Gum Recession and Exposed Tooth Roots: A Patient's Journey

Q: Gum Recession and Exposed Tooth Roots: A Patient's Journey

Hello： Surgical procedures inherently carry many risks and uncertainties, so it is advisable to communicate clearly with you before the operation. <br>1. <br>If the orthognathic surgery has been successful, it is recommended that you relax, as the most challenging part has been o

Gum recession and root exposure?

Hello Doctor, I had almost a full mouth of dental bridges at a very young age.
Last year, I started experiencing issues with my upper teeth, and I also have Class III skeletal malocclusion.
In early 2022, I had the dental bridges removed and received individual temporary crowns for orthodontic treatment (after removing the bridges, many of the roots were no longer viable, leaving only six root canal-treated teeth in the upper jaw).
In December 2022, I underwent orthognathic surgery.
I continued with orthodontic treatment afterward, but after the surgery, the orthodontist informed me that three of my upper front teeth might also be at risk (most of the roots are exposed, and the gums have receded during the surgery).
Additionally, I have significant tooth loss in the upper jaw, and due to the prolonged absence of teeth, there is extensive alveolar bone loss.
Therefore, the doctor suggested that I consider an All-on-4 implant approach for the upper jaw.

I would like to ask how long after the orthognathic surgery I can proceed with the All-on-4 procedure? Is it necessary to wait until the orthodontic treatment is completed before doing the All-on-4? Furthermore, is it reasonable for the orthodontist to inform me about the risk to my front teeth roots only after the surgery? After all, multiple CT scans and X-rays were taken prior to the surgery, and there should have been no issues to proceed with the operation.
Thank you for your assistance.

NH, 30~39 year old female. Ask Date: 2023/01/22

Dr. Lin Jiayong reply Dentistry

Hello: Surgical procedures inherently carry many risks and uncertainties, so it is advisable to communicate clearly with you before the operation.
1.
If the orthognathic surgery has been successful, it is recommended that you relax, as the most challenging part has been overcome, and the subsequent reconstruction will be relatively easier and carry less risk.
2.
If you have questions about the original treatment plan (such as transitioning from orthodontics to an All-on-4 procedure or even involving the zygomatic bone), it is advisable to seek a second or third opinion at a medical center regarding the reconstruction methods, costs, timelines, etc.
However, if you are already receiving treatment at a medical center, it is best to follow the recommendations of the physicians there.

Reply Date: 2023/01/22

More Info

Gum recession and exposed tooth roots can be a significant concern for many patients, particularly those who have undergone extensive dental procedures, such as orthodontic treatment and jaw surgery. Your journey reflects a complex interplay of dental health issues, including bone loss, gum recession, and the challenges of maintaining tooth integrity after significant dental work.

Understanding Gum Recession and Its Causes
Gum recession occurs when the gum tissue surrounding the teeth pulls back, exposing more of the tooth or even the tooth root. This condition can lead to increased sensitivity, a higher risk of decay, and aesthetic concerns. Several factors contribute to gum recession, including:
1. Periodontal Disease: Infections of the gums can lead to inflammation and loss of gum tissue.

2. Genetics: Some individuals may be genetically predisposed to gum disease or have thinner gum tissue.

3. Aggressive Brushing: Using a hard-bristled toothbrush or brushing too vigorously can wear down gum tissue.

4. Hormonal Changes: Changes in hormones, particularly in women, can affect gum health.

5. Misaligned Teeth: Teeth that are not properly aligned can place additional stress on the gums.

In your case, the presence of a skeletal malocclusion (class III) and the subsequent orthodontic treatment likely contributed to the gum recession and the exposure of tooth roots. The surgical interventions you underwent, including the jaw surgery, may have further impacted the health of your gums and the stability of your teeth.

Timing for All-on-4 Implants
The All-on-4 implant technique is a popular solution for patients with significant tooth loss or those who have experienced extensive gum recession. This method involves placing four dental implants in the jawbone to support a full arch of prosthetic teeth.
Regarding your question about the timing of the All-on-4 procedure after jaw surgery, it is crucial to allow adequate healing time. Typically, after jaw surgery, the bone and soft tissue need time to stabilize before any implant placement. This healing period can vary based on individual circumstances, but it often ranges from three to six months.
It is generally advisable to complete any orthodontic adjustments before proceeding with the All-on-4 implants. This is because the final positioning of your teeth and the alignment of your bite can significantly influence the success of the implant placement. If your teeth are still shifting or adjusting, it may affect the final outcome of the implant procedure.

Communication with Your Dental Team
Your concern about the timing of the information regarding the potential loss of your anterior teeth is valid. Ideally, all relevant information about the condition of your teeth should be communicated before undergoing significant surgical procedures. If your orthodontist had access to your imaging studies, they should have been able to assess the viability of your teeth more accurately. If you feel that there was a lack of communication or oversight, it may be worth discussing this with your dental team to ensure that you receive comprehensive care moving forward.

In conclusion, your journey through dental challenges is complex, and it is essential to work closely with your dental professionals to navigate the best course of action. Ensuring that you have a clear understanding of your treatment options, timelines, and the implications of each procedure will empower you to make informed decisions about your dental health. Always feel free to ask questions and seek second opinions if you feel uncertain about the recommendations provided.

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