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Periodontics/2nd time around Dental Implant


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 not being told in advance, 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.  Supposedly, according to my treatment plan, I need a J 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 ?  I am so upset that I had to go to the ER for anxiety.

Alexis, I understand your concern.  I think before you proceed with any additional treatment you align yourself with doctors who don't scare you.  It also seems like you don't really understand the benefits and risks of all the treatment being proposed.  Honestly, I am not sure that a bridge in this case isn't the best treatment plan.  It sounds like you are dealing with doctors who have very strong personalities, and of course for $15,000 there is a conflict of interest, of course they want to do the treatment.  There may be some wisdom in getting another opinion from a doctor who doesn't know the first 2 so you can get an unbiased clear opinion as to how to proceed.

I think you need a 3rd opinion, it might be worth traveling out of town to get one.

Good Luck
Dr. Siegelman


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Bryan M. Siegelman, DDS


I can answer any question relating to the diagnosis and treatment of periodontal disease. I can also answer questions relating to the placement and restoration of dental implants.


I have been practicing Perioodontics for the past 20 years. I limit my practice to periodontics and implant dentistry. I am a diplomate of the American Academy of Periodontology. I am in private practice in Pennsylvania and am on staff at the local hospital in my home town. My practice website is

American Academy of Periodontology, Academy of Osseointegration, American Dental Association, American College of Dentists, Pennsylvania Dental Association

I have a BS from Muhlenberg College, I did a general practice residency at St. Joeseph's Hospital and Medical Center in Paterson, NJ. I received my DDS degree and specialty certificate from the University of Maryland Dental School.

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