Category: Feedback from Periodontist

My final treatment plan

On Wednesday 16th of November I finally received my final treatment plan. My orthodontist and implant surgeon finally made up their mind and came up with the final treatment plan. The implant surgeon sent me an email and a few minutes later my orthodontist called me to explain what will happen.

The main reason why they started discussing my treatment again is because I have sent them an email asking how the bottom braces will interact with the implant. My orthodontist convinced me to start wearing braces both top & bottom to get the best result.

January things will finally start

So they have decided to move on with the treatment as follows:

January 18th:

  • Extraction of front tooth 21 at implant surgeon office.
  • Installation of the implant (without temporary tooth) and install some bio material to fill some missing bone.
  • Installation of a healing abutment.
  • I will have to take the extracted tooth with me. The rest of the day I will have a gap at location 21.

January 19th:

  • Appointment at orthodontist.
  • My extracted tooth will be used as pontic. This means, the tooth will be attached to a bracket on my top-row archwire. This way the gap will be hidden.
  • Installation of brackets and wire on top row (with the pontic). I will need the top braces for minimum 6 months.
  • Installation of brackets and wire on bottom row. I will need the bottom braces for minimum 9 months.

After this procedure I will have to:

  • Get used to the braces 🙁 (Oh my!)
  • Wait for the implant abutment to heal (takes about 6 months)
  • Optional: This step depends on the healing process. Checkup the tissues around the implant and gum correction (takes about 2 months)
  • Checkup healing of implant. Then wait another 2 weeks minimum / 3 months maximum
  • Installation of definitive porcelain crown.

Everything will be fine!

Summarised this means I will end up in full metal braces. So I will get braces installed on top and bottom teeth. My worst nightmare will come through. I have decided not to think too much anymore and to move on with the treatment.

Yesterday, I visited my general dentist (30 minutes appointment) to get my yearly checkup and as expected she was happy to see my gum and teeth are in good shape. She wished me good luck with the implant and braces and reassured me everything will be fine! Wish me luck!

by bracesat44

This week will be the week?

It’s been a while!

It has been little bit silent again. Most of the time I have been waiting and waiting and waiting. I don’t have all answers yet. Don’t know if I have to start the braces treatment. Or do I have to start with the implant immediately? This week might be the week to get the final treatment plan!

First the implant surgeon didn’t send my medical record to my dentist. So I had to ask her over and over again to share it with my dentist (and orthodontist). We have been waiting for this report since my in-take appointment in July. Delays, delays, delays 🙁

I have been sending emails and made some phone-calls… Now finally end of September we received the report. The report states that:

  • My front tooth needs to be extracted to get rid of the root infection.
  • Orthodontic extrusion is not needed. We can skip that.
  • Orthodontic treatment is still possible but can be done independent from the implant placement.

Now what does the orthodontist say?

So I tried to contact the orthodontist… Again: It took weeks to get a response. Looks like there was a misunderstanding. After receiving the Implant report my orthodontist thought that a braces treatment was not necessary anymore. This is strange because she suggested to get braces installed to make room for the implant? Remember?

I managed to have a call with the orthodontist last week. I asked her what to do: Do I need to start a braces treatment or not? Is there any reason to skip the braces and move on with the implant? She told me she will contact the implant surgeon and see what to do. On Thursday 27th of October (This week!) I have an appointment with the orthodontist to see how we can move on. Let’s see what this week will bring!

by bracesat44

It’s definitive: My tooth is lost :(

Last Tuesday (July 5th) I visited a new periodontist office. My last visit in May at another periodontist office ended-up with double feelings. She suggested to get a second periodontist appointment with focus on implants… I was able to schedule that appointment pretty quickly. That appointment happened last Tuesday.

Arriving quiet on time I ended up in the dentist chair. An assistant told me she would take some X-rays first. (I even didn’t see the perio yet!). Immediately I felt very nervous and didn’t want to get X-rays again. So I started explaining her that I already had many X-rays taken in the last few months. I asked her if she was able to see those pictures in my medical file, but for some reason she couldn’t fine any usable picture except from the pictures taken at my very first dentist appointment.

I was not able to convince her. She told me that they needed other pictures that are compatible with their medical systems. In my opinion this gave me a very strange an uncomfortable impression. So I had to get out of the chair and follow her. Again X-rays like those I had before at my first ortho appoitment. But I really had to go through with it. After taking the X-Ray the assistant invited me to get back to the chair. Then she took another kind of photo-machine and explained me she would take +7000 pictures (!) with a special device (some kind of toothbrush). Thank God this was not an X-ray device. It took 10 minutes to take the pictures ending up with a 3D rotating model of my teeth. Pretty cool! I think this was the only type of pictures I never experiences before! 😉

Then the assistant disappeared… and I had to wait for 20 long minutes! Again waiting, waiting, waiting. Remember? Finally the periodontist arrived and started examining my mouth. (Like my previous first perio appointment). She told me my gum, bone and teeth were pretty stabilized. I was happy to hear that. But then she added: “But I’m afraid the pocket around your tooth 21 is way too deep, the tooth is lost :(“

This moment was the first moment that I really felt I have to give up my tooth. She explained me what to expect from an implant. I even was able to explain her that I’m interested in some kind of extrusion procedure (As described here). I also explained about my crooked teeth and that I’m seriously considering getting braces IF I can combine it with a fake tooth and the extrusion procedure. After discussing the eventual procedure she told me she will get back with a pricing estimate.

In the meantime I received the estimate. Also the plan was included:

  • The implant procedure will cost me 1780€ (!). Extracting the tooth / putting the implant in place / temporary crown / some biological bone placement.
  • Also there might be some extra gum procedures needed depending on how easy my gum will heal. (+370€ optional).
  • Also finale check. (+80€).
  • The final crown should delivered & placed by my dentist. Don’t have price of the final crown yet. So it looks like this is going to be an expensive adventure 🙁

I have sent back an email asking about “where the braces treatment comes in” and who to contact now? The dentist? The periodontist? The orthodontist… Many questions for sure! So waiting for the response now. I think this story can go 2 ways:

  • Ortho / Perio / Dentist agree on the extrusion procedure with braces. This way I will benefit from fixing some crooked teeth, extrude tooth 21.
  • Ortho / Perio / Dentist don’t agree on the extrusion procedure with braces. Then I don’t think it will be worth to start a braces treatment. I that case my tooth will be extracted manually starting the implant procedure immediately.

Waiting for the email response and get some feedback from dentist. But one thing I know for sure: I have to give up my tooth and look into the implant procedure.

by bracesat44

Use braces to extrude my tooth?

Today I have returned from my periodontist appointment. The appointment started exactly at the schedule hour. First he checked all the pockets on each and every tooth. Then he checked my gum and stability of my teeth. Most of my teeth are acceptable (pockets varying from 2mm to 3 mm. Some are 4mm), except from the pocket around my front tooth 🙁 It didn’t workout as expected. After 3 months it looks like I’m still nowhere. I came to the conclusion I better give up my front tooth definitely. So what are the next steps? What are my options? What did I learn today? An important question came forward: Use braces to extrude my tooth?

Option 1: Try to save the tooth by adding bone graft material to the vertical pocket, next to my front tooth. A 2h procedure. The periodontist will have to do some “magic” with my red and white blood cells to create some kind of bone graft that can be put in place. Because the periodontist is pretty busy, this can only happen end of October! 🙁 The final outcome of the procedure is still not 100%. So even after this procedure I might still loose my front tooth after waiting for another 6 months. Having to restart over again and moving to option 2.

Option 2: I learned about this option “by accident”. While finishing my appointment, the orthodontist did hear about my bone graft conversation and the next steps as described in option 1. She told me there is a possibility to use braces to “generate” some bone. I have found some information about this procedure here! The bracket can be used to pull my front tooth down slowly. While moving downward some bone will be generated. This might be sufficient to put an implant in place.

Option 2 as suggested by the orthodontist today. Bone grafting while wearing braces!

To be honest, I started thinking about option 2 while driving home. Option 1 is not 100% sure it will work. My general practitioner (doctor) will have to be involved (to take blood). The periodontist will have to cut in my gum. I will have to wait for X months again AND it will cost +600€ again… Even when the procedure is successful my front tooth might give up one day (in 5, 10 or 20 years) ending up with a gap in my front row,… Getting an implant at 60 years old, won’t be so easy.

Option 2 might short-cut time (yes time is ticking and I want to move forward) & will fix the dead tooth, and the issues with my crooked tooth. Also it will start to bring some stability in this whole story. Way to many uncertainties and I hate it.

Today I was hoping for the perio to tell me he was able to save my front tooth. Not needing implant, not needing braces. But it looks like I’m going to give up on this idea, move forward. Get the braces and fix the tooth with the implant!

What I will do next? I will call the ortho-office tomorrow and ask if we can skip Option 1 and just move on with Option 2. That means I’ll have to find some guts to explain I decided to go for the braces and implant 🙁 Will keep you posted!

by bracesat44