DENTAL CARE The Healthy Smile

Jeffrey Gross, DDS, FAGD

Q: I Broke My Only Tooth. What are My Options? A: So I was asked by a nice gentleman that came into my office yesterday. With all of this cold weather, sitting at home will drive many of us stir crazy. Getting out and chatting with me and my staff has gotten very popular over the last couple of weeks. Allow me to explain the situation that I saw. My new acquaintance, who happen to be the brother of one of my patients, wore a full upper denture. On the lower, he wore a kind of a partial denture with a hole in it for one tooth. The partial denture did not have any means to attach itself to the tooth to give it some grab. The only function of that tooth was to keep the partial from bouncing from side to side. The tooth itself was broken so badly that it biting down on it caused pain. After I took an x-ray, I saw that the tooth, which was actually covered by a crown, had fractured almost 90% of the way and was holding on to itself by a thread.

Let’s discuss our options for this case. One possibility is to try and maintain the status quo. This person has been wearing a full upper denture and an almost full lower denture with one of his own teeth. If I could keep and repair the tooth, I could return him to the way he was for a couple of decades. Fix the tooth and we would be done. Unfortunately, the tooth was decayed below the gum and this simple solution was not viable. A second solution was to remove the tooth and place an implant. If I place one implant, I could attach his old lower teeth to this implant. This would work for a while except that the torque on the lone implant would cause it to fail. So I thought, let’s add another implant for support and protection for this implant. When I evaluated, the gum in the potential area, I found that there was inadequate bone for that area for a conventional implant. However, a mini-implants would work. This case could be a hybrid. Let me explain what the term “hybrid” would mean in this situation. This patient would have a combination case using regular implants and mini-implants. Yes these cases are possible. Each style of implant needs it’s own unique connection to the denture. I would need more mini-implants than conventional size implants. Remember, they are called “mini’s for a reason. The way to make to make up for their small size is to increase their number. This plan would allow him to have stability of his lower teeth utilizing a relatively simple and easy approach. Lastly, we could remove the tooth and make a new lower denture. This would be the least desirable of my choices, but it is a choice. We needed to make a separate decision regarding his upper denture. If it was in good condition we could either clean it up or simply reline it. If it was past it’s prime and causing an unhealthy collection of bacteria and a source for disease, we would need to either disinfect or remake that upper denture.

The point of all this discussion and thought is that multiple options are always available. Every person’s dental wants and desires needs to be evaluated and discussed. A variety of treatments need to be explored. What may be right for one patient may not be correct for another. My job is to help you, pick the most fitting plan for each and every case. If you are uncertain as to how to proceed with your oral care or just want a second opinion, please feel free to call me at 440.951.7856. I always enjoy talking to each and every one of you. Have a great week and stay warm! Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine. 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com