Category Archives: Dental Implants

How Far Back Should Dentures Go?

I’m new to this whole dentures thing. In all honestly, I never thought I’d be without teeth at my age (42). I need to know how far back they are supposed to go. The problem I am facing is that my lower dentures do not cover the area where my wisdom teeth were and I’m chewing on gums. It’s uncomfortable. I spoke to my dentist and he told me he put them back as far as they go. How do people with dentures deal with the wisdom tooth area?

Todd


Dear Todd,

Man holding his jaw in pain

Dentures have problems. Even the best fitting dentures will reduce your chewing capacity by 50%. While you may never be completely thrilled with your dentures, there are some things your dentist can do to make this as pleasant as possible for you. Fixing this issue is one of them.

Your dentures should go past the wisdom tooth area and into the beginnning of the retromolar pad. Covering the retromolar pad completely is a bad idea because you will end up with interferance with your upper dentures, but going onto the beginning of it is fine and preferred.

So if your dentures can cover your wisdom teeth, why is your dentist acting like it can’t? While I cannot read your dentist’s mind, my suspicion is that he does not want to admit it can be fixed because fixing it means re-doing the denture completely.

If you have already paid for these, you won’t really have any leverage. You could show him this blog post and appeal to his integrity. If that does not work then you can threaten to share your experience on the review sites. This will impact¬† his business and he’ll know that.

An Additional Problem with Dentures

Before and after facial collapse
An Example of Facial Collapse

I am concerned that you have dentures at such a young age. Hopefully, your dentist warned you about the danger of facial collapse when you wear dentures for years.

When your teeth were first extracted, your body immediately began resorbing the minerals in your jawbone. It does this in order to be as efficient as possible with your body’s resources. Unfortunately, after about ten or so years you will no longer have enough jawbone left to support your denture.¬†This is known in dental circles as facial collapse. The good news is there is a way to prevent it.

Preventing Facial Collapse

Implant Overdentures
Fixed implant bridge

If you place dental implants into your jawbone and then anchor your denture to them, which is a fixed implant bridge, not only will your dentures be completely secure but it will also prevent facial collapse. The implants serve as prosthetic tooth roots and signal to your body that your minerals are needed so that your jawbone can retain your teeth.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Did My Dentist Handle My Sinus Perforation Correctly?

I had a dental implant placed. During the procedure, the dentist perforated the sinus cavity by a few millimeters, which he explained is quite common. The bone never quite filled in so he eventually ended up removing the implant. I was sedated during the procedure and no antibiotics were administered. A few days later I started having congestion in the nose and a crackling sound. I wasn’t feeling well and thought I might be getting an infection. When I went in for my follow up, he told me everything looked fine. He also said that there was no need to repair the perforation and that it would heal on its own. I told him I thought I was getting an infection and insisted he prescribe me an antibiotic, to which he reluctantly agreed. Since then, I have not had any problem with the congestion. Now I am wondering if I should have had antibiotics to begin with. He said we can try again after everything is healed up. Do you know what the time period for that typically is?

Kathey

Dear Kathey,

illustration of a dental implant

Not providing you antibiotics at the beginning, when there was no sign of infection, is not a problem. However, there are a couple of other issues here that I am concerned about.

First, the sinus perforation. While they do sometimes happen, I would not exactly call it common. Even more disturbing was the amount of the perforation. In dental terms, a few millimeters is HUGE. How did this happen? Did he do the appropriate diagnostics, which would include a CT scan? This is important because dental implants are a 3 dimensional procedure, so you need 3 dimensional images. Without that, you not only risk a sinus perforation, but damaging nearby nerves.

A second thing that concerns me is that the bone never integrated with the dental implant. Did he tell you why? Was there even enough bone there to begin with? Again, I’m curious about the diagnostics which would have given an idea about the bone support.

A Second Dental Implant Procedure

Getting your implant redone is not as simple as just waiting for things to heal. Even if you had enough bone to begin with, when the implant was removed, it would have taken some bone with it.

That bone will have to be replaced in order to even attempt a second procedure. You will need to have some bone grafting done. Then, after that has had time to heal you can get the implant done.

He also needs to answer why the implant failed. If he doesn’t know, how can he assure you it won’t happen the second time. In your place, I’d ask for a copy of the original diagnostics and then take them to another dentist for a second opinion on the reason for dental implant failure.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Can a Maryland Bridge Attach to a Dental Implant

I have two dental implants that had a natural tooth between them. Now that natural tooth needs to be removed and my dentist is recommending a Maryland Bridge. Is it possible to attach a Maryland bridge to the dental implants? I was concerned about attaching the metal to the porcelain. Have you seen this successful?

Charlie

Dear Charlie,

Illustration of a Maryland Bridge

The short answer is yes, it is possible to bond a Maryland Bridge to a dental crown. That being said, it is tricky. The ideal bond is metal against enamel, not metal against porcelain.

It would have been better if your dentist had anticipated that when you have two dental implants on either side of a natural tooth it is very likely that the tooth will eventually need to be replaced. With that foresight, he could have placed the abutments parallel to one another so that you could have changed two screw-retained crowns to a dental bridge with little trouble.

As it is unlikely that your dentist planned ahead, I would suggest your best option will be to place a third dental implant in between the two others, if there is room.

If not, then you can try the Maryland Bridge, but it will take some preparation of the crowns to make it work.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

How Can I Keep My Face From Collapsing with Dentures

I am only 32-years-old and have recently been diagnosed with a severe calcium deficiency. My dentist said this is why my teeth are always falling apart. He wants to extract the rest of my teeth and give me dentures. I have heard that getting dentures can make your face collapse, which makes you look like a grandmother. I still have two toddlers. I want to look like their mother, NOT their grandmother. Is there anything I can do which will help prevent this from happening? I am getting treatment for my calcium deficiency, but my dentist says it is too late for what is going on with my teeth.

Avery

Dear Avery,

images of before and after facial collapse

For those who are unaware, facial collapse is something that happens when you get dentures. As a result of no longer having teeth, your body immediately begins resorbing the minerals in your jawbone to use elsewhere, as a means of being efficient with your body’s resources. After all, you don’t have teeth to support any longer so you no longer need that bone.

The problem with that is after ten or so years, you no longer have enough jawbone left to support your dentures and end up looking like the woman on the left side of the picture above. This woman now looks decades older than she really is.

While there is a way to prevent this that I will go over, I don’t think you will need to have your teeth extracted. Certainly not all of them. I have no idea why your dentist is blaming your calcium deficiency for your teeth issues. That has zero impact on what is going on with your teeth now.

Your teeth are fully formed so developing a calcium deficiency in adulthood will not impact the health of your teeth. It can cause cramps, nerve damage, and osteoporosis. So why is your dentist saying this? I’m only guessing here, but dentists have different levels of willingness to fight to save teeth. Yours seems to be on the low end and all he wants to do is extract them and be done.

In your place, I would look for a dentist who is willing to put in the work to save your teeth. Don’t get anything done until you get a second opinion. See another dentist for a cleaning and check up and get their unbiased opinion. Do not tell them what your other dentist said. Just let them examine you and give their recommendations.

Preventing Facial Collapse

Implant overdentures illustation

For those who do have to have all their teeth extracted, there is a way to prevent facial collapse. If you have dental implants placed, it signals to your brain that there are still roots of your teeth there and therefore it will not resorb any of the minerals from your bone, thereby leaving it completely intact.

Once the implants are placed and integrated with your bone, then your dentist can anchor a set of dentures to them. These are known as implant overdentures and will be completely secure, unlike removable dentures.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Trying to Get Answers About Beautiful Restorative Work

I am having a hard time finding the right information just by looking online on the internet so I am hoping you can help me sort through some things. I need a bunch of restorative work including ten dental implants on my upper arch and five on my lower. I’m not as worried about what my lower arch will look like, but I do want my upper arch to look natural. Here are some of my questions.

1. Which brand of implants is best?

2. Would I be better off with zirconium of porcelain crowns?

3. I had one dentist tell me that white colored metal fused to porcelain, or gold fused to porcelain, will not show a black line, Is this true?

4. Are zirconium abutments for my implants, more aesthetically pleasing than all white abutments?

Kevin

Dear Kevin,

Implant overdentures illustation

I can tell you are working hard to do your research and you have some great questions. I’d like to steer your questions in a slightly different direction. All of your questions are about the materials. What you should be asking, if you are looking for great aesthetic work, is whether the dentist has the post-doctoral training and accuracy to provide you with solid, yet beautiful work.

If you wanted to commission a beautiful portrait of your family, you probably would not be asking about which type of canvas or paint brushes should be used, but rather who would be the best artist to do the work. It is the same with cosmetic dentistry.

First, I would look for someone with post-doctoral training in dental implants. It won’t matter how beautiful they are if they don’t end up failing. After you have narrowed down some implant dentists, I would then look for their cosmetic qualifications. Have they done post-doctoral training in cosmetic work. Smile makeovers and other types of cosmetic work are not taught in dental school. Have you looked at their smile gallery to see if they produce beautiful work? Even better, do they have someone on staff that is AACD accredited?

These are the questions you need to look into. I will correct one piece of bad advice you were given. Any dental crown that is fused to metal will eventually show that black line. Additionally, it will end up looking more opaque because of the metal base that needs to be covered.

I hope this helps you.
This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Cancer Patients Losing Teeth

I have had a long year and a half of cancer treatments. My teeth are an absolute wreck as a result. I have several teeth needing crowns and two that are so bad they need to come out. I did brush during my treatments. Though, I threw up a lot so that might be why my teeth are so bad. I heard that vomiting can cause problems for teeth. My problem now is what to do about it. I’m on a break from treatments but need to replace these teeth and I’d like to see if I can prevent this from happening further. Do you have any advice for someone in my position?

Sarah

Dear Sarah,

I am so sorry for what you are going through at the moment. I know cancer survivors and they are a tough group of people. The treatments are as hard on your body as the disease itself. Don’t be too hard on yourself about your teeth. If you underwent any radiation, that is likely a strong culprit in the deterioration of your teeth.

diagram of a dental implant next to a natural tooth

First, let’s talk about replacing the teeth you lost and then we can give you some ideas about how to prevent this during the next round of treatments. The best tooth replacement is a dental implant. It will be the closest thing to having a healthy, natural tooth in your mouth again. I would actually wait until your treatments are done because it requires a prosthetic tooth root to be surgically implanted. You want to wait until you are feeling your best for that. In the meantime, I’d get a dental flipper. It will give you a temporary tooth replacement until you are ready for the implant itself.

Caring for Your Teeth During Cancer Treatment

One thing I would recommend is that you ask your dentist for a Fluoride prescription. This will help you keep your teeth as healthy as possible during treatment. A second thing to do is deal with any vomiting situation immediately. It is the acid from the situation that eats away at your teeth. The best thing for you to do is rinse out your mouth immediately after in order to neutralize any acid.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Dental Implant Failure…again

I went to my dentist for dental implants. He’s done quite a bit of them for other people so I felt fairly confident. When he went in for the first surgery, he ended up not giving me the dental implant because he said there was not enough bone structure to retain it. He suggested we do bone grafting. I agreed to that and had that procedure done. Two surgeries down. No implant. After had time to heal, we went in for the dental implant surgery again. Yet again, he said there is still not enough bone and he suggests now that I just get a dental bridge. Here’s what I want to know, is it still possible for me to get a dental implant? Did he do anything wrong?

Kevin

Dear Kevin,

diagram of a dental implant next to a natural tooth

I am sorry you’ve had this experience. You must be very frustrated. I have some good news for you. It is very likely you can still get the dental implant. You will just have to do it with a different dentist. You asked me if your dentist did anything wrong. That’s hard to say. I am curious what type of diagnostics he did ahead of time to determine if there was enough bone structure, but other than that, it seems like he was genuinely trying his best to give you a good outcome.

Truthfully, one thing to be grateful for about your dentist is his integrity and desire to add to his skill set. Not all dentists are even interested in learning about bone grafting let alone try and do it. Plus, when he attempted to give you a dental implant the second time, after you did the procedure he suggested, and there was still not enough bone, he was probably horribly embarrassed.

Some dentists, with less integrity, would have just placed the dental implant knowing it would fail in a few years. Instead of trying to make himself not look bad, he told you the truth, looking out for your best interest rather than his. To me, that says this dentist is a keeper. So, even after you go somewhere else to get your dental implant, I would still use this dentist for all of your other care.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Should My Husband Get All-On-Four Dental Implants?

My husband needs to replace his bottom teeth. His upper teeth have been gone for a while and he has dentures there. We were told that you shouldn’t do dentures on bottom teeth because they won’t stay in the way the top ones do. Our dentist said he needs to get all-on-4 dental implants. I just want to explore if there are other options before we make a decision?

Pricilla

Dear Pricilla,

All-on-4 Dental Implants

I am curious why that is the only option he gave your husband. A dentist is ethically obligated to give his or her patients all of their options. He is correct that dentures are a bad idea on bottom teeth. While it is true that dentures will struggle to stay in on the lower arch, that does not happen right away. This is an issue because of bone resorption.

When his teeth are removed, his body recognizes that and begins to resorb the minerals in his jawbone in an effort to be as efficient as possible with his body’s resources. The big problem with that is after ten or so years, he will no longer have enough jawbone left to retain his dentures. This is known as facial collapse.

This bone structure is important no matter what tooth replacement option he chooses.

All-on-4 Dental implants (pictured above) are what dentists will sometimes offer to patients who have lost some jawbone structure but still want dental implants. However, there are other options.

Implant-supported denture

The first thing to find out is whether or not he has lost bone structure. If he hasn’t, then his best option is to get an implant overdenture. This uses between for and six dental implants and then anchors a denture to them.

If he is missing bone, depending on the amount, he has two choices. First, he can have the all-on-4 procedure his dentist suggested, as long as he hasn’t lost too much bone. The one downside to this procedure, however, is that if one implant fails, the entire unit has to be redone. A second option, no matter how much bone he’s lost, is to have a bone grafting procedure done to build it back up. Then, he can do implant overdentures if he wants. He could get a denture too, but bear in mind he will end up with facial collapse. Having dental implants in the jaw bone, prevents that from happening.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Is My Husband Reacting to His Dental Implants?

I am quite sensitive to smells and I’m wondering if my husband is having a reaction to his dental implants. His mouth and breath smell awful. He’s had the implants placed and his dentist has given him temporary, acrylic dentures. Eventually, he’ll have porcelain dentures. However, I’m wondering if we need to switch his dental implants before that happens. His dentist gave him the metal implants. I’m wondering if he is reacting to the metal and that is what is causing the horrible odor I keep smelling. I mentioned to his dentist the possibility of switching him to the zirconia implants but he acted like that was a ridiculous idea. Is it?

Kaitlyn,

Dear Kaitlyn,

Metal and Zirconia Dental Implants

I wouldn’t say you were being ridiculous. It sounds to me more like you are trying to make sure your husband is okay. Even if he doesn’t think that the dental implants are an issue, he should have been more respectful of your care and concern for your husband. I am sorry you were treated that way.

That being said, your husband’s metal implants are made from titanium, which is not only one of the most biocompatible materials around, it is also inert. The inert part will tell you the metal doesn’t really have a smell. The biocompatible part means it is highly unlikely he is having any type of reaction to it. It would be foolish for me to say that no one is allergic to titanium. Each person’s body is unique. However, I would look at more common issues first.

The first thing I would check is to see if food or other debris is getting caught in his temporary dentures. This is fairly common and can cause a putrid odor. Using something like a WaterPik, will clean things out. A second possibility is an infection. However, that almost always has other symptoms such as pain or fever. You did not mention either of those.

Switching Dental Implants

Without an extremely good reason that cannot be solved any other way, I do not recommend switching his dental implants. I am not opposed to zirconia implants. They do a fine job. The problem is what would be involved in switching them out.

First, he would need his implants removed. This takes bone structure with it. Because of that, he will no longer have enough bone to retain the new dental implants you want to place. Now, your husband needs a bone grafting procedure done to provide him with the missing structure. Once that has healed, he is onto another surgery to place his new implants. If that is succesful, he will be back to where he is now.

Each of those additional procedures has a risk of failure. If he has successful implants. Keep them.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.