Back to the oral surgeon

I went back to the oral surgeon to discuss how to progress, the plan, and insurance.

First we went over the dental plan. First a surgically assisted palate expander would be placed in my mouth by Dr. F. Then I would go to Dr. S and he would cut into my gums to break some bones in my mouth. I didn't ask too many questions about this since the thought of it grosses me out, this is why they have anesthesia. But this is a necessary step since my bones are fused and wont move the way the palate expander would make them. The recovery time for this is about a week and I will be swollen. Dr. S didn't tell me if I would have any pain, but I read a bit about this on the internet and there isn't any real pain. Then I would have to crank the palate expander twice a day for around 2 weeks - how long will depend on how much Dr. F wants to expand. Once I'm expanded I will have gaps in my teeth, Dr. F told me he would put on some temporary fake teeth so things look good in the meantime.

Approximately 4 months later I will be ready for the bone graft. The bone graft would likely be taken from my shin just below the knee. Some fancy synthetic bone growing stuff thing would also be used to help the bone grow in. Dr. S estimated that the recovery time for this would be closer to 2 weeks because of the grafting from the leg, I would probably have a limp for a good week. The palate expander could be taken off at this time since the bone will fill in the gap created. After another 4 months they'll do some x-rays to see how the bone graft set, if it has set then I will be ready to start with the implants.

At this point no one knows how many implants I will need, there are currently 3 teeth that are candidates and the gap would create a spot for my missing lateral incisor, which would be a 4th. My left canine, which is part of the two tooth cap/bridge with the bicuspid, may not (and it sounds like wont) be salvaged because of the lack of bone in the area of the tooth's root. That will be decided at the time of the bone graft. The bicuspid, which is set back in my mouth, is also an unknown. As I recall the tooth was in good condition before it was capped, but may have broken down since then, that tooth is an unknown until the cap is removed. My front tooth is another tooth that may have to be removed. About a year and a half ago I had the tooth capped, ever since then the tooth has been a little loose and it occasionally hurts, particularly if I bite into harder foods. It could be from the tooth having to deal with a cap, or from lack of bone, though Dr. S thinks there is good bone (though not perfect) to hold the tooth. A decision will be made about that tooth prior to the bone graft.

Then we talked about prices and insurance. As I previously stated Dr. S does not take my health insurance and my insurance does not provide out of network coverage. I have 2 options: pay out of pocket or change my insurance. Dr. S said that if I opted to pay out of pocket he would discount me and he would charge $3000, I would also have to pay around $1500 for an anesthesiologist. This would be done in the office, but this would only cover the palate expander. The insurance girl did say that I would still have out of pocket expenses of around $3000 with insurance, that sounded high but she also didn't know what exactly was being planned and what surgeries would be done so I'm not going to get stuck on that amount. But with insurance I wouldn't be paying for the anesthesiologist. I'm sure I'll be in contact with her again.

Changing my insurance is slightly more complicated and will delay things until next year. My insurance change period is in the fall and the change takes effect for January 1. Then they would still have to get approval for surgery which will take another 6-8 weeks. I wouldn't get started with things until late February. If I did wait though I would be able to set up a flex-spending account, where you put pre-tax money into an account to pay for medical expenses and then get reimbursed as you pay out. This could save me a bit of money, especially when looking at $9000 for braces and the out of pocket expenses for the 2 surgeries.

The other issue is that even if I decide to pay for the palate expander I still have to have the bone graft. I'm not independently wealthy, I can't afford another $5000 for that, assuming it would only cost $5000. I suspect it will cost more because it is a more complex procedure. So, I would still need to change my health insurance no matter what.

If I opt to pay out of pocket for the palate expander and change insurance for 2009 to cover the bone graft then I should probably wait until October or November to do the palate expander. That's assuming 4 or 5 months after the palate expander until I could get the bone graft. And I would also need to allow another 2 months to get approval for the bone graft. So paying out of pocket for the palate expander would only save me 3 or 4 months of a delay.

The other factor is that if I pay out of pocket then I would have the palate expander done at the office, if I wait and use health insurance then it would be done in the hospital.