Hi Jon,

I'm going to answer your post by taking one subject at a time.

With regard to the "uncertainty" about placing implants in your upper jaw:

1) It is not the gums that are too narrow, it is the bone. The width of the gums have nothing to do with placing implants unless there is severe gum recession. In the upper front area of the mouth, just like the lower front area, the cartlidge of bone is narrow to begin with. In your case, you also have bone loss because you have been missing teeth in the upper front for many years which has caused the bone to deteriorate even further. So placing implants in the front of your mouth would be very difficult and probably not successful without at least one or two previous bone grafting surgeries.

2) Extracting your upper canines and replacing them with implants would only be a wise option if you had extremely healthy bone in the canine area. If the bone in those areas is questionable at all, it may not be wise to place the implants there and expect them to anchor 4 other teeth (two centrals and two laterals) making the implant retained bridge 6 teeth or units wide. That's alot of pressure on 2 implants even in very healthy bone.

3) Dental school is students who may or may not have ever performed extensive reconstructive cases such as yours. There is going to be mixed opinions because none of them wants to be the one to attempt to do what they are unsure of unless they are someone who likes to take risks.

I have lots of experience in oral surgery, periodontics and prosthodontics. Without a doubt even in private practice, these specialists have difficulty agreeing with treatment options. The main reason is this........ oral surgeons look at the bone from a health stand point and they see all the failures that occur when dentists do things that they shouldn't. Periodontists think similarly as the oral surgeon and also see the failures of others but their main concern is the health of the gum tissue. Prosthodontists......... their first concern is the cosmetic part of the reconstruction, not the foundation of which it is built upon.

I have seen people who have had major dental reconstruction of their mouth done in different dental schools and I can only remember one case that was actually done well. They have no physically technical know how of how to put it together in the mouth because they don't do it enough. I'm truly concerned for the long term result of all that you are going through.

As for the second opinion......
MOST dentists are no longer affiliated with dental school after they graduate unless they specifially teach at one. Dentists can't wait to get out of the grips of these places and practice on their own. There is no communication amongst dentists in private practice and dental school interns, etc unless they are on the staff at the school. Dentists themselves never refer their patients to a dental school (unless a patient makes that request) nor do they ever seek their own treatment at one. Dentist actually sympathize with patients who have been tortured by a dental student! I truly think it would be wise to get an opinion from a dentist in private practice that someone could refer you to. It is imperative that you get a copy of your radiographs and records from the school to take with you.

Jon at this point, the dental school is just shooting darts and seeing which one lands where. Unfortunately, your treatment plan is going to change every time you turn around and some of it will most likely be because of failure of treatment that has already been done. I see it all the time............ Please consider an outside opinion.

Bryanna ~'.'~