Choosing Between Dental Implants and Dentures: A Patient's Dilemma

Q: Choosing Between Dental Implants and Dentures: A Patient's Dilemma

Hello, Dr. <br>Kuo Chao-Ju： To maintain periodontal health, the most important factors are patient and thorough brushing, as well as the use of interdental brushes or dental floss. <br>If there are sensitivity issues with teeth that have exposed roots, it is advisable to return f

Dental issues consultation?

Hello Doctor: Before I turned 20, I had my lower left molars (possibly wisdom teeth) extracted due to deep cavities.
On the right side, I also had one upper and one lower molar extracted because the cavities were too deep to save.
Around the age of 20, I encountered an unethical practitioner from National Taiwan University who killed the nerve of a salvageable lower right molar next to a decayed tooth, as I did not understand dental medicine at the time.
He then placed three crowns (dental bridges) for me! Since then, food particles have been getting stuck in the bridges! A few years ago, another dentist opened the bridge, and the natural teeth inside had cavities! I want to redo this bridge, but it seems impossible! This would leave me missing three teeth, so I can only consider dentures or implants! Implants are really expensive! Some dentists have suggested that dentures might be better and safer than implants, as dentures have a long history in the literature! I still don’t know whether implants or dentures are better.
I only know that dentures are less stable than natural teeth.
My dental condition is as described: I am missing two teeth on the lower right side, and I have an improperly fitted bridge from the unethical practitioner! Until now, the missing teeth have caused misalignment in my bite.
Other dentists have mentioned that 1.
If I don’t undergo orthodontic treatment soon, I will spend more on corrections in the future! 2.
The area with the bridge may require surgery to remove it...
I previously did not have severe periodontal disease, but later, a dentist at Yang Ming Hospital diagnosed me with it.
Since learning the correct brushing technique, I have been brushing back and forth 15 times for each tooth, which takes me about 40 minutes to finish! I used to brush very hard, which caused gum recession! Although the dentist at Yang Ming taught me the correct brushing method, it takes too much time, so I end up brushing only once a week! I am a patient with mental illness.
Later, my gums continued to recede due to infrequent brushing, leading to one of my lower left molars showing its root! I apologize; it’s not that I don’t brush my teeth, but brushing takes too long.
I don’t mean to pose a problem for you, Doctor.
Recently, the tooth with the exposed root has been slightly uncomfortable, especially when eating bread! I can feel discomfort when it comes into contact with anything.
I think I may now have severe periodontal disease! What should I do? If it cannot be treated, extraction may be the only option! Implants are very expensive! I don’t want to lose my natural teeth! I was thinking about periodontal flap surgery, but I know I need to treat the periodontal disease first.
However, for the periodontal surgery, my bridge would need to be removed first, which would then lead to dentures, implants, or orthodontics! If the surgery is unsuccessful, what will happen to me? I can’t imagine how much this will cost me! I heard there is a type of removable denture that can be easily fitted and removed, which sounds convenient.
But that’s just advertising! It hasn’t been proven or recommended by dentists! If it were effective, many people would have already used it.
What should I do? Can you help me, Doctor? Especially with the tooth that has the exposed root! However, I still cannot visit your clinic because I live in the northern part of the country.
I apologize! Lastly, thank you for your response.

Guo Zhao Ru, 40~49 year old female. Ask Date: 2020/11/27

Dr. Zeng Guanghui reply Dentistry

Hello, Dr.
Kuo Chao-Ju: To maintain periodontal health, the most important factors are patient and thorough brushing, as well as the use of interdental brushes or dental floss.
If there are sensitivity issues with teeth that have exposed roots, it is advisable to return for an evaluation or treatment by a dentist.
Regarding the maintenance of dentures, necessary adjustments should be made by a dentist.
Director Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2020/11/27

More Info

Choosing between dental implants and dentures can indeed be a challenging decision, especially given your complex dental history and current condition. Let's break down the options and considerations based on your situation.

Understanding Your Dental Condition
From your description, it seems you have experienced significant dental issues over the years, including multiple extractions and the placement of a dental bridge that has led to further complications. The presence of periodontal disease and the exposure of tooth roots indicate that your dental health requires careful management. The discomfort you feel, especially when eating, suggests that immediate attention is necessary.

Dental Implants vs. Dentures
1. Dental Implants:
- Pros: Implants are designed to function like natural teeth. They are anchored into the jawbone, which helps maintain bone density and prevent further bone loss. Implants also do not require alteration of adjacent teeth, which is often necessary with bridges.

- Cons: The cost of implants can be significant, and they require a surgical procedure. Additionally, if your bone density is insufficient, you may need a bone graft, which can add to the expense and complexity of the procedure.

2. Dentures:
- Pros: Dentures, particularly removable partial dentures, are generally less expensive and can be made quickly. They can restore function and aesthetics without the need for surgery.

- Cons: They may not provide the same level of stability as implants and can sometimes feel less secure. Over time, they may require adjustments or replacements as your jawbone changes shape.

Factors to Consider
- Bone Health: Since you mentioned concerns about bone density and the possibility of needing bone grafts for implants, it’s crucial to have a thorough evaluation of your jawbone. If your bone is not adequate for implants, dentures may be a more immediate solution.

- Periodontal Health: Before considering any restorative options, addressing your periodontal disease is essential. This may involve deep cleaning (scaling and root planing) and possibly surgical intervention to restore gum health. Once your gums are healthy, you can make a more informed decision about implants or dentures.

- Financial Considerations: If cost is a significant concern, discuss payment plans or financing options with your dental provider. Some clinics offer payment plans that can make implants more affordable over time.

- Comfort and Maintenance: You mentioned that brushing your teeth takes a long time, which can be a barrier to maintaining oral hygiene. Both implants and dentures require proper care, but dentures may be easier to manage if you struggle with lengthy oral hygiene routines.

Recommendations
1. Consultation with a Specialist: Given your complex situation, it would be beneficial to consult with a periodontist or an oral surgeon who can assess your periodontal health and bone condition. They can provide tailored advice on whether implants or dentures are more suitable for you.

2. Addressing Periodontal Disease: Prioritize treatment for your gum disease. Once your gums are healthy, you can explore your options for tooth replacement with a clearer understanding of your dental health.

3. Consider Temporary Solutions: If immediate restoration is needed, discuss the possibility of temporary dentures while you work on your periodontal health. This can provide you with a functional solution while planning for long-term treatment.

4. Evaluate Your Lifestyle: Consider how each option fits into your lifestyle. If you find it challenging to maintain oral hygiene, discuss with your dentist which option might be easier for you to manage.

Conclusion
Ultimately, the decision between dental implants and dentures should be made based on a comprehensive evaluation of your dental health, financial situation, and personal preferences. It’s essential to work closely with your dental care team to develop a treatment plan that addresses your immediate needs while considering long-term outcomes. Don't hesitate to seek a second opinion if you're unsure about the recommendations you receive. Your dental health is crucial, and taking the time to make an informed decision will benefit you in the long run.

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