All I want for Christmas are two front teeth.
September 10, 2007 4:34 PM   Subscribe

I have two porcelain Maryland bridges next to my front teeth, but now I am thinking of finally dealing with it and getting a dental implant. but I have some questions.

I have a genetic distinction that leaves me without about four teeth. When I was 19 I got a pair of Maryland bridges for the two most prominently displayed, which I have had to replace already two times in eight years. The issue is down to vanity: why wait for a screw to heal in the bone when I can 'solve' the problem now with Maryland bridges? I have a public career and am worried about how work/relationships would perceive me, although I know I would be better off getting the longer-term work done.

I now realize I just need to go ahead and get the surgery, but I would love to hear about adult experiences of getting a dental implant and dealing with the result of waiting. What is it like in the meantime, how long is the wait before a tooth can be put in permanently, and is the screw visible?
Also important: what is kissing like?
posted by parmanparman to Health & Fitness (9 answers total) 4 users marked this as a favorite
I would suggest that you also ask this question to your dentist. Although I haven't had any implants done, I had a ton of dental work done (had neglected it for decades), including a partial lower bridge and a full denture on top, removal of bone (yeah, yeah, I'm getting old as heck!)... I worried about the same thing.. though the use of some temporary dentures and such, there was never a day that I couldn't go out in public.... (even after an 8 hour sitting to get 95% done in one day).

Point being, dentists are very aware of the need to keep us presentable while they do the work... talk to him/her and find out what the plan might be.
posted by HuronBob at 4:42 PM on September 10, 2007

For the details for your particular case of course consult an oral surgeon/periodontist/prosthodontist. It is important when placing an implant to replace a single tooth that the placement of the implant fixture is perfect and the angle matches up to the natural teeth.

If your bone in the implant area is sufficient, expect the healing time to be about 5-6 months. You will likely be able to wear the existing bridgework while it heals. They will need to be removed to place the implant fixture, but can be immediately recemented.

When it comes time to use that implant, the bridges can be removed, and abutment posts screwed into the implant fixtures and temporary plastic crowns placed until permanent porcelain crowns can be made. If the back surfaces of the adjacent teeth had been contoured/cut to fit the Maryland bridges, composite plastic fillings can restore the natural shape to those teeth.

I can't comment on your kissing, I don't know if you are any good at it! Hey, just kidding, it will be more natural than the bridgework, implant crowns look and feel very natural.
posted by Jazz Hands at 4:59 PM on September 10, 2007

Implants are great the pain of placement is equal to an extraction.after the gum tissue surrounding is healed enough a crown is fitted (no screw) more
posted by hortense at 5:04 PM on September 10, 2007

I had an implant put in for my top front tooth two weeks ago after going through several bridges during the past 15 years.

The surgery was completely painless. I was sure I was going to walk away with nice prescription for a painkiller, but I was assured as I left that there would be none to very little discomfort, and if I felt any pain I should call them right away. I didn't even need an aspirin, and I was eating food within two hours.

After they put in the implant, they put on a temporary crown. It's made of plastic, and close inspection reveals it to be a fake, but it does the job from greater than two feet away. It completely covers the screw, and although you need to be careful with it, it doesn't completely impede your ability to eat. or kiss. or do anything, really.

After the temporary crown, my dentist let the area around my implant recover for 2 weeks, and then applied a real crown.

It was easy, it was painless, and it was practically unnoticable for a week, then completely unnoticable. I'm kicking myself for waiting for so long. Do it!
posted by jgee at 5:06 PM on September 10, 2007

I have a single tooth implant replacing a molar and love it. I decided to go with an implant because I didn't want to cut into the adjacent teeth to support a bridge, nor did I want the bone loss from a missing tooth anchor. As I was missing a chewing/grinding tooth, I also wanted my bite back without fretting about being gentle to a bridge.

Depending upon the particulars of your healing abilities, the implant takes a few weeks to several months to integrate with the bone in your jaw. Your situation may allow for the implant and crown to go on at the same time. Otherwise, for front teeth the dentist will give you a temporary bridge or Flippers. For back teeth, you're offered the choice of a temporary crown or foregoing the temporary and just having the the top of the screw is covered with a small metal cap while your bone heals.

The restoration I went through was more lengthy as extra bone had to be transplanted into my jaw before the implant could be placed and we had to wait for the graft to heal before the implant post was installed. The surgery for that was done completely from the inside of my mouth and although a rather large cut was made through the gum of my lower and upper jaws, I can't feel or see any scar. I remain amazed by the healing abilities of mouths.

The surgeries went fine, I was under general for all of it. Post surgery, I was sent home with scripts for painkiller which turned out not to be needed. Neither procedure compared at all to the previous tooth extractions I had had in that the implant surgery didn't cause much pain or swelling and I was back to shoveling food into my piehole within 24 hours.

The screw is not visible once the permanent crown goes on, it's hidden inside the body of the replacement tooth. The dentist uses what sounds and feels like a tiny little socket wrench (complete with racheting noises) to attach the crown to the implant: it doesn't easily come off on its own. My prosthodontist spent a lot of time taking molds and photos to create a crown which looked like it belonged in my mouth (despite its location way in the back), as a result my implant is indistinguishable from my natural teeth in color, shape, and feel. It's in there rock solid too, to the point where I prefer chewing on that side of my mouth.

It was costly (not covered by insurance) and it did take a long time (doubly long because I had to wait for two rounds of bone growth) but I'm happy with the result and would definitely go with another implant if I happened to lose another tooth in the future.
posted by jamaro at 5:47 PM on September 10, 2007

jamaro - if you don't mind me asking, how much did it cost in total? I have a Maryland bridge as well and if I were to go with the implant I'd need to grow more bone tissue in my jaw as well. I've been putting it off because of the expense - just easier to keep cementing the bridge back in place. Maybe I can budget it into the flex plan next year.
posted by any major dude at 6:36 PM on September 10, 2007

$8K. Mine was pretty messed up, however (tooth roots poking giant holes into sinus cavities, super thin jawbones, oy) plus I live in an area with a very high cost of living, so I hesitate to offer my ghastly costs as a benchmark (other than an "at least it won't cost that much" benchmark).

Because the length of healing time involved you'll be able to spread it across two years of flex spending by timing it so the healing/waiting portion lands at the end of the plan year. Your dentist will outline the costs during the consult; I knew what my wallet was getting into well before we started. It was pay-as-I-went, with the costs spread over quite a bit of time: did the sinus repair, paid for it, waited for it to heal. Did the graft, paid for it, waited to heal. Did the implant post, paid for it, waited for it to heal. Did the crown, paid for it, smiled.

Some of the sinus repair and bone graft costs were eventually picked up by my medical (not dental) insurer as were all the scripts for antibiotics and the aforementioned painkillers. I don't recall how much of that $8K made it back to me, it's been ~7 years.

What spurred me into doing something was the alarming and noticeable rate of bone loss I encountered after the tooth extraction. The longer you wait, the more bone will have to be replaced at the site of the missing tooth. Upper jaws lose it faster than bottoms, so I'm told. I figured worst case, I would shore up the jaw with the graft, stop the erosion with the post, and pay for the crown (which was ~$800) when I got around to it but as it turned out the span of time involved gave me plenty of time to save up.
posted by jamaro at 7:10 PM on September 10, 2007

My only advice is to seek a dentist/oral surgeon that uses a Waterlase dental laser for this procedure. We used it in the most recent office that I managed and it helped speed recovery time for our patients, but most especially for the people we referred to the periodontist next door who used one as well.

Also, remember not to eat nuts or super crunchy things with your temporary crowns.
posted by bilabial at 4:01 PM on September 12, 2007

I don't know if you are still looking for information on this, but for the sake of people who find this in a search, and because I wished for something like this while I was researching implants:

I got an implant for a front upper tooth this summer. Because several years had passed since I had lost the tooth, bone loss had occured, and they weren't sure whether or not a bone graft would be needed until they actually got into the space. (This caused some uncertainty about the cost.) It turned out that some other, outside bone (cow bone?) was all that they needed. I had the surgery under laughing gas and went home with a complimentary container of ice cream. There was a lot of bleeding. I remember it being pretty darn sore as the anesthesia wore off, but I managed to make it through without taking the strong meds. YMMV. I was on exclusively soft foods for quite a while - but then, I was also paranoid. If your implant fails, you don't get a refund. Smoothies, mashed potatoes, cottage cheese... yum.

Because I went to my dentist later that same day, I only had to spend a few hours with a metal post sticking out of my gum. The temporary crown covered the post just fine - you could tell it was fake if you looked really closely, but that may also be the case with your bridges. The temp was stuck on so well that the hygienist had trouble getting it off. It was very important to have good communication between the dentist and the oral surgeon, btw.

One difficulty that I encountered was trying not to be too active in the weeks following the surgery. Getting my blood pumping would make the spot sore, and because the surgeon had specifically told me to avoid risk and hard labor, I was worried that overworking the spot would make the implant fail. Unfortunately, my work involved lots of heavy lifting and risk of falling. If I had had a desk job, it wouldn't have been a problem.

In the three months while I waited for osseointegration to finish, I avoided eating on that side of my mouth, which may have looked a little strange. (Something to keep in mind.) At the end of three months, after getting an x-ray with the surgeon, I went to the dentist for my crown. We had ordered it two weeks before this; the hygienist went to great pains to match the color and detailing with my other teeth. My dentist used glue to attach the implant. It went directly on to the post. I did a version of the procedure that cut out at least one step - I think it was the one where they open up the gum and put in the part of the post that will stick out of your mouth.

The most painful part of the process was when the dentist opened up the surface of the gum surrounding the post in preparation for putting in the permanent tooth. (I have no idea why he did this.) I had to wait 15 minutes before I could drive home.

After the surgery, I had some funny feelings (numbness?) in the part of my face above the implant and next to my nose. If I put pressure on the right spot, it still feels funny. Nerve damage can be a risk, depending on where your implants will be. It's not annoying, and I think it may be due in part to the mild strangeness of having more bone there than there was before.

I anticipate many years of happiness with my implant. It was a little annoying, but 4 weeks (or even 4 months) of annoyance is worth it, in the long run. As long as you can schedule some time for recovery (=no hard labor), do it!
posted by ramenopres at 8:06 PM on November 1, 2007 [1 favorite]

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