Q.
Hi Dr.Andrew Moore, I would really appreciate some of your time and expertise on a somewhat drawn-out string of events because your work looks so great. I’m doing research on my titanium implant; because I don’t like the way that it looks and I am very hesitant to complete the treatment with my current practioner(s). In September of 2007 I broke off the bottom half of my right front tooth. I went to the dentist and had a root canal the next day. At my 1 month follow-up appointment to start preparing the crown, she asked if the tooth was loose- I said no and she told me that it was cracked up the root and would need to be extracted. From there, my best option would be to have an implant. I had the tooth pulled about three weeks later; after a treatment partial had been constructed to fill the gap in the front of my mouth until the permanent crown could be put on. I had the titanuim implant put in by a periodontist a month or two later and was told to come-back a few weeks later to check for infection. When I was consulting with the periodontist before the proceedure, I told him that I did not like the discoloration (the gum looked grey because the root was substantial enough that having it pulled left a shadowed indentation) he told me that he would graft skin during the proceedure to “puff out” the gum a bit, bringing it in line with the rest of my gums. He did not do a skin graft; at the time he installed the rod, he said he had decided against a skin graft because my gum had grown in so well around the extraction site and the fill of the titanium post would be enough to make the gum look natural. I went to the next appointment and the implant had healed well. I scheduled a second follow-up for x-rays to be performed three months later. I never went to my x-ray appointment because I got pregnant in that period, and feeling that it was not medically necessary, wanted to avoid an x-ray. Now I’m in a position where I need advise: I will have my baby mid-march and will be able to complete the proceedure at this time. The problem is that my gum still looks bruised (the grey metal underneath is visible) and I don’t want to have the tooth put on before I KNOW it’s going to look good. I hope I don’t sound too shallow, but I have been very self-conscious of how my once-beautiful smile looks since all this began. My husband thinks that when the crown is put on the implant, it will push the gum up and will look much better. I am not as confident. Looking at your implant picture on this site gave me hope that I can have a good out-come but I need to find-out what this will take. Should I ask the periodontist to do the skin graft like he said he would, or will the crown push the gum up, concealing the titanium below? Or does some other form of cosmetic concealing need to be applied to make it look like the rest of my gums? If I feel like the periodontist cut a corner to speed up the proceedure, should I just find a new periodontist who I feel does good work or should I just go through him because he knows my case? Finally, did my tooth need to be extracted? It was cracked up the root, but the top of the crack was only about two millimeters above the gum line in an upside down U shape on the back of the tooth. Is it possible that a crown could have been put on with a small incision up the gum? Or did the necessity for a root canal prevent this possibility? Any advice or information you offer me will be greatly appreciated. Thank you again for your time, sad mama