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Oral Surgery/Corrective Dental Implant Plan

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QUESTION: I am seeing a Periodontist to fix the mistakes the last one made.  My implant #8 was off angle, and insufficient bone graft was placed by the original surgeon. It left me with a tiny strip of gum above #8. I thought everything was going well with the new periodontist.  He was referred by an MUSC teacher, and has a good reputation.  The amount needed to fix the one tooth, crown and grafts is close to fifteen thousand dollars.

So, the new dentist removes my old implant; while his associate, another surgeon did the soft tissue graft.  He then put in a bone particulate graft, and also snipped the Nasopalitine nerve. ?? (I was a bit upset about that, but was told no harm will come to me). Everything healed.  Before I got the soft tissue graft, the dentist said he could do a bridge instead, and mentioned it twice, and on my records.  His claim is that it would bulk up better, and there would be no little triangles in between the teeth.  He said it would me a more esthetic result.  How would he know this, before the next Block Graft ?

I was, and still am shocked, at why he would try to change up our treatment plan.  Other dentists I spoke to said do the implant.  I cannot get over this.  We had this plan made in 2012, and it took me two years to come up with all that money and financing.  Is he trying to protect himself from a not so great result ?  The dentist had such a big ego that when I first went to very 1st consult, he said that he can fix me, and that only one other doctor in the state could. I cannot imagine why after all the planning , preparation, and treatment plan that he gave me, that he would start waffling like this.  Especially with this kind of money of which I have spent over a third of the 15,000.  My next step is supposed to be a J Block Graft of Puros for $5,000.

I am thoroughly intimidated by my dentist, and I know most surgeons do not want to take over where he has left off. Because I already tried to go to another reputable surgeon, and he did not want to step on the other's toes, and take his business, since they know each other.  This is a nightmare to me.  Supposedluy, according to my treatment plan, I need a Block Graft, after healing to put in the new Implant, and also do the Crown (different Dr.)  When I asked his associate why he was recommending a Bridge as a Treatment Plan, the associate said it is because the Dentist is a perfectionist.

But, as a patient, all he did was scare me.  Should I be concerned?  I am so nervous to tell him I am confused by his actions, because he will tell me to go elsewhere. I should have gone to the top cosmetic periodontist in ATlanta, GA, but it is six hours away every time, and I would have to stay at hotels.  Is there any guidance you can give me in this preposterous situation ?

ANSWER: Alexis -  I am not sure of the quality, skills or certification of the doctors who have worked on you.  First of all, I am not totally comfortable with periodontists doing these surgeries.  Sure a simple case they can handle, but a situation such as your, only a board certified oral and maxillofacial surgeon should plan and perform necessary surgery.  I don't like the obvious confusion they have created in you.  Periodontists are not trained as surgeons and have taken up implants and grafts because it is the big money maker.  So my suggestion is to have an evaluation of your situation by a board certified oral and maxillofacial surgeon.  In the Atlanta area, there are a number of board certified oral and maxillofacial surgeons.  

So try to find such a surgeon for an evaluation.  If for some reason you cannot find a board certified oral and maxillofacial surgeon, you can get back to me and tell me specifically where you live and I will find a board certified oral and maxillofacial surgeon near you.

---------- FOLLOW-UP ----------

QUESTION: I have had two consults with reputable oral surgeons. Both said that there is enough bone width for a dental implant, but not enough bone height.  Surgeon #1 said he would have done one large bone graft, rather than two bone graft treatment plan. Surgeon #2 said maybe another soft tissue graft should be done.  

The first one also said that his business partner is good friends with the very first periodontist that caused me this huge problem to begin with, and there maybe a conflict of interest. He said he does not know how to supplement bone on top of bone, unless it was an autograft, requiring another invasive procedure. And both surgeons mentioned "vascularity". Surgeon 2 will not take the case.

Question:  Can anything be done, if there is good bone width, but not bone height ?  Can a second bone graft be done to achieve the height for #8, or is my case doomed ?

Answer
Alexis - I'm not sure what can done without directly examining you.  I can't say say that something can or cannot done.  If you are not satisfied with the responses as to what can be done, the only way to arrive at an unbiased answer is to get an opinion at a major dental school.  There are a number of them in this country.  They are located at the dental schools.  Oral and maxillofacial surgeons there and in surgical residencies are exposed to many different situations.  Their exposures to many different situations allows them to arrive at plans to correct situations created by other doctors.

So, I can't say your case is doomed, but again, I have not examined you.  Contact one of these highly skilled surgeons at a dental school or surgical residency.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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