. Fifteen years on it now and I hardly notice it. I was worried that it being the older/cheaper option, I wouldn't be satisfied with it, but now I'm glad I went with it, because it hasn't given me any problems and saved me a ton of money.
posted by Lunaloon at 9:21 PM on December 14, 2018

I have two implants, one on each side, in my lower molars. My experience with the implants was so good that I asked my Dentist why implants aren’t always the recommended option. He said that lower molars are the easiest implants, followed by the front teeth. The upper molars are not great because of potential impact to the sinus areas. Made sense to me.

To me it sounds like neither of the options are really making you feel comfortable so maybe you should wait and get a third opinion.
posted by MadMadam at 7:27 AM on December 15, 2018 [1 favorite]

I'm in the midst of a similar procedure for my second upper molar. At the outset they said I would need a bone graft and maybe a sinus lift, but I wound up not needing the sinus lift. The bone graft was no big deal, they drilled the hole for the implant and packed it with granules of something, which had to heal before the actual implant was installed.

All that is done now and through it all I needed nothing more than ibuprofen. My crown is due to be installed in the new year.

I get my work done at the dental college here, and aside from the failed root canal that started all this it's been smooth sailing.
posted by rhizome at 12:43 PM on December 15, 2018

So you saw two specialists and they said two different things? I would aim for option 2, but see specialists in *implants* about cost and requirements. The sinus lift is the extra expense part, and maybe you don't need it. The bone graft is standard, you get (stop reading if you are easily grossed out) a puree of cadaver or cow bone inserted into the cavity, and in time, it creates a new scaffolding to surround the implant.

Implants are not a single day thing. They implant the post and bone graft (the post is like a screw), you wait three to four months, then you get the mold for the crown, then you get the crown. So depending on how the payment is scheduled, this could be a multipayment thing so you don't have to come up with it all at once.

I would agree never cap a healthy tooth if it can be helped. I'm in the US. I'm not your dentist but I've had three or four implants! (They were tedious but fine; I was more anxious beforehand. A Xanax and following the clinic instructions were fine. They said after the first or second day, I could eat whatever I wanted except for really foolish things like popcorn. For the first day or two, I had mashed potatoes and ice cream and so on and then after that I slowly but surely forgot about it, and now sometimes can't remember which are implants and which aren't.)
posted by A Terrible Llama at 1:19 PM on December 15, 2018

I had the sinus lift and bone graft - it was easy peasy.

I had to have two teeth extracted, upper right back - that recovery was much worse than the implants. Before the oral surgeon stitched up the sockets from the extractions, he put some bone grafts in there to help add more bone to prep for the implants to come. I healed really well and then two weeks ago, had the two implants put in - still didn't have enough bone and I needed the sinus lift. He didn't even need to put in stitches, I just have these two metal posts now, there was hardly any recovery time. After my week follow up, he was pleased with how things look and I'll see him in a few months.

Yes, it was very expensive, like I could have remodeled my bathroom expensive, and part of cost was the anesthesia because I was knocked out for both procedures, but I felt that I am young enough that I wanted a permanent solution. I didn't want to deal with temporary teeth or something that needed more maintenance. I was very lucky I have a fantastic oral surgeon and I felt completely comfortable in his hands and I just didn't think about the procedure. He's the one who has to know the procedure, not me, and my ignorance helped the squeamish side of me a lot.
posted by NoraCharles at 10:14 PM on December 15, 2018 [1 favorite]

I just had an extraction and bone graft on Friday on #14, one of my upper molars. My dentists strongly recommended an implant because #15 already has a root canal that isn't looking great and #13 is still in good shape (so why grind down a perfectly healthy tooth to install a bridge?) My first dentist actually recommended replacing #15 with an implant as well, to preempt anything that might compromise #14. My endodontist confirmed that there were issues with #15, but I went to another dentist for a second opinion and what we ultimately chose to do is to try to retreat and save #15 (with the understanding that it might ultimately need to be extracted anyhow).

The extraction was done by a regular dentist, and she did the bone graft at the same time since we knew going in that there would be an implant (this seems to be standard practice around here in NYC at least). Like everyone else has said, the bone graft part is NBD, it's literally just packing the socket with bone granules and putting in a few stitches to hold it in. I don't know if I'll need a sinus lift yet, but it seemed like a possibility rather than a given so I've got my fingers crossed. The recovery so far has been quite tolerable, but we are investing in an immersion blender because this is going to be a months long endeavor. Financially this is going suck no matter what but the possibility of one implant instead of two helps, and at least it will be spread out over two insurance years.

The driving factor for me was bone loss and long-term reliability. I'm relatively young and have a history of terrible teeth so the "set it and forget it" nature of implants is a major pro (and probably why my regular dentist recommended proactively doing #15 now). However, you need teeth to maintain bone in your jaw, implants will do it but actual teeth are best (hence one more attempt to save #15.) If you get a bridge now and want an implant later, it will be more difficult to do because there will be less bone to work with. Your calculus on this may vary depending on your age, dental history, and budget. For me I'd rather spend some more money now on a permanent fix that is less likely to need more attention down the line.
posted by yeahlikethat at 12:50 PM on December 16, 2018