Pin in tooth - options as its becoming loose?

silentbutnice

I cracked a premolar in April which had a filling in it. The tooth was only a quarter of what it originally was. I went to dentist and he gave me the option of getting a pin inserted or extracting it.

I choose the pin as I've already had the tooth beside it extracted and I didn't want another gap.

Now the tooth has started to crack again and before it comes apart I want to go to the dentist and see what options I have.

I've no problem getting it extracted but I really don't want to have another missing tooth there. I know nothing about fake teeth, so could someone here give me an idea of what options are open to me in order to get a replacement tooth?

Thank you.

helimachoptor

an implant is an option but saving the tooth may also be an option.

Only the dentist can tell for sure, but one of the dentists on here should be able to give you some general advice.

silentbutnice

helimachoptor wrote: »

an implant is an option but saving the tooth may also be an option.

Only the dentist can tell for sure, but one of the dentists on here should be able to give you some general advice.

Thanks, would appreciate if I could get some views just so as I know what the dentist is talking about tomorrow

Dianthus

Existing space. Options are:
1: Leave gap
2: Denture
3: Implant
4: Bridge

There'll be pros and cons to each option, and your mouth may not be suitable for all 4 options.
Most dentists have models or photos to show people also. And ALL prefer lots of questions versus a confused patient, so don't worry about the asking.

silentbutnice

Dianthus wrote: »

Existing space. Options are:
1: Leave gap
2: Denture
3: Implant
4: Bridge

There'll be pros and cons to each option, and your mouth may not be suitable for all 4 options.
Most dentists have models or photos to show people also. And ALL prefer lots of questions versus a confused patient, so don't worry about the asking.

Thanks mate. I suppose it comes down to a suitable mouth and a suitable pocket in the end

Scruffles

silentbutnice wrote: »

Thanks mate. I suppose it comes down to a suitable mouth and a suitable pocket in the end

and according the dentist of mine-will have to wait up to six months for healing time before an implant can be put in after an extraction.

Oral Surgeon

Scruffles wrote: »

and according the dentist of mine-will have to wait up to six months for healing time before an implant can be put in after an extraction.

No no no, if you are seriously after an implant, the tooth should be removed by the implant surgeon carefully/surgically to preserve all available bone and in many situations, an implant placed at that time is the best option.

A standard extraction without consideration for an implant or the bone or allowing bone resorption for 6 months is leaving you with a less favourable site for implant placement and increases the need for graft.

Oral Surgeon

silentbutnice wrote: »

I cracked a premolar in April which had a filling in it. The tooth was only a quarter of what it originally was. I went to dentist and he gave me the option of getting a pin inserted or extracting it.

I choose the pin as I've already had the tooth beside it extracted and I didn't want another gap.

Now the tooth has started to crack again and before it comes apart I want to go to the dentist and see what options I have.

I've no problem getting it extracted but I really don't want to have another missing tooth there. I know nothing about fake teeth, so could someone here give me an idea of what options are open to me in order to get a replacement tooth?

Thank you.

Did your dentist say that a crown is an option?
If the tooth is broken down but not painful, it may be...

silentbutnice

Oral Surgeon wrote: »

Did your dentist say that a crown is an option?
If the tooth is broken down but not painful, it may be...

Zero pain with the tooth. Its not broken down now, but I can see cracks appearing which leads me to believe that it will break very soon. When it originally cracked back in April I was left with a quarter of my original tooth and I didn't think I'd be able to get it rebuilt as easily as I did.

So I'll just see what he says tomorrow. I just hate the thought of loosing another tooth on the side of my mouth and having an even bigger gap there.

Oral Surgeon

silentbutnice wrote: »

Zero pain with the tooth. Its not broken down now, but I can see cracks appearing which leads me to believe that it will break very soon. When it originally cracked back in April I was left with a quarter of my original tooth and I didn't think I'd be able to get it rebuilt as easily as I did.

So I'll just see what he says tomorrow. I just hate the thought of loosing another tooth on the side of my mouth and having an even bigger gap there.

Ask about a crown so. There may or may not be enough tooth to crown....

silentbutnice

Oral Surgeon wrote: »

Ask about a crown so. There may or may not be enough tooth to crown....

Can a crown be done there on the spot or will it take a second visit?

Oral Surgeon

silentbutnice wrote: »

Can a crown be done there on the spot or will it take a second visit?

Very few clinics have the machine needed to make a crown on the spot. Most, prepare the tooth, take the impression and put on a temporary until the crown is made in the lab and can then be cemented 2-3 weeks later.
Some dentists swear by these immediate crowns, some don't... I'm not gone on them but I'm no expert in crowns....

silentbutnice

Oral Surgeon wrote: »

Very few clinics have the machine needed to make a crown on the spot. Most, prepare the tooth, take the impression and put on a temporary until the crown is made in the lab and can then be cemented 2-3 weeks later.
Some dentists swear by these immediate crowns, some don't... I'm not gone on them but I'm no expert in crowns....

Thanks. And the last question.... Roughly how much would a crown typically cost?

davo10

Oral Surgeon wrote: »

No no no, if you are seriously after an implant, the tooth should be removed by the implant surgeon carefully/surgically to preserve all available bone and in many situations, an implant placed at that time is the best option..

No, no, no.?

1. You do not know this patient, have not seen his/her x-rays whereas the dentist has.
2. You do not know which tooth it is and how much bone exists for implant placement, if there is a lot and the implant bed will not encroach on the floor of the sinus, healing followed by placement is the more accepted and predictable option.
3 in order to attain primary stability for the implant during immediate placement, the implant must be wider than the extracted root, this may be problematic as you may have to use a wider implant than necessary leaving less surrounding bone especially on the buccal aspect to retain the implant.
4. Any apical pathology associated with a heavily restored tooth can effect the outcome of the implant placement.
5. Some resorption of the bone is inevitable regardless of whether an implant is immidiately placed, if the surgeon is inexperienced or does not have an in depth knowledge of the procedure, how, where and to what depth the implant needs to be placed, when the bone resorbs, the collar of the immediately placed implant becomes exposed causing a real cosmetic problem, especially for people with a high smile line.

Best leave it to OPs dentist to advise on best course of treatment

Oral Surgeon

davo10 wrote: »

No, no, no.?

1. You do not know this patient, have not seen his/her x-rays whereas the dentist has.
2. You do not know which tooth it is and how much bone exists for implant placement, if there is a lot and the implant bed will not encroach on the floor of the sinus, healing followed by placement is the more accepted and predictable option.
3 in order to attain primary stability for the implant during immediate placement, the implant must be wider than the extracted root, this may be problematic as you may have to use a wider implant than necessary leaving less surrounding bone especially on the buccal aspect to retain the implant.
4. Any apical pathology associated with a heavily restored tooth can effect the outcome of the implant placement.
5. Some resorption of the bone is inevitable regardless of whether an implant is immidiately placed, if the surgeon is inexperienced or does not have an in depth knowledge of the procedure, how, where and to what depth the implant needs to be placed, when the bone resorbs, the collar of the immediately placed implant becomes exposed causing a real cosmetic problem, especially for people with a high smile line.

Best leave it to OPs dentist to advise on best course of treatment

Will do davo10, silly me, what would I know??
Welcome back to dental issues by the way, I missed you.

Zardoz

Oral Surgeon wrote: »

Very few clinics have the machine needed to make a crown on the spot. Most, prepare the tooth, take the impression and put on a temporary until the crown is made in the lab and can then be cemented 2-3 weeks later.
Some dentists swear by these immediate crowns, some don't... I'm not gone on them but I'm no expert in crowns....

Well if he decides to get the tooth crowned he will almost certainly need to get it root treated first I'd imagine and that will cost a nice few bob.

davo10

Oral Surgeon wrote: »

Will do davo10, silly me, what would I know??
Welcome back to dental issues by the way, I missed you.

I've been back a while, I just don't feel the need to post on every issue raised, only the ones that I feel I have something to add.

Oral Surgeon

davo10 wrote: »

I've been back a while, I just don't feel the need to post on every issue raised, only the ones that I feel I have something to add.

Thanks, you really added lots to this thread.

Oral Surgeon

Zardoz wrote: »

Well if he decides to get the tooth crowned he will almost certainly need to get it root treated first I'd imagine and that will cost a nice few bob.

Not necessarily

btkm8unsl0w5r4

Davo and OS, lets not do the sniping things on the public forum. Davo I would entirely disagree, but in simple terms the OP asked if they should removed the tooth, the advice to wait is valid as it leaves opportunities open, extraction leave only one possibility. If you want to discuss the pros and cons of immediate placement the dental lounge is the best place for that.

davo10

Oral Surgeon wrote: »

Thanks, you really added lots to this thread.

Fitz, you know that immediate placement is only suitable under certain conditions, not for all and that the patients clinician be it their GDP or a specialist is best placed to give that advice, not here on this forum. We preach this day in day out to people who visit dentists in hotels or travel abroad, do you disagree with anything in my post?, the OP could go back to his/her dentist and say an oral surgeon advised that immediate placement is the only correct treatment when it may not be.

btkm8unsl0w5r4

Immediate placement is in my opinion the first preference for implant treatment and is suitable in most conditions where the tooth still remains. It saves, time, money, bone and soft tissue. With advances is surgical protocols, implant design and the range of implants available there is only one contraindication to it....less than 2 mm residual bone in the post maxilla or a molar is going to create a 3-4 walled defect upon removal without leaving any interfurcal bone. So long as the implants are kept out of the zone of resorbtion. Primary stability is usually very good in my experience, and when you wait 3 months after extraction stability is usually pretty poor as the bone is immature. Primary stability is only a factor if you want to load. Bicon implants have no rotational stability and they work fine. I would find the wait and place protocol old fashioned, inefficient and carries worse outcomes from an aesthetic point of view.

Now whether all dentists are conformable with this is another story, I have changed my view on it a lot in the last 4 years or so after seeing the work from the Tarnow group on gap distance. But for the rare case where its not possible there are 100 times, teeth have been removed and the surgeon wishes they were still there. Chronic infections are not a problem, primary stability is not a problem, buccal position are not a problem (they are but if don't know to place them palatally and out of the resorbtion zone, then you shouldn't be doing it, and buccal placements in healed ridges are just as bad).

Again I think OS is saying that in the majority of cases its is best to still have the tooth before implant consultation and I agree with that, nobody is giving out a treatment plan here, only saying that the patient would better in most situations to still have the tooth or root there in their head than not.class 4 defects being the only contraindication and they are rare enough and to be honest I have my surgeon immediately graft and place them also

Oral Surgeon

Jeffrey Wailing Sword wrote: »

Immediate placement is in my opinion the first preference for implant treatment. It saves, time, money, bone and soft tissue. With advances is surgical protocols, implant design and the range of implants available there is only one contraindication to it....less than 2 mm residual bone in the post maxilla. So long as the implants a kept out of the zone of resorbtion. Primary stability is usually very good in my experience, and when you wait 3 months after extraction stability is usually pretty poor as the bone is immature. Primary stability is only a factor if you want to load. Bicon implants have no rotational stability and they work fine. I would find the wait and place protocol old fashioned, inefficient and carries worse outcomes from an aesthetic point of view.

Now whether all dentists are conformable with this is another story, I have changed my view on it a lot in the last 4 years or so after seeing the work from the Tarnow group on gap distance. But for the rare case where its not possible there are 100 times, teeth have been removed and the surgeon wishes they were still there. Chronic infections are not a problem, primary stability is not a problem, buccal position are not a problem (they are but if don't know to place them palatally and out of the resorbtion zone, then you shouldn't be doing it, and buccal placements in healed ridges are just as bad).

Again I think OS is saying that in the majority of cases its is best to still have the tooth before implant consultation and I agree with that, nobody is giving out a treatment plan here, only saying that the patient would better in most situations to still have the tooth or root there in their head than not.

Exactly

georgieporgy

silentbutnice wrote: »

I cracked a premolar in April which had a filling in it. The tooth was only a quarter of what it originally was. I went to dentist and he gave me the option of getting a pin inserted or extracting it.

I choose the pin as I've already had the tooth beside it extracted and I didn't want another gap.

Now the tooth has started to crack again and before it comes apart I want to go to the dentist and see what options I have.

I've no problem getting it extracted but I really don't want to have another missing tooth there. I know nothing about fake teeth, so could someone here give me an idea of what options are open to me in order to get a replacement tooth?

Thank you.

What kind of filling did you get with the pin? White or silver (metal).