For someone with chronic periodontal disease and bone loss, would it be best to use veneers to improve the look of the teeth or go directly for implants? Obviously, having the teeth removed is permanent (though so is the progression of periodontal dz) and I can't imagine being ready to run and do that now, but I also think it's important to be practical and realistic. Veneers would cost tens of thousands, probably about the same as implants? How long do implants last vs veneers and what is the best option?
Lumineers or Implants Best with Periodontal Disease?
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Dental implants or veneers in periodontal disease
Veneers are cosmetic restorative procedure while implants are designed to replace missing teeth. Both have distinct indications. And there is periodontal disease which is a condition that requires attention, no matter what treatment option you choose. Here is a common scenario:
- Treatment of periodontal disease
- Extraction of teeth with advance periodontial disease where prognosis is very poor
- Use veneers where indicated providing tooth is stable and has good long term prognosis
- Consider implants where teeth are missing or where periodontally involved teeth are planned for extraction.
- If both veneers and implants are planned, then the veneers and final crowns are best done at the same time to achieve an aesthetic consistency.
Both are options for you
It would really all depend on your current bone levels around your teeth. If you've already had deep gum cleanings and all disease is gone then your bone can be evaluated with a CT skan by a periodontist to see even if you are a candidate for implants or not.
If not enough bone is present for implants you may want to consider the veneers as an option to improve your smile. They wont have a very long term prognosis tho if you have poor bone levels already. This is not a question easily answered over the internet without xrays etc. Please get two opinions on your treatment.
Implants and Periodontal Disease
Most importantly, you must be sure that you eradicate all active periodontal disease. Once all the infection is gone, and disease is arrested (where it doesn't get worse) you will need to have your Board Certified Periodontist evaluate how stable your periodontal status is. Lumineers can be bulky and may be more difficult for you to perform proper oral hygiene, which is the opposite of the goals of periodontal disease treatment.
Implants are definitely a great option. However, patients with periodontal disease have higher failure rates and may require bone augmentation prior to implants placement which may increase the length and cost of treatment. Longevity of both Lumineers and dental implants is directly proportional to patient's compliance and oral hygiene, as well as good overall health. Bottom line, make sure your disease activity is arrested prior to any option you choose.
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Get healthy first.
I would advise you find a dentist who has periodontal training and is very interested in Preventive Dentistry. The priority is to stop any active periodontal disease and secondly eliminate any periodontal defects, establish a good preventive program, and then after acheiving good dental health to consider Cosmetic or any major dental restorative care. Implants can get periodontal disease the same as natural teeth can so unless your periodontal disease is eliminated this would be a bad choice. As far as cosmetic result is concerned, this can be acheived with a number of restorative options. Implants would only be indicated if your teeth have reached a point where stable dental health can not be established and so much bone support has occured that it is impossible to maintain or stabilize your teeth. Also implants are not an alternative to veneers. Implants are simply root replacements and the implants would themselves still need cosmetic restoration with porcelain crowns or etc.
Veneers should only be considered if periodontal disease is stable and controlled
It could be considered "curing periodontal disease" by removing the teeth and placing implants. If implants are a plan, now or in the future, then adequate bone is needed. It is possible that the bone level NOW is ok, but won't be there later.
Depending on the situation, veneers on "long teeth" (receded gums and bone) will appear long and unesthetic ("not pretty"). Based on the overall goal, veneers may not be an option and may not last as long due to the periodontal disease.
Without seeing xrays or photos, it is hard to make a suggestion. I would speak with experienced dentists that have treated cases like yours to see what they suggest.
Long-lasting smile improvements for patients with periodontal disease
What you may not realize is that through more-recent advanced therapy, your periodontal disease may be controlled, cured, and even possibly reversed! Make sure you have the best information for treating the periodontal problem first. It may not be necessary at all for you to lose your teeth, negating the need for implants. Then you can use porcelain to restore your smile on a healthy foundation. With this plan, you will give yourself the smile of your dreams that is healthy and will last.
Thorough periodontal exam will determine which teeth are hopeless first.
Implants and veneers are not interchangeable. If a tooth is periodontally involved, and has significant bone loss, it will probably become hopeless in the near future whether it has a veneer on it or not. Periodontal disease weakens the foundation in which teeth are implanted in (bone and gums).
Veneers only cover the crowns of teeth for esthetics, they do not stabilize anything periodontally. Implants can be planned inadvance with a good periodontal/restorative team, so that you are always in a fixed (if possible) temporary, as you loose teeth in preparation for implants. Implants placed correctly with the right plan for the final outcome are successful at 95-98% in a medically healthy individual.