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Being pressured to use different implant tooth type
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mayniac@aol.com
medicine forum beginner


Joined: 05 Mar 2006
Posts: 5

PostPosted: Mon Jul 17, 2006 5:11 pm    Post subject: Being pressured to use different implant tooth type Reply with quote

For some background, I have/had two baby teeth that had no replacement
adult teeth -- those I believe are the second baby molar, or the 5th
tooth from midline on each side of my lower jaw.

I'm around 40 and the baby teeth have hung in there until now. The one
on my lower right jaw had been crowned in my teens to make it taller so
the teeth above wouldn't get longer, but the one on the left jaw wasn't
done since I'd waited too long. Neither has had much root at all for
years.

So, the tooth on my lower right jaw began having a problem getting food
caught under one edge of it, so it was time to get that replaced. When
I talked about it with my dentist, it was simply mentioned that we
would replace that tooth. My oral surgeon discussed possibilities with
me but said that my dentist would make the final decision of what kind
of tooth to put in there and whether other work would need done. The
oral surgeon said that was what would make the decision of where to
locate the implant.

I talked to my dentist and he presented me with three possiblities. The
first which he preferred involved replacing the baby molar with a
correct pre-molar and doing crown work on the teeth surrounding it to
make it fit properly. It was implied but not certain that work might
have to be done on the upper teeth. Another possibility was to do some
modification to the surrouding teeth without crowns and put in a
smaller tooth that wasn't quite a pre-molar but wasn't also a baby
molar. The third option was to replace the baby molar. He told me that
it was really cosmetic but that it just seemed awful to put in a baby
tooth when you were changing things like this and if it were him he
would want to look more normal and have the correct looking tooth. I
clarified with him that it was not a functional thing and decided to
have the baby tooth replaced looking the same as my crowned baby tooth.
I specifically did this because I don't want to grind down perfectly
good teeth on both sides and my insurance will not pay for purely
cosmetic work. The dentist told me that he would have the oral surgeon
place the implant accordingly.

Now, months later, I'm ready for the implant. My teeth on either side
of the implant have brown staining where the enamel is starting to
errode, as my dentist tells me, and he says that those will eventually
turn into cavities and he should fill them before the crown goes on.
Then he goes on to pressure me into letting him cut more of the molar
behind it off "while he's in there anyway" and add to the tooth in
front of it because it has a line on it that looks like it's developing
a crack, anyway. I did see a faint white line on the screen when he was
showing me it with the tooth cam. This was high pressure and he kept
saying that it is what he would do with his mouth, etc. I felt like I
couldn't say no, and left with appointments for the work. I asked him
at the time, though, why he could do this when he originally told me
that my decision on which of the three options to go with would depend
on the placement of the implant. His reply was that my oral surgeon had
been smart and placed it where it would work for either.

Anyway, thinking about it I realize that I do NOT want this work done
unless it is absolutely necessary. I'm worried that he told my oral
surgeon that I had agreed to something that I didn't because of the
amount of pressure he is putting on me now and that my implant may be
in the wrong place. I have a call in to the oral surgeon. I'm also
concerned because he wants to remove a chunk of my molar and patch it
like a filling, not doing a crown. I believe this may make my tooth
very heat sensitive. I have a tooth he filled on the other side that he
said was a deep cavity (it was under an old filling) that is very heat
sensitive and he's told me the only cure for that would be a root
canal. So, if he removes part of the molar, won't that be the
equivalent of doing a deep filling? I don't want to be unable to eat
hot food on either side of my mouth!

I look at where the implant is now that there is the healing abutment
on there and I can see that it is definitely not centered where the
baby tooth was, but is several mm closer to the back side, which would
lead it to be centered for the kind of tooth he is pressuring me into.

So, I have lots of questions:

1) Does an implanted tooth have to be centered on the implant post?

2) Is it normal to want to replace a baby tooth shape with a whole
different shape and size of tooth in a 40 year old? Won't this make
bite allignment be off with the surrounding teeth that are adjusted to
a crowned baby tooth being in there?

3) Is it likely that removing a chunk of tooth and composite filling
over it will make my tooth heat sensitive?

4) If the answer to number 1 is no, should I be getting a second dental
opinion quickly? How would I go about finding out who a *good* dentist
to check with is?

5) Is there a clear advantage that isn't cosmetic to changing what
tooth is in there?
Back to top
Mark & Steven Bornfel
medicine forum Guru


Joined: 30 Apr 2005
Posts: 888

PostPosted: Mon Jul 17, 2006 6:47 pm    Post subject: Re: Being pressured to use different implant tooth type Reply with quote

mayniac@aol.com wrote:
Quote:
For some background, I have/had two baby teeth that had no replacement
adult teeth -- those I believe are the second baby molar, or the 5th
tooth from midline on each side of my lower jaw.

I'm around 40 and the baby teeth have hung in there until now. The one
on my lower right jaw had been crowned in my teens to make it taller so
the teeth above wouldn't get longer, but the one on the left jaw wasn't
done since I'd waited too long. Neither has had much root at all for
years.

So, the tooth on my lower right jaw began having a problem getting food
caught under one edge of it, so it was time to get that replaced. When
I talked about it with my dentist, it was simply mentioned that we
would replace that tooth. My oral surgeon discussed possibilities with
me but said that my dentist would make the final decision of what kind
of tooth to put in there and whether other work would need done. The
oral surgeon said that was what would make the decision of where to
locate the implant.

I talked to my dentist and he presented me with three possiblities. The
first which he preferred involved replacing the baby molar with a
correct pre-molar and doing crown work on the teeth surrounding it to
make it fit properly. It was implied but not certain that work might
have to be done on the upper teeth. Another possibility was to do some
modification to the surrouding teeth without crowns and put in a
smaller tooth that wasn't quite a pre-molar but wasn't also a baby
molar. The third option was to replace the baby molar. He told me that
it was really cosmetic but that it just seemed awful to put in a baby
tooth when you were changing things like this and if it were him he
would want to look more normal and have the correct looking tooth. I
clarified with him that it was not a functional thing and decided to
have the baby tooth replaced looking the same as my crowned baby tooth.
I specifically did this because I don't want to grind down perfectly
good teeth on both sides and my insurance will not pay for purely
cosmetic work. The dentist told me that he would have the oral surgeon
place the implant accordingly.

Now, months later, I'm ready for the implant. My teeth on either side
of the implant have brown staining where the enamel is starting to
errode, as my dentist tells me, and he says that those will eventually
turn into cavities and he should fill them before the crown goes on.
Then he goes on to pressure me into letting him cut more of the molar
behind it off "while he's in there anyway" and add to the tooth in
front of it because it has a line on it that looks like it's developing
a crack, anyway. I did see a faint white line on the screen when he was
showing me it with the tooth cam. This was high pressure and he kept
saying that it is what he would do with his mouth, etc. I felt like I
couldn't say no, and left with appointments for the work. I asked him
at the time, though, why he could do this when he originally told me
that my decision on which of the three options to go with would depend
on the placement of the implant. His reply was that my oral surgeon had
been smart and placed it where it would work for either.

Anyway, thinking about it I realize that I do NOT want this work done
unless it is absolutely necessary. I'm worried that he told my oral
surgeon that I had agreed to something that I didn't because of the
amount of pressure he is putting on me now and that my implant may be
in the wrong place. I have a call in to the oral surgeon. I'm also
concerned because he wants to remove a chunk of my molar and patch it
like a filling, not doing a crown. I believe this may make my tooth
very heat sensitive. I have a tooth he filled on the other side that he
said was a deep cavity (it was under an old filling) that is very heat
sensitive and he's told me the only cure for that would be a root
canal. So, if he removes part of the molar, won't that be the
equivalent of doing a deep filling? I don't want to be unable to eat
hot food on either side of my mouth!

I look at where the implant is now that there is the healing abutment
on there and I can see that it is definitely not centered where the
baby tooth was, but is several mm closer to the back side, which would
lead it to be centered for the kind of tooth he is pressuring me into.

So, I have lots of questions:

1) Does an implanted tooth have to be centered on the implant post?

2) Is it normal to want to replace a baby tooth shape with a whole
different shape and size of tooth in a 40 year old? Won't this make
bite allignment be off with the surrounding teeth that are adjusted to
a crowned baby tooth being in there?

3) Is it likely that removing a chunk of tooth and composite filling
over it will make my tooth heat sensitive?

4) If the answer to number 1 is no, should I be getting a second dental
opinion quickly? How would I go about finding out who a *good* dentist
to check with is?

5) Is there a clear advantage that isn't cosmetic to changing what
tooth is in there?



My personal opinion is that unless you have a veeerrrry unusual looking
situation, it is difficult to justify crowning the adjacent teeth to
change the contour of the space. Furthermore, many teeth develop black
marks on their contact areas that NEVER become decay, so unless this guy
has a crystal ball or it's decayed RIGHT NOW he has no way to know that
it will become decayed.
I would get a second opinion.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
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Jacob
medicine forum addict


Joined: 27 Jun 2005
Posts: 95

PostPosted: Mon Jul 17, 2006 7:52 pm    Post subject: Re: Being pressured to use different implant tooth type Reply with quote

It sounds to me like you need to discuss this much more with your dentist,
as well as get another opinion. As you might imagine, it's impossible to
really give you any meaningful reply without examining you as well as your
x-rays. Don't do anything you don't want done, and good luck!

<mayniac@aol.com> wrote in message
news:1153156312.225858.147570@m79g2000cwm.googlegroups.com...
Quote:
For some background, I have/had two baby teeth that had no replacement
adult teeth -- those I believe are the second baby molar, or the 5th
tooth from midline on each side of my lower jaw.

I'm around 40 and the baby teeth have hung in there until now. The one
on my lower right jaw had been crowned in my teens to make it taller so
the teeth above wouldn't get longer, but the one on the left jaw wasn't
done since I'd waited too long. Neither has had much root at all for
years.

So, the tooth on my lower right jaw began having a problem getting food
caught under one edge of it, so it was time to get that replaced. When
I talked about it with my dentist, it was simply mentioned that we
would replace that tooth. My oral surgeon discussed possibilities with
me but said that my dentist would make the final decision of what kind
of tooth to put in there and whether other work would need done. The
oral surgeon said that was what would make the decision of where to
locate the implant.

I talked to my dentist and he presented me with three possiblities. The
first which he preferred involved replacing the baby molar with a
correct pre-molar and doing crown work on the teeth surrounding it to
make it fit properly. It was implied but not certain that work might
have to be done on the upper teeth. Another possibility was to do some
modification to the surrouding teeth without crowns and put in a
smaller tooth that wasn't quite a pre-molar but wasn't also a baby
molar. The third option was to replace the baby molar. He told me that
it was really cosmetic but that it just seemed awful to put in a baby
tooth when you were changing things like this and if it were him he
would want to look more normal and have the correct looking tooth. I
clarified with him that it was not a functional thing and decided to
have the baby tooth replaced looking the same as my crowned baby tooth.
I specifically did this because I don't want to grind down perfectly
good teeth on both sides and my insurance will not pay for purely
cosmetic work. The dentist told me that he would have the oral surgeon
place the implant accordingly.

Now, months later, I'm ready for the implant. My teeth on either side
of the implant have brown staining where the enamel is starting to
errode, as my dentist tells me, and he says that those will eventually
turn into cavities and he should fill them before the crown goes on.
Then he goes on to pressure me into letting him cut more of the molar
behind it off "while he's in there anyway" and add to the tooth in
front of it because it has a line on it that looks like it's developing
a crack, anyway. I did see a faint white line on the screen when he was
showing me it with the tooth cam. This was high pressure and he kept
saying that it is what he would do with his mouth, etc. I felt like I
couldn't say no, and left with appointments for the work. I asked him
at the time, though, why he could do this when he originally told me
that my decision on which of the three options to go with would depend
on the placement of the implant. His reply was that my oral surgeon had
been smart and placed it where it would work for either.

Anyway, thinking about it I realize that I do NOT want this work done
unless it is absolutely necessary. I'm worried that he told my oral
surgeon that I had agreed to something that I didn't because of the
amount of pressure he is putting on me now and that my implant may be
in the wrong place. I have a call in to the oral surgeon. I'm also
concerned because he wants to remove a chunk of my molar and patch it
like a filling, not doing a crown. I believe this may make my tooth
very heat sensitive. I have a tooth he filled on the other side that he
said was a deep cavity (it was under an old filling) that is very heat
sensitive and he's told me the only cure for that would be a root
canal. So, if he removes part of the molar, won't that be the
equivalent of doing a deep filling? I don't want to be unable to eat
hot food on either side of my mouth!

I look at where the implant is now that there is the healing abutment
on there and I can see that it is definitely not centered where the
baby tooth was, but is several mm closer to the back side, which would
lead it to be centered for the kind of tooth he is pressuring me into.

So, I have lots of questions:

1) Does an implanted tooth have to be centered on the implant post?

2) Is it normal to want to replace a baby tooth shape with a whole
different shape and size of tooth in a 40 year old? Won't this make
bite allignment be off with the surrounding teeth that are adjusted to
a crowned baby tooth being in there?

3) Is it likely that removing a chunk of tooth and composite filling
over it will make my tooth heat sensitive?

4) If the answer to number 1 is no, should I be getting a second dental
opinion quickly? How would I go about finding out who a *good* dentist
to check with is?

5) Is there a clear advantage that isn't cosmetic to changing what
tooth is in there?
Back to top
Joel M. Eichen
medicine forum Guru


Joined: 24 Mar 2005
Posts: 4062

PostPosted: Tue Jul 18, 2006 12:14 pm    Post subject: Re: Being pressured to use different implant tooth type Reply with quote

I guess I am being lazy but could you post an x-ray or a picture of
what's going on?


Joel


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