I finished my IMRT in June '07 for left tonsil ca. I now have some decay on the most back tooth on the radiated side which had a root canal years ago and is also an anchor for a bridge. My DDS referred me to an oral surgeon and they both consulted with my RO. My DDS said that if I want to try and save the tooth, he will remove the bridge and try to fill the cavity. He says that the tooth, already being weak from a root canal, might not be strong enough to hold the bridge again. If the tooth cannot be saved, they recommend that I go for HBO Tx and have the tooth extracted. I asked about having implants and they advised against them. Why can some oral ca radiated patients have implants and others not?

Based on what was explained to me, its all up to the jaw bone. This is what my dentist/prosthodontist and ENT told me. I cant do implants even though the oral surgeon said I could.

The answers that you are getting from your dentist and oral surgeon are probably reflecting the comfort level (or experience) that they have with placing implants post radiation.

I would recommend that you seek another opinion and you might be able to find someone that would be willing to place implants after HBO treatments. Factors which you will have to consider are that implants are not 100% successful in even non-radiated jaws and they are more successful in the lower jaw than the upper due to bone density. You don't mention if the bridge is an upper or lower one.

Jerry

Another option could be a post crown. The tooth already has endo done on it. The dentist drills out a cavity in the remaining core of the tooth, and down into the roots. A direct resin pattern of all this is made, invested to make a mold, the resin burned out of the mold and and cast in gold. Now you have a perfect gold post that fits directly into the preparation, that can be cemented into place. This is then cemented into the prepared tooth and roots, giving strength to the tooth which would then take the load of a conventional bridge. This is a very old technique. It is cost effective, the tooth which is actually dead after the root canal, is actually like an implant. It becomes ankelosed into the bone without a vital core or periodontal ligament. Even the Sharpies fibers that allow the micro movement of a tooth within its boney socket become desiccated, and the thing is essentially the same as an osteointegrated titanium implant. The gold core gives it the strength of the metal since endodontically treated teeth are naturally brittle. I have seen post and core restorations like this done even when the entire crown of the tooth has been lost, and all that remains are the two or three roots of a remaining molar. It's worth a discussion as an option.

Christine, Jerry & Brian...Thanks for the information. I will definitely discuss your suggestions with my dentists. Jerry, The bridge is a lower one. Also, Jerry, how do I find an oral surgeon who is experienced with post radiation patients?

You don't say where you live. East Coast is a big are. I have one In Princton NJ. Other people may be able to help you if be more specific as to where you live.

Take care,
Eileen

I have one in Allentown PA. There are alot of active OCF memebres from different parts of PA. Please update your location so we can help you.

Other than a direct recommendation from someone like Eileen or Christine, the best way to find someone is through the state or local dental society. Both should be listed in your phone book or a call to the American Dental Association in Chicago, should help you get more local phone numbers.

Of course if the tooth and root can be saved, then all of this is a moot point. I would try anything the dentist suggests if he/she thinks they can save it.

Jerry

I would be a happy guy just to be told,, Now you can get dentures JIM. Even for cosmetic reasons and remove them to eat. Look like GUMMY BO the clown here.