Dental implants post recovery

donfoo

It's pretty surprising there are no threads on dental implants in this group. Well, here's my situation.

Brief backstory - My cancer treatment, radiation and chemo, was a decade ago and successfully treated the cancer with very few long term side effects. Two teeth were extracted as a precaution prior to treatments with no long-term side effects. Early this year, I had all on four implant procedure and now preparing for the final prosthetics. Instead, it turns out 4 of the 8 implants failed to integrate with the bone, so out they came today.

I'm very conflicted how to proceed as there was no satisfactory reason for the failed implants, but the dentist is pressing to try again, placing new implants and fitting temporaries at no added cost. It's great the dentist stands behind his work, but disconcerting not knowing the root cause of the failure: is it lacking dentist skill and experience, is it substandard implant material, is it weakened bone or immunity from rads?

I was always aware of potential ORN, weak bone, and compromised immunity from radiation and guarded about any dental work that affected the bone. Seeking evaluation and recommendations before dental procedures affecting the bone. Some have mentioned HBOT as a precaution.

Well, how do I proceed? Take his recommendation, proceed with new implants, or defer getting other opinions and consultations from specialists.

Two significant factors push me to do it now: I've travelled several hundred miles to get this done and his offer to do this without extra costs. On the other hand, there isn't much supporting rationale the new ones will properly integrate. The initial implant surgery also had a couple issues that question his capabilities that I had let go until today.

I'm leaning to let him try again against my better judgement but hope my experience will provide insight to how this can go for others.

wbcgaruss

Hello, Don good to hear from you, and sorry you are going through some difficulties.

First off I have had no dental implants so I can’t speak from experience.

So you had 2 teeth extracted before cancer treatment.

Earlier this year, you had all on four implant procedure. What is an all-on four implant procedure?

This is before the final prosthetic, is the final prosthetic going to be removable or fixed?

I have known people in our Local Cancer Support Group that had posts in their jaw and then a plate that would be then put in, I assume like a denture that fastens onto the anchoring inserts.

So you had 8 implants in all and 4 came out. Have all 8 been put in by this doctor or only the 4 that failed?

They failed to integrate with the bone.

That could have many meanings and many reasons why it happened.

Now you are not sure how to proceed, 4 implants failed and the dentist is as you say pressing you to try again.

So the dentist wants to place new implants and fitting temporaries at no added cost.

He seems reasonable that way and it is good business practice.

You say…it is disconcerting not knowing the root cause of the failure: is it lacking dentist skill and experience, is it substandard implant material, is it weakened bone or immunity from rads?

I agree very much!

The dentist wants to try again and is willing to give you a little extra and is anxious to do it But remember you are the one who has to deal with damages moving forward, it is your mouth and you gotta live with whatever you end up with. So he does 4 more and they fail and you are stuck with the results. I assume putting implant posts in again will require a larger implant screw, I am guessing here. I am thinking of a job around the implant, at home, or on a car if you stripped a screw out you could use a bigger one in the messed up hole and it will hold. Don’t know if that’s the case here I am not familiar with the procedure.

Anyway, it doesn’t sound settling to me.

I am not nor would I tell you what to do But...

I would think I would want to know the root cause of the failure before I would proceed doing anything else.

I would think a CT Scan, or possibly MRI would shed some light on it as to why the inserts didn't hold.

Or maybe they could go down in the area of the failed inserts and get a small bone sample, or look at the area with a tiny scope, I don’t know what all's available these days.

It’s like a miss in an engine, you want to do the diagnostics before you do a bunch of adjustments or just throw a bunch of parts at it. Get it on a computer and see what troubleshooting says before you proceed because there may be six things or possibilities that could cause the miss. You want to be right the first time fixing the engine but if it doesn't work out no great loss you can put in another part or do an adjustment.

With H&N people and the jawbone and teeth inserts it is of the utmost importance to be right the first time, period, it is of the essence although doctors are human too and we can't expect them to be perfect so it is up to us to be discretionary about our medical care.

You say you were always guarded about any dental work that affected the bone.

Seeking evaluation and recommendations before dental procedures affecting the bone.

Don’t stop now continue on that path.

You say...I'm leaning toward letting him try again against my better judgment, against your better judgment means your gut feeling, that thing in the back of your mind that says maybe I should second think this, or that feeling that knowledge and age has given you to steer your course.

You say...The initial implant surgery also had a couple of issues that question his capabilities that you had let go until today. That is what we call a red flag, remember that in your thoughts of this matter and decision.

You say...Two significant factors push me to do it now: I've traveled several hundred miles to get this done and his offer to do this without extra costs.

I understand this and it’s a situation and an offer hard to turn down.

After all you just want to get the dental implants and get home.

But don’t base your decision on travel or costs, this is a health issue, a head and neck issue, a bone issue, a life issue, a quality of life issue.

I still remember my radiation doc saying to me lo these 12 years ago now about head and neck cancer treatment and I feel it applies here… This Is A One Shot Deal … It is something you don’t want to revisit once or over and over again.

If there are issues a few months from now are you going to have to make the trip back, my thoughts also go to issues later on since the first implants did not work out will the next ones he puts in be good but give trouble later, just something to think about.

So would you make the trip later with issues or go local?

OK, I have talked a lot but I don’t know if I have said much.

I think I did because this matter is Extremely important to Head and Neck Patients.

I am in the same situation as Don is here as well as many on this board.

Every time I have a tooth that feels a little funny I can’t be like a normal person and if it’s bad go get it pulled because of the fear of bone death or osteoradionecrosis.

https://oralcancerfoundation.org/complications/osteoradionecrosis/

My dentist has a friend who got throat cancer just like me but he was in a better situation than me to live in a post head and neck cancer treatment life.

He has no teeth, as some on here have already had no teeth before treatment or had the rest they had pulled before treatment so it eliminates worries like this thing called bone death.

It is surely an unusual situation when you can say someone who has lost their natural teeth is in a better situation than you but this is the situation.

My takeaways are…

Go with your Gut Feelings on this…

Don’t prioritize travel or cost, it’s what you have to live with or deal with later.

Stay with the old Don...You say you were always guarded about any dental work that affected the bone.

Seeking evaluation and recommendations before dental procedures affecting the bone.

Don’t stop now continue on that path.

Remember in H&N situations this is a one-shot deal.

Be reasonably sure you are doing the right thing.

Be comfortable with it.

If you are not comfortable with it there is a reason.

And I think the reason for your decision either way is your life experience, your medical experience you have been exposed to, and above all your experience with head and neck cancer and the knowledge you have absorbed.

Love you Don you are a great guy and a great H&N supporter all these years.

Wishing You The Very Best

(NEGU) Never Ever Give Up

Take Care, God Bless,

Russ

And don’t forget to pray, pray, pray.

Be careful for nothing; but in everything by prayer and supplication with
thanksgiving let your requests be made known unto God.

wbcgaruss

Don I found this video check it out…

Can Cancer patients go for Dental Implant? - Dr. Rajeev Kumar G

https://www.youtube.com/watch?v=wJQcHlSBBk0

Dental implants are very viable treatment options in cancer patients especially in someone undergoing extensive resection and radiotherapy. Nowadays we use implants to support the prosthesis because usually the damage is very extensive. The points to be noted is when and where the implants to be placed , normally it is done after 6 months after the surgery, taking into mind also the radiation that is given in that area which would influence the healing in terms of the fibrosis and the vascularity of the bone in that area. So if it has got a lot of radiation in that area then the healing of the implant will not occur and it will fail. Also we need to understand if the prosthesis if it is going to be very extensive, if the implants can bear the load of it. So that also takes into account. So that is a factor that comes when it comes to the loading of the implant, which normally is delayed in any treatment of cancer patients. Also we need to see the amount of radiation that is given in that area of it is very high then the quality of bone will definitely not be higher for dental implants and we also need you see in what time this is done. Normally dental implants are placed after 6 months after the surgery in that area and we also need to see the extent of the damage is that when we are loading the implant, we also have to delay it because the immediate loading can also cause the failure of the implant.

Don, I would like to add I have a dentist and his hygenist both very aware of H&N cancer patients.

I also go to an oral surgeon who my dentist sends me to for more serious dental concerns and extractions

Both the dentist and the oral surgeon have worked closely with my radiation oncologist and know the radiation I was given.

I feel well covered for what they can do for me and feel I am so Blessed to have and to have had so many wonderful care people in all my situations watching over me.

With God watching over and taking care of me I am in the best possible situation I can be.
But for the Grace of God, and the Holy Spirit's intercession for me, I never would have left the hospital in 2019, Amen

Praise God!

Wishing You The Very Best

Take Care, God Bless,

Russ

(NEGU) Never Ever Give Up

And I always loved Crystal's saying she held dear…

Crystal (LitlcjDoll) on CSN

"No matter how you feel, Get Up, Dress Up, Show Up, and never give up."

donfoo

Hi Russ,

Thanks for the nice post. Today, I was able to understand the procedure done yesterday and what lay ahead. The bottom jaw seemed stronger so they added two posts, making for total of five. The upper bone did not hold up and three came out.

They are concerned about the upper bone so took a less risky path of full cleaning of tissue, infection, and bone, then covered it up. This as close as restoring back, so the plan is to monitor and wait a few months for the bone and tissue to heal.

Meanwhile, I can do more research and get a couple independent consults to assess the health of the bone is the upper jaw.

Thanks again,

don

wbcgaruss

Very good Don, it sounds like you have a plan laid out and it gives you time to research and finalize.

Praying for your continued healing and dental work and like the rest of us dealing with our new normal in life whatever it may be.

Take Care, God Bless

Russ

NEGU (Never Ever Give Up)

Jkchapa79

I had no idea that you could get dental implants post radiation! I’m sorry you’re dealing with the implant failures. I’m currently undergoing extensive dental treatment because my dental/oral health is now becoming a real concern. I’m being treated at University of TX dental clinic. I see a dental resident, & I can tell you they are phenomenal and go above & beyond. I am going to look further into the implants.