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Dental implants are a long-term solution for tooth loss, but people investigating this treatment need to have good dental and medical health and ideally should not have any signs of periodontal disease (severe gum disease). Advanced periodontal disease can be tricky to treat as it may become chronic, requiring ongoing care to control it. However, severe gum disease often causes tooth loss, so does this mean patients with gum disease can’t have implants?

The short answer is probably not. A dental article published some years ago found the survival rates of dental implants in people with periodontal disease were little different compared to those without this condition. Anyone visiting our practice is carefully assessed for suitability. We review your medical and dental history to determine if implants are the best treatment and provide a good chance of long-term success. One issue with severe gum disease is that it can destroy the jawbone, leaving inadequate bone for implant placement.

When this is the case, a special type of implant may be needed called a zygomatic implant that uses the cheekbone instead of the jawbone. Another option is to have a bone graft to build up the missing bone in the jaw, which could help people who have had severe periodontitis successfully treated.

We often see patients with tooth cracks, but while some are serious, other types may not need any treatment. There are five different types of tooth cracks which are:

• Craze lines
• Split tooth
• Vertical root fracture
• Cracked tooth
• Cusp fracture

Craze lines are microfractures only affecting the enamel. They can be a sign of bruxism (tooth grinding and clenching) or the result of another form of trauma. If treatment is needed, it’s probably only due to aesthetic reasons, but it may be important to prevent bruxism to protect the teeth in future. A split tooth is more serious and can extend from the tooth crown to below the gumline. Sometimes it is possible to salvage the tooth, but often it must be removed.

A vertical tooth root fracture is most often associated with previous root canal therapy. Unfortunately, this is another frequently hopeless case where the tooth will need removing. A cracked tooth may be salvageable depending on the location and depth of the crack. Sometimes a tooth can be restored with a dental filling or crown, or other times it may need root canal therapy. A cusp fracture can cause tooth sensitivity, but depending on the extent of the fracture, there’s a good chance the tooth can be restored with a dental crown or another type of restoration.