Peter Joseph, DMD

In my opinion, I think you need professional cleanings every 3 to 4 months. This kind of dentistry is not bionic. It is advanced. It is also a lot and needs regular professional maintenance. Cleanings every 6 months may allow for problems to occur and be a major issue down the road. Any good dentist will be ok seeing you, even if they did not do your reconstruction.

Please really consider the implant. It will be the most stable option choice for decades to come with less risk to other issues vs a bridge. The perforated tooth is hopeless and needs to be replaced with an implant. in some cases (yours may be one) the implant can be placed the same day as the extraction. In certain cases immediate temporization can be completed as well to help keep soft tissue esthetics ideal. Your periodontist or oral surgeon will help you make those decisions. Do research to make sure you are seeing someone well recognized in your community. The tooth next to the perforated tooth, the other root canal tooth) does not look very good. I would also consider replacing that with an implant as well. That can be done in the near or distant future. One option, to help avoid a removable temporary, is to use a cantilever temporary form the other root canal tooth while implant or bone graft healing is being completed at the perforated tooth. I hope this helps. Good luck.

So, from your pictures it's not clear what your teeth look like. What I can tell from your pictures is that your lip doesn't move the same amount between the right and left sides. That can be due to scar tissue, nerve damage, or improper healing. I think that is the first step into getting the smile you want. You may need other dentistry, but that cannot be diagnosed with these pictures. I would see a very good facial plastic surgeon or a really good oral surgeon to help diagnose and offer solutions to fix your smile. An option could be to use botox to the right side and that would help the lip move uniformly, but you would end up with a situation where you don't show much at all when you smile which may make you look pre-maturely older. I hope this helps.

The traditional orthodontic route (vs invisalign) is most certainly the best way to go. You have flexibility on having the canines reshaped at the lateral sites (a little faster) or moving them into their ideal canine position. Sometimes reshaping the canine to look like a lateral can be difficult or lead to other issues as a lot of tooth structure needs to be removed (read: you may need a root canal and will definitely need at least veneers or a crown to make them really resemble lateral incisors) So timing wise this may make sense but may offer some issues with increasing the cost/invasiveness of the procedures. As most have stated, getting the canines into their true position and placing implants at the lateral sites and replacing the primary (baby) teeth with implants is your best ultimate option.

I agree with Dr. Dorfman. Likely the tooth is failing. The most predictable long term approach may be to replace the tooth with an implant. Bone regeneration is going to be necessary. It's a matter of whether the implant can be placed during the extraction or if you have to regenerate the site first and have the implant placed later. I would get a 2nd opinion from someone very reputable in your area.

This is a significant problem. Likely, you are losing bone and potentially the thicker, protective attached gum tissue. This can happen for several reasons, but the important thing to do is to have them evaluated by a very good clinician. Perhaps a really good periodontist in your area may be able to help. Sometimes compromised areas can be dealt with and maintained with increased frequency of professional cleanings and the addition of some oral home care aids like a water pik. But this problem cannot be evaluated over the internet. You need a very good, quality/comprehensive care professional to evaluate and recommend how to address your situation.

IF you have a lot of wear, it is likely you will need to address your wear issues. Sometimes wear also causes changes to your gum line in addition to the loss of tooth length. In those circumstances a periodontist will work with your restorative doctor to determine if gum needs to be removed or added to help you get your cosmetics and function back.

If you are looking to show more tooth or show less gum there are procedures for both. In some cases, orthodontics is used as an adjunct to help achieve your goal. If you are looking to show less gum an esthetic crown lengthening procedure may be possible. If you are looking to show less tooth and have recession, then some gum grafting may be possible and there are several techniques to allow for great results. If neither is possible, there is some great evidence to show that lip repositioning procedures will help you possibly attain your goals. In any instance, you need to have a very good restorative doctor or prosthodontist and a very competent periodontist to help you achieve the smile you are looking for. They can help you get to the right people and complete the procedures you need.