Concerns About Replacing Upper Front Teeth: Expert Advice Needed

Q: Concerns About Replacing Upper Front Teeth: Expert Advice Needed

Hello： Because your description is not very clear, and the issues are quite detailed and complex, I suggest that you consult with a dentist who has actually examined your dental condition for clarification. <br>From your description, it seems that you have seen at least three den

Issues with dentures for the upper four incisors?

As a child, I didn't like brushing my teeth, which led to severe cavities.
By middle school, I had a total of four upper front teeth, two on each side, that underwent root canal treatment about 20-23 years ago.
A significant portion of the teeth was removed, and at that time, the dentist did not mention the need for crowns.
Over the years, I have experienced significant discoloration, particularly on the inner surfaces of the teeth, which appear either gray or brown.
The area where the filling was done on the inner lower edge has a horizontal line that has slightly chipped away.
Whenever my tongue or lips touch the inner lower edge of the teeth, it feels jagged and uneven.
Once in elementary school, I fell forward while running and hit my front teeth, causing some bleeding, but I don't remember much else.
Last year, I experienced unexplained itching and pain in my left back tooth, and after multiple visits to the dentist, it was diagnosed as temporomandibular joint (TMJ) inflammation.
The dentist mentioned that I had an old jaw fracture that healed improperly, leading to bone deformity, combined with long-term teeth grinding and malocclusion, which caused the TMJ inflammation.
My upper teeth protrude significantly compared to my lower teeth, and they do not align properly, although my facial appearance seems fine.
Therefore, I wear an occlusal splint at night and avoid other treatments because I am concerned that the four upper front teeth might break.
The splint is made for the lower teeth.
Last year, I consulted two dentists regarding the treatment of my upper four front teeth, and they provided differing opinions.
One dentist stated that the previous root canals were not done properly, and that all four upper front teeth would need to undergo retreatment.
Due to the limited tooth structure remaining, he suggested that pins would be necessary to support crowns.
The other dentist advised that there was no immediate need for crowns, as I was not concerned about the appearance of the teeth, which are discolored and have visible cracks.
He suggested that since I have lived with this condition for 20 years, I could wait unless I needed orthodontic treatment for my bite.
He believed that only one tooth had a structurally risky condition.
Recently, I noticed that the inner lower edge of my left front tooth has chipped slightly, and it feels jagged whenever my tongue or lips touch it.
I am worried that the filling might be loose and could lead to further damage.
I am unsure if this recent chipping is a new issue or related to the previous damage.
I plan to see a dentist for an examination soon, but I would like to ask for advice regarding my upper four front teeth.
If the chipped area on the inner lower edge of the tooth is stable and not loose, should I leave the four teeth as they are, or would it be advisable to get crowns now? I am not under financial or time pressure; I just fear that if I wait, I might end up needing implants for all four teeth due to the extensive fillings.
However, I also wonder if getting crowns now would be better, as the longer I wait, the more fragile the teeth may become.
Can the four upper front teeth be treated with pins simultaneously? I am concerned that since the teeth are close together, placing pins might risk damaging them.
Should I space out the treatments, doing two teeth first and then the other two later, or is it not advisable to place pins on all four teeth together, even if done in stages?
My biggest concern is if I need to get crowns on the upper four front teeth and they break during the procedure or if the remaining tooth structure is insufficient for pin placement.
How should I handle this situation? It seems impractical to place implants for four adjacent teeth, as that would require extensive gum surgery, which could compromise the surrounding tissue.
Currently, I brush my teeth every morning and night, and I try to brush during lunch if I have time.
I always use dental floss beforehand.
My teeth and gums are sensitive, and I sometimes experience itching or discomfort.
Dentists have noted that I grind my teeth.
I understand that I need to have my condition evaluated by a dentist, but since my situation is complex and my next appointment is still some time away, I find myself worrying excessively about my teeth breaking and needing implants.

I hope the dentist can provide some advice.
I apologize for not being able to express my concerns more succinctly; I thought that providing detailed information would help in assessing my situation accurately.
I look forward to your response, and thank you for taking the time to read my entire message.

Li Qiuqiu, 30~39 year old female. Ask Date: 2021/02/18

Dr. Lin Jiayong reply Dentistry

Hello: Because your description is not very clear, and the issues are quite detailed and complex, I suggest that you consult with a dentist who has actually examined your dental condition for clarification.
From your description, it seems that you have seen at least three dentists, so you should consider discussing the actual clinical management with one of the dentists you trust the most.
Thank you! Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2021/02/18

More Info

When it comes to addressing concerns about the replacement of upper front teeth, particularly in complex cases like yours, it's essential to approach the situation with a comprehensive understanding of dental health and treatment options. Given your history of dental issues, including root canal treatments, discoloration, and concerns about the structural integrity of your teeth, it's crucial to consider both the immediate and long-term implications of any dental procedures.

Firstly, the condition of your upper front teeth, which have undergone root canal treatments and show signs of discoloration and structural compromise, warrants careful evaluation. The fact that you have experienced issues such as rough edges and potential fractures indicates that these teeth may not be stable enough for traditional crowns or other restorative options without further intervention. In cases where the tooth structure is significantly compromised, dentists often recommend using dental posts (commonly referred to as "pins" or "stabilizers") to provide additional support for crowns. However, as you rightly pointed out, placing posts too close together can pose risks, including the potential for fractures or complications in adjacent teeth.

Regarding your concerns about whether to proceed with treatment now or wait, it is generally advisable to address dental issues proactively, especially when there is a risk of further deterioration. If the internal structure of your teeth is at risk of fracturing, delaying treatment could lead to more extensive damage, potentially necessitating more invasive procedures like extractions and implants. However, if your current dentist has assessed that the teeth can remain stable for the time being, it may be reasonable to monitor the situation closely while maintaining excellent oral hygiene.

In terms of your specific questions about the possibility of placing posts in all four teeth simultaneously, this is typically feasible, but it depends on the individual tooth's condition and the dentist's assessment. If the teeth are closely spaced, your dentist may recommend a staggered approach to ensure that each tooth receives adequate support without compromising the others.
If you are considering the option of crowns or even implants, it is crucial to have a thorough examination, including X-rays, to evaluate the health of the surrounding bone and gum tissue. If the teeth are deemed unfit for crowns due to insufficient structure, extraction and subsequent implant placement may be necessary. However, as you noted, placing implants for four adjacent teeth at once can be challenging and may require careful planning to ensure proper healing and integration.

Given your concerns about potential fractures and the overall health of your teeth, it would be prudent to seek a second opinion from a dental specialist, such as a prosthodontist or an oral surgeon. They can provide a more detailed assessment of your dental health and recommend a tailored treatment plan that addresses your specific needs and concerns.

In summary, while it is understandable to be apprehensive about the condition of your upper front teeth, proactive management is key. Regular dental check-ups, maintaining good oral hygiene, and seeking professional advice will help you navigate this complex situation. If you feel uncertain about your current treatment plan, do not hesitate to consult with another dental professional to explore all available options. Your oral health is paramount, and ensuring you have a clear understanding of your treatment choices will empower you to make informed decisions moving forward.

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