<p>Just got back from the dentist. I have so little tooth structure left he said I need to have the gums cut to length the tooth so he can put the crown on. The tooth already had a root canal so it’s somewhat weaker than a normal tooth. </p>
<p>My other option is removing the tooth and have an implant. I will need a sinus lift.</p>
<p>I wonder if anyone had to make this choice before and have experiences to share.</p>
<p>I feel your pain. Or at least I did a few months ago.</p>
<p>My crown (to be put in next week) was below the gumline so he used two cords to separate the gums from the teeth so that they could take an impression to make the crown and also make the temporary. The temporary is in there to make it easier to eat and to prevent the gums from growing over the remaining stump. They said that they would have to cut the gums if that happened.</p>
<p>I guess the question is how much of the gum will they have to cut? If it is very minor, then that would seem to be the less invasive way to go.</p>
<p>I had this process done over the summer. My tooth, an upper molar, broke below the gum line. To save the tooth, I had periodontal surgery and a crown. The periodontal procedure is called “crown lengthening,” which exposes enough of the tooth structure to adhere the crown to. No anesthesia - just typical dental localized numbing.</p>
<p>There is about a six week wait between the surgery and the final crown (you’d be fitted with a temporary), because the gum needs to heal. The surgery wasn’t a huge matter; three stitches, some temporary packing, prescription strength Advil and an antibiotic just in case of infection. I returned a week later to have what was left of the stitches removed.</p>
<p>I’m glad that I had the procedure - the tooth looks and feels fine. In my view, it’s always better to save the natural tooth, if at all possible.</p>
<p>BC & GM : do you have a root canal on the tooth previously ? </p>
<p>I am thinking of implant because I was told since the tooth already has a root canal and a crown done 9 years ago and this is the second time around, this crown with the gum surgery would most likely last even a shorter time. Since first one lasted 9 years, this restoration would probably only last 5-7 . </p>
<p>An implant would hopefully last longer. </p>
<p>The surrounding two teeth to this problem one also need new crowns so I wonder if a bridge would do. I just emailed the dentist to ask about this option.</p>
<p>You have a tough decision. I don’t like bridges because they are hard to floss, so if possible, I would rather have a crown. If the choice were an implant versus a bridge, I would probably choose the implant. </p>
<p>Even if the crown lengthening/new crown only lasts five years, you can still have the implant at that point. Over the years, I have found that every time a dentist tells me that his/her work will last x number of years, it ends up lasting twice as long, but I’m very careful with my teeth. </p>
<p>I don’t have a root canal on my crowned tooth. My dentist suggested one, because I had sensitivity (but not pain) when the tooth originally broke, but because it subsided after the repair, I decided not to do it. The gum area above the tooth is somewhat sensitive, but not particularly bothersome. My dentist said that she can do a root canal through the crown, if it ever comes to that. </p>
<p>Good luck.</p>
<p>I had a root canal with mine but didn’t have a prior crown. I have no experience with bridges (haven’t even studied them).</p>
<p>You might try asking around your friends. I found that it was easy to find other people that had these procedures in my office given the relative ages of my coworkers. We hire a lot of people from asia and many of them have had far more dental work than I’ve had, presumably due to poor care in where they grew up.</p>
<p>munchkin, there are many different ways to treat the same problem, and the costs vary considerably. (I suspect I don’t need to tell you this . . . ) If I were you, I would get a second and maybe even a third opinion from another dentist. </p>
<p>You want the solution to last for the rest of your life so this tooth doesn’t need something else in a few years.</p>
<p>^This dentist would be my third consult. I have already consulted with two other dentist before this. They pretty all say the same thing - they tend to advise me to do an implant. I asked this dentist what would he choose to do if he was in my place, and after considering, he said he would do an implant. </p>
<p>The dentist emailed me a reply this morning regarding a bridge - he advise against one as the surrounding teeth had root canals and not strong enough to support a bridge. At this point I am leaning towards an implant. The bad thing for me is, the surrounding two crowns have to come out too and with my kind of track record, who knows if they are as bad as this one. I may be looking at 3 implants :eek: though the dentist said they do not look as bad as the one right now on the x-rays. </p>
<p>So I have to decide : gum surgery and save the tooth for perhaps 7 years, gum surgery would help the surround two teeth as well because in the situation when the decay is bad, the dentist would have more teeth to work with as gum surgery affects the surrounding two teeth as well. </p>
<p>Implant, which will for sure last longer than 7 years, hopefully for the rest of my life but will not help the situation with the other two surrounding teeth, in case I need the help.</p>
<p>I am seeing the specialist this afternoon. He will be doing either the gum surgery or implant.</p>
<p>Good luck.</p>
<p>I had tooth completely rotten and broken off. There was absolutely no way to put crown on it. Actually only way to pull it was to yank it out with little hammer, there was nothing left to pull it with. I had implant, which took barely 1 minute to put in after tooth was yanked out (took a long time to do that). If implant is all by itself, you cannot tell implant from real tooth. I have 5 implants, 3 of them connected, two stand alone. The problem is that they became very expensive, last one (last year) was $4000. I have 2 dental insurances both of them covering implants (not very common) and I used them over 2 calendar years (having implant in October and crown in February of the next year), so basically I had 4 coverages for my one implant. I still had to pay $1200 out of pocket. I do not know anything about sinus problem.</p>
<p>Compare the cost of the crown lengthening to the cost of an implant. Compare the severity of the procedures and the crown length. wins this debate. In CA the cost of an implant with the crown is close to $7,000 in the SF Bay area. Crown leng. is a much less invasive procedure and if 3 dentists all gave you the same advice I think I’d listen to them.,</p>
<p>Good luck with whatever you decide to do. Implants are generally very successful with about a 98% long term success rate and very few risks in the hands of a well qualified oral surgeon. I base this on personal observations/research as a 30 yr dental hygienist.</p>
<p>Crown on a tooth like that would be probably more temporary solution. Boy, I have tons of them also, the tooth that I have described above has rotten under crown.</p>
<p>Update: The specialist I consulted is a periodontist, instead of an oral surgeon. The decision is to do an implant. He would simultaneously do an implant on a lower tooth that had been pulled last year and pull the diseased tooth in question on the upper quadrant. A bone graft can be done simultaneously taking bone tissue from the lower tooth. </p>
<p>So in this case I don’t need cow or cadaver bone tissue but would use my own. A sinus lift would be done at the same time as the bone graft. </p>
<p>I am glad I do not live in SF, the estimate for one implant is $3600, additional $400- $500 for the bone graft, pulling a tooth -$220. </p>
<p>Before the consult I was afraid of bone grafts and the sinus lift. At least I understand the process a bit better now and feel more comfortable. </p>
<p>I am looking at 2 implants and 3 crowns this year. If I am lucky. Oh joy.</p>
<p>I’ve been wondering how you’ve been. I may be looking at some of this work down the road.</p>
<p>What is a sinus lift? My dentist explained it oh so briefly when we went over options.</p>
<p>The nice thing is the permanence of the implants.</p>
<p>^I typed out an answer but found this article that explains a sinus lift way better than I ever can. </p>
<p>[Sinus</a> Lift Article | Dentures & Dental Implants | Colgate® Oral Care Information Seniors](<a href=“http://www.colgate.com/app/Colgate/US/OC/Information/OralHealthAtAnyAge/Seniors/DenturesAndDentalImplants/SinusLift.cvsp]Sinus”>http://www.colgate.com/app/Colgate/US/OC/Information/OralHealthAtAnyAge/Seniors/DenturesAndDentalImplants/SinusLift.cvsp)</p>
<p>The periodontist who I consulted made it sound like a piece of cake. Better still, the price he charges ($1800) for the implant includes a sinus lift. </p>
<p>From the article, it sounds like a sinus lift is almost the same as a bone graft so I am slightly confused. He said I do need a bone graft which costs an additional $400 - $500. </p>
<p>Since he would be using my own bone tissue from the lower molar, I feel more comfortable.</p>
<p>I have an irrational fear of having cadaver or cow tissue because of CreutzfeldtJakob disease (mad cow). No dentist can ever answer me if the treatment of cadaver or cow material for implants eradicate the prions believed to be the cause. I know I am a little irrational about this. </p>
<p>Upper molar implants have highest risk of failure because the bone is softest. Just my luck my upper molars are all in such bad shape. However, it’s not as if I have choices. Gum surgery will weaken the surrounding two teeth, which may or may not be saved at this point - same problems with the diseased one, cavity under crown, had root canals done. The dentist would not cut open the crowns on the surrounding teeth to check until the implant is in for the one in the middle. So I feel like I am living with a dental time bomb - ticking and getting worse but nothing I can do about it. </p>
<p>As I mentioned before, this is going to be a tough year dental wise.</p>
<p>Just got back from the periodontist. I had an implant done and a tooth extraction and a sinus lift AND (last minute surprise the good doc sprung on me, TWO crown lengthening :eek:). </p>
<p>I don’t know what hurts more, my jaw, my gums or my pocket book. 
</p>
<p>I am not a happy camper because I hate surprises at the dentist chair and I have had too many before. </p>
<p>I questioned and questioned the periodontist about the crown lengthening (gum surgery) but he insisted he had them in his notes from the previous consult and this was discussed with my dentist. 
</p>
<p>I am a wimp when it comes to sitting at a dentist chair with my mouth frozen and arguing with a man with a drill about what is best for me.</p>
<p>The periodontist said 1. the crown lengthening is no biggie 2. it’s going to help the dentist with the new crowns he had to put in. </p>
<p>I asked, what happens when the dentist take out the existing crowns and find both teeth are too far gone and I need extraction and implants like the one he just took out ? Won’t the crown lengthening at $800 a tooth be for naught ?? </p>
<p>He assured me that won’t be the case. :rolleyes: </p>
<p>When it comes to dentists and my teeth all I can say is that I am a mess. In addition to the physical pain and money pain now I am feeling rather inadequate and mad with myself for not putting my foot down and said, "No, I DO NOT remember discussing this procedure before, I don’t care what your notes said and I do not want this done at this time " or “We can proceed according to your professional opinion but if the other two teeth cannot be saved I want the fees for the gum surgery to be credited towards the implants”.</p>
<p>You can write him a letter with the last sentence you just wrote in it.</p>
<p>I know exactly how you feel. My mouth is also a mess, and everytime I see the dentist it’s another $1000 or so, for nothing that seems to make any difference. Different dentists believe that different things “need” to be done.</p>
<p>Condolences for your pain. I’m over that now but I remember it well.</p>
<p>Was all of this done in one appointment?</p>
<p>^Everything was done in one session. I believe it took him only about an hour. Extraction, gum surgery/crown lengthening, implant, scraped out the bone for the bone graft, went back to the extracted tooth for the sinus lift and bone grafting. Another surprise was that he said I didn’t have enough bone myself from the implant to place in the extracted tooth so now I have some bovine tissue as well. Hello, Creutzfeldt–Jakob (mad cow) disease …</p>
<p>I think the gum surgery hurt most of all. It’s starting to hurt now.</p>
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<p>I may do that later, right now I am too stressed out to do anything, except for whining, I suppose.</p>
<p>I would discuss this with your dentist and let him/her know how unhappy you were with the actions of the periodontist. If your dentist referred you to the periodontist, then he/she should know of your unhappiness with how he handled things. It’s terrible to be put in the situation you were put in by this periodontist. He should not have proceeded until you were comfortable with what was being done. Shame on him. He must appreciate the fact of the vulnerable state of a patient in your situation. I would also let the periodontist know of your dissatisfaction with his handling of the situation.</p>
<p>Please don’t beat yourself up, but whine away. I feel for you. I too have lots of dental work in my future.</p>