I have finally made the decision to get dental implants to fix my smile. When I was very young (under 7) I fell in the bathtub and my two front teeth were knocked so hard that they moved my permanent teeth so badly it caused permanent damage. Long story short, it resulted in years of orthodontics - my teeth never have looked right since. All through my elementary, junior high and high school years - I had a terrible smile. My front teeth were so jacked up that it really did cause people to look differently at me. When I was small it was 'cute' in the way that kids are with missing teeth. As I grew older, I was thankful for my metal braces because it covered up the fact that my teeth looked so bad in the front. When I was 17, the braces came off and I got a bridge in the front. I was SO happy because it was the first time I had decent looking teeth in the front. It was such a nice change that I didn't realize that the new bridge still looked horrible. It was not aligned right with my other teeth because of the misplacement of the teeth they were anchored to. They were acceptable but made my smile a little crooked and people just thought that my teeth 'could use some work' - not realizing how far they had come from when I was a child. Eventually I realized "oh geez, you're not done with fixing your teeth." Since the 3 teeth are in the front of my mouth, I've been super fearful and anxious about getting my teeth fixed. I always assumed I would need a new bridge. I've had recurring nightmares about my teeth falling out in the middle of meetings at work or while kissing my husband. With every dream I think to myself that it is a sign that my teeth actually will fall out in the near future and I need to get them fixed. As I researched the replacement of my bridge on RealSelf, I learned about dental implants. It seems like a permanent solution that was what I needed. And the before and after pictures I've seen are AMAZING. Every time I look at them, I gain more confidence to get my teeth done. So I've consulted with 3 different doctors. I wanted to be sure I was getting the right facts. Each doctor had a little different style and gave me similar info. All 3 were a little perplexed at my situation at first (due to the placement of my natural teeth that are connected to my bridge) and each gave me different quotes. I didn't want to make my decision purely on the cost, but it definitely was a factor. I am extremely worried about the year long process to get the dental implants (I don't qualify for the one-day procedure) because I'm worried about having no teeth for so long. It makes me sweat with nervousness just thinking about it. All 3 dentists reassured me that the flipper I would have would allow my missing teeth to go undetected and my speech will be minimally impaired, if at all. I pray they are right. I would be devastated if anyone saw me with no teeth in the front. I'm not vain, but c'mon - who wants to be seen with no teeth? I've chosen the last doctor I consulted with about the implants. Yes, cost was one issue. But honestly, I had made up my mind before he gave me the quote. He was patient with me and my questions and most importantly, he had great reviews online. The 2nd doctor had zero reviews and I felt really uncomfortable that I couldn't find any info on him. The first doctor I didn't like -- I felt he was more concerned about upselling me than fixing my teeth. So the first step of removing my current bridge and getting the bone graft done will be done on 12/31/13. Happy New Year, right? I'm so so so nervous but excited that I'm finally going to do this. By the time this is all done, my 2 implants with a 3-tooth bridge/crown will most likely cost around $10k. It will take about 10 months. Crazy. But it has to be done. I'll update after the first step and let everyone know if it's as scary as I am imagining it. Luckily the doctor I chose said he doesn't need to take bone from my chin like the other doctor did -- he said he will use a powder to create the new bone that I need. The 'flipper' will be available immediately after and I should be able to go to work within a few days. Did I mention I'm nervous? Wish me luck! Updated on 27 Dec 2013: I'm just a few days more to go -- yikes! I'm excited and nervous at the same time. I only have one day off after the surgery so I'm hoping I'll be ok enough to go to work on the second day. I'm uploading my before xray photos. The 3 teeth circled in red is the home of my future implants. Updated on 3 Feb 2014: It's been a month since the first surgery. I had 2 teeth and the bridge removed and had a bone graft. Not fun. There wasn't much pain but a lot of discomfort and a ton of swelling. The whole right side of my face was swollen like a ballon for about 4 days. I started to forget what I really looked like and had to keep going back to other pictures to remember that I wasn't normally so swollen, lol. Other than the first day, I only needed prescription strength ibuprofen. The first day I took something a little stronger, mostly so I could sleep comfortably. Last week the dentist pulled out the gortex membrane that was holding the bone graft powder in. It was a weird feeling, tons of pressure but it didn't really hurt. They say I'm healing fine but it will be a total of about 5 months before I'm healed enough for the next surgery. I hate the flipper. It actually doesn't look bad - in fact, it's the first time my teeth have looked so straight in the front. But it's super uncomfortable and it's difficult to talk. They said my bite was so tight that it was challenging to get the flipper to fit well so it sort of hangs down and makes my speech impaired. I hate it but am hanging in there. I'm going to pick up an Essix retainer tomorrow with the partial built in and I'm hoping that's a better option. Anyways, I'm encouraged so far by the progress. I feel like (I hope) the worst part is over. I do still feel like there is a long road ahead but I'm feeling optimistic. Total spent so far approx $3k. I have another $3k (approx) left for the next surgery and then the cost of the crown and whatever else the other doctor will recommend. I'm sure there will be more cost than I anticipated. Updated on 2 Jul 2015: It's been so long since I've updated. I fell behind on my treatment plan due to my busy schedule. I should have been done 6 months ago but I'm still going through the process. My gums healed fine and a few months ago my periodontist placed the implants in my gums. That surgery was a breeze compared to the first one. Of course the sedation and anti-anxiety pill helped a ton. It was another $4500 so total cost right now is $7500. I've also been referred to a prosthodontist who will place my final bridge. Today I had my implants uncovered (lasers opened up my gums and doctor pulled the implants down and put metal caps on it) and immediately went to the prosthodontist to have an impression taken for my temporary provisional. This temporary bridge will be placed in two weeks to allow my gums to settle in so the doctor can get the best fit on my final bridge. I guess this step is necessary to get the best fit since the teeth are in front of my mouth -- no hiding anything there! I'm still wearing my flipper but it's been adjusted to fit my mouth better since the last update. I don't mind it but can't wait until I never have to wear it again!
You have beautiful smile already, but if you are concerned with shifted midline, it can be improved with restorations. I say improvement because if dental midline cannot be corrected with bodily movement with orthodontics or surgery to coincide with facial midline, the only thing we can do with restoration is to fool the eyes to mask midline discrepancy.When dental midline is canted to either left or right, it is noticeable right away. When dental midline is shifted but perpendicular to horizontal plane it is less noticeable (literature is available on this subject).Just looking at your picture there is a slight cant on the midline. I usually use inter-pupillary line to determine horizontal occlusal plane. Consult with a prosthodontist near you and ask for treatment options.
Healing abutment is placed either right after implant placement or after phase II surgery(uncovery of implant when it was buried under the tissue) to be able to access implant later. When healing abutment is placed there is a biological change on bone and soft tissue. It is called biological width. This will happen any time something gets attached to implant with exposed tissue. This is due to exposure of implant-abutment junction to environment and this process can take up to about 2 months. The best treatment outcome can be achieved by custom made healing abutment or temporary implant crown for anterior teeth. This customization of tissue will help developing emergence profile for the best esthetic outcome and can be used to fabricate custom abutment for the final restoration.Your question sounds like you are ready for phase II surgery to uncover the implant. Surgeon can either use laser or blade to expose your implant. There is a preparable permanent abutment that can be trimmed after tissue healing and the process is just like crown preparation. But we see decline on this process due to technical challenges. I would recommend placing healing abutment if it is posterior or place temporary crown if it is anterior tooth. Let your tissue heal and treat with custom abutment and crown (cement retained crown) or screw-retained crown. Usually there is no need to trim the tissue after healing abutment as long as you have custom abutment vs pre-fabricated abutment.
