[lelo]

Hi Bryanna ~ ( & anyone with advice )

I have been lurking for a bit.. you have great advice !! I am a newbie ready for advice. I will give you my dental background :

I am 38 yr old female. Advanced periodental disease. Smoker my entire life. ( quit 3 months ago ). Very good health otherwise.
Family history of periodental disease : Mom - teeth out at 38 -dentures
Aunt - most teeth out at 45 - dentures
Grandpa - teeth out at 42 - dentures
Very infrequent trips to dentist.

I have recently been told I need full mouth extraction. 2/3 to 3/4 of bone loss. Not much for shrinkage to gums. My teeth are not that decayed... just have lost so much bone they tell me it won't hold teeth forever. No pain or bleeding even.

I want full dental implants.

Here is what my periodontist and dentist have suggested -

first step: fabrication of immediate detures ( for when they remove all my teeth )
second step: full dental extraction, bone graft EVERY tooth socket and sinus augmentation.
third step 4 months later implant 8 lower and 8 upper endosteal implants.
forth step 3 months later attach fixed dental bridgework

The only concern he has is because of loss of bone in upper jawbone, the length of final upper restoration may appear as though the teeth are longer than normal. He says there may be other restorative options if this is a concern to me.

Well, the final quote was $ 98,000.

YES, I am concerned that after $98,000 the upper teeth look longer than normal !! I am hoping for your thoughts on this?? Have you heard of this.. and why wouldn't he quote me this "OTHER" option to begin with?? After all... $ 98,000 should be the CADILLAC of restorative treatment..?? YIKES...

I am also hoping you can give me an idea of HOW MANY full mouth dental implants surgeries performed would be considered an EXPERIENCED level??

Considering I am willing on spending $ 98,000 and need FULL MOUTH.. I want to find the most experienced dentist in this arena possible. ( AS WELL AS ONE WHO IS CONCERNED WITH THE BEST LOOK AT COMPLETION )

Any questions you think I should address with him or any other dentists I am considering ?? I want to speak with a few dentists...

Any suggestions would so be appreciated ~

[Bryanna]

Hi lelo,
Welcome to neurotalk!!

To make things easier to read, I'll put your statements in <<< >>> and I'll follow in caps with my reply.

<<<<I have recently been told I need full mouth extraction. 2/3 to 3/4 of bone loss. Not much for shrinkage to gums. My teeth are not that decayed... just have lost so much bone they tell me it won't hold teeth forever. No pain or bleeding even.>>>>

YOU HAVE WHAT IS CLASSIFIED AS SEVERE BONE LOSS AND MOST LIKELY SOME OR MANY OF YOUR TEETH ARE BASICALLY HELD IN BY A LITTLE BONE AT THE END OF THE ROOTS AND MOSTLY GUM TISSUE. THE DEEP POCKETS WITH LITTLE GUM SHRINKAGE MEANS THERE IS ALOT OF BACTERIA LIVING UNDER THE GUMLINE. IT IS NOT UNCOMMON FOR THIS TYPE OF PERIODONTAL DISEASE TO BE BASICALLY SILENT IN THAT THERE IS LITTLE TO NO BLEEDING OR PAIN. BUT YOU SHOULD KNOW THAT THE DISEASE IS VERY ADVANCED WHICH I WILL EXPLAIN LATER HOW THIS PLAYS A ROLE IN THE LENGTH OF YOUR DENTURE AND IMPLANT BRIDGE TEETH.

<<<<I want full dental implants.>>>>

OK. HOPEFULLY YOUR DENTIST(S) HAVE REVIEWED YOUR HEALTH HISTORY EXTENSIVELY AND YOU ARE A GOOD CANDIDATE FOR IMPLANTS. I MENTION THIS BECAUSE NOT ALL DENTISTS REVIEW THE HISTORY AS WELL AS THEY SHOULD.

<<<<Here is what my periodontist and dentist have suggested -

first step: fabrication of immediate detures ( for when they remove all my teeth )>>>> OK, THIS IS GOOD.

second step: full dental extraction, bone graft EVERY tooth socket and sinus augmentation.>>>> AGAIN, IF THIS MUCH BONE GRAFTING NEEDS TO BE DONE, IT INDICATES THAT THE PERIODONTAL DISEASE HAS DETERIORATED MOST OF THE BONY RIDGE AND THERE IS NOT MUCH LENGTH OR WIDTH REMAINING OF YOUR OWN NATURAL BONE. THE GRAFTING IS DONE TO TRY AND REGAIN/REGROW SOME OF THE MISSING BONE SO THE IMPLANTS HAVE SOMETHING TO INTEGRATE INTO. DEPENDING ON HOW MUCH INFECTION IS PRESENT DURING THE EXTRACTIONS, THEY MAY OR MAY NOT BE ABLE TO PLACE THE BONE GRAFT MATERIAL AT THAT TIME. WHICH WOULD MEAN THAT THEY WOULD DO THE EXTRACTIONS, LET THAT HEAL FOR A FEW WEEKS AND THEN GO BACK IN AND DO THE BONE GRAFTING. BONE GRAFTS NEED TO BE PLACED IN HEALTHY BONE OR THEY WILL BECOME INFECTED AND FAIL. DID THEY DISCUSS THAT POSSIBLE ISSUE WITH YOU?

SINUS AUGMENTATION FOR THE PLACEMENT OF DENTAL IMPLANTS ..... THIS IS USUALLY DONE WHEN THE SINUS MEMBRANES HAVE DROOPED DOWN AND FILLED THE GAPS WHERE TEETH USE TO BE. DEPENDING ON THE HEALTH OF THE BONE IN THESE AREAS, SOMETIMES BONE GRAFTS CAN BE PLACED AT THE SAME TIME. BUT AGAIN, THE BONE NEEDS TO BE HEALTHY ENOUGH TO RECEIVE THE BONE GRAFT OR IT WILL BE REJECTED.

<<<<third step 4 months later implant 8 lower and 8 upper endosteal implants>>>>> I KNOW ALOT OF DENTISTS WHO RUSH TO PLACE THE IMPLANTS AND MOST OF THE TIME IT'S NOT WORTH IT. ESPECIALLY IN CASES WHERE THERE IS ALOT OF DISEASE AND BONE LOSS PRESENT AT THE TIME OF THE INITIAL SURGERY. IT IS BEST IMO TO WAIT AT LEAST 6 MONTHS POST OP EXTRACTIONS AND BONE GRAFTING BEFORE PLACING IMPLANTS. THE LONGER THE AREAS ARE ALLOWED TO HEAL, THE MORE SUCCESSFUL THE INTEGRATION OF THE DENTAL IMPLANTS WILL BE. COMMON SENSE..... WHY RUSH THE PROCESS AND RISK FAILURE?

<<<<forth step 3 months later attach fixed dental bridgework>>>>
AGAIN, 3 MONTHS IS GENERALLY NOT LONG ENOUGH FOR THE DENTAL IMPLANTS TO PROPERLY INTEGRATE WITH THE JAWBONE, ESPECIALLY IN EXTENSIVE CASES SUCH AS YOURS. TO WAIT 6 MONTHS POST OP OF THE PLACEMENT OF THE IMPLANTS BEFORE DOING ANY RESTORATIVE TREATMENT IS BEST, IMO. IT ALLOWS TIME FOR THE IMPLANTS TO INTEGRATE SOLIDLY ENOUGH TO HOLD THE PROSTHESIS AND IF FAILURE SHOULD OCCUR, IT GENERALLY OCCURS IN THE FIRST 6 MONTHS POST OP IMPLANT PLACEMENT.

<<<<The only concern he has is because of loss of bone in upper jawbone, the length of final upper restoration may appear as though the teeth are longer than normal. He says there may be other restorative options if this is a concern to me.>>>>
OK, THIS IS WHERE THE LOSS OF BONE AND LACK OF GUM SHRINKAGE THAT I MENTIONED EARLIER COMES INTO PLAY. ONCE THE TEETH AND EXTRA GUM TISSUE (DEEP POCKETS) ARE REMOVED THERE IS NOT GOING TO BE MUCH NATURAL BONE LEVEL LEFT. THE BONE GRAFTING CAN ONLY REPLACE ABOUT 30-50% OF THE ORIGINAL BONE. THEREFORE, THE BONY RIDGE WILL NEVER BE AS WIDE, THICK OR SHAPED LIKE NATURAL BONE. IT WILL HAVE A FLAT SHAPE TO IT INSTEAD OF RAISED. THIS MEANS THAT THE TEETH WILL BE LONGER THAN NORMAL TO ACCOMODATE THE SPACE THAT SHOULD BE BONE. IF THE TEETH WERE NOT MADE LONGER, YOUR BITE WOULD BE NONEXISTENT.

<<<<Well, the final quote was $ 98,000.>>>> WOWZA!!!

<<<<YES, I am concerned that after $98,000 the upper teeth look longer than normal !! I am hoping for your thoughts on this?? Have you heard of this.. and why wouldn't he quote me this "OTHER" option to begin with?? After all... $ 98,000 should be the CADILLAC of restorative treatment..?? YIKES...>>>
HIS TREATMENT PROPOSAL IS THE CADILLAC OF RESTORATIVE TREATMENT! HE HAS NO CONTROL OVER THE LENGTH OF THE TEETH PERSAY BECAUSE HE HAS TO MAKE THEM ACCORDING TO YOUR SKELETAL STRUCTURE WHICH INCLUDES THE DETERIORATION OF YOUR JAWBONE, YOUR TMJ, FACIAL MUSCLES, ETC, ETC. IF THE TEETH ARE TOO SHORT, YOUR BITE OR OCCLUSION WILL BE VERY OFF AND THIS WILL CAUSE A COLLAPSE IN YOUR SKELETAL STRUCTURES. THIS COLLAPSE LEADS TO ALOT OF PROBLEMS WITH CHEWING AND EVENTUALLY LEADS TO IMPLANT FAILURE FROM THE UNNATURAL FORCES WHEN CHEWING ON TEETH THAT DO NOT FIT INTO YOUR NATURAL OCCLUSAL PATTERN.


<<<<I am also hoping you can give me an idea of HOW MANY full mouth dental implants surgeries performed would be considered an EXPERIENCED level??>>>> MANY!! FULL MOUTH RECONSTRUCTION SHOULD NEVER BE DONE BY AN AMATEUR. I KNOW THEY HAVE TO LEARN ON SOMEBODY, BUT I CAN TELL YOU IT WOULDN'T BE ME!! DUE TO THE COMPLEXITY OF THIS TREATMENT, MOST OF THE TIME THE TREATMENT PLAN DOES NOT GO AS EXACTLY PLANNED DUE TO SOME UNFORESEEN CIRCUMSTANCES. THE DENTIST NEEDS TO BE EXPERIENCED ENOUGH TO BE ABLE TO DEAL SUCCESSFULLY WITH WHATEVER CIRCUMSTANCE SHOULD ARISE. THE ONLY WAY HE KNOWS HOW TO DO THAT IS ....... FROM EXPERIENCE.

<<<<Considering I am willing on spending $ 98,000 and need FULL MOUTH.. I want to find the most experienced dentist in this arena possible. ( AS WELL AS ONE WHO IS CONCERNED WITH THE BEST LOOK AT COMPLETION )>>>
I AGREE 100%!

<<<<Any questions you think I should address with him or any other dentists I am considering ?? I want to speak with a few dentists...>>>>
ASK..... HOW MANY OF THESE CASES HAVE YOU DONE AND WHAT IS THE SUCCESS RATE? HAS HE HAD TO ALTER THE TREATMENT PLAN IN MANY OF THESE CASES AND IF SO, WHY? CAN YOU SPEAK TO ANY OF THESE PATIENTS? CAN YOU SEE PHOTOS OF BEFORE AND AFTER OF PATIENTS WHO HAVE UNDERGONE SIMILAR TREATMENT? HOW READILY AVAILABLE IS THE DENTIST IF YOU SHOULD HAVE A POST OPERATIVE COMPLICATION ON A WEEKEND? WILL YOU SEE HIM OR A COLLEAGUE? DOES THE DENTIST HAVE A PROBLEM IF YOU CHOOSE TO WAIT 6 MONTHS BEFORE PLACING IMPLANTS AND THEN ANOTHER 6 MONTHS BEFORE DOING THE PERMANENT BRIDGEWORK? IF SO, WHY RUSH THE CASE?

ALSO...... MAKE SURE YOU HAVE A VERY CLEAR UNDERSTANDING OF WHAT THE FEES WILL BE AND WHAT THE PAYMENT ARRANGEMENTS ARE BEFORE YOU START THE TREATMENT.

Lelo, I hope this helps with your concerns. Please keep in touch with us throughout this process....... there is alot to be learned from it for many people!

Bryanna ~'.'~

[lelo]

Hi Bryanna,

Thank you for your advice !

I have just returned from my consultation with the periodontist who would like to perform the dental implants. I was armed with MANY questions.

His reasoning for only waiting 4 months after removal of all of my teeth to implant surgery is : I have so much bone loss that he is afraid of going too long after removal to implants. I know that once you remove all of your teeth, your bone shrinks because your body sees no use for the bone without teeth. He stated he doesn't want the bone to shrink to the point that the implants wont "take". Seems to make sense I guess. We have planned another meeting in 3 weeks with my regular dentist to be there as well. I would like to press this issue further as I am concerned with 4 months. Thoughts??

After the implants are in.. I agree with waiting longer than 3 months for the bridgework restoration. At this point I will have the implants in to help reduce the bone loss.. so why not wait !! He was "open" to longer wait time on this.

His experience with full mouth : This is a MAJOR concern for me. His office has been doing implants for close to 20 years. Himself I believe 10 years, and his partner 20 years. He has personally done many "all top" or "all bottom". He has never done an entire mouth at once. RED FLAG for me !!!!!!!!! His answer to this is that he never finds people have the $$$$ to do this full treatment. Yes, it is expensive. However, no one else has ever been in my shoes ??? I am VERY worried about this. I do live in a large city in the midwest. These are seasoned and well recommended periodontist and dentists. I was VERY surprised to hear they have never dealt with FULL MOUTH dental implants.
My worry is now to find someone that has. I plan to make the rounds in my city to see who has.
Should I be calling periodontists?? Prostidontists?? I don't trust in trying cosmetic dentists?? What do you recommend? I would be willing to do out of state for $100,000 worth of work... But would feel so much better having them close in case of problems.

Any suggestions would be appreciated ~

Lelo

[Bryanna]

Hi lelo,

I am so glad that you are not hesitant to ask your dentist questions..... so many people shy away from doing that and it is so important to take part in your care..... at least in my opinion it is.

One of the concerns that I would have is the mere 4 month post op between extractions and the placement of the dental implants. It sounds like the dentist has treatment planned quite a bit of oral surgery to be done at the time of the extractions. Which is understandable considering the severe periodontal disease that has caused deep pocketing (extra gum tissue) and moderate bone loss. Keeping all of that in mind...... the surgical sites will need time to heal from the extractions, the sinus lifts, and the bone grafts. Yes, there is bone loss after all extractions. However, the placement of the bone graft material is meant to alleviate some of that bone loss and if it's disturbed too early or placed in unhealthy bone, it will fail. If dental implants are placed too soon into the new graft material, they will not hold. Under less extensive circumstances, bone graft material generally takes 4-6 months to integrate with the jawbone. Even at that stage of healing, the bone is not completely solid but in healthy bone it will continue to solidify around a dental implant for another several months or longer. What type of grafting material does the dentist plan on using? Did you discuss the possibility of not being able to place the grafts at the time of the extractions if there is infection from the periodontal disease? Is he placing temporary implants first?

I'm going to copy and reply to this statement you made....
<<<He has personally done many "all top" or "all bottom". He has never done an entire mouth at once. RED FLAG for me !!!!!!!!! His answer to this is that he never finds people have the $$$$ to do this full treatment. Yes, it is expensive. However, no one else has ever been in my shoes ??? I am VERY worried about this. I do live in a large city in the midwest. These are seasoned and well recommended periodontist and dentists. I was VERY surprised to hear they have never dealt with FULL MOUTH dental implants.>>>
THIS LACK OF EXPERIENCE DOING THE WHOLE MOUTH SHOULD BE A RED FLAG TO YOU. DOES IT MEAN HE IS NOT CAPABLE OF DOING IT? NO...... BUT WILL HE BE ABLE TO HANDLE AN UNEXPECTED TWIST IN THE TREATMENT PLAN IF ONE SHOULD ARISE? MAYBE. WILL HIS PARTNER STEP IN AND WORK WITH HIM IF NEED BE? THE OUTCOME OF YOUR CASE NOT ONLY DEPENDS ON THE SKILL OF THE DENTIST.... IT ALSO INCLUDES.... HIS TOLERANCE AND WILLINGNESS TO MAKE CHANGES..... HIS LEVEL OF PERFECTION, WHAT IS ACCEPTABLE OR NOT ACCEPTABLE TO HIM.......... AND THE QUALITY OF THE MATERIALS AND CRAFTMANSHIP OF THE DENTAL LAB THAT WILL BE FABRICATING YOUR CASE. I WOULD ASK TO SEE PICTURES OF HIS WORK. ALSO ASK WHY HE USES THE LAB THAT HE DOES OVER OTHERS IN YOUR AREA AND ASK IF THEY ARE LESS EXPENSIVE THAN OTHERS IN THE AREA. IF HE SAYS THEY ARE CHEAPER, THEN THAT WOULD TELL ME HE SETTLES FOR LESSER QUALITY THAN YOU MAY BE INTERESTED IN.

He probably has never been able to sell this magnitude of a treatment plan before. Not that some of his patients wouldn't benefit from it but you are his first! He is jumping in his boots over this treatment plan....believe me!! The main thing is that he being able to deliver the quality of care all the way around because this is not something you want to do more than once.

Let me know your thoughts on all this...... we'll talk more.

Bryanna

Originally Posted by lelo

Hi Bryanna,

Thank you for your advice !

I have just returned from my consultation with the periodontist who would like to perform the dental implants. I was armed with MANY questions.

His reasoning for only waiting 4 months after removal of all of my teeth to implant surgery is : I have so much bone loss that he is afraid of going too long after removal to implants. I know that once you remove all of your teeth, your bone shrinks because your body sees no use for the bone without teeth. He stated he doesn't want the bone to shrink to the point that the implants wont "take". Seems to make sense I guess. We have planned another meeting in 3 weeks with my regular dentist to be there as well. I would like to press this issue further as I am concerned with 4 months. Thoughts??

After the implants are in.. I agree with waiting longer than 3 months for the bridgework restoration. At this point I will have the implants in to help reduce the bone loss.. so why not wait !! He was "open" to longer wait time on this.

His experience with full mouth : This is a MAJOR concern for me. His office has been doing implants for close to 20 years. Himself I believe 10 years, and his partner 20 years. He has personally done many "all top" or "all bottom". He has never done an entire mouth at once. RED FLAG for me !!!!!!!!! His answer to this is that he never finds people have the $$$$ to do this full treatment. Yes, it is expensive. However, no one else has ever been in my shoes ??? I am VERY worried about this. I do live in a large city in the midwest. These are seasoned and well recommended periodontist and dentists. I was VERY surprised to hear they have never dealt with FULL MOUTH dental implants.
My worry is now to find someone that has. I plan to make the rounds in my city to see who has.
Should I be calling periodontists?? Prostidontists?? I don't trust in trying cosmetic dentists?? What do you recommend? I would be willing to do out of state for $100,000 worth of work... But would feel so much better having them close in case of problems.

Any suggestions would be appreciated ~

Lelo