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.
