Dental implantsin Brick Township, NJ

Dentistry has a working life, and most people are not told this

Crowns, bridges, large fillings and root canals are repairs. Good ones last a long time. None of them last forever, and each replacement removes a little more tooth structure than the last. The cycle usually runs like this: filling, larger filling, crown, root canal and crown, then eventually the tooth cannot hold a restoration any longer.

The useful question at 45 is not "can this crown be redone one more time." It is "how many more rounds does this tooth have in it, and what is the plan when it runs out."

Knowing the answer changes what you do today. A tooth with two rounds left is worth repairing. A tooth with none is worth planning around.

When a bridge fails, the problem is rarely the bridge

A bridge rests on the teeth at either end. Those two teeth were cut down to hold it, which means they are more vulnerable than they were, and they are harder to clean because the bridge spans between them.

When a bridge fails, it is usually because one of the abutment teeth has decayed underneath or fractured. That matters because of what happens next. If the failed abutment cannot be saved, you now have two teeth missing instead of one, and the longer bridge that would replace it needs to be anchored even further back on teeth that were healthy last year.

This is the moment where implants change the arithmetic. Replacing the failed tooth with an implant stops the chain. The healthy tooth at the far end goes back to being a tooth instead of a pillar.

Smell or a bad taste around an old bridge is worth acting on rather than waiting out. It usually means decay under the margin, and decay under a bridge margin does not stop on its own.

Getting out of a partial denture

A removable partial hooks onto the remaining teeth with clasps. It works, but it puts sideways force on the teeth it clips to, and those teeth tend to loosen over the years. Many people who have worn one for a decade have lost another tooth or two to it and had the partial added to each time.

There are three ways out, depending on what the scan shows.

Implants replacing the missing teeth directly

If the gaps are small and the remaining teeth are solid, individual implants or a short implant bridge take the partial out of the picture entirely. Nothing clips to anything. The remaining teeth stop being used as anchors.

Implants supporting the partial

Where there are not enough implant sites to replace everything, a smaller number of implants can carry the partial instead of the natural teeth carrying it. The appliance still comes out, but the load moves off the teeth.

Starting over on a fixed arch

When the remaining teeth in an arch are mostly compromised, spending on each one individually is often spending twice. In that case the honest recommendation is to plan the arch as a whole rather than chase teeth one at a time. We say this when we think it, and we will tell you if we think the remaining teeth are worth keeping.

What we look for on the scan in this age group

By the mid forties most people have some history in their mouth, and the scan is where that history shows up. The things that change the plan are:

• Bone loss around teeth that look fine from above. This decides whether a tooth is a candidate for repair or not.
• Old root canal treatments with an area at the root tip. Some of these are stable and some are not, and the difference is visible.
• Sinus position over the upper back teeth. Long-missing upper molars often mean the sinus has dropped into the space, which affects whether an implant goes in directly or after a graft.
• Nerve position in the lower jaw, which sets how long an implant can be in the back of the mouth.
• Cracks and vertical fractures, which usually mean a tooth is not restorable no matter what is spent on it.

None of this is visible on a standard two-dimensional x-ray with any reliability. That is why the 3D scan comes first.

Sequencing when several things need doing

Most Brick patients at this stage do not have one problem. They have four, at different stages, and a budget that does not cover all of them this month.

The order we work in is: anything actively infected first, then anything about to fail that can still be saved cheaply, then the planned replacements. The point is to stop the situation getting worse before starting on the parts that improve it. A written plan with that sequence, and what each stage costs, comes out of the first appointment.

Getting here from Brick

From the Parkway it is a straight run south to the Route 37 interchange, then east. From the Laurelton side, Route 70 to Brick Boulevard and down Hooper Avenue works, and Route 88 and County Route 528 feed into the same roads. The whole route is mainland, so it does not pick up the Route 37 bridge traffic that builds on the eastern side in summer.

If you are coming from the Brick beaches on the barrier island, the trip is different: that is Route 35 and then west over the bridge, which is the slower approach between Memorial Day and Labor Day. Early morning appointments are easier in those months.