Teeth not only are used for chewing, speech, deglutition, but also to support the face and lips. Imagine what someone looks like when they take out their dentures. Their faces collapses. So yes teeth can affect your facial shape and structure and why we opened Radiante' Dental & Facial 6 years ago. We needed to fill a deficient area in aesthetics that provided more conservative and comprehensive solutions for patient's faces and smiles. When a tooth is missing, think about what happens. The other teeth may shift into that space and end up causing another problem, the tissues around that missing tooth collapse into the space, including lips, cheeks, and even tongue will fill in that space. We can see this when we take photos of patient's mouths and see waves along the sides of the tongue following the anatomy of the teeth on both sides. So the answer is yes, they can. Implants are not perfect. They do not duplicate natural teeth. They are a good substitute and the best tooth replacement treatment today. Best, IV
The xray/CBCT would give the best indicator for sufficient implant support. The OMFS is correct. Limited opening and lack of bone support, could be considered contraindications and once healed, an evaluation must be made regarding the risk vs. reward. Agree with you that living without a tooth is not ideal, especially for someone as young as you. I am much older and I wouldn't want to be without one of my molars. I would look at the risk/reward ration and would perhaps take that risk. There are implants that are large round, shorter implants that could work in a limited space. Your mouth opening is the #1 thing I noticed, which looks no more than 40 mm or so. Are you a TMJD patient? I would wear an orthosis to see if your muscles relax and allow more opening. Or you could go under twilight which would allow the dentist more relaxed muscles and a less difficult management of the procedure. Best of luck, IV
Wow, that's a bummer! Some of what i would wonder about this case is what material the bridge was made of and how many abutments and pontics? Generally a 6 unit bridge is similar to a 6 anterior veneers...overall not the best cosmetic plan, but I understand sometimes this is unavoidable. Many dentists are using Zirconia bridges for cosmetic purposes, but I have discovered that Zirconia recipe's and the composition can vary. Some are not as strong as others even though technically, these consist of "metal" and should be strong. Nevertheless, fractures are actually common on Zirconia crowns and bridges. For a long span bridge of 3 pontics or more, this is the only case where I deviate from APC (all porcelain-type) materials and will go to the traditional POM or PFM (porcelain fused to metal) materials which are tried and true strong, long lasting. Cosmetically not as good generally, but in the right hands, can be a strong and attractive result. wish you luck on this. Best, Dr. Ivan
Again, I find myself agreeing w/ Dr. Citrin, but would add something that a lot of doctors, especially younger doctors, would not think of...it is the knowledge, skill and time required is what a doctor offers from their training and experience to provide any treatment, espcially cosmetic dentistry. Composite veneers require the same skills, and knowledge and maybe even more time to achieve a decent cosmetic result. So in my opinion, if it takes the same time, skill and judgement, why would I use an inferior composite material, that won't last as long, won't be as strong and stain resistant, and charge less? So in my practice, there is no reason for me to use composite veneers unless and until there is a composite that is superior to porcelain. In my opinion, that doesn't yet exist. Good luck! Best, Dr. Ivan
I like Dr. Citrin's answer and would only add a couple of things: first, LVI, Las Vegas Institute was one of the first and oldest training facilities, way before Kois, Dawson and others, began to train dentists in cosmetic dentistry, and would be the credential I would look for in a cosmetic dentist. In addition LVI trains dentists not only in cosmetic dentistry but also understands the functional problems, called neruomuscular dentistry, that seems to be what you are experiencing. This is probably the biggest problem I see with patients getting cosmetic dentistry or veneers, is that there is no specialty in cosmetic dentistry, and therefore hard for the lay person to find who is really competent in this area, and almost any dentistry, even the smallest filling can cause or trigger some of what you are sensing or feeling. It could be a preexisting issue that now is coming to the surface because of the changes that were done. Normally moving the upper teeth out rarely causes the symptoms you are experiencing, but is not unusual. One thing I highly recommend is to use an orthosis. It is similar to a nightguard but positions your jaw on the appliance in a position that relieves symptoms, if assessed and fabricated properly. An LVI trained cosmetic dentist would know how to achieve this position and would relieve symptoms at least temporarily while wearing the orthosis and maybe that's all you might need. This is the case with me. I only have to wear my orthosis 1-2 times per month when I feel the symptoms begin or in periods of stress when I am clenching or grinding my teeth more, and then I am okay the rest of the month. Others my need to do what Dr. Citrin stated and sometimes build up the back teeth and change your bite. But always do the simplest, most conservative treatment first and that would be an orthosis. Best, Dr. Ivan
