Topic: Upper Front Teeth

One of my upper front teeth has been giving some problems for a few years.  It's already been treated with a root canal.  Now I've been advised to have it extracted and replaced with an implant or a bridge. 

Can I hear from anybody who plays bassoon and/or contra with a bridge on upper front teeth?  How about somebody who plays with an implant?

Many thanks.  I need to make a decision pretty soon.    Justin

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Re: Upper Front Teeth

Aa a bassoonist with normal front teeth but a knowledge of dental medicine, I'd advise you to have a mold of your upper teeth made before you undertake any restoration. Any implant or other procedure should restore your dentition to its previous alignment and shape as shown on the model, not to the dentist's "ideal" shape or alignment. If this can be done, you should be able to resume playing with minimal difficulty after all the healing has occurred. PLEASE -- make sure your dentist knows of your musical activities and embouchure requirements, and even bring in your reed and bocal so he/she can see what you need to make a proper embouchure.

Talk to your dentist regarding the choice of implant or bridge, and get all the plusses and minuses of each procedure -- then make your decision regarding treatment.

Good luck --

Bill

Dr. Bill Dawson, bassoonist and teacher
IDRS medical consultant
Past President, Performing Arts Medicine Assoc.
Author of "Fit as a Fiddle: The Musician's Guide to Playing Healthy"

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Re: Upper Front Teeth

From a friend of my who is a dentist and  a musician(trombonist)

The moderator's suggestion to get a pre-op impression taken was a very good one. This is a tough task to accomplish. A player who's played a long time with a specific alignment (even one that's totally screwed up) and has adapted his embochure to that alignment can have a very hard time adapting to anything new. And double reed players are probably tougher to accomodate than even brass players, and they're bad!

I think for the original poster of this thread, it wouldn't matter so much whether he got a fixed bridge or implant, but rather how the resulting teeth are shaped that will affect how he plays. Having said that, though, it's amazing how adaptable some folks are to dental changes. And, there are plenty of old Dixieland-type brass guys who play with dentures. I bet that wouldn't work well with a double reed, though.

Ultimately, the goal would be to get this patient something as close as possible to what he had to begin with, ignoring any attempt to idealize either the esthetics or bite, have him always bring his instrument when trying things in provisionally, and hope for the best. If this guy plays professionally, he'll need the best possible help to get through the various interim (healing, provisional replacements, etc.) stages of having a tooth out and replaced, for sure.

Warren

Last edited by delmar (2009-01-29 06:05:02)

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Re: Upper Front Teeth

As someone who plays with not one but two implants on my top two front teeth, I would encourage you not to get too hung up about your ability to adapt.  I expect you will have more trouble re-learning how to say "s" than you will getting your embouchure back up to snuff.  I do like the previous poster's suggestions to get a pre-op impression and to work from that rather than to re-shape the teeth in the dentist's idea of a perfect smile.  This will get you back playing faster.

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Re: Upper Front Teeth

Justin, I hope you have already resolved your questions, and have moved forward. I, too, am "in the middle" of this process. As a high school student at the Brevard Music Center in 1969, I fell and cracked my right upper front tooth--a local dentist "saved" the tooth, but my home dentist had to do a root canal on it at the the end of the summer. Over the years, through the neglect of continuous use of a retainer, this very tooth gradually mis-aligned itself, with the left edge slightly overlapping (to the front) its neighbor. It also slowly began and continued to darken, and about 12-15 years ago, my dentist advised me to replace it with a crown, which could be matched, color-wise, to my other teeth.

He did, indeed, make a mold of my "un-straight" alignment, but he and I agreed to install the new crown so it would be, more or less, in perfect alignment with the rest of my uppers. As Nancy Duncan advised, there was, indeed, a short but manageable transition, getting used to my "new" embouchure. The new alignment was well worth the 1-2 weeks it took to get used to it!

More recently, the old root canal itself began "resorbing"; my dentist likened it to becoming more brittle, with the increasing danger that it might just "snap off" if I did nothing. I elected to proceed with the implant, primarily since it seemed to be a more permanent AND more structurally stable option. Additionally, having a bridge would apparently involve some shaving down of the neighboring teeth, on which the bridge would anchor--and I didn't want to "intrude" on otherwise healthy, normal teeth if I could avoid doing so.

I had the whole tooth--root canal and crown--extracted, and had a bone graft, all by a referred periodontist. I've likened the bone graft to filling the extraction gap with "dental silly putty", which biologically hardens into actual bone tissue after 5-6 months--then the implant is "installed" into this thickened "bone" area, and the dentist pins the final crown into the implant.

My dentist made a mold of my alignment prior to the extraction, and made two separate devices, or "appliances" I could use after the extraction. One is the traditional "flipper", which consists mostly of a mold of my upper palate, onto which is attached a single tooth-where the new gap is. Advised that it would not hold that tooth "rock-solid" while playing, he also made another device, much like the modern clear plastic retainers used now, that molds over all the upper teeth--and he cleverly glued an artificial tooth in the appropriate gap, so that when I wear it while playing, no one can tell I'm missing a tooth. Since it goes all the way back to my upper molars, though, I can't eat with this one--it's just for playing.

Unfortunately, I encountered problems with the original bone graft--it did not "take"! While preparing to install the implant, my periodontist said there still wasn't enough bone material on which it could be properly anchored! YIKES! I consulted with another periodontist, and was prepared, just two years ago, to try again, possibly having another bone graft and simultaneously having the implant "tucked in". As would have originally been done, I would still have to wait 6+ months for all this to harden before the installment of a final crown, which would be pinned into the implant. It was about this time that I got diagnosed with stage 1 lymphoma (see my recent article in the Double Reed), so subsequent surguries were put on hold. Hopefully, I will be able to resolve this soon...until then, I am making do with my removeable appliances--definitely NOT a desireable long-term solution.

I hope this helps put some of this in perspective!

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Re: Upper Front Teeth

hi RGWalton,..nice post thanks for this useful discussion placed,...

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