As mentioned in my Timeline of Events post, dental implants can be a great treatment option when cleft patients are finished with the necessary surgeries and are ready to replace missing teeth. 
So you want to be able to smile?
While there are many options for replacement of missing teeth, dental implants are popular because they feel the most like natural teeth. You can floss around them, they are lone standing (not connected to other teeth), and the best part is the other teeth in the mouth remain untouched. 
Some qualifications do need to be met first before proceeding with dental implants:
- Meet with a prosthodontist to evaluate how the teeth come together and if there is enough space between the teeth for implants
- Adequate bone density and volume remains after bone graft procedure
- Skeletal growth is complete
- Good oral hygiene
- No other serious medical conditions that could affect implant success
What are dental implants?
A dental implant is like a replacement of the root of a tooth. Dental implants are integrated into the jawbone and are not visible from the outside of the mouth once they are placed. They are made of titanium, which is a biocompatible material, meaning it is not rejected by the body.
Will dental implants ruin my bone?
No. Dental implants, just like teeth, actually preserve the bone. You can think of it as: implants and teeth give bone a reason to be there! Dental implants stabilize bone, unless of course, an infection occurs. 
What makes up the dental implant parts?
The part that goes into the bone is the actual implant. After placement of the implant, a little cap will be screwed into the top of the implant to prevent any debris, soft tissue, or bone from getting in there during healing. This is called either a cover screw or a healing abutment.
After healing is complete (about 3 months), the cap can be removed, and an abutment can be placed. This acts as the structure to support a crown.
The crown is then what looks like a tooth and goes on top of the abutment.
Why do I need to see a prosthodontist? 
The prosthodontist will evaluate your bite and also the size of the space of the missing teeth. Measurements will be done 
, and the prosthodontist will do a mock up in wax of how the teeth would look ideally when they are finished. Using this as a guide, a template will be made using a CBCT (3D x-ray) and the model to guide where the implants should go in order to achieve the ideal location of the teeth 
. The best thing a prosthodontist does is PLAN! It is very important to allow a prosthodontist to plan the location of the implants to have a worry-free implant surgery.
Plus, I’m a prosthodontist, so don’t you want to come see me?? 
What happened to me
I will discuss the bone graft aspect more in tomorrow’s post, but I did have 2 iliac crest grafts (bone taken from the hip) that failed when I was young. In 2009, I had a successful bone graft that was actually cadaver bone and not taken from my hip. A successful bone graft in this situation meant there was enough volume and density for implant placement. Also, no bone had been lost after the graft.
About 5 months later, I had a CBCT taken, and a guide was made to best place the implants exactly where they needed to go. I had 2 dental implants placed where I was missing teeth #7 and 8. In non-dental terms, due to my cleft, I was missing my right central tooth and the tooth to the right of that one. Two months after dental implant placement, an impression was made, and the implants were then restored and finished with the crowns.
I LOVED having dental implants. I had never felt more “normal.” I was able to floss between them, bite into an apple for the first time ever, and I was smiling more than ever before. I took an x-ray every year to make sure all looked well. I never had any issues…until 2017. 
I started to notice more food getting caught in my implants, and when I would wake up in the morning, there would be dried up mucous on the top of the crowns where the implants were. I started to freak out. This was my biggest nightmare. All I was thinking was: ANOTHER SURGERY??? I can’t do this. I can’t do this again. 
I had an x-ray taken, and my fears had been confirmed. I was rapidly losing bone around the implants. In the x-ray, it was also obvious that there was a communication between my nose and mouth, and the only things “plugging” up the hole were my implants. Needless to say, I was flipping out. I had not neglected caring for my implants, and I had just had an x-ray taken 5 months prior, and the bone looked fine. I had an aggressive infection, and there were 3 options at this point:
1) Remove the implants and have another bone graft
2) Leave the implants alone and wait for them to fully fail
3) Remove the implants and do a small bone graft just to close the communication
- In this scenario, I would have to look into my other options for replacement of my missing teeth
Because I naturally just go hard at life, I chose option #1 
. I had agreed to a 4th bone grafting surgery 10 years after I had thought I was done with my cleft surgeries for good. Not to mention, I had finally finished school and was so ready to just relax and enjoy life a little bit. Then this hit me. I was so upset, and I know a lot of cleft patients would feel the exact same way.
“You have to remember this is not something that is life-threatening. It’s something that can be fixed.” 
I still remember my dad saying that to me when I called him crying in the car after my appointment with the oral surgeon. This is something that is so important to realize. Through all of these hard and difficult operations, I still CAN enjoy life. The fact that I do or do not have teeth does not define me. My dad saying this still resonates with me as I’m healing from the surgery. It really has helped me get through the difficult recovery and the complications I encountered.
Stay tuned for tomorrow’s post to see what happened next because unfortunately, the story is not over quite yet…