bone graft?

[Doctor Bagel]

i need some dental expertise here.

i just went to see my new dentist after having to switch because of insurance changes and discovered that i have bone loss by my upper second molar that's clearly a result of getting my wisdom teeth pulled last year. the dentist said she could refer me to a periodontist, but the only thing that would fix it would be a bone graft, which seems scary as hell to me, and i'm not a person who fears dental work. i asked her what the bad consequences of leaving it unfixed would be, and she explained that it leaves my second molar in a more vulnerable position. however, the second molar is having no problems currently, and i do take good care of my teeth. she mentioned that it might be possible to offset the bad effects of the bone loss through thorough flossing and brushing around the area. is this correct, or should i pursue the bone graft pronto?

my current thinking is that i'll wait and see if it looks like it'll be a problem and then get it fixed because of both the fear of the procedure and the expense. should i be more concerned about this than i am?

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[UBTom]

I would get a second opinion first.

There can be many causes as to why you are losing bony support for the tooth, from difficulty in keeping the area clean to occlusal trauma. I would go to a periodontist for an evaluation and see if anything needs to be done.

If there is a dental school near where you are, it's a great place to go to for an evaluation.

HTH!

 

[Frank Cavitation]

Some of this may depend on the amount of bone loss. It doesn't matter how well you floss, if we are getting into furcation involvement it will be difficult to avoid going down the slippery slope of perio disease.

I know I should be fearless when it comes to dental procedures, but if I need a graft to come from the iliac crest I'd be sweating too. Hope it does not come to that!

 

[Energon]

First of all, make sure you get a second opinon on the extraction theory. If you are in your 20's and have that significant amount of bone loss, there may be other factors at work here like: LJP (look into the perio condition of your incisors as well) or bony pathology. But its ok, most of this stuff is fixable. Go to the periodontist for an eval. I really like Dr. Tom Hong's advice on this one. It might be better to go to a dental school since Oral surgery and Radiology/Diagnostic teams can have a look at your case too.
Best of luck

 

[no2thdk999]

If you don't get it fixed, it will be a problem. Maybe not today or tomorrow, but eventually.

Decide today whether or not you want to keep that tooth. If the answer is no, why do anything about it ever? If the answer is yes, why not repair it now while it can be the most easily and predictably fixed? The longer you wait, the trickier it will be to repair.

In my neck of the woods a consult with the periodontist is about $85 if you bring your own films. To me that is cheap peace of mind to know you did all you could.

A bone graft is not the worst thing that can happen to you. I will GUARANTEE that getting your 3rds out will have been the worse experience. A site like this will likely use a mixture of bone sources (man made and otherwise) but probably not any autogenous bone. If they do use your own bone it will likely be from your mandible.

DON"T worry about this. If you had your 3rds out and a dry socket this will be a piece of cake!

Lastly and most importantly, don't let your insurance pick your provider or determine treatment! They care about making a profit not making sure you can chew food at 85.

JMHO
Rob

 

[Energon]

Cadaver bone, synthetic bone and bovine bone products are used in grafting. There is one guy I know at NYU who has shown that plaster or paris works just as well.... yes plaster of paris!!!!

 

[UNLV OMS GUNNABE]

Lastly and most importantly, don't let your insurance pick your provider or determine treatment! They care about making a profit not making sure you can chew food at 85.

Rob

This is easy to say when you're not in financial trouble. I know the majority of people here would rather see managed care fall into a bottomless pit, but personally, it's the only thing I can afford right now with a family.

 

[no2thdk999]

You haven't seen my student loan portfolio!

Thanks for pointing this out. I should have been more specific and said don't let your insurance company pick your dental provider or determine your dental treatment. Dental insurance in its common form in the US is not really insurance. The maximum you can get out of most policies is $1500/year. I don't know to many people that this amount would financially devestate for life so why be insured against it?

Health insurance is another story. And since most MD's participate to a great extent, a medical HMO can still get you a high caliber physician. In many areas the same cannot be said for a dental HMO.

JMHO
Rob

 

[Frank Cavitation]

Regarding bone grafts, I remember from the perio lecture that putting in the bone is not hard, but the ability to regenerate PDL attachments is still unpredictable. So, if they fill up the void on 2D for instance, you could still have a deep uncleansable pocket which essentially defeats the purpose. Then maybe there's a need to guided tissue regeneration etc.

Question for you guys: if the wisdom tooth was mesially impacted, one should expect the 2nd molar distal aspect to have a void in the bone, right? In a normal young person does bone normally fill up the socket or is it more likely to be ridge resorption?

 

[Energon]

Wow if the pocket does remain that deep you are right it is pointless. However I was under the impression that GTR in these cases goes without saying. As far as your question, I was always under the impression that in a young healthy person the empty socket fills with bone without any ridge resorption... but then again what the hell do i know... ask me the same question in another year.

 

[oms fan]

I agree with everyone else who have said you should consult a periodontist.

Under normal conditions, if you extract the mesially impacted thirds early you can help prevent periodontal disease on the distal of the seconds. Do it early enough and bone should grow. It doesn't hurt to throw in some bone matrix in the extraction socket either.

This is from "Contemporary Oral and Max Surgery", 4th ed. pp.185

"By removing the impacted third molars early, periodontal disease can be prevented and the likelihood of bony healing and bone fill into the area previously occupied by the crown of the third molar is increased."

and pp. 190-191
"Patients whose third molars are removed before age 25 are more likely to have better bone healing than those whose impacted teeth are removed after age 25. In the younger patient, not only is the initial periodontal healing better but the long-term continued regeneration of the periodontium is clearly better"

 

[UNLV OMS GUNNABE]

You haven't seen my student loan portfolio!

Thanks for pointing this out. I should have been more specific and said don't let your insurance company pick your dental provider or determine your dental treatment. Dental insurance in its common form in the US is not really insurance. The maximum you can get out of most policies is $1500/year. I don't know to many people that this amount would financially devestate for life so why be insured against it?

Health insurance is another story. And since most MD's participate to a great extent, a medical HMO can still get you a high caliber physician. In many areas the same cannot be said for a dental HMO.

JMHO
Rob

Well said, just keeping you honest

 

[gryffindor]

There is one guy I know at NYU who has shown that plaster or paris works just as well.... yes plaster of paris!!!!

I think this is what my honors thesis is supposed to be about. Plaster of paris (calcium sulfate) plus some concoction of growth factors that increase osteoblast proliferation. Now, if I could only motivate myself to finish it tonight and defend it tomorrow....

 

[Energon]

Griffin:
Excellent. This guy I know (used to be our professor) has used hybrid Plaster of Paris (with growth factors) in graft cases for implant support, re treating failed endo cases and perio. Hope everything works out for you

Best of luck

 

[Doctor Bagel]

hmm, thanks for the input. i guess i should ask for the perio consult then. my problem this year is that i have a dental hmo, and who knows how diligent they're going to be. next year, i can switch back to a more fee-for-service type of situation where i can see whomever i want and hopefully get approval for this type of thing. so, hopefully either the hmo can take care of it or it can wait until january of next year.

the weird thing is that the third molar in this spot wasn't impacted. all my others were bony impacted or whatever that's called, and this one was just a simple extraction, so i would think i'd have this issue at another site.

 

[Energon]

Go to a university setting and make sure oral radiology looks at the case first.

 

[Dr.SpongeBobDDS]

why do so many of you think going to a dental school is always such a good idea. For one thing, the work will take three to four times as long; secondly, a graft is going to be done by perio residents and will cost almsot as much as as private practice.

it doesn't take a radiology professor to diagnose a vertical bony defect. If the bone is gone, it's gone. Pretty simple, really.

 

[UBTom]

Yeah, the actual tx takes a long time... But if you want to go somewhere where you can get a 2nd, 3rd and 4th opinions all at once, a dental school is the place to go!

My school does that... You can come in for just the workup and consult without becoming a patient, but it'll cost you $47 extra. Nonetheless, for that fee you get a comprehensive consult with as many specialists as needed and IMHO is well worth the money.

 

[Doctor Bagel]

doesn't it take a lot more time to do the whole dental school thing? right now, i've actually got more money than time, which is pretty sad considering i don't have much of the former. i'm thinking that i would like to get an expert opinion on this, though, because it seems puzzling to me. argh, i feel like i can't win with my teeth, but i know that it's probably all my fault for putting off the wisdom teeth removal for nearly ten years.

 

[Dr.SpongeBobDDS]

it varies from school to school, but generally takes a verrry long time. At my school, for example, you would likely have two or three long (~3 hr) appointments before the issue of a bone graft was even considered. It's a lot to go through if you don't have the time.

If you're curious, ask the dentist to show you the radiograph so you can see where the defect has occurred. As long as its not in front or in back of the tooth it should be pretty easy for you to see what's going on.

And a bone graft really isn't as scary as it sounds; don't let yourself get too worked up over words. All it really entails is working a little around the already existing area, filling it with the appropriate material and then covering it up to let your body heal itself. No big deal really. Just a little more involved than getting a filling.