Expert: Joseph Zelig, DDS, D.ABP www.smileinthecity.com - 12/17/2006

Question
Hi,  I am desperate to find someone to help me.  I begun implant procedure on UL1 in August this year and was assured the gum line would look good after implantation around that tooth.  After having the implant placed into the bone I was told the next stage would be an abutment three months later. After 7 weeks I was still in pain from the implant op and could not touch my face near the nose as it hurt even to wash. My dentist wanted to go back in and take a look which I reluctantly agreed to. The dentist said he found debris at the site (as at the time of implant he had to regenerate bone to take the implant) and through the second procedure removed the membrane. After this second op I have been left with gum recession around the left eye tooth the tooth next to it and also the UR1 both front.  The pain around the implant area around my nose i.e. left side is better but now I have discomfort on the right side which was always my good side and painful sensitivity to my UR1, 2 and 3.  I never had any pain from these teeth before.  The gum line has receded due to surgery around my UR1 and UL2 and the neck of the tooth to the UR1 is exposed and sensitive causing pain.  Also gum recession on the left eye tooth UL3 which is quite severe. I am distraught as I had a very good gum line before and  is now ruined.  I have seen a gum  expert in the UK who has said that he would have to carry out a couple of gum graphs to try and help the situation but thinks he would have to put veneers on the teeth to alter the look of the gum line. I do not want my gum line altered or my perfectly good teeth to have veneers and be made to look longer I want my gums back the way they were and should be as I would never have embarked on implant surgery if I had known I was risking my gum line around the UL1 let alone my perfectly good teeth. Please can you  help I need to know who I can go to in the world to put this right for me. I have lost all faith in the implant dentist as every time he has treated me it has resulted in pain and gum disfigurement. I also need to finish the implant procedure as I have a temporary sticky ribbond bridge insitu at present which is cumbersome in my mouth.

Comments from the gum specialist below:

In regard to the gingival recession the canine can be predictably treated. The ridge below the pontic can also be bulked out. The most problematic area is the lack of papilla mesial to UL2 and UR1. It may well be possible to mask this when the ridge is bulked up combined with either crowns or veneers on the UR1 and UL2. Orthodontic extrusion is also sometimes used to help.  

Answer
Hi,
I am sorry to hear that you are having significant problems with you dental implant saga. Implants in the esthetic area can be tricky and in my opinion are the most difficult areas to work in. Unfortunately, the damage is done and now you have to work on rectifying the situation. The gum specialist that you saw seems to know what he/she is talking about. He/she had realistic expectations and the liklihood that you have to veneer the adjacent teeth is a real possibility. The first thing you need to do is find a specialist that you trust and feel comfortable with. Ask around, go meet specialists in your area, and put your trust in someone reputable. i would love to give you more technical info, but I need to SEE what you are referring to and share my thoughts with you about what you can expect after gum grafting. If you could email me a picture of your teeth, it would help me. My email address is jzelig@smileinthecity.com
I look forward to hearing from you.

Warm Regards,
Joseph Zelig, DDS