I had a apioectomy scheduled two weeks ago. the endodontist got "97% finished" and realized that the root was split and she could not save the tooth. Now I have a big gaping hole in my first upper left molar. What is better to replace it with so I don't compromise all my other teeth? An implant? A bridge? Does anyone have any experience with this?

If you can afford it and your periodontist or oral surgeon can do a successful bone graft (a simple procedure, done when the tooth is pulled) then I'd opt for the implant. This essentially replaces the root of the tooth and can last a lifetime. I have 6 implants and am very happy with them. A bridge works well too, but then you must compromise the adajacent teeth, on opposite sides of the tooth to be pulled, in order to anchor the bridge. A bridge will cost less, but an implant will be the closest thing to a real tooth.

I'm having to make the same decision. My dentist is encouraging me to go with the bridge because adjacent teeth have had a fair amnt of dental work. He's not covered by my insurance so I'm considering going elsewhere - any tips on how to choose a competent dentist to do this kind of thing? I'm assuming a bridge is rather intricate work and very expensive.

Any idea why I can't just keep this tooth in spite of the fractured root? Any idea why the root would fracture? He said in my case it happened when my prvs dentist installed the post for the crown - I wonder if I could go back to that dentist and demand reparation....especially if his error will cost me several thousand dollars!!!!!!!!!!!!! :eek: :nono:

Thanks for any thoughts -

A dental crack isn't necessarily blamed for dental error. It's basically the reality of what happens when a tooth is ever worked on. Any dental work, even a filling, can put a weak tooth at risk, which is never readily apparent, during the dental work. Most dentists, who have been in practice for a few years, can do competent bridge work. Ask about where they do the lab work and how important it is for him or her to achieve a natural looking bridge. Some dentists care about the artistic component more than others. Price doesn't always dictate quality. I've had good looking crowns that were less expensive than one dentist, who I thought did a lousy job on a more expensive crown. The cost of your bridge will be dictated by how much extra work the dentist has to do on your adajacent teeth, i.e. the prep work for the bridge. If the adajacent teeth are failing as well, or might potentially have future problems, this will determine the longevity of your bridge. I'd still opt for an implant, if you can afford it. If you do go that route, only have an experienced periodontist or oral surgeon do the implant(s). Good luck.

thanks for your reply wmkcolors. the adjacent teeth both have a lot of fillings - he said he'd put crowns on them to strengthen them, and then do the bridge. he did explain about how i'd have to build my bone up (an infection in the root of this tooth ate through my bone over the last several years so there's not enough there) if i wanted to do the implant. sounds too complicated - they'd have to take bone from my hip - yuck!!! he's thinking the adjoining teeth are going to need crowns eventually anyway, so we could do it all now. is a bridge troublesome in any way? is there an advantage to the implant?

thanks for your help : )

A bridge works well, but you do have to keep the tissue under the bridge and the areas around it clean. Buy a Waterpik, which really cleans those hard to reach areas in the mouth. Not sure why the dentist opts for bone grafting from your hip, because all of my bone grafting has been done with material from the labs, basically sterilized cadaver bone (worse than it sounds!!!) and grafted to my existing bone right after I've had a tooth pulled, to build up that area. After the bone graft fuses, then, a few months later, an implant can be placed. Who is giving you this advice? A general dentist or a periodontist or an oral surgeon? Bridgework is fairly common, and, like I said, in my earlier reply, just make sure your dentist has done the procedure many times and likes to achieve a natural look. Due to your infection, I'd only have a periodontist or oral surgeon pull your tooth.

thanks. he's a general dentist with a good reputation. presents at conferences, etc. he also said another way to build up the bone is from cow bone. uh....? ok. i think for him the selling point on the bridge is that the adjacent teeth look like they'll need crowns anyway. now that i type that, i think 'so what'? will have to double check that with him. i guess he didn't want to disrupt those teeth if they were healthier & this would be like preventive dental care.

also, i wonder why he didn't put me on antibiotics if i have an infection in my head. sounds funny but weird. altho he did say it was sort of encapsulated in the root area so wasn't spreading to my brain (& i thought i'd found the reason for all my confusion about life!!).

between this, my thyroid problems and now my gynecologist is calling to "discuss the results from your recent pap test" i feel like i'm falling apart.

thanks for your thoughts....hope all is well on your end!