Need opinions on complex dental reconstruction and bone grafting decision
Hello everyone, I’m currently facing a very difficult decision and I’m hoping that someone here may have had similar experiences or can share their opinion. I have been in orthodontic treatment for over 10 years. Unfortunately, the results were only partially successful. I still have fairly misaligned teeth and a crossbite. In addition, I had an impacted supernumerary tooth (tooth 15) that went unnoticed for many years. Because of this, there is now almost no bone left in that area, and the adjacent teeth (14 and 16) have already been affected. I only found out about this tooth quite late. The X-rays were never properly explained to me at the time. My orthodontist once simply told me I had a “replacement tooth” there in case a lower tooth would be lost. Apart from my dissatisfaction with my current tooth alignment, I now have a much bigger problem: the bone loss is progressing, and there is a cyst-like lesion with recurring inflammation. I would generally like to undergo orthodontic treatment again, as I feel the remaining teeth should still be properly aligned. I have already consulted several orthodontists. However, they all say that while the other teeth could be straightened, the area around tooth 15 cannot be treated orthodontically in a meaningful way due to the severe bone defect. I still have all four wisdom teeth. The surgeon who extracted teeth for me in September last year intentionally left them as possible “reserve teeth.” There was even discussion about transplanting a wisdom tooth into the affected area. However, this seems very difficult due to the lack of bone. On the current CBCT (DVT), the bone defect looks just as severe, if not worse, than immediately after the extraction. I have now been offered the following treatment plan: * Removal of the affected upper teeth from the 16 region * Treatment of the inflammation * Bone grafting using bone from the iliac crest (hip bone) * Soft tissue and gum reconstruction (including palatal tissue) * A temporary prosthesis during the healing phase * Placement of implants once everything has fully healed and stabilized I am only 20 years old, and I am honestly very unsure. On one hand, I would still prefer to correct my teeth orthodontically, but on the other hand, all doctors I have seen advise against it and recommend implant-based rehabilitation as the most realistic solution. I also need to pay for the entire treatment myself, as neither the insurance nor orthodontic care for this situation is covered once you are over 18. I was also told that I need to decide within the next six months. Otherwise, there is a risk that the neighbouring teeth will continue to drift into the defect, which could worsen the situation further. I am attaching my current X-ray and the cost estimate. I would really appreciate any experiences or opinions, especially from people who have dealt with similar bone loss, iliac crest bone grafts, or implants at a young age. Thank you very much in advance for any advice.
