The difficulty of finding a solution

[Whatteeth]

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?

 

[Whatteeth]

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.

On another note, nice to see a fellow Strangelove fan.

BTW, when I logged in just now, Chrome said this site had a data breach and passwords aren't safe?

 

[DocT]

If money is an issue, I would start with restorative dentist and build solid treatment plan, that you will be comfortable with. In this case you can see the whole picture - what needs to be done, how much and what what would be the time frame. Restorative dentist will be your coordinator and middleman b/w you and specialists. Graft and implants are great, but specialist needs to know, what the expected / targeted final result you are looking for. Restoring dentist is the doctor who can show you all your options,introduce and explain all aspects of your treatment, discuss your needs and your vision for the outcome. If you have knowledgeable coordinator, who can create comprehensive plan for you, you can see more alternatives and you can set up treatment phases - phased treatment is common solution for large expensive cases not covered by dental benefits. Before you start doing anything, you need a plan, step-by-step, and clear vision of final result.You don't build the house without blueprint; you shouldn't make a decision regarding your treatment until you understand all your options.
Also, I would keep as many teeth on the bottom as I can.It's hard to tell based on Panorex, but some of them look salvageable to me and they will save you some money or give you the bigger break b/w treatment phases; of course, if you decide to go this way. Keep in mind, bottom denture is not stable and very uncomfortable. If you keep any teeth,they will retain your denture in place.
Personally I prefer to place a graft at the same time as you pull teeth out. My reasons: 1 - extraction socket walls provide graft retention, keep it in place and prevent micro movement - it's easy to keep sugar in the jar than on the table top; 2 - graft surrounded by walls will receive blood supply more or less uniformly from surrounded tissues unlike implant placed on top of fully or partially formed tissue; 3 - extraction and graft at the same appointment will reduce the amount of surgeries. Every time you go back and cut the tissue, you are damaging newly formed blood vessels system; disrupt histological tissue formation potentially causing scars formation - tissue that hard to deal with.

 

[Whatteeth]

Thanks. I'm pretty sold on grafts at the time of extraction, and I'd love keeping some teeth. It worries me a little the xray wasn't clear.

I'm leaning toward paying for a consult with a local person - you say restorative dentist, is that a periodontist?

But the work - a $16,000 for the bonegrafts alone (extractions are insured), $60K-$80K for upper and lower implants...

I'm thinking implants are better than dentures, but the cost is so high, it has me thinking of looking for international for all of that.

 

[DocT]

Prices look a bit too high to me. Think careful before you make any decisions. On the bottom, I think you can go for bridge on your own teeth on one side and implants on another. Upper teeth, you can do implant crowns for the front teeth and partial removable denture for the back. If denture is not comfortable, you can gradually replace it with implant restorations - bridge. So, generally speaking you are restoring your teeth by segment. 6 segments - 6 different phases with breaks in b/w. Restorative dentist is either GP - general practitioner or Prosthodontist. They have to go first and creat plan suitable for you. After that this doctor will decide where to start and either, do it himself or refer you out to a specialist who can do specific procedure. Periodontist or surgeon can’t see the whole picture since they cover much narrower field. Just think about it. You do not need extractions, grafts or implants; you need “teeth”- that part of the tooth that you can use - crowns. Who makes crowns ? - restorative dentist. So your discussion should be with doctor who makes teeth, not implants. Treatment plan is based on amount of crowns and their position in the mouth, not immediate extraction of everything.
Also I have some concerns regarding you loosing your teeth, because they fracture at the gum line. Did you break majority of your teeth?

 

[Whatteeth]

I had crowns on many if not most of my teeth, and most of them have come off, which is why they're at the gumline.

I had the UCSF dental school look a couple times, and they say 'get all the teeth removed'. They'd said the two front top teeth and one other might be saved (before one of the two top front veneers came off leaving just a spiked tooth).

I like your optimism on saving teeth but haven't heard it from anyone who I have been to.

On the prices being high - the $16,000 for root grafts came from the last GP at $600/tooth. Well over a decade ago from a quality oral surgeon who doesn't take my insurance it was $800/tooth for extraction/root graft, no doubt much more now.

UCFS's estimate was $80,000 as I recall. I'm also going by estimates I've seen people post from "Clear Choice", a company that specialized in whole mouth implants, of nearly $40,000 each for top and bottom.

So, maybe stick with my plan, see Phrostodontist (thanks for reminding), both for plan and get an estimate, and then decide between local and international, but finding the right international seems very hard, they all look alike.

I could do this with a number of local phrostodondists, but each consult seems to be $150-$200.