Hi Bryanna,

I am a newbie here ( my apologies if my query has already been covered in previous posts ). I read that your replies have been helpful & educational, i thought of sharing my own issues and maybe ask some questions too

I lost my 4 upper incisors 20 years ago, in 2014 i decided to have 4 implants on those missing teeth. I have been going to my dentist ( overseas ) for implant procedure since 2014. She put in 2 implants on 2 lateral and bone graft to prepare implants for central incisors. I came back every six months but each time, the dentist would only add bonegraft saying my gums are still not ready. October this year, i came back to the dentist again, she tried to screw in 2 implants for the central incisors but she said my gums are still too soft and the implants are not stable, she took out the implants and added human bone and told me to wait another 6 months to heal. When i checked the gums, there's a big hole. I came back to my dentist to ask why there's a hole, she told me the bones are still growing and they should tighten up in months time.

But it is so creepy, freaking me out, whenever i lift my lip, i see a big hole.

What do you think? Is it normal ?

Thank you,
Fridy

Hi Friday,

Welcome!

I am going to re post some of your post and reply to you in bold type to make it easier for you to follow the information I am able to provide for you.

<<I lost my 4 upper incisors 20 years ago, in 2014 i decided to have 4 implants on those missing teeth.>>

I ASSUME YOU ARE REFERRING TO YOUR 2 UPPER CENTRALS AND 2 UPPER LATERAL TEETH. WHY WERE THEY EXTRACTED? DID YOU OR DO YOU HAVE PERIODONTAL DISEASE? HAD THEY BEEN INJURED OR ROOT CANALED PRIOR TO THE EXTRACTIONS? IF SO, WHEN DID THE INJURY OCCUR AND WHEN WERE THE ROOT CANALS DONE? WERE ANY OF THOSE TEETH RETREATED WITH ANOTHER ROOT CANAL PROCEDURE, IF SO WHEN?

ONCE I HAVE THOSE ANSWERS I CAN THEN INFORM YOU MORE THOROUGHLY REGARDING THE HEALTH AND THE LOSS OF THE BONE.

THERE IS A CONCERN REGARDING THE LENGTH OF TIME BETWEEN WHEN THE TEETH WERE EXTRACTED AND WHEN THE BONE GRAFTING AND IMPLANT WORK WAS BEING DONE ...
WHEN ONE OR MORE TEETH ARE EXTRACTED AND DEPENDING ON THE INDIVIDUAL CASE, WITHIN THE FIRST YEAR OR SO THE JAW BONE RECEDES BY 50%. IF THAT AREA OF BONE OR THE ADJACENT BONE WAS INFECTED AT THE TIME OF THE EXTRACTION OR THERE IS UNCONTROLLED PERIODONTAL DISEASE, THEN THE LOSS OF BONE COULD BE EVEN GREATER.

IF AT THE TIME OF THE EXTRACTIONS THE PATIENT AND THE BONE WAS HEALTHY AND BONE GRAFTING WAS DONE, THEN THE BONE WOULD RECEDE AT A SLOWER RATE. PLACING IMPLANTS IN HEALTHY BONE WITHIN THE FIRST POST OP YEAR WILL OFTEN STOP OR SIGNIFICANTLY SLOW DOWN THE RECESSION OF THE BONE.

NOT PLACING BONE GRAFTS AND IMPLANTS WITHIN THE FIRST POST OP YEAR WILL SIGNIFICANTLY COMPROMISE THE INTEGRITY OF THE BONE AS EACH YEAR PASSES BECAUSE THERE IS NOTHING TO PREVENT THE BONE LOSS FROM OCCURRING.

BONE GRAFTING INTO THE JAW BONE REQUIRES THAT THERE BE ADEQUATE NATURAL BONE TO HOLD THE GRAFT MATERIAL. THE GRAFT AND GRAFT SURGERY WILL THEN STIMULATE THE THE CELLS TO GO THROUGH A NATURAL CHEMICAL PROCESS OF BREAKING DOWN OLD BONE TO BUILD NEW BONE IN THAT AREA. THE GRAFT IS JUST A CATALYST USED FOR THE PURPOSE OF BREAKING DOWN AND BUILDING NEW BONE. THE GRAFT IS NOT IN OF ITSELF STABLE ENOUGH TO HOLD AN IMPLANT.

OVER A 20 YEAR SPAN, THE JAW BONE HAS RECEDED AND MOST LIKELY BECOME FLAT AND THIN DUE TO THE RECESSION, ETC. IN THAT INSTANCE, THE GRAFT MATERIAL CAN ONLY BE PLACED ON TOP OF THE EXISTING BONE WHICH IS NOT THE SAME AS IF IT WERE BEING PACKED DOWN INTO HEALTHY, SUBSTANTIAL NATURAL BONE. THE GRAFT ITSELF DOES NOT SOLIDIFY LIKE NATURAL BONE AND WOULD NOT BE STABLE ENOUGH TO HOLD AN IMPLANT. IT WILL BASICALLY JUST SIT ON TOP OF THE BONE AND NEVER INTEGRATE.

IN CASES WITH LONG TERM RECESSION, THE TYPE OF BONE GRAFT USED IS IRRELEVANT DUE TO THE INABILITY TO PLACE THE GRAFT INSIDE OF THE BONE. REPEATED BONE GRAFTING PROCEDURES WILL NOT INCREASE THE CHANCES OF INTEGRATION BECAUSE THE FOUNDATION THAT IS NECESSARY FOR THE IMPLANTATION IS NOT PRESENT.

<<I have been going to my dentist ( overseas ) for implant procedure since 2014. She put in 2 implants on 2 lateral and bone graft to prepare implants for central incisors. I came back every six months but each time, the dentist would only add bonegraft saying my gums are still not ready.>>

THE IMPLANTS IN THE LATERAL SITES, WHAT WAS THAT SURGERY LIKE? WERE THERE SEVERAL TRIPS TO HER AND NUMEROUS GRAFTS PLACED BEFORE THE IMPLANTS WERE PUT IT. ARE THEY STABLE, SOLIDLY IMPLANTED INTO THE BONE? ARE THEY VISIBLE THROUGH THE GUM TISSUE AT ALL? HAVE THEY BEEN RESTORED WITH CROWNS?

THE STATEMENT ABOUT THE GUMS NOT BEING READY...
YOUR GUMS HAVE ALSO RECEDED OVER THE 20 YEAR SPAN. MEANING THERE MAY NOT BE ENOUGH GUM TISSUE TO COVER THE GRAFT MATERIAL. IS SHE HARVESTING ORAL TISSUE FROM YOUR PALATE AND GRAFTING IT OVER HER SURGICAL WOUNDS?

AS I MENTIONED EARLIER, YOUR EXISTING BONE NEEDS TO BE ADEQUATE TO BE ABLE TO PACK BONE GRAFTING MATERIAL INTO. ADDING MORE GRAFTING MATERIAL IS NOT GOING TO TAKE THE PLACE OF YOUR OWN NATURAL BONE.

<< October this year, i came back to the dentist again, she tried to screw in 2 implants for the central incisors but she said my gums are still too soft and the implants are not stable, she took out the implants and added human bone and told me to wait another 6 months to heal. When i checked the gums, there's a big hole. I came back to my dentist to ask why there's a hole, she told me the bones are still growing and they should tighten up in months time.>>

SHE REMOVED THE LATERAL IMPLANTS OR JUST DIDN'T PLACE THE CENTRAL IMPLANTS DUE TO INSTABILITY?

THE GRAFT IS NOT SOMETHING THAT GROWS. IT IS A CATALYST TO ENCOURAGE YOUR CELLS TO GROW YOUR OWN BONE WHICH EVENTUALLY TAKES OVER THE GRAFT. BUT IF THE GRAFT IS JUST SITTING ON TOP OF THE BONE AS OPPOSED TO BEING "IN" THE BONE, YOUR CELLS ARE NOT LIKELY TO TRIGGER THE GROWTH OF MUCH NEW BONE. THE BONE DOES NOT "TIGHTEN UP" AND INADEQUATE GUM TISSUE MAY NOT CLOSE OVER THE WOUND PROPERLY.

WHAT ARE YOU WEARING TO COVER UP THIS AREA OF YOUR MOUTH, A REMOVABLE PARTIAL DENTURE? IS THAT WHAT YOU'VE HAD FOR 20 YEARS OR DID YOU HAVE A PERMANENT BRIDGE FROM CANINE TO CANINE?

<<But it is so creepy, freaking me out, whenever i lift my lip, i see a big hole.>>

YEA, THIS IS NOT GOOD AS DEBRIS AND BACTERIA CAN ENTER THAT OPENING AND MIGRATE FURTHER UP. DOES SHE HAVE THE WOUNDS SUTURED?

<<What do you think? Is it normal ?>>

BY ANY CHANCE DID YOU PUSH TO HAVE THE IMPLANTS DONE OR WAS IT HER IDEA? PRIOR TO ANY OF THIS SURGERY, DID SHE DISCUSS ANY CONCERNS ABOUT THE LONGEVITY OF THE RECEDING BONE AND WHAT THAT ENTAILS AS FAR AS COMPROMISING THE IMPLANTATION OF THE DENTAL IMPLANTS?

IF YOU ARE COMFORTABLE WITH SHARING A BIT MORE ... ANY CHANCE YOU COULD HAVE HER SEND YOU YOUR XRAYS BOTH PRE AND POST OP AND POST THEM HERE? I WOULD TAKE A LOOK AND OFFER YOU MY OPINION ON WHAT IS ON THE XRAYS. JUST MAKE SURE YOUR NAME IS NOT VISIBLE.

Bryanna

Hi Bryanna,
Wow! Thanks for taking the time to answer my queries, really fast! i think it is going to be a long discussion of my case.

By any chance, do you have colleagues in Sydney that i can probably see to look into my case? Or can you probably recommend someone/clinic?

Really appreciate your help!

Thanks
Fridy

Hi Fridy,

You are welcome.

Unfortunately, I do not know of anyone in particular that I could refer you to in Sydney. FYI, I am in the US.

Your case is complicated because the dentist has attempted to provide you with nothing shy of heroic dentistry considering that those upper front teeth were removed 20 years ago. This type of heroic dental surgery frequently comes with its own set of complications, but each case is unique in of itself.

Is your dentist a general dentist?

Did she inform you of the risks and accelerated failure rate associated with this specific type of dentistry?

Whoever you end up consulting with about your case will be careful not to say or do anything that could be interpreted negatively against their peer who performed the surgery. So it would behoove you to give them the impression you are very concerned about the STABILITY and LONGEVITY of this dental work and would like their opinion if it would be a better option to rethink this treatment plan. On the other side of the coin ... if you give them the impression that you are completely set on having dental implants and that you want to keep the lateral implants and move forward with central implants no matter what ... they will likely not offer you much information and just tell you to go back to her.

Hi Fridy

Welcome to NeuroTalk.

You might like to check out Healthshare (Healthshare | Empowering Australians to make better health choices).

Healthshare is intended for Australian residents - anybody can, for free, ask a question there and its Health Professional members will try to answer it.

You can also search Healthshare for dentists in Sydney who may be able to help you.

Fridy,

You may be able to get some help from the Healthshare site that Kiwi offered. To make it easier to navigate, I am giving you the actual link to the dental question section.

What is the success rate of dental implants?
| Healthshare

In my opinion it would behoove you to be very careful about who you consult regarding your dental case because your situation does NOT in any way, shape or form fall into the uncomplicated dental implant category where the success rate is 80-90%. Your situation being that the teeth needing replacement were extracted 20 years ago presents a HUGE complication all in of itself. It is important to be cautious or guarded with any dentist who tries to sell you on a high success rate regarding the placement of dental implants in that area of your mouth.

I did not skim through the whole dental question section just the first page. Based on what I read there, the two dentists on that page that I think "may" offer you some straightforward information are:

Dr Keith Hengpoonthana

Dr Jeremy Rourke

Please keep us posted on how things are going.