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.

Thank you Kiwi33 and Bryanna.

I emailed my dentist overseas and said to give it
3 months and let the gums heal and grow. Asked me
Not to worry because everything is under control. I sent them pictures of hollow gums and ( central ) and the implant on lateral can be seem through the hole. But said it's still okay and that the gums are healing okay.

I guess i just have to wait 3 months until i see some
Progress?

I am a bit unstable now, not sure how abouty next steps. The only reason i decided to do implant overseas is because it is cheaper. But
With all the return flights and all my holidays used up, it is really the
Biggest mistake in my life. I was supposed to have 4 implants on my front teeth but instead, i had 2 lateral and a big hole at central. I am rethinking my treatment options but my moves are limited because my resources are so limited ( money, time, information ). I am relieved that i came across
This avenue where i can share my dilemma.

Bryanna, i will provide more information from
The questions you put through soon i am still thinking how to answer properly

thanks guys.

Hi Fridy,

I really don't mean to alarm you or cause you any further stress. I know this has been a huge undertaking for you, but your concerns about what is happening are very warranted. I sincerely doubt that you will get much positive healing and in fact the gum tissue may continue to recede as the inflammation decreases.

The jaw bone has receded greatly over the 20 year stretch since those teeth were removed. The amount of gum tissue shrinks to accommodate the recession of bone leaving the remaining gum tissue frail and thin. It is not a surprise that the lateral implant is visible because there is not enough bone or gum tissue to cover the implant. Dental implants require adequate healthy bone and gum tissue to successfully integrate. Otherwise, the implant is basically just sitting in soft tissue and it will eventually become infected and/or fall out on it's own. If that implant was embedded in jaw bone and there was ample gum tissue to cover the bone, as there needs to be, it would not be visible at all. This situation is not going to change for the better because the bone nor the gum tissue have any natural means for substantial growth.

I understand why you sought the care that you did. However, your dentist should have informed you of the huge risks you were taking and the likelihood of these surgeries not being successful. Did she inform you of those things prior to the onset of any of this dental work?

Here is what often happens in cases like yours. The dentist convinces the patient to continue waiting and to continue doing surgeries to "correct" the "in-correctable" anatomical defects. As the time go on with one failure after another, the patient either gets fed up and/or the dentist at some point informs the patient that "their body rejected the surgeries and implants". They make it seem like they did everything they could to make this work, but YOUR body rejected all of the efforts. Unfortunately, the end result will be difficult to restore dentally, even with a partial denture or a permanent bridge, due to the numerous surgeries over a long period of time.

Usually this back and forth dentistry goes on for several months or even years before the patient or the dentist concedes that it has to stop. At that point, most dentists will not feel obligated to reimburse the patient any of the money they spent on this arduous and expensive dental venture because they believe the patient was in compliance with all of the treatment. The dentist is then most likely able to convince the patient that the reason for the "failure" had nothing to do with the dental work that was provided.

In my opinion, it would be wise and well worth your time and money to consult with a different dentist. One who is forthright with the factual information as I have provided for you here pertaining to the reasons why dental implants are not likely to be successful in your case.

I'm so sorry you are going through this. I hope you will find my information to be helpful to you in one way or another.

Hi Bryanna,

Thank you so much for the advice.

I will aim at visiting other dentist soon to check out my case.

During my initial consultation overseas, i had a bridge then, and i thougjt i wanted my teeth to look more natural. They knew that the teeth have been
Missing 20 yrs, but then they told me that they had a lot of cases like me before and that success rate is really high. They told me that if we started the procedure ( this wAs in november 2014) they'll put through the 4 implants and come back 3 to 6 months for the abutment/ crown. Hearing that it
Was that simple, i immediately made the deal and went on surgery the next day. They put 2 implants on lateral and graft all over. I then came back after 6 months (2nd visit) but they've only fixed the positioon of thr two lateral because i have complaints because they were visible (purplish) and i seemed to feel them under my nose and then they said they put more bonegraft on central. After about 8 months (3rd visit), i came back again hoping they'll finalise it but
Said they put membrane and more bonegraft on central. Then last Ocober was my 4th visit, they tried to screw in two implants on central, after one week, they tighten the screw said it wasnt too stable, then another week said the bones are too soft. They took off the implants and made a crown with heaps of gums because i had to go back home. Said the gums would heal. On the day of my flight, i checked out the gums and saw that massive hole seems to be where the 2 implants were taken off i came back on that day to the dentist but was advised that it will heal and that it was normal, i should let the healing process take its course.

Now whenever i see my gums i feel devastated
I honestly dont know it they can fix it but i felt i had to choice but to stick with them.

Hi Fridy,

Thank you for the detailed explanation. I have many, many years in oral surgery as a chair-side assistant and I can easily visualize what you are telling me. I have seen and partaken in this type of "heroic" and invasive surgery countless times and many times the patient was given the impression, by the dentist, that this was a routine oral surgery and that the success rate was high. To be very honest with you, it is not routine surgery in the least and the success rate of implant integration is very unlikely.

I think at this point you can see, given how many times you have had top undergo surgery in the last 2 years, that this is not routine surgery. I also think you can see that the FAILURE rate of integration of the implants is highly likely given that the lateral implants are visible indicating that they are not embedded in your jaw bone. They are actually held in by very little bone and mostly soft tissue. You should not be able to feel them underneath your nose. That sensation also indicates they are not embedded in bone, but rather in soft tissue.

They keep putting more bone graft on top of the receded bony ridge and keep trying to fill in the areas of hollow bone that they have created with each surgery. No amount of graft material is going to be stable enough to hold implants. As I mentioned earlier, the graft material is only a catalyst, it cannot take the place of your own jaw bone. A catalyst in this situation is a substance that increases the rate of a chemical reaction which is meant to stimulate the growth of new bone. However, the graft (catalyst) needs to be packed INTO healthy, subtantial bone in order for it to stimulate your cells to grow new bone. Placing the graft (catalyst) on top of receded bone does not stimulate your cells to grow new bone. Therefore, the graft will eventually recede, be absorbed by the body, or just lay there and never solidify enough to hold a dental implant. Dental implants that are not held in by the jaw bone will become infected and/or fall out on their own.

Also, something to consider with all of this invasive dental work is the toll that it's taking on your overall health. With each surgery, with each bone graft you run a high risk of developing a systemic (physical) infection. Not just in the immediate area of the surgery, but elsewhere in your body as the bacteria is traveling throughout your bloodstream. If they have not informed you of this type of infection, then I feel they may not be taking your overall health into consideration as they continue to put you through this horrendous ordeal.

You do have a choice. You can see how this is not going at all as they told you it would. Unfortunately, continuing on this path with them is not going to result in a positive outcome. It would be best to get a completely different oral surgeon to evaluate your case before this escalates any further. The dental treatment to remedy this will also be complicated. However, the sooner you address this, the better the outcome will be. You may also be able to recapture the money you spent on this work if you don't wait too long to seek other help to remedy it.

Again, I know you are in a terrible situation. I cannot stress enough how much you need to trust your instinct on this and move forward with seeking help from a completely different dental practice and oral surgeon.