How a $6,000 Dental Surgery Recommendation Turned Out to Be Completely Unnecessary

A Real Case Study in Dental Overtreatment

By Dr. Daniel Choi Board Certified Periodontist

Sarah is in her early 30s and was born with a congenital condition affecting about 2% of the population—she was missing one of her adult front teeth (tooth #9). As a teenager, she wore a Maryland bridge, and then in college, she had a dental implant placed by an oral surgeon. For nearly 10 years, that implant functioned perfectly without any issues.

Recently, however, she noticed some inflammation around the implant. She went to an emergency dentist who observed bleeding and pus when examining the area. The dentist prescribed clindamycin (an antibiotic) and referred her to a periodontist—a gum and bone specialist.

The Patient's Background

The Alarming Diagnosis and Treatment Plan

At the periodontal office, Sarah received concerning news. After taking measurements and reviewing her case, the periodontist told her:

She had bone loss on the front surface of her implant
This bone loss was "inevitable"
She needed open flap surgery with bone grafting
The procedure would include membrane placement and PRF (platelet-rich fibrin) therapy
Without this intervention, she would lose her implant
Total cost: $3,000 to $6,000

Additionally, they recommended gum grafting on several other teeth, suggesting the use of Alloderm (cadaver tissue) for the procedure.

Understandably overwhelmed, Sarah did what any informed patient should do: she sought a second opinion.

My Examination: A Different Story

When I evaluated Sarah, I started with a thorough periodontal examination. Using a periodontal probe, I measured the depth of the gum pockets around her implant. Her measurements ranged from 3-4 millimeters with mild bleeding.

While not perfect, these findings indicated perimucositis—inflammation of the gum tissue around the implant—not peri-implantitis, which involves actual bone loss. This is a crucial distinction because perimucositis is much easier to treat and doesn't require invasive surgery.

But the real revelation came when I reviewed her CBCT scan (a 3D dental x-ray).

The CBCT Revelation: The Truth About Her Bone

Here's where the case took a dramatic turn. The periodontist had claimed Sarah had no bone on the front (facial/buccal) surface of her implant. When I examined her 3D imaging, I found 1.6 millimeters of cortical bone on the facial aspect of the implant.

Let me explain why this matters so much:

When we place dental implants in the front of the mouth, especially in patients with congenitally missing teeth, one of our primary concerns is having adequate bone on the outside surface. This bone is critical for:

Long-term implant stability
Maintaining gum tissue health
Preventing recession
Achieving optimal aesthetics

The reality? Sarah actually had good bone coverage. She was one of the fortunate patients who, despite being born without a tooth, had sufficient bone structure when the implant was placed. Not everyone is this lucky.

The proposed $6,000 surgery to add bone where there was supposedly "no bone"? Completely unnecessary.

Why Unnecessary Surgery Can Be Dangerous

I told Sarah directly: "If this was my mouth, I would not do this surgery." Here's why:

Risk #1: Loss of Papilla

The papilla is the triangular gum tissue between teeth. Once lost, it's extremely difficult to regenerate, leading to unsightly black triangles that are nearly impossible to correct.

Risk #2: Gum Recession

Surgical procedures can cause the gum tissue to recede, especially in patients who already have thin gums. This is particularly problematic with front teeth.

Risk #3: Creating Problems Where None Exist

Sometimes the surgical intervention itself causes inflammation, complications, or aesthetic issues that weren't present before.

Risk #4: Financial Burden

Obviously, spending thousands of dollars on unnecessary treatment is problematic in itself.

The principle here is simple: if it's not broken, don't fix it. Sarah's implant had been stable and functional for a decade. The bone was intact. We had an inflammation problem, not a bone loss problem.

The Conservative Treatment Plan That Actually Worked

Instead of surgery, I recommended a much simpler, evidence-based approach:

1. Better Antibiotic Selection

Sarah had been prescribed clindamycin, but antibiotic resistance to clindamycin is now so widespread that it's largely ineffective. I switched her to doxycycline and metronidazole (Flagyl), which are much more effective for dental infections.

2. Mechanical Plaque Removal with a Gingival Stimulator

This is a rubber-tipped tool available at any drugstore for about $5. I instructed Sarah to:

Dip it in 3% hydrogen peroxide
Gently massage along the gum line around the implant
Repeat three times daily

This simple technique mechanically removes bacteria from the sulcus (the space between the gum and crown), directly addressing the cause of inflammation.

3. Hydrogen Peroxide Rinses

Regular 3% hydrogen peroxide from the drugstore, used as a 20-second rinse a few times daily. It's antimicrobial and helps reduce inflammation.

Total cost of treatment? Approximately $20 for supplies plus antibiotics.

I scheduled Sarah for a follow-up in one month, confident this conservative approach would resolve her issue completely.

What DID Need Attention: The Gum Grafting Question

I want to be clear: the other periodontist wasn't entirely wrong about everything. Sarah does have a legitimate concern—just not with her implant.

Sarah has what we call a thin tissue biotype. Her gums are naturally very thin on certain teeth (specifically #5, #11, and #12). Thin gums are more prone to recession as we age. At 30, this isn't a crisis, but by 40 or 50, she could experience significant gum recession without intervention.

So I did recommend connective tissue grafting for those areas—but with two important differences:

Not immediately. First, we needed to resolve the implant inflammation.
Using her own tissue, not Alloderm. For patients with thin tissue biotype, cadaver tissue (Alloderm) doesn't provide predictable long-term results. It tends to relapse. Connective tissue grafts harvested from the patient's own palate are far more successful and durable.

Red Flags Every Dental Patient Should Know

This case highlights several warning signs that should prompt you to seek a second opinion:

🚩 Red Flag #1: Jumping to Invasive Treatment

When a provider immediately recommends the most expensive, invasive option without discussing conservative alternatives, be cautious.

🚩 Red Flag #2: Doom and Gloom Without Clear Evidence

Statements like "bone loss is inevitable" or "you'll lose your implant" should be backed up by thorough imaging review where the provider shows you exactly what they're seeing.

🚩 Red Flag #3: Pressure Tactics

Being rushed into scheduling surgery without adequate time to consider your options, do research, or seek additional opinions is a major red flag.

🚩 Red Flag #4: Dismissive Communication

If your questions are brushed off or you feel unheard, trust that instinct. You deserve a provider who educates and partners with you.

What Good Dental Care Looks Like

In contrast, ethical, patient-centered care includes:

✅ Taking time to explain diagnoses in understandable terms
✅ Showing you imaging and walking through findings
✅ Discussing multiple treatment options from conservative to aggressive
✅ Encouraging second opinions when appropriate
✅ No pressure or fear-based tactics
✅ Transparency about costs and alternatives
✅ Listening to your concerns and questions

The Bigger Picture: Overtreatment in Dentistry

I want to address something uncomfortable: overtreatment is a systemic issue in dentistry that we need to discuss openly.

Unlike many medical specialties, dentistry has significant subjectivity in treatment planning. Different dentists may legitimately recommend different approaches for the same condition. Unfortunately, this gray area can be exploited by offices more focused on production than patient welfare.

I'm not suggesting the other periodontist in Sarah's case was intentionally deceptive. Perhaps they genuinely interpreted the findings differently. Perhaps their treatment philosophy is more aggressive. Perhaps there was a communication breakdown.

But here's what concerns me: looking at the same patient with the same imaging, I saw a completely different clinical picture. And that should give all of us pause.

My Advice to Dental Patients

If something feels off, get a second opinion. If that second opinion is drastically different, consider getting a third. Your oral health is too important and too expensive to leave to chance.

Remember:

You have the right to understand your diagnosis fully
You have the right to see and understand your imaging
You have the right to explore all treatment options
You have the right to take time before making decisions
You have the right to seek other professional opinions

Good dentistry isn't always about doing MORE. Sometimes it's about having the wisdom and restraint to do LESS.

Sarah's Outcome

After one week of conservative treatment:

✅ Inflammation resolved
✅ Thousands of dollars saved
✅ Unnecessary surgery avoided
✅ Peace of mind restored
✅ Appropriate future treatment planned (connective tissue grafting when timing is right)

Sarah's implant, which had served her well for a decade, continues to function perfectly. Because sometimes the best treatment is the one you don't do.

Final Thoughts

I share cases like this not to shame other practitioners, but to educate patients. You deserve to make informed decisions about your oral health. You deserve providers who see you as a partner, not a profit center.

If you're facing a dental diagnosis that seems expensive, aggressive, or unclear, don't hesitate to seek additional input. The right dentist will support that decision, not discourage it.

Have you experienced a similar situation? Have questions about a treatment plan you've been given? Leave a comment below or schedule a consultation. I'm here to help.

About the Author

Dr. Daniel Choi is a board certified periodontist since 2011. He is committed to conservative, evidence-based dentistry and patient education.

Disclaimer: This blog post is for educational purposes only and does not constitute medical advice. Every patient's situation is unique, and treatment recommendations should be made based on individual clinical examination and imaging. Always consult with a qualified dental professional about your specific concerns.

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