TromboneChat

Hi all
I have broken the tooth next to my front tooth off at the gum line, no chance of capping or crown.The only option I seem to have is an implant ( ker-ching  £2000 plus) or a high end denture which clips in between the teeth either side. Is there anyone out there  who has had the same problem and can tell me how it worked out?..I assume the implant would be a good out come, but no idea if the denture would be strong enough...I'm a bass player...
thanks - in hope!
Alex.

Quote from: Alex.C on Yesterday at 08:14 AMHi all
I have broken the tooth next to my front tooth off at the gum line, no chance of capping or crown.The only option I seem to have is an implant ( ker-ching  £2000 plus) or a high end denture which clips in between the teeth either side. Is there anyone out there  who has had the same problem and can tell me how it worked out?..I assume the implant would be a good out come, but no idea if the denture would be strong enough...I'm a bass player...
thanks - in hope!
Alex.

Perhaps you need to see another dentist. That happened to me on a front tooth! My dentist took a root canal impression and had a heavy-duty cast pin created which fit a crown. He had the crown made over-size so that it fit down over the stump of the tooth under the gum line. He then cemented both the cast pin and crown back on. It's been over two years and it is just as solid as any other tooth.

...Geezer

Don't forget, Geezer, that dentistry in the US and the UK is ... different. Like Bach 42 vs Conn 88 different.

Sorry. I couldn't help it.

I seriously hope you can get it fixed and still play trombone the same as always.

On this side of the pond, it usually works like Geezer said...I'm nearing the end of my two front teeth getting implants...They made me a plastic mouth piece with two fake teeth glued into it so it looks pretty and so that I can continue to play...It is expensive and I didn't have any roots left to attach too, so I had few options...I'd have someone else look at it...We maybe advanced here in the states, but a root canal with a post for a tooth cap should be routine in this day and age I would think...Best of luck to you, hard to play without teeth, I know....

I had a tooth break at the gumline and the dentist extracted it (I did get a second opinion but that guy agreed too.) 

Later when I could afford it, I had it replaced.  My new dentist said no implant, my jawbone wasn't thick enough at that point.  So he crowned the tooth on each side and made a bridge - there's a tooth in between that is continuous with both crowns. 

I've since repeated this process two other places.  The results are very good, no effect on playing and I can eat more comfortably. 

The cost of the bridge was considerably less than an implant, less than half I think. 

Hi Alec,
I don't know where you are in the UK but you might be able to get your dentist to refer you to the nearest Dental Hospital. You might have to be fairly insistent but play the "end of my career" card.
Now you might be thinking that you don't want any young students practicing on you but the chances are that you will be seen by a lecturer/tutor or, if you do see a student, they will be supervised at all times.

I have been receiving treatment at the Bristol Dental Hospital for about 20 years now. Much better than a local practitioner because they have access to any new ideas.

The bridge crown suggested by Timothy42b would probably be a good idea. It worked for me some years ago but I had other underlying jaw problems.

Good luck.

Cheers

Stewbones

Alex
A dental implant is usually the best option albeit expensive. When done right the implant and crown will never give you trouble and last a lifetime. A denture for one tooth is rarely tolerated. A bridge is another option but that means having to grind down the adjacent teeth to support the bridge. Unless the adjacent teeth need crowns the implant is best and even if the adjacent teeth need teeth need crowns I still like the implant option.
In the front have the implant placed by a periodontist and restored by any competent dentist.

Quote from: ronkny on Yesterday at 04:15 PMAlex
A dental implant is usually the best option albeit expensive. When done right the implant and crown will never give you trouble and last a lifetime. A denture for one tooth is rarely tolerated. A bridge is another option but that means having to grind down the adjacent teeth to support the bridge. Unless the adjacent teeth need crowns the implant is best and even if the adjacent teeth need teeth need crowns I still like the implant option.
In the front have the implant placed by a periodontist and restored by any competent dentist.

And how long will this procedure take? How long will the OP have to be off his horn?

...Geezer

Thanks for the comments chaps....
it's a tooth that had a root canal about 20 odd years ago and has had it really...implant it is then, and I was saving my cash for that 62H.....
Alex.

I hope it's successful. Finding a sympathetic (to musicians) dental surgeon or implant specialist may be the key. May be worth asking around locally for a recommendation; Some are very switched on to latest techniques and equipment, some probably  not so much. Good luck! Stephen 

You will be unable to play for about six months.

Best of luck to you.

...Geezer

Quote from: Geezerhorn on Yesterday at 04:01 AMYou will be unable to play for about six months.

Best of luck to you.

...Geezer

Very likely

But I was lucky with my last major dental work; complete new upper denture held in with implants. This was done at the local dental hospital and I had insisted that the new denture was an exact copy of the denture I had had before. It was put in place and immediately felt different. I tried it with a mouthpiece and it was different! The dentist said to try it and if it didn't work, he would change it. That was on the Thursday. I went home and did 2 hours practice. It was better than what I had had before and on the Saturday I did Verdi's Requiem on Bass Trombone. That is over 10 years ago and everything is working fine still

Cheers

Stewbones

Quote from: Geezerhorn on Jun 27, 2017, 07:55PMAnd how long will this procedure take? How long will the OP have to be off his horn?

...Geezer
No more than a couple of weeks at the most. As long as he doesn't put pressure on the implant.
When implants are placed they are either buried under the gum for healing or just above the gum line or they may have a provisional crown for esthetics. It takes about three months for the implant to fully integrate with the bone. Then you can have the permant crown placed and wail away on your horn.

Quote from: Geezerhorn on Yesterday at 04:01 AMYou will be unable to play for about six months.

Best of luck to you.

...Geezer
Nah. Two weeks at most. If everything goes perfect.

I've first-hand experience with this exact problem....same tooth, on my left side.

Last fall I lost the tooth (eating an apple!...but, partly my own fault from years of irregular dental visits and irregular cleaning).

BUT.... (a lesson for anyone interested)... I've live with extremely crooked and crowded teeth my whole life, yet been able to perform at high professional standards.

My current dentist blames the bad tooth on years of neglect as well as years of crowded teeth doing their own damage to the bone structure, that didn't help the strength of the gums, hard to get at food particles (even from good brushing and flossing).

Would braces have helped in my teens or '20's? Yes, they would have made a big difference over the years. But, that's 'water under the bridge' now.

Here in Toronto, there's a fantastic dentist, Dr. Jack Train. Jack is a trumpet player himself, and is pretty much an expert on dental care for the brass player, having given lectures in New York and elsewhere as well. He's the 'go-to' dentist for brass players... very lucky to have found him....he's saved my career!

THE GOOD NEWS.... I've been in preparation to receiving an implant, due this September. I've got the implant receptacle in place, and just waiting for it to take hold properly. Over the winter and spring, I've been to the dentist to take care of numerous other problems that have been long neglected. (....just don't ask me for dollar for coffee! I don't have any money left!)

And, I put in a fake tooth (a 'flipper') which is easily removable. (...don't want people to mistake me for a banjo player without it!)

I've adjusted to being able to play without the front tooth. It seemed hopeless for the first few days, but I've adjusted. I've been experimenting with a lot of different mouthpieces over the last several months.

I'm not playing at 100%, so haven't 'put myself out there' for some work, and have even turned down work when I've been out of shape from in-between dental visits, or am told not to play for a couple of weeks in order for some procedures to heal up. I've been doing some rehearsal bands and some other 'less visible' work, so I know that I haven't lost any technique or musicality.

The only weird problems are some particular notes might not 'speak' as well, due to having the gap in my teeth and not being able to put any pressure on the mouthpiece for certain notes or playing situations.

Other than that, everything is fine! I'm on track to being normal...and now, without any major dental visits in the future (just waiting for the implant) I feel back on top of my playing.

MORAL OF STORY.... hang in there! You'll be fine. Sure, you'll risk bankruptcy along the way, but you only get one set of teeth.

OTHER MORAL.... take care of your teeth! Floss, floss, brush, brush! Go to the dentist.....get your teeth cleaned on a regular basis !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

If you've got abnormally crooked teeth, consider braces if you're a student so that you don't need to do it later in life.

Find a dentist that understands the needs of brass players!!!!

Good luck, and good teeth!

Quote from: ronkny on Yesterday at 07:06 AMNah. Two weeks at most. If everything goes perfect.

Quote from: ronkny on Yesterday at 07:05 AMNo more than a couple of weeks at the most. As long as he doesn't put pressure on the implant.
When implants are placed they are either buried under the gum for healing or just above the gum line or they may have a provisional crown for esthetics. It takes about three months for the implant to fully integrate with the bone. Then you can have the permant crown placed and wail away on your horn.

Which is it?

...Geezer

My dentist, Jack Train (an expert at this) let me start playing 2 weeks after having the implant put in.

He said 3 weeks is fine in most cases, 10 days for some. My procedure went fine, and is healing up beautifully.

Quote from: cmillar on Yesterday at 07:31 AMMy dentist, Jack Train (an expert at this) let me start playing 2 weeks after having the implant put in.

He said 3 weeks is fine in most cases, 10 days for some. My procedure went fine, and is healing up beautifully.


That's reassuring!

...Geezer

Quote from: Geezerhorn on Yesterday at 07:12 AMWhich is it?

...Geezer
Ok
Hers the details I'm trying not to get into the weeds.
If the tooth is present and there's no infection, the tooth can be extracted and the implant placed in the same appointment. Sometimes the tooth is extracted and we have to wait three months. Then the implant is placed.  
Sometimes the implant is buried under the gum. Usually because a bone graft was nescessary. Sometimes a healing cap ( a healing screw) can be seen coming through the gum. Sometimes a healing abutment ( a custom made titanium/plastic partially tooth/root shaped is screwed into the implant. https://www.youtube.com/watch?v=uBbdc8L-Fsc

With just the healing cap placed the gum heals in the shape of a circle. If a custom is made the gum heals in the shape of a root.. The custom is better because then the crown/gum interface looks like a real tooth as it comes out of the gum since no roots/teeth are round.
 

And finally, sometimes a temporary crown with a custom abutment is screwed into the implant.  Usually so the person does not have a missing tooth. This temp is non functional and no pressure is applied to it especially in a horizontal direction as would be the case of a mouthpiece.
If it's a one stage surgery it takes three months before a permanent crown is placed
If it's two stage (graft then implant) it takes six months.
Either way as long as no pressure (especially in a horizontal direction) is applied to the implant while it is integrating(fusing to the bone) the person can play their horn.

Quote from: ronkny on Yesterday at 07:42 AMOk
Hers the details I'm trying not to get into the weeds.
If the tooth is present and there's no infection, the tooth can be extracted and the implant placed in the same appointment. Sometimes the tooth is extracted and we have to wait three months. Then the implant is placed.  
Sometimes the implant is buried under the gum. Usually because a bone graft was nescessary. Sometimes a healing cap ( a healing screw) can be seen coming through the gum. Sometimes a healing abutment ( a custom made titanium/plastic partially tooth/root shaped is screwed into the implant. https://www.youtube.com/watch?v=uBbdc8L-Fsc

With just the healing cap placed the gum heals in the shape of a circle. If a custom is made the gum heals in the shape of a root.. The custom is better because then the crown/gum interface looks like a real tooth as it comes out of the gum since no roots/teeth are round.
 

And finally, sometimes a temporary crown with a custom abutment is screwed into the implant.  Usually so the person does not have a missing tooth. This temp is non functional and no pressure is applied to it especially in a horizontal direction as would be the case of a mouthpiece.
If it's a one stage surgery it takes three months before a permanent crown is placed
If it's two stage (graft then implant) it takes six months.
Either way as long as no pressure (especially in a horizontal direction) is applied to the implant while it is integrating(fusing to the bone) the person can play their horn.

Thank you.

I believe the take-away is for one to be prepared to be off the horn for 6 months or so. If it's less, that's fantastic. But I wouldn't want to naively go into the procedure thinking it's a glorified plug-n-play only to have the rug pulled out from under me. For anyone following this thread, we are that much more informed.

...Geezer

Quote from: Geezerhorn on Jun 28, 2017, 08:21AMThank you.

I believe the take-away is for one to be prepared to be off the horn for 6 months or so. If it's less, that's fantastic. But I wouldn't want to naively go into the procedure thinking it's a glorified plug-n-play only to have the rug pulled out from under me. For anyone following this thread, we are that much more informed.

...Geezer
No, no, no. Not six months. I f you can't play your horn for six months then the implant surgery in FUBAR. 
I I was having the surgery and I made a living playing my horn instead of being a dentist I'd use a flipper (a removal temporary bridge. (I usually make them with invisalign tray with tooth colored composite place in the shape of a tooth where the tooth is missing) until the permanent crown was placed. Then you can take it out if needed while playing or leave it in when in public.

What do you eat during the six months that you can't put pressure on your new teeth?

Quote from: robcat2075 on Jun 28, 2017, 08:40AMWhat do you eat during the six months that you can't put pressure on your new teeth?
Mush

Quote from: robcat2075 on Jun 28, 2017, 08:40AMWhat do you eat during the six months that you can't put pressure on your new teeth?
So if it's only one tooth you can easily eat around it.  Otherwise a soft diet. Compressive forces on implants are not as much of an issues as lateral forces on implants.

Quote from: ronkny on Jun 28, 2017, 08:30AMNo, no, no. Not six months. I f you can't play your horn for six months then the implant surgery in FUBAR. 
I I was having the surgery and I made a living playing my horn instead of being a dentist I'd use a flipper (a removal temporary bridge. (I usually make them with invisalign tray with tooth colored composite place in the shape of a tooth where the tooth is missing) until the permanent crown was placed. Then you can take it out if needed while playing or leave it in when in public.

Is there a longer heal time for elderly patients?

...Geezer

Quote from: ronkny on Jun 28, 2017, 08:30AMI'd use a flipper (a removal temporary bridge. (I usually make them with invisalign tray with tooth colored composite place in the shape of a tooth where the tooth is missing) until the permanent crown was placed. Then you can take it out if needed while playing or leave it in when in public.

That's where I'm at....otherwise I look like a banjo player when I don't have the trombone on my face.

FYI...I had a little bone grafting/preparation work done last fall, and wasn't allowed to play for about 3 weeks.

Then, I had to wait for over 3 months to get the actual implant put into the bone. (I could play as much as I wanted during this time...except I was busy getting a bunch of fillings and root canals during that time!)

Now, I've had the implant put in place, and have been allowed to play again after 2 weeks. I'll get the actual tooth sometime in September.

My playing is back up to usual, aside from the few idiosycracies I have to deal with from not having the front tooth while I play. But, all is good. As I've discovered, the human body is very adaptable.

Also, I've been taking Fermented Cod Liver Oil. My gums look great, and even the dentist is impressed at how fast things are healing up all the time and how good my gums look now. My mouth and teeth feel much, much better after a few months of the Fermented Cod Liver Oil.

When I haven't been playing, I've used the Warburton 'Buzzard' to keep the muscles in shape. It's been great!

OOPS!!...correction....I mean the Warburton P.E.T.E! (not 'Buzzard'...that's for later when you can buzz the mouthpiece!)

The P.E.T.E. concentrates work on the correct embouchure muscles...just don't overdo it!

Also....bass trombonist Sharman King (Vancouver...Vancouver Opera, all the top commercial freelance work, formerly w/Buddy Rich) has always played without one of his upper front teeth! (...I believe it's an upper tooth).

I had lessons with him years ago, and he'd be removing his 'flipper' to play duets, then putting it back in. When you see him on a gig, he'd be putting the tooth in and out all the time!

He just got used to playing without it.

Quote from: Geezerhorn on Jun 28, 2017, 08:50AMIs there a longer heal time for elderly patients?

...Geezer

Note to self: EVERYTHING takes longer to heal with the passing years - until there is no healing left in the body and we die.

Note to self: Be prepared for 6 months off the horn if I need an implant. If it takes a LOT less, fantastic!

...Geezer

Quote from: Geezerhorn on Jun 29, 2017, 05:51AMNote to self: EVERYTHING takes longer to heal with the passing years - until there is no healing left in the body and we die.

Note to self: Be prepared for 6 months off the horn if I need an implant. If it takes a LOT less, fantastic!

...Geezer
see reply #20
I do this for a living

Quote from: ronkny on Jun 29, 2017, 07:38AMsee reply #20
I do this for a living

So do I - as a patient that is. AND as a patient, I always prepare myself that the worst could happen so that I am not caught emotionally flatfooted if it does. However, I always try to beat the system during recovery. IOW's, if they tell me it's a routine 3-day hospital stay, I try to get myself ready for discharge in two days, while my room-mate languishes in self-pity. I don't see the above procedure being anything other - as far as self preparations are concerned. I would mentally prepare myself for the possibility that all you-know-what could break loose and yet keep positive thoughts in my head that it will all be routine after-all and I will again beat the system. With all due respect, I will dare to say that I have had much more experience as a patient than you.

...Geezer 

Quote from: Geezerhorn on Jun 29, 2017, 07:48AMSo do I - as a patient that is. AND as a patient, I always prepare myself that the worst could happen so that I am not caught emotionally flatfooted if it does. However, I always try to beat the system during recovery. IOW's, if they tell me it's a routine 3-day hospital stay, I try to get myself ready for discharge in two days, while my room-mate languishes in self-pity. I don't see the above procedure being anything other - as far as self preparations are concerned. I would mentally prepare myself for the possibility that all you-know-what could break loose and yet keep positive thoughts in my head that it will all be routine after-all and I will again beat the system. With all due respect, I will dare to say that I have had much more experience as a patient than you.

...Geezer 
Maybe. I've been a patient lots though.
And since I do the dentistry for a living I can tell you that at least in my hands and my specialists things rarely if ever go wrong no. We are deliberate and thorough in our treatment planning.  And it's not brain surgery so our outcomes are pretty much 100%. Any dentist can expect that with proper training and treatment planning. Not just me.

Quote from: ronkny on Yesterday at 04:16 PM  And it's not brain surgery so our outcomes are pretty much 100%. Any dentist can expect that with proper training and treatment planning. Not just me.

Geezer and I are old enough to remember when dentistry was a much less developed field.

Either that or I ran into a lot of bad ones as a child.  That is part of the reason I avoided them most of my life and ended up with a lot of catchup work when I finally started again. 

I have a lot of trust in any of those at the practice I use. 

Quote from: timothy42b on Today at 07:02 AMGeezer and I are old enough to remember when dentistry was a much less developed field.

Either that or I ran into a lot of bad ones as a child.  That is part of the reason I avoided them most of my life and ended up with a lot of catchup work when I finally started again. 

I have a lot of trust in any of those at the practice I use. 

+1

People often dream of traveling back to a more simplified time. Okay, but not before painless dentistry and that ain't too far back.

...Geezer

Quote from: timothy42b on Today at 07:02 AMGeezer and I are old enough to remember when dentistry was a much less developed field.

Either that or I ran into a lot of bad ones as a child.  That is part of the reason I avoided them most of my life and ended up with a lot of catchup work when I finally started again. 

I have a lot of trust in any of those at the practice I use. 

+1

People often dream of traveling back to a more simplified time. Okay, but not before painless dentistry and that ain't too far back.

...Geezer