March 5, 2010 at 12:00 am #9718
AnonymousMarch 7, 2010 at 12:00 am #9735
I saw your website, nice site. I’m looking for advice about periodontal treatment.
I have widespread gum recession and bone loss (5 to 6mm pockets, although my periodontist is putting me on extensive SRP to reduce pocket depth and to “seal up” the gums to keep bacteria out). I live in Vancouver, Canada and the periodontist I’m seeing says he is not able to do guided tissue regeneration (e.g. bone augmentation) for the widespread bone loss that I have.
Fortunately, I have large teeth and roots but the bone level is getting low. My teeth are not loose yet but I need to take action now.
I’m looking for a 2nd opinion and I’m looking for a better periodontist who can do the bone augmentation to provide more support for my teeth. I was wondering if you could point me to periodontists in western Canada or in the northwestern U.S. who are experts in bone augmentation, bone grafting for teeth, or even gum/bone regeneration in teeth. Ideally, I’d like to see such an expert who is close to Vancouver, e.g. Washington state, Oregon state, or western Canada.
But I could even fly out to other parts of Canada or the USA to see such an expert.
Do you have any suggestions about some experts or treatement in this field for my situation? Thanks for your helpMarch 7, 2010 at 12:00 am #9736
Jack Wasserstein, DDSMember
Thank you for your post. I can only generalize without actually doing an exam, but based on your description, here are some options to consider with pros and cons:
The molar you are talking about is tooth #14. As I understand it the tooth below #19 is missing, so #14 has grown downward into the empty space. This is mother nature’s way of making sure that your teeth always bite together, which is to say that opposing teeth always grow toward one another until there is contact. Thus when you loose an opposing tooth the remaining tooth continues to grow into the empty space. This is the situation that you are describing now.
The options that you mentioned are typical for correcting these types of situations but I would also add the option of removing 14 and replacing it with an implant too.
Orthodontic eruption: orthodontically intruding the tooth. This can be costly and time consuming. Furthermore its possible to create a periodontal pocket as the tooth intrudes because there is no guarantee the the tissue will reattach to the exposed root surface as it is being intruded. If the furcation (intersection of the roots of the tooth with the trunk of the tooth is already exposed, I would rule this option out all together. I would recommend this if the attachment of the tissue is at its normal level on the tooth, but higher in the mouth because of the supraeruption.
Root canal and crown: This is typically how this situation is mitigated. Sometimes a root canal is not necessary if the amount of tooth structure to be removed does not involve the nerve chamber of the tooth. In that circumstance this is ideal. When the root canal is necessary some other decision criteria should be considered – Is the furcation of the tooth exposed, what will the final crown to root ratio be after the reduction of tooth structure. This measurement is the ratio of the length of root in bone vs the length of tooth out of the bone. In general you want this ratio less than one – more length of root in bone vs tooth above bone. If this ratio is above 1 or the furcation of the tooth is involved I would recommend removing the tooth in favor of placing a dental implant.
Replace with dental implant: If the conditions above are positive – furcation involvement or unfavorable crown to root ratio then an implant should be considered. The implant has the most predictable and long term prognosis.March 8, 2010 at 12:00 am #9737
Thank you doctor!
—– No, the orthodontist is not going try to intrude my tooth through gums soft tissues, and reattach the exposed root with soft tissues. He said he can use mini-screws to lift up the whole tooth and the gum, in other words after it’s done my tooth and the gumline will look just as it is now (with expposed roots), only a few millimeters higher (I think the only thing that will look different is my gum-line (?) around tooth #14 will be slightly higher than the rest).
I never thought about extraction and implant option, not that I didn’t know. I just wanted to save my tooth 14, and do what’s best for it… Anyway, thank you very much for your advice!!March 8, 2010 at 12:00 am #9738
Jack Wasserstein, DDSMember
If it is only 2 or 3 mm you should be ok, but the same warning applies. As the tooth is moving back into the bone,, toward the base of the root, it is unlikely that you will get the bone and periodontal apparatus to reattach to the root that is exposed now that will be submerged. You will likely end up with a periodontal pocket. The TAD is just used for anchorage. I think your orthodontist can better advise you of the risks because he is the one who has seen you clinically. Hopefully now though you have better insight to the issues. Good luck with your treatment :).
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