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Oral Surgery/Gum Grafting

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Question
I had a front tooth implanted over a year ago. The implant is fine and healed well. A few months later a very tiny bone fragment came through the gum very close to the gum line. It created a pin hole in the gum. Within a day the tiny hole stretched an split. At this time you could see a tiny tear and a very small part of the titanium metal. I had a gum graft but after that healed it looked worse than the original tear, then a few months later another gum graft and again it healed worse than the last gum graft, now the 3rd gum graft failed completely and now about 1/10th of an inch of the titanium implant is exposed. I am feeling very hopeless for any further grafting. I have very healthy gums and the implant is perfect, what can be done to restore the gum to cover the titanium if anything can be done now?

Answer
Stacy, this is a very challenging problem. The esthetic zone is very difficult to treat especially after many failed attempts. Every time you have surgery on that site, you will loose bone and soft tissue support. The original surgeons should have informed you of that. There are a few approaches to fix this problem.  The easiest way to to remake the crown and add pink porcelain to the area of where the gums are. This will depend on some factors to see if it would work for you. Alternatively, the crown can be removed, the area can be grafter with bone and soft tissue, and allowed to heal without the crown attached to the implant and then replace the crown after 3 to 4 months after the bone graft and soft tissue graft. You should be aware that you will need to find an experienced surgeon with past and predictable results. Surgeons that have already operated on you will not make the situation any better if they have not been able to already. Look for an experienced (board certified by the ABOMS) oral and maxillofacial surgeon.  I hope that helps.Good luck.

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon

Expertise

Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com

Experience

Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

Organizations
American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Publications
Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

Education/Credentials
S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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