Researching for the Right Dental Implant Doctor - Las Vegas, NV

So far I have had consultations with 4 dentists....

So far I have had consultations with 4 dentists. The one I am currently speaking with is Dr Golpa assistant Carlos. At each stage and consult I have learned more and more about the industry and procedures and some of the little things that are done. Currently after a few weeks of communicating with Carlos, I was going to make the appointment and fly from NY to Las Vegas to have it done. However I am one of those people who need to know the details of what I am spending so much money on and I requested a line item list. I was sent 2 paper which were identical except for the final prosthesis. One covered upper and lower PPMA for the final and the other covered upper and lower Zirconia which is the porcelin with the lifetime guarantee. When I went to verify the the final costs, it turned out that the paper had one thing but I was told that that price covers upper Zirconia and lower PMMA even though it did not say that. Now Im confused because you can buy upgrades to the upper and lower Zirconia and the all inclusive package had the upper and lower Zirconia but I was told " there may be a "clanking" of the teeth when talking with Zirconia/Zirconia". Does anyone experience this ??

Well we are moving forward with Dr Golpa

I spoke with Carlos on the phone and we went over my outstanding questions and I was very happy with the conversation. As well as being a likeable person, he brings a sense of calm to what for me has been an anxious process. We booked the dates and paid the downpayment. I asked Carlos how I could be sure that if I wasn't satisfied with the permanents would they be redone to my satisfaction. This is important to me because after going through the consultation with 3 other dentists, I never felt confident in the answers I received to this question. My appointment date in April 29th. Kind of excited, a little nervous but I am feeling confident after talking with Carlos and Amanda.

moving forward with Dr Golpa

Carlos assured me that all will be done to assure my satisfaction and the way he described Dr Golpa as a very talented and capable. I believe him. Amanda helped with the hotel reservations and was on top of making sure we are all on the same page as far as coordinating lodging and transportation. The two of them seem extremely capable and makes me feel good.

Paperwork

The office sent me the medical paperwork to fill out. Also in the email was a descriptive list of processes depending on any medical issues I have which I do. I am a controlled diabetic and have a cardiac stent from 10 years ago which I just received the go ahead from my Doctors , so I try to stay aware of the processes involved in any procedure and this list helped.

Paperwork

One of the things mentioned in the informative packet I was sent mentioned getting pictures so Dr Golpa has an idea of what you want the teeth to look like. This got me thinking, I used to have a very nice smile when I was younger and before time and fear of dentists took their toll. I started looking at pictures of me when I had that nice smile. Aside from a chipped front tooth courtesy of my brother, they were perfect and I thought that this is what I would like them to be again. The most recent dentist talked me into shaving down all my upper teeth and putting in a bridge that spans 6 teeth. There was only 1 missing there, an implant would have been the better suggestion but I went with the supposed professional and did it. well at the time it did not feel right and he said you just need to get used to it, I never did. It actually feels like it pulls to one side. And the worst thing of all, when I smile it is plain to see that it is crooked. Looking at the pictures, I am praying that Dr Golpa can return me to those days. I used to smile so much more then....

Using my pictures

The more time I spent looking for pictures, the more I realized how much of a disservice that my local Sayville dentist did to me. The bridge he put in changed the mechanics of my mouth so much and his response was always 'it takes time to get used to the teeth'. While viewing my pictures I started to remember how they fit together and how there was never a misalignment. I cannot believe I accepted this for 5 years. With the current bridge the teeth on the left side align well but the top starts separating from the bottom at the left lateral incisor and gaps away and returns at the right lateral incisor and are so far out in the front that I can't run my tongue along the front of my teeth. 2 more weeks and hopefully this nightmare will be a thing of the past. These are the pictures I am bringing to Dr Golpa and am hoping he can do it.

Trying to find the right look

After giving some more thought to supplying Dr Golpa with pictures, I realized that this is probably a very important step in making the process successful. As Dr Golpa is probably not a mind reader I started thinking of what would be the best way to convey my idea of my perfect smile to him.
I noticed as I was looking for pictures on the internet that I was focusing on the teeth themselves then it hit me. There are teeth size, teeth layout, teeth spacing, and most importantly for me , how they fit into the whole face when I smile. In some pictures people had big front teeth or the teeth overlapped the bottom teeth more etc. My whole strategy for showing Dr Golpa what I wanted changed. I started looking for pictures of just teeth to portray the sizing in relation to other teeth. Like some people have larger incisors or smaller canines. So I compiled a group of pictures that show those characteristics of my old smile. Then once that was done, I started looking for pictures of how I wanted the smile to look while within the picture a whole face. Finding similiar looking smiles in the context of the whole face would give Dr Golpa guidance in shaping the prosthesis with the final look I want in mind. Then when I meet Dr Golpa I will have all these pictures printed out and explain to him what I would want for extra clarification. This may help in all being on the same page. I will let you know, 7 more days until I leave for Las Vegas!

Leaving for Las Vegas and Dr Golpa tomorrow !

My medicines were called in to my local pharmacy. I picked them up and as per my instructions I started the mouth rinse twice a day to help prepare my gums. I will do that all the way through until the bottle is empty which I think they said is about a week after the surgery. I also received Ibuprofin , I take 1 before surgery and every 4 hours afterward (this is for swelling , would have been something else but I am diabetic and can not take the other med). I am supposed to start the antibiotics 2 days before the surgery and continue until the bottle is finished. And finally , Hydrocodone for pain as needed. Taking it one day at a time now, and I will video document everything so you all can see what my experience is like and most importantly, the outcome.
Wish me luck !

Finally Home !

We arrived home yesterday ! I have tons of notes and pictures. Will be posting my experiences this week. Amazing !!!

Day one The Consultation

We walked in to a very nice office and were greeted by very nice and good looking people who had the best smiles I have ever seen. Like walking into a whos who of beautiful people !
We met Amanda who I had communicated with several times and she was also the one that coordinated a lot of the travel and transport arrangements. Very pleasant. Then Carlos came to the front and said hi. Carlos took the brunt of my never ending questions before my arrival. He had a big smile and was very friendly and then went back to work. Amanda gave us the forms to fill out, as you would get in any office. Also included were papers that helped me in understanding the process and what to expect. After finishing the paperwork, I was brought into the back and met the Amanda2, one of Dr Golpa's assistants. Very nice, young and pretty. She proceeded to examine and document the current state of my teeth, then took xrays and pictures with state of the art equipment. Me being into technology, I was impressed with the advanced equipment and how expertly the people worked with it. Carlos then brought me to another room and took my CT scan and then we went back. Amanda2 explained so much and was so patient with my questions, and as she reviewed my file (I had sent lots of email and pictures) and we chose the color and style of what my dream teeth would be. And after so much more discussion and her extreme patience with me ( I am a high maintenance patient and I know it). Dr Golpa came in and we talked. It was obvious he had already reviewed my file. He talked about things specific to my case and how to deal with them (specifically I already had an implant that was put in 8 years ago that failed and needed to come out) He listened to every word I said, something I had never experienced in any of the many dental offices I had been in. We spoke about the choices of teeth and color, he looked over our choice thoughtfully and agreed on the color and style of the teeth. And that was it ! Now I have been to 4 consultations with dentists who advertise they do this advanced procedure and every one of them spent a portion of the consult telling me how good they were and how happy the patients were. Dr Golpa not once patted himself on the back, I felt his focus was on me and what I wanted. Amanda2 went over some additional prep stuff and that was it. The surgery was on for next day. When I left the office I remember being so impressed at how competent and proficient every one I met and interacted with in this office was. They all struck me as extrememly qualified and good at what they did. That helped with my anxiety.

Day 2 The surgery

We arrived at the office the next day at 11:15 AM. I met Dr Young , the anesthesiologist. Very pleasant, but very professional. He struck me as very confident, and capable. I felt in good hands which says a lot for the high anxiety dental patient I have been over the years. We went into the surgery office. Dr Young and Dr Golpa's assistants told me the process and what to expect. And then I woke up ! It was over !! Some vague memories, like a dream. No real pain. just a little tenderness and what seemed to be a team of people all focused on me. I guess being a bit groggy, I really didn't remember much. My wife filled me in later. Dr Golpa met with her right after the surgery, filled her in on the details and that was it ! We left the office around 6 PM. But to me it seemed like no time had passed.When I got back to the hotel, I looked in the mirror and saw the implants in. I was amazed. All I took was the Ibuprofen. Didn't really need anything else. Had a liquid dinner and slept. I was so amazed. And thankful for the people in that office.

Day 3 The temps

We arrived at the office on the 3rd day and Amanda and Dr Golpa put the temps in. The first few attachment screws went in with no problem, then there was a problem. Dr Golpa took over and had to apply a lot of pressure. I got worried and wondered what was going on. After several minutes and lots of pressure and pushing, the screw must have caught and the finished putting in the rest. The problem screw had made me a little anxious. But then when I looked in the mirror, I was so amazed at what Dr Golpa and his staff had accomplished. Even though I knew this journey will take months to see if the implants take, I felt so grateful to be looking at a smiling face I had thought I would never see again. I felt a wave of emotion come over me and at that moment in time it felt as if all was right in the world !

Closer view of the new teeth

At month 1 I am so grateful for this.

I cannot believe it has been a month already. Being a diabetic, my healing will take a little longer and for the first week or so the unusual dull pains and other types of pulling feelings I felt I attribute to that. Over the next 3 weeks they lessened significantly and now I only have a small area of tenderness in one small spot in my lower jaw. Nothing that I am concerned with. I am so much more confident and talk and smile sooo much more ! To say I am extremely pleased is an understatement. The shame I used to feel that made me not smile or talk to people as much is gone. Now when someone smiles at me as I am walking down the street or in a store, I just give them a big ol smile right back !!!!!

Month2

It is now 2 months since my procedure. The tenderness I had is gone. My gums have receded a little and now I feel what I can best describe as an occasional pinch in the spots where the implants are. I assume this is the healing and it is barely noticeable. And where I was just relieved to have my teeth back, now I am thinking more about how slight off center the prosthesis is. A friend who I met on this site who went through the same procedure told me to make sure I mention this and any other issues to Dr Golpa when I go in for my perms. I will and I feel very confident that this will be addressed as Dr Golpa is kind of like an artist who takes pride in what they do. Overall I am still very happy to have teeth back and there are times I find myself smiling naturally and then I realize that I forget I got new teeth and smiled without the self consciousness and it feels natural and good !

Month2 update

I was asked "When you say the gums have receded, is that a swelling issue, like the swelling is going down?" and thought I would take a picture to show what I meant. Before, the prosthesis covered the implants, now the implants can be seen. Not by anyone but me when I move my lip down. When I eat more food seems to get caught under the prosthesis . The water pic is getting plenty of use. I am hoping when the perms go in they will be fitted better to my gum line and the 2 front teeth will align better with the center of my nose. Even though I cannot imagine myself without them and am very grateful for them, I would like the perfect fit. Currently the upper and lower prosthesis in the back of the right side is about 1/2 inch from my wisdom teeth and on the other side, it is flush up against the wisdom teeth. Once these things are addressed, they will be perfect !

Month 3 Update

It is now 3 months since my procedure. My gums have stopped recedeing and they seem to only have receded a little bit. The occasional pinch like feelings I had in my gums are now gone. Now I feel, what I can best describe as, an unpainful tendereness by 2 of the implants. I assume this is still part of the healing and it is barely noticeable. I only feel it when I brush or lightly rub my finger on the gum. And where before I was just relieved to have my teeth back(which I still am !), now I am thinking more about the asthetics and mechanics of the prosthesis. Basically how slight off center the prosthesis is and the alignment to my face and some speech issues. With the upper and lower prosthesis, the back of the right side is about 1/2 inch from my wisdom teeth and on the other side, it is flush up against the wisdom teeth. When I am talking alot, I develop a lisp of sorts or slurring and the speech starts to sound unnatural. It has happened at some inopportune moments but I am hoping that the perms will help alleviate this. Last month I mentioned how I am hoping when the perms go in they will be fitted better to my gum line and the center of the front teeth will align better with the center of my nose. Carlos had assured me they will and so far they have not steered me wrong in any aspect of this journey .

Picture of temp alignment

Month 3 Update 2

Just an fyi. The other day at work I got a pleasant surprise. It was Carlos from Dr Golpa's office calling to check on my progress. My wife mentioned that it was the 3 month anniversary of my visit to Dr Golpa's and he inquired as to how I was and if there were any problems. I felt glad that they followed up. After that call, I started thinking about the whole office experience at Dr Golpa's and remembered the one dentist in Farmingdale NY, I had started up the preliminary things with . When I compare those 2 offices and especially the surgery area, I can only be grateful for my change of choice of Dr Golpa's. Immaculate, professional, and they follow up !

Month 4 Update

It is now 4 months since my procedure. My gums have completely stopped receding and the tenderness I was experiencing in my gums at 2 implant sites is now only noticeable at the lower front left implant. And while relieved to have my teeth back, now I am thinking more about the asthetics of the prosthesis as noted in month 3 and more so about the continuing lisp and slurring of my speech and how unnatural it sounds. Very noticeable. It still feels like my tongue is too big. But I am still hoping that the perms will help alleviate this along with some uneven alignment along my gum area. with the center of my nose. I keep remembering how Carlos and everyone else had assured me they will perfect as I wait for the complete healing and look forward to a good fitting of the permanents. So far they have not steered me wrong in any aspect of this journey.

Month 5 Update

It is now 5 months since my procedure. The tenderness is still noticeable at the lower front left implant. The aesthetics of the prosthesis as noted in month 3 is still a concern, and sometimes the prosthesis feels like it is 'pulling' if you can imagine that. The lisp has lessened but is still noticeable at different times. But I am still hoping that the perms will help alleviate all of these issues and I am putting all my confidence in Dr Golpa and his staff to see me through to a happy ending !

Unexpected update Broken teeth

4 days after my 5 month update, I sat down to dinner with my wife and bit into a veggie burger and heard 'Crack' ! Felt as if my heart was in my stomach. A veggie burger ! Since I got my temps I have had steaks ! Well after looking at it, I emailed Dr Golpas office and send pictures of the crack, and requested guidance from them. To my amazement, the following day which was a Sunday ! I received a call from Carlos. I could not believe it ! Well we talked about it and as it is close to my 6 month anniversary of the implants, he recommended I come in. I was a little concerned about the stability of the implants but he looked up something called 'torque' when mine were put in and he said the 45 and 50 torque I had on them were pretty good so it should not be an issue. I trust them. So I will be heading back on Nov 9th to get my perms. The crack may have occurred because my temps did not have the titanium bar in yet. Will post the results when I return.

At Dr Golpa's

We arrived in Las Vegas yesterday and went to Dr Golpa's office Monday morning. Arrived around 10:45 am and spoke with Jose and Cat (Catalina). Very nice and seemed very interested in my concerns. ( I will go into more detail here when I get home and have more time) The temps were removed for repair. After a while they began putting the prosthesis back in. It was a bit of a problem and took a bit and after some modifications, it went in. Got back to hotel around 4pm. I am hoping the process of making the permanent prosthesis and putting them in goes smoother , and they are perfect (again I will go into more detail when home). Will be meeting with Dr Golpa in the morning , getting picked up at 7:30 am. May be an issue on if the permanents will be done by our departure time on Thursday. I am hoping they will. Otherwise we may need to see about changing the airline tickets. I will update this over the weekend.

Back Home (a little disappointed)

We arrived home last night. It was good to get home. Things did not go very well. I now realize how personal and emotional this process is.
Aside from the costs involved, my hopes of a problem free experience combined with worries about potential problems and how to address those problems if they arise, can combine for quite an emotional experience.
I am home with the repaired temps. Pretty much the same as before except for my jaw being a little sore (always is after the dentist for me) and an occasional sharp pain when I yawn. Not sure what that's about. I have to make another trip to Las Vegas (from NY). 3 weeks to 3 months is the time frame.
I am getting my notes together and will update during the week detailing the issues and outcomes I had.

My trip

Now that I have had a few days to come to terms with how upsetting the trip was for me, I have gone over it a few times with a clear frame of mind. If there is a positive that I can take away from the unsuccessful trip, it is the fact that I am much more aware of how many issues need to be addressed in a complex procedure such as this. After the permanents were put in I found them so uncomfortable and bulky, it felt as if I was wearing a sports mouth guard. If I spoke, my lip would get caught on it (like it was pulled up) . Not sure how the temps and the permanents were so different. Maybe the process to make the PMMA is very different from the Zirconia, I do not know. But after thinking about it for the last couple of days, I started examining the temps and discovered that the right side of the prosthesis is thicker than the left side now. I'm not sure if that had to do with the repair but I now know that I much prefer not having that thicker width. It is uncomfortable and feels awkward. Also the temp prosthesis is now flush against my lower gum in the center, probably from adding material after the repair. But in a few areas of the temp prosthesis, it is a seamless transition into my gums, perfect . That is how I think both the upper and lower permanents should be. Much more natural and comfortable, no bulges. That would be perfect. Another thing is the smoothness of the prosthesis. When we talked of how the perms were not right, some modifications were done. And those areas were rough. Maybe it is usually polished smooth before the end, I don't know. But having it smooth is also very important for me. Also the day we put the perms in, my wife told me ( she came with me every day and sat in the waiting room, 14 hours over 3 days. Big Christmas gift for her this year !!) there were 4 surgeries. It was a busy day. I will ask Carlos about these issues I have addressed here. One thing that did stand out in my mind was how attentive the staff and Dr Golpa were. I think they stayed late to try to address my concerns. That says a lot to me. It is a personal and complex procedure. The office is attentive and seems dedicated to getting me to that perfect outcome that I want.

Pic

Pic of temp after repair

Update to Trip

I emailed Carlos (office manager) right after the last entry (Monday) with the questions I had about the issues. He promptly responded saying Dr Golpa would call me Tuesday to follow up on those issues and he inquired as to the aesthetic look of the center line which is now fine. I guess the office is still busy as I have not heard back from anyone as of yet. I am hoping I will before the weekend. Partially because that pinching I felt (Nov 14th post) seems to be getting worse and I am now feeling an occasional dull pain on the opposite side of the same prosthesis. I hope this is not having any impact on the actual implants.
My email to Carlos had the following questions:
"
How come the perms were so different than the temps ?

Also can you tell Jose and/or Cat in the lab that part of my temps have a seamless transition into my gums, perfect, and that is how I would like all the perms to be, the wider areas of the prosthesis are awkward and uncomfortable.

Also I'm not sure but I do not think a new impression of my lower gum was done. Couldn't that cause an issue with fit as well ?

And after adjustments and trimming are done, the prosthesis is rough, is it polished smooth before the final attachment ?

My wife said you had 4 surgeries that day, shouldn't I schedule a day that is not so busy ?

And any other thoughts or advice you might have are appreciated.
"
And as an afterthought I will also ask (which is a big concern for me) Why both visits to the office did we have so much difficulty screwing in the prosthesis to the implants ?

I worry about the alignment of the hardware putting stress on the prosthesis, implants and my jaw(month 5 update).

In Carlos' email he said "You can rest assured that we will correct all issues prior to delivery."
I guess I can live with the difficult implementation and extra trips as long as the outcome is worth it.

Technical Problem

I just got 8 voice mails spanning from Monday to this morning all at once. I need a new cell phone provider.
Dr Golpa called me on Tuesday and touched on most of my questions. I must admit to feeling relieved to hear him explain things. As well as knowing my case is still as much of a priority for him as it is for me. He obviously is aware of the emotions his patients feel. I am grateful for that.

After Thought

As I was putting my image and video file in my folder ( If you already hadn't noticed, I am detailing in text, video and images my entire journey) I started looking through all the pictures. In a short period of time it was so obvious that there was only 1 picture that showed my teeth before ! And that was taken by Dr. Golpa's staff. As I looked at it, I was horrified. And amazed that I am where I am today. The odyssey had many visits to 'dentists' ( tempted to use so many other adjectives here.) which added to the misery and at great expense and pain. Then I looked at my recent pictures and noticed I was smiling to myself. And then I chuckled as I realized I was also eating an apple ! So I looked around and found a picture of me in my early 20's and compared the now and the then. It was something I wanted to share. Remembering where I was just 6 short months ago, I am thankful and find it fitting as Thanksgiving approaches.

Month 8 Update

Holidays are over and I have been getting some questions on my 'all on 4' which reminded me I needed to update this for Month 8. Not much has changed from my last posting except the occasional pain I get by the implant by where the break in my lower prosthesis occurred. I am guessing that it is not a perfect fit to the angle of the implant and some pushing or pulling pressure is the cause of this. Once the Zirconia permanents are in, I hope this will stop. Beginning to plan my 4th trip to Vegas and will ask to see Dr Golpa before anything begins so I can show him the difference in thickness of the prosthesis from the left side as compared to the right side and the area that juts out that my tongue kept catching on, and there is no space under the repaired prosthesis that allows me to clean under it. I want them perfect, and they assured me they will be. I know these are only repaired temps but I want convey the things that are wrong before I arrive so that a fifth trip from NY is not necessary. But to be fair, when I am not focusing on my now 8 months old temporary teeth, I do not think about them a lot. That is a good thing.

Month 9 Update

Not much has changed from my last posting I still get the occasional pain by the implant where the break in my lower prosthesis occurred. The repair is not a perfect fit to the angle of the implant. There is no space between my lower and the gum so cleaning is an issue. Once the Zirconia permanents are in, I hope all these issues and the fit are perfect. Beginning to plan my 4th trip to Vegas but am waiting a little longer because of the bad weather we have been having. I will ask to see Dr Golpa before anything begins so we can discuss the things in my previous post. I really want them perfect, and they assured me they will be. I will plan my trip so that I will not chance another trip. I really want it to be done and perfect this trip. I still find the procedure ,and what it has given me, a blessing.That is a good thing after watching my parents and brother struggle for years with their dentures.

Almost 1 year update

I have emailed Carlos at Dr Golpas to see what availability he has. I would like to get my perms and have them be perfect. Even though it has been a year, my quality of life has improved tremendously even with the temps and the occasional pain from the repair needed when the temp broke. Dr Golpa and his office still has my trust, as they have stood by their work with me and with others that I have been in touch with. My email included specific issues and a request to meet with Dr Golpa before any work is done to review and discuss these issues. I am also arranging the trip to meet with Dr Golpa on the first day so in case the lab has a problem making the perms fit perfect, there should be enough time to address it before I leave as a 4th trip to Las Vegas would be a big inconvenience. My first trip was April 26 2014. Hoping to hear back soon !

New appointment

My email to make the appointment for the permanents addressed these specific issues.
I would like to meet with Dr Golpa to show him first hand my concerns. Specifically :
1- the upper and lower prosthesis' are both much thicker on the right side. I would like them to mirror the left side in that respect.
2- The occasional pain from where the lower prosthesis was repaired is still happening. I believe it has to do with the alignment of the implant to the repaired area of the prosthesis.
I would also like to make sure the perms are perfect before I leave. How can we accomplish this so I do not need to make another trip ?
So with that, the appointment to get my perms is set for Tuesday, April 28th.
I was told "we will do is spend the day Tuesday with Dr. Golpa making the adjustments to your current bridges, until they are corrected to your satisfaction."
As I was more concerned with the permanents and not so much the temps, I responded " my concern is not so much the temps, but getting the perms right and the time it takes to correct any errors if something is wrong."
Then Carlos explained to me "In the past with old technology, wax-ups were done. The problem with wax-ups is that its wax. Things shift and shrink, etc. Think of your temps as the wax-ups. Adjustments and changes will be made to them, until they are perfect. We can then scan them, and mill the perms from that scan, this way it will be exact. We will then make any minor adjustments to the perms. " That clarified things for me, understanding the process helps me in my approach to explaining the issues to Dr Golpa.
This is the detailed explanation of the issues that I will give to Dr Golpa
First and foremost, I am extremely happy with the look of the teeth and do not want that to change at all. The structural issues I have are:
1 - My top right - prosthesis is too thick compared to the left side.
2 - My bottom right - prosthesis is too thick compared to the left side.
3 - Back teeth do not meet. Cannot chew on that side.
4 - Extra material was added during the repair and always feel pressure, difficult to clean
5 - After the repair to my temps, my lower left implant has given me occasional pain and especially after steak, that is also the side that the teeth do not meet.
Hopefully all will go well with the new process and the look will remain the same and all the alignment issues will be corrected without a return trip. Wish me luck !

Leaving for Las Vegas in the morning

Leaving for Las Vegas to go get my perms in the morning. I really want the perms to look exactly like the temps but with the structural issues fixed.

The structural issues I refer to are:
1 - My top right - prosthesis is too thick compared to the left side.
2 - My bottom right - prosthesis is too thick compared to the left side.
3 - Back teeth do not meet. Cannot chew on that side.
4 - Extra material was added to the bottom prosthesis during the repair and I always feel pressure, difficult to clean
5 - After the repair to my temps, my lower left implant has given me occasional pain and especially after steak, that is also the side that the teeth do not meet.

Keeping my fingers crossed that this will be the final trip !

Back to Las Vegas June 15th

Dr Golpa called yesterday and he seemed to be very interested in the issues I am having. He asked me several questions about the fit and how the bite was working. Also spoke of the material used and I think he was recommending PMMA for the bottom prosthesis. All in all, the personal attention and interest felt nice. I will be going on June 15th and from the conversation with the Dr, part of the prosthesis hardware may need to be repositioned. I will post more details when I know more. I posted a picture of the Zirconia to show how natural the teeth look. I hope we can keep the Zirconia and just make the fit perfect with no pain.

Leaving for Vegas in the morning.

I am leaving in the morning to try and get the issues with the perms fixed. Trip 4 and the office has been nothing but great about things. However the issues do need to be resolved and I am hoping this will be it. It has been mentioned to me by a few people that the issues I seem to be having are tied to the lab. Looking back on my previous posts, it does seem likely. The issues with the screws going in smoothly, the thick first perms that were too big, the repaired temps hurting, etc. I decided to take an inventory of the issues for this trip to show to Dr Golpa. I know he will understand and address my concerns. He always has so far. He really is my favorite dentist and I have had a lot !
But as I always say ' Eye on the prize' and in this case perfect comfortable and strong teeth are the goal.

My list of questions and things to address and hopefully fix are:

1. Sharp pain in lower right back when I yawn or move jaw certain way.
2. The lower right 3 teeth feel as if they are being pushed in when I eat things like a steak or apple.
(The other side meets perfectly and the bite pressure is perfect. No problem chewing and it feels strong)
3. Aching jaw (lower right) after steak dinner, usually the following morning.
4. The lower prosthesis feels uncomfortably snug and hard to get under it to clean.
5. Prothesis gum line is uneven (top and bottom). *See pic*
6. Lower prosthesis feels as if it is not aligned with my gumline or upper prosthesis. *See pic*
7. Why is lower right back teeth much thicker than lower right left ? (uncomfortable) *See pic*
8. Why does Top left back extend 1 tooth past the end of the lower prosthesis
9. Area of top left prosthesis at gum line that sticks out and always gets big chunks of food caught. *See pic*

Is there an problem with my gum impression ? Could that be why we are having so much trouble getting a good fit with the prosthesis.

It seems the Zirconia prosthesis is more bulky and not the same as the PMMA templates we made the last time I was there ?
Are these lab issues ?

Wish me luck !

Has anyone seen the new reality series on this subject yet ?

1 month post 4th trip to Vegas

So I have been back from Vegas a month now. I wanted to give myself time to adjust to the new lower PMMA prosthesis before commenting. When I arrived and went over my list, I felt as if my concerns were being taken seriously. After explaining what I was feeling Dr Golpa had the lab make a new lower PMMA prosthesis. It needed a lot of customizing to make it fit better. And for the most part the issues were being addressed but after 4 trips I knew that no matter how good it feels while I am in the office, it's how it feels after a month.

These are a list of the issues I brought and discussed with the Doctor. ( new comments by *)
1. Sharp pain in lower right back when I yawn or move jaw certain way.
*this is mostly gone now, only happens 2 or 3 times a week.
2. The lower right 3 teeth feel as if they are being pushed in when I eat things like a steak or apple.
(The other side meets perfectly and the bite pressure is perfect. No problem chewing and it feels strong)
*This was fine for the first couple of weeks but then the pressure feeling started to return.
3. Aching jaw (lower right) after steak dinner, usually the following morning.
*This has stopped so far
4. The lower prosthesis feels uncomfortably snug and hard to get under it to clean.
*The fit also feels a little better
5. Prosthesis gum line is uneven (top and bottom).
*Now I laugh at myself for even listing this
6. Lower prosthesis feels as if it is not aligned with my gumline or upper prosthesis.
*Alignment feels better
7. Why is lower right back teeth much thicker than lower right left ? (uncomfortable)
*Still thick, that is the side the implant is on the outer edge of the prosthesis as well.
8. Why does Top left back extend 1 tooth past the end of the lower prosthesis
*Fixed with the new prosthesis
9. Area of top left prosthesis at gum line that sticks out and always gets big chunks of food caught.
*One of the several adjustments made to the Zirconia while I was there – Fixed but found out from the lab tech that when they do things to the zirconia they then have to 'fire' it in the oven and they can only do this a few time as it makes it weaker.


The first thing becoming more apparent is ' The lower right teeth feel as if they are being pushed in' statement. I realized that the implant on the lower right back, where I get that feeling, is actually on the very outside edge of the prosthesis (see picture) so the pressure when I bite is not evenly distributed. Kind of like a table with 3 legs, it's only ok as long as the pressure or weight is directly over the legs. If that implant was centered like the others, I think that this would be perfect and not such an unnatural feeling. But I think that would mean redoing the Zirconia prosthesis which I was told they can only 'fire' Zirconia prosthesis in the oven so many times because they get weaker so they would have to make a new one. I actually wished they had made a new one that was wider in the back when I was there. That would make that implant and prosthesis sync up with my natural gum line. My concern is over time if this type of stress will loosen the implant and maybe break the prosthesis, especially now that they changed it from Zirconia to PMMA which is not as strong. My wife is even worried about making me a steak because the cost to have it done was a lot for us and the trips from New York are not cheap and I agree that a fifth trip is a bit much.
I would love to hear thoughts from anyone who might have some experience with this procedure.
Las Vegas Cosmetic Dentist

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