When do you decide not to save the teeth?

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Posted on By Josh Branco In Full Arch & Dentures

I often see patients that question whether it is worth the cost to save their teeth or to remove the teeth and do full arch implants. I usually recommend working with the natural teeth, but I was curious how you all approach these types of questions and when do you personally consider abandoning the teeth for implants?

For example: 40 yr old male needing an extensive amount of dental care. He is on board for treatment, but is questioning longevity and if full arch implants would be a better option as he will not be able to spend another round of significant money on his teeth in his life time.

Thoughts?


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8 Comments

Hi Josh; This patient bears some responsibility for the condition of his mouth. However, had this patient received better care by our colleagues, he might not be in the situation that he is in. I cannot tell whether this patient had the necessary restorations on the endodontically treated teeth causing endodontic failure but the endo itself was poorly done. Under no circumstances would I remove his remaining healthy teeth and place implants. Implants fail too. Save what can be saved and place implants where needed. Gerald


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That is basically what I discussed with the patient and the plan is to save everything we can. I was just wondering in general when do you decided to pull the plug?


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Hi Josh;
Can you defend, in court or before office for professional misconduct ,your rational for removing healthy teeth?
Have you seen the amount of bone needed to be removed to place 2 zirconia implant supported restorations...This is criminal and we all know it.
That aside: Does the patient take meds that produce severe dry mouth? That to me might be a reason to remove teeth. If you remove the teeth this 40 year old will have no proprioception for the rest of their lives. Just a thought.
gerald


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Hey Josh, in my experience, the patient usually goes to another dentist that tells him what he wants to hear and do a classic dental treatment, it fails and they come back to "pull the plug".


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Hi Josh, I get to see a nice amount of cases like this. In my experience, when a patient is 40 years old and has this kind of tooth decay, usually responsibilities are shared.
Misdiagnose leads us to see one small spot of the problem and maybe we miss some critical aspects of this patients.
For example, skeletal class, hyoid bone position, tmjs position, sleep habits, airway, meds.
Lot of dental treatment for a 40 year old guy. That means he's gone to the dentist in his life.
When we get to find the piece of the puzzle that is missing we get to manage risk.
An I believe that's crucial for our prognosis.
One of the tough decisions when removing everything are the canines. I usually set an strategy to look for simetry so I can transform the case if the patient loses other teeth along time.


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Hello Josh,

I get presented with this type scenario in my practice and the way I always approach it is as following. I always analyze what teeth can be potentially saved with NON HERO-DONTIC approaches, then I analyze the positioning of these teeth in the mouth and see if they will be in my way to PREDICTABLY restore the whole mouth.... One of my mentors used to say, a healthy tooth or bone that restricts your plan is a deseased tooth unless the patient is willing to do ortho.

All in all I would first evaluate the resorable teeth, a root is still better than implants... and as long as it has a good prognosis and they are positioned adequately in a 3D perspective i would keep them.

This patient is very young, Implant supported prosthesis even-though have had good results over the years they have been found to also have complications over time. Below is a good reference to look into to find about complications that can be encontoured. I think that regardless of what you do in this case at age 40, he will most likely have to invest a considerable amount of money in his mouth again.

Best,

Jonathan


Dhima M1, Paulusova V, Lohse C, Salinas TJ, Carr AB.: Practice-based evidence from 29-year outcome analysis of management of the edentulous jaw using osseointegrated dental implants. J Prosthodont. 2014 Apr;23(3):173-81. doi: 10.1111/jopr.12084. Epub 2013 Jul 26.


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Dental restorations are treatments that repair, fix, and restore your teeth. That can mean covering your teeth with dental crowns so they’re stronger, or removing infections so your teeth are healthy. It can also mean replacing teeth that you have lost. When you have more than one problem to work on, you need more than one dental treatment. But it’s best to head in with a plan. You don’t want to replace a tooth with a dental bridge if you’re just going to get dentures. A full-mouth reconstruction is a plan to restore your teeth. It begins with a thorough exam from Dr. Betts. With his combination of real-world experience and advanced training, he can help you decide which dental restorations are best. By calling our Decatur, AL dental office today, you can set up that initial exam and consultation. Then you’ll know what your full-mouth reconstruction will look like — and how great your smile will look like as well. For more. you can visit at https://www.dentistanyc.com


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Just looking at your panorex which is not enough information, I would try desperately to convince this patient to retain their dentition.....IMHO there is always another chance down the road if needed to enter that option if and when needed....not at this moment IMHO. Dr. Salama


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Salvin
KLS Martin