The difficulty of finding a solution


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For years, I've been missing most of my teeth. Gradually, another crown, and another, come off.

I went to UCSF, and they recommended I have all my teeth extracted, and if I want the best option, implants.

They are somewhat limited on the services they offer, and I didn't feel they're the best pick for completing the service necessarily.

I recently went to a new dentist about a dental infection, and her first reaction was, I should see someone about trying to save my two front teeth. I asked her, but it having my teeth all extracted and implants is the best solution, can I keep those two, which I'd like if I could? She then changed to 'no, you can't keep them'.

Options include:

- Try to find a well-reviewed local Periodontists for all the work. Pro: likely good quality. Con: expense - I've heard of estimates up to $100,000.

- Clear Choice implants - I've heard of estimates around $60,000. Pro: 'good enough' quality? Con: corporate, less personal, still expensive.

- Foreign dentist office: almost impossible to feel I can select the 'right' one for quality. Pro: savings, value Con: difficult selection, risk of problems

One option: a local consultation. Even that has issues. Who is the 'right' periodontist to get a consultation from? Everyone seems to have their own biases (how likely is a local provider to suggest a foreign office if it were the right choice?) and 'networks' of contacts they prefer for their own reasons.

I'm sympathetic - they all feel they're providing a good service for good value, but they're not all the best choice.

Most of the progress I've made is that for years, I had the idea that 'implants' meant getting every tooth replaced by an implant tooth, while this year I learned that's not much recommended, that it means getting about 6 'posts' and implants are sort of like dentures on them.

And then there are still more options - should I get removable or non-removable implants, for example? How can I get the longest-lasting solution?

You get the idea. All this has kept me from resolving this, but it's getting where it's pretty problematic for me to not get this done.

I'd like to find quality advice for a 'last chance' for any option to save any teeth and confirm a plan, even if the likely 'all teeth removed, get implants', and to figure out how to find the right option for which office - local or foreign - to use.

I could do this today if I 'just pick' any of the above - just go local, just go to clear choice, just go to a foreign office. But of course that would not let me feel I was avoiding lower quality/lower value/higher risk. So, any ideas how to get the best advice and solution to selecting an office?
 
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MattKW

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Sure, but in the absence of Xrays etc, it gives me an indication of your teeth problems, which sounds largely perio-based. So I would go to a periodontist or two for opinions. Patients who have had periodontal problems are not always suitable for implants unless very well maintained, so this is where you should start. A proper assessment of all your teeth and a frank discussion about your situation. Maybe implants are just not for you.
 
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Most of my teeth are broken off at the gumline, except some crowns, some teeth in quite bad shape (blackened), the two top front teeth, one left with a veneer but both 'shaved' for the veneers into little spikes, maybe a couple others partially broken off.

To find a good periodontist for a consultation, I'm expecting them to have biases such as being negative about international offices; the only way I'd know to find one pretty much is google and read reviews.

I could ask a dentist for a recommendation but again, they tend to have relationships that might make them recommend someone because they help each other.
 

MattKW

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OK, so you're at a loss for saving any strategic teeth, in which case a full clearance is the way to go.
You know as much as anyone that internet reviews and testimonials are unreliable. Seeking an international dentist that way is no netter than looking locally. I have seen patients come back from overseas tourist clinics with stuff that I don't even recognise, and then they expect someone to fix it. It can often end up having everything removed.
I also think you're a bit harsh about why dentists refer to certain specialists - I refer to the ones that act as an extension of my practice, and if I get negative feedback I let the specialist know or I simply stop using them. I have done this to a periodontist, a paedodontist, an orthodontist, and an oral surgeon.
I always use a periodontist colleague to do my implant surgery because they handle soft and hard tissue well. Oral surgeons tend to be a bit limited in soft tissue skills for my liking. If you are going for a major rebuild with implants, then a large specialist practice with a periodontist, oral surgeon, and prosthodontist will give you the best result. But you'll pay for what you receive. Your first step is going to see if your ideal treatment is even possible.
 
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It'd be great if there was a way to save teeth. Not looking promising.

There's a big difference for me between 'not getting complaints' and 'finding the best office to use'.

But it sounds like a periodontist consultation is a good idea; but I have little more to go on than 'search for nearby periodontists'. I drove by one today. As for where I'd actually want to go for treatment, the OP describes that.
 

MattKW

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OK, all upper teeth hopeless and lower teeth not far behind.
Simply, I'd suggest extraction of all teeth, then get upper and lower full dentures while it heals up over a 3 month period.
If you still want to look at implants, you appear to have enough bone so a fair possibility. I would have to wonder why your teeth became so badly damaged initially with multiple decay, root canals, and crowns. Maintaining implants can also be difficult and gum infections (peri-implantitis) is more likely than with real teeth. So if your hygiene and diet has been a problem in the past, then implants may be a high-risk procedure for you.
 
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As to why so many problems, I'd cite two things: a lack of brushing, and dry mouth for unknown reasons.

That might make implants risky, but I'm not sure of a better option. I guess removable or not is one choice.

So, that's part of what's going on.

But my main topic for the thread was the difficulty in choosing an office.
 
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How is the quality of the pano xray? They did it where the machine pushed into my shoulders twice, making me move my head, so I wondered if it came out ok.

Is $600 ok for synthetic bone grafts? The local dentist is going to do some extractions and that's the bone graft price. It seems probably just a little high, but it's gonna add up with 'all teeth' extracted to what, ~$20k just for bone grafts?
 
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MattKW

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Have the extractions without grafts, then heal, then go to a periodontist for evaluation. If you have poor hygiene and dry mouth (undiagnosed), then implants won't be the correct choice.
 
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I have an appt Monday so it's an $1800 question on the bone grafts, if she takes out the expected three, hm.
 

MattKW

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I think it's wasting your money when you are nowhere near ready for implants and will be wearing dentures for some time.
 
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Don't bone grafts have to be done at the time of extraction? Aren't I close to 'ready' for implants, in terms of just extractions, heal, implants?
 
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MattKW

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No, and no. Healing is 3 months. Are you going to walk around gummy?
 
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The dentist today said $14,000 for all the grafts; that one tooth can be extracted without a graft; and that she won't do just that one, it's all or none. She referred me to somewhere I might have the grafts insured, I'll call them tomorrow and see.

As for walking around 3 months gummy - haven't really thought about it, you see the current situation. I could go either way, I'd probably get the temporary dentures if insured, but not spend thousands to have them for 3 months.

The dentists said 1 upper and about 4 lower teeth could be saved, and she doesn't recommend saving the one upper. That's more optimistic than I heard from from UCSF (and you suggested pretty much remove them all also).

I'd love to keep any I can, but understand that also conflicts with the 'good' solution of complete implants, I guess the alternatives are partials which don't seem like a good idea... So I might try to consult with a Periodontist, but have to find a good one.

She suggested one she uses... considering a foreign office, for the quality solution/affordability... $60-100K here total?
 

MattKW

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You need to get an opinion other than $14K for all grafting. You won't know the costs here unless you at least get a consultation.
I'm done and I'm bowing out. Good luck.
 
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Thanks for replying Matt. It looks like you're the only person participating here. As I said, I am planning a consult with a Periodontist, just need to select one.
 

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