One of the reasons your dentist is telling you to hold of is because they probably want to give you at least one functional chewing side on the right, before addressing the left side. Even though you lost your tooth a long time ago, it doesn't necessarily mean you don't have enough bone for implant placement. This greatly varies between individuals. In order to establish whether you have sufficient bone or not, I would recommend taking a CT Scan (3D x-ray) and have it clinically evaluated by a Board Certified Periodontist. Best, Dr. Krivitsky
Gummy smile can be or skeletal (skull growth) or dental (short teeth) origin, or a combination of both. Skeletal cases are treated with orthognathic surgery or can be helped with a less invasive lip repositioning (Lip lowering) technique. Dental cases are addressed with a crown lengthening procedure. In your case, judging from your photos, the gummy smile is of skeletal origin. If orthognathic sugery is too invasive and costly for you, look into lip repositioning. Best, Dr. Krivitsky
Smoking can adversely affect the success of dental implants. It is protocol to quit smoking at least 2 weeks prior to implant placement, though longer periods of time can certainly be beneficial. Please be aware, that formed smoking habits may have permanent damages to your tissues even after quitting. That said, patient's who smoke still get dental implants. However, your Board Certified Periodontist may choose longer healing periods and/or a conservative surgical approach.
Even when bone loss is severe, it is possible to augment bone and place dental implants in most cases. Usually major bone augmentation is done with patient's own bone, allograft bone material or a combination of boss. Emdogain in particular is an enamel matrix protein that will not be significant for this procedure. In order to evaluate the outcome, your Periodontist must look at the amount of horizontal and vertical bone loss, the anatomy of the defect, and then treat/erradicate any periodontal disease prior to implant placement. If you don't have enough bone to replace all teeth with implants, you have several options available to you. You may choose to go with a hybrid prosthesis (5-6 implants supporting a fixed denture without the flange) or an overdenture (2-6 implants supporting a removable denture). These options may provide enough stability and comfort for you and may minimize the amount of procedures you need to have for implant placement. Please discuss your concerns with your Board Certified Periodontist so he/she can present the best options for you.
It is very difficult to answer this question without proper diagnostic information. Definitely, if you have crows feet or drooping around the upper and lower lip, then adding a flange (base) around dental implants may serve as support, evening out lines and creating a younger appearance. Implant brand will not be a deciding factor here. I suggest searching for a Board Certified Prosthodontist and Periodontist for proper evaluation and mock up of the treatment outcome.
