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Dr. Peel
Dr. Peel, Dentist
Category: Dental
Satisfied Customers: 981
Experience:  General dentist with 20+ years of experience.
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I'm dreaming of a dental make-over. I found a before/after

Customer Question

I'm dreaming of a dental make-over. I found a before/after pair depicting someone with teeth that are similar to mine. She had gum transplants to improve the appearance of her front (top, center) teeth.I have a handful of issues and I'm wishing I could start fresh with teeth that don't decay, break, or die. Are there any good arguments in favor of 55-year old with "okay" teeth replacing them with implants?
Issues: I have at least 8 amalgam fillings that my dentist says are so old they should be replaced. I just lost a tooth (position #3) that broke after surviving a too-big filling for a few years. I have to get a fake tooth made to replace it. The #4 tooth requires a root canal. My teeth aren't white, and didn't improve very much with professional whitening. They are too long to be considered attractive or even neutral, partly because my gums have receded. My jaw is so crowded that flossing has always been an ordeal. I illustrated another issue --jaunty angle--on the visual aid.This does boil down to two questions: 1) are gum transplants the best way to improve the look of teeth like the ones in the 'before' picture? 2) If I'm sick of my teeth and have some costly work coming up, is it worth considering replacing them with implants, or do those cause un-solveable problems down the line?
Submitted: 11 months ago.
Category: Dental
Expert:  Dr. Peel replied 11 months ago.

Hello and thanks for asking. I see the before and after pictures that you provided. It would be better to see your own teeth but I will answer based on your questions regarding the model.

1. If the teeth are in good shape otherwise and periodontally sound (no disease, pockets, inflammation), there is a grafting procedure that can be done which essentially takes tissue from another area of the mouth ( possibly palette) and positions it so that it effectively lowers the gum line around the teeth that look 'long' to you. It is, in fact, the only way to solve the toothy appearance of the smile line. As you can see, the results vary. Doctor skill and host site reaction to the graft are variables that can cause either result that you see in both of those pictures.

I cannot tell from model pictures if you are even a candidate for that procedure or not so I will just say that good communication with your dentist is first and foremost important. He/she will let you know from a clinical examination , if that procedure is an option and will do their best to create the optimum outcome that you wish.

Good cosmetic dentistry can do wonders for patients appearance but cannot always, or even should, match model pictures. The pictures can aid in communication and let the dentist see your personal aesthetic value and that's all.

2. If your teeth are still somewhat healthy and you have decent periodontal health, no dentist would extract them and replace with implants just for cosmetic reasons. There is no implant that is as healthy, stable or as good as a natural tooth , even if the tooth needs crowns for replacing decayed crown structure or to effect appearance. In addition, implants do have their own problems. They are best used to replace one or two teeth but not a whole arch.

If you do, indeed, need extractions there are several alternatives that you should discuss with your dentist.

One- implants, provided they are few.

two- a bridge

three- a removable prosthetic device

Redoing the large , aged amalgam fillings would be a good start. It is always best to stabilize the bite (pre-molars and molars) before addressing the anterior cosmetics. If you are after a complete makeover your dentist may want to address all at once or in stages, depending on your wishes , finances and your general and dental health.

I hope this helps you make some decisions. Come back and ask more if you need further help as you move forward. Best of luck!

Dr. Peel

Customer: replied 11 months ago.
Thanks. This is very helpful. The pressing issue at the moment is two fold. I just looked up numbering systems. I guess the dentist who did the extraction used the "universal" or "American" system, which numbers the teeth 1 through 32.So, on my upper right jaw, my wisdom teeth were extracted 30 years ago. #2 is present, #3 is absent as of recently (because it broke and became painfully infected) and #4 requires a root canal. I understand that I must have something in place of #3.What is best way to fill the space between #2 and #4? The cheapest?And how long can I delay? I ask because I'm in a cash crisis that will last a few months at least. I have a type of dental insurance, but it doesn't cover much. I would have to borrow the entire cost, and I'm allergic to borrowing. I will if I have to, though.