Category Archives: Dental Implants

Dental Implants

Dental Implant Incompetence

Can you help me? I had two dental implants placed. One of them felt loose to me. I went back to the dentist and he did an x-ray and said that the implant itself was fine. He felt it was just a matter of the dental crown being loose. He said that was easy to take off and cement back on. He started to work on it but it felt stuck, so he got some special tool. He was yanking hard. But, when the crown came off, the dental implant came with it! Do implants usually do that with tough crowns?

Jeremiah

Dear Jeremiah,

illustration of a dental implant

I actually had to take a step back and walk away for a moment after reading your experience. The level of incompetence that it would take for your dentist to do this is almost unbelievable. Obviously, it was not the crown that was loose. If a crown is actually loose, then it will usually fall out without any assistance at all from the dentist. I’m not sure how in the world it did not occur to him that the problem was the dental implant itself once the crown didn’t easily slide off. It’s almost unfathomable to me.

While I am only guessing here, the amount of incompetence necessary to do this makes me wonder if he realized what the problem was and was trying to cover it up. To fix a loose crown is easy. To fix a loose implant is a big deal.

You didn’t say when this crown was placed in relation to the implant placement. It’s possible that your dentist didn’t give enough time for the bone to integrate with the implant. This is known as premature loading and can lead to the implant coming loose. Another common problem is an infection, but that is usually accompanied by pain and fever, neither of which you mentioned. There are others as well.

I’m going to recommend that you have both of these sites looked at— the one with the lost implant as well as the implant that is still there to see if an expert implant dentist can figure out what went wrong here and if your second implant is safe. Look for someone with post-doctoral training in implants as well as a high success rate (no less than 97%). When you go, don’t tell them who the dentist is that did the work. They may know one another, which can lead to a friendship conundrum for the dentist.

Replacing the failed implant will require some additional work, such as bone grafting to fill in the lost bone, but it can be done. I also think you can get a refund on the failed implant.

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Dental Implants

Implant Bridge Does Not Match My Bite

I had a dental implant bridge placed, but it does not match up with the rest of my bite. Now the side of my teeth with the dental bridge hits first when I bite down, which hurts a LOT. I am wondering if the surgeon did something wrong. He insisted that he was in charge of the whole thing, but when I went to see an implant dentist after my surgery and he said that he would have recommended a different placement. I don’t know what to do here.

Kate

Dear Kate,

implant bridge
An example of a full arch implant bridge

I am glad that you wrote. It sounds like the surgeon threw off your bite with improper placement of the dental implants. This needs to be fixed. If it does not get fixed, it could very likely lead to TMJ Disorder.

It is a basic principle of implant dentistry that it is the restorative dentist who plans the placement, not the surgeon. Yet, your oral surgeon assured you he was in charge. If you can get your dentist to admit that the oral surgeon placed them in the wrong place then you can get a refund from him. I would also ask him to pay for the bone grafting you are now going to need.

Replacing dental implants is not as simple as taking out dental implants and then putting in new ones. When the implants are removed, they will take bone with them. That bone is necessary in order to retain the dental implants. Because of that, you will need a bone grafting procedure to build back up the lost bone.

Then, once the bone grafting is healed, you will be able to have the new implants placed for your implant bridge. Just make certain that your dentist plans the treatment and NOT the surgeon.

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Dental Implants

Dentist Can’t Get My Implant Crowns to Match

I have two implant crowns that are visible when I smile. Before getting the crowns, I had a dental flipper. It matched my teeth okay. These crowns however are obviously different from my teeth. My dentist has switched them three times. He’s pretty frustrated with me and said that I am way too picky and that my teeth are between two shades and I should just be grateful that I have teeth. Am I being too picky? He also said that if he keeps switching out the crowns I could lose the implants. I don’t want to do that either. Help.

Sandy

Dear Sandy,

illustration of a dental implant

First, I can already tell you that you are not being too picky. The fact that you were happy with the dental flipper is evidence of that. Your dentist isn’t being honest with you. If the dental implants are placed correctly, then they will not come out because your dentist switches the crowns. If he didn’t place them correctly than they would be at risk either way.

Matching porcelain crowns, especially ones on front teeth are difficult to match. Even the best cosmetic dentists will need two to three try-ins before they get the match exact. Though, most dentists are smart enough to use a temporary try-in paste so that they can make those changes without dealing with the permanent bonding cement.

Unfortunately, I do not think that your dentist can do this. If he’s saying the problem is that your teeth are between two shades, then he does not have the cosmetic skill to match them. He’s just using the standard shade guide and not going beyond that. Ask for a refund on the dental crowns and tell him you’re going to have that part done elsewhere. The dental implants are fine, so do not ask for any money back on that.

color map for a tooth The standard shade guide is sufficient for back teeth. However, teeth that are visible to the light when you smile need some adjustments made. This is when your dentist would create a color map for the ceramist. It would add different shades and tints to the tooth in a way that helps it the match your adjacent teeth exactly. It takes a lot of cosmetic training and an understanding of color theory to make this work.

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Dental Implants

How to Avoid Dental Implant Failure

I have some questions regarding dental implants. First, my dentist wants to add a CT scan to my diagnostic tests. That seems like overkill to me and just a way to get more money. My second question is more on the type of implant fixture to get. I want one where the parts will be easy to replace. Can you advise me on that?

Alice

Dear Alice,

zirconia dental implants

You have asked great questions. Let’s start with the CT scan. This is actually very important. While you will be able to find a dentist who will give you a dental implant without doing a CT scan, you will not want that dentist. They would just be giving you what you want in order to draw in your business without having your best interests in mind.

The reason that you’d want a CT scan is because it gives a 3-dimensional image of the area. This is important because getting dental implants placed is an advanced procedure where many things can go wrong such as perforating your nasal cavity or hitting a nerve. The resulting images from the CT scan can prevent that. Some dentists trying to skimp will use short implants thinking they won’t have to worry about the nasal cavity that way. But, those are not sturdy enough in the long-term.

As for the type of implant, I would not focus on what has easily replaceable parts as much as which manufacturers have the best quality control. Dental implants have to be made to very exacting standards, otherwise you risk dental implant failure. This is another area where some dentists will take the “cheap” road. They can save hundreds of dollars per implant by doing a cheap implant fixture from overseas, but this causes you serious problems in the long run. The implant is much more likely to fail. However, it will fail a year or more down the road so it would be difficult to prove the implant was at fault.

Most excellent implant dentists I know use implants from one of the following manufacturers:

  • Straumann
  • Nobel Biocare
  • 3i
  • BioHorizons
  • Zimmer
  • Astrotech

The key here isn’t for you to know everything there is to know about dental implants and make sure your dentist does them. There is not enough time for you to learn what takes dentists years. Instead, focus on finding a dentist with good post-doctoral training in the dental implant procedure (not just dental school), who has done a large number of cases with a high success rate (no less than 95%).

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Dental Implants

Dental Implant Failure Disaster

I had to get a dental implant because of a serious infected tooth. I had a crown but there was another infection, so the dentist said it had to be pulled.  He suggested I get a dental implant. When he gave me the Novocain for the tooth extraction, it felt like the needle went into my brain. Ever since then, I’ve had a burning in my mouth that is driving me crazy. I complained about it on every check up appointment for my dental implants, but he kept saying it was normal and would go away after a few weeks. Then, it came time to place the dental crown on the dental implant. He had trouble getting it on and had to press it super hard. It hurt like mad the entire time. While I was at that appointment, I told him the burning was still happening. He said it was Thrush, which seemed like an excuse to me. He did give me an antibiotic but that didn’t seem to help.

Then, a couple of months later, I was on vacation and the crown just fell off. I went to see a dentist there who told me that the implant was infected and needed to be removed. Now, I’m stuck with no tooth. I don’t think I want to go through everything with a dental implant, so am thinking of getting a dental bridge. Is there a way I can get the dentist to refund me for the failed implant?

Carl

Dear Carl,

illustration of a dental implant

I am sorry this has happened to you. What a disaster! The burning in your mouth that you’re feeling is burning mouth syndrome. It is obvious to both of us that you did not have thrush. He just used that as an excuse. The common denominator  for people with this condition is a traumatic dental appointment, which you certainly had.

As to whether you can get a refund, you can always ask. If the dentist has integrity he will want to do the right thing about a failed implant. I suspect he will not give you the refund. In that case, you have limited options. You could take him to court, but you’d have to prove that he was at fault. It would be helpful to have another dentist on your side for this. I think the failed dental crown is more easily provable.

I have some doubts about the infection because you didn’t mention anything about pain or a fever. Those usually follow an infection.

If you don’t want to start over with a dental implant, a dental bridge is your best second option. I still think an implant is possible, but you’d want to do it with a different dentist.

Given that you’ve had some traumatic dental appointments, I want to suggest  that you see a sedation dentist. This will give you a pain-free/anxiety-free dental appointment.

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Dental Implants

Deformed and Missing Teeth

I have a problem with both of my lateral incisors on my upper teeth. One of them is completely missing and never came in. The other is smaller than it should be. I want to fix this before I go to college. I have a dental flipper for the missing tooth area currently, but my parents were told that the flipper should be temporary. They both passed my senior year of high school. I stayed with some friends until graduation. I was going to use their life insurance for college, but I received a great scholarship so now I am free to use the money to fix my teeth. Do you have any suggestions?

Caroline

Dear Caroline,

illustration of a dental implant

I had so many emotions reading through your question. First, I want to express my condolences at the loss of your parents while you are yet so young. Next, I want to say congratulations on your scholarship. That is absolutely fantastic, especially given all the difficulties which you experienced during your senior year. That says a lot about your perseverance.

As to your tooth, I am going to suggest that you replace the congenitally missing tooth with a dental implant. This is the most secure tooth replacement we have. It is expensive and does require surgery, but as young as you are, it will be important in order to preserve the bone structure. You may even need some bone grafting done before the implant is placed. There are other options, such as a dental bridge, but the implant is the best option.

As for the other tooth, I am going on the assumption that it is a deformed tooth and not a baby tooth still left in place. On that assumption, you will want to use either a porcelain veneer or a porcelain crown depending on how small the incisor is.

The trick with both of these procedure will be matching the color of the implant and other restoration to the natural teeth that are adjacent to them. These are very visible teeth, which means light hits them exposing all their variations.

You will need an expert cosmetic dentist to get this done right.

Best of luck to you at university. I have a feeling you are going to accomplish great things. This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

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.

Dental Implants

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.

Dental Implants

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.

Dental Implants

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.