Tag Archives: tooth replacements

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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Invisalign

Can Invisalign Work With Missing Teeth

I never got to have braces when I was younger. Since then, I lost a couple of teeth. I am too embarrassed to smile. I have a job and they recently hinted that they want to promote me. However, because it is an upfront position, I would need to get my smile fixed up. The job description does include a professional appearance. I was thinking I should straighten them because I have some crooked teeth, too. Do you know if Invisalign would work with missing teeth? Do I have to replace the teeth or can the gaps just be closed?

Amanda

Dear Amanda,

Invisalign aligner

Congratulations on your possible promotion. It is obvious they value your work. Invisalign can work with missing teeth. Depending on which teeth are missing, you may or may not need to replace them. One thing to be aware of is that different dentists have varying degrees of confidence when it comes to cases such as yours. I would feel better if you got about three opinions from different Invisalign dentists so you have a bigger picture in your mind.

If you do need to replace your teeth, I suggest you replace them with dental implants. They are more expensive, but they are the most like having natural tooth structure. More importantly, they’re the only solution that will protect you from bone loss in the area, which will impact your smile.

As you are trying to get the most professional appearance possible, using Invisalign will also allow you to whiten your teeth and straighten them at the same time for a fraction of the cost. This is because the aligners will double as teeth whitening trays. All you’ll need to purchase from your dentist to whiten your teeth is the professional strength gel. You won’t need the custom-fitted trays because you can use the aligners.

Best of luck on your promotion!
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Dental Implants

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.
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Dental Implants

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.

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Dental Implants

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.

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Dental Implants

Temporary Tooth Replacement before Dental Implants

My daughter has a congenitally missing tooth. Our plan is to replace it with a dental implant once her jaw is completely developed. In the meantime, we have done orthodontics and have the space opened up. Our dentist provided a Maryland Bridge for the temporary tooth replacement as we wait for her jaw to grow, The problem we are having is the bridge keeps falling out. She used the ceramic wings. At first, she thought she’d just need to try a different cement, but that didn’t help. Now she’s thinking that maybe metal wings will stay better. My only concern about that is the metal will look darker and affect the appearance of her teeth. Is there something we are overlooking?

Lacey

Dear Lacey,

I can tell you are a good mother and are doing everything in your power to give your daughter the best care possible. Your choice of a dental implant is a great one and will serve your daughter well.

One of the things you are running up against here is your dentist, though I am sure she has good intentions, does not understand how a Maryland Bridge works.

First, you should know these are not meant to be temporary tooth replacements. In order to get these to stay on your teeth properly, there actually needs some tooth preparation on the adjacent teeth, as seen in this image below.

Maryland Bridge Tooth Prep

A small notch needs to be added to the tooth to help keep the bridge in place. My guess is your dentist is just trying to keep these on with the bonding alone, which will not work.

Switching to metal wings, won’t be a great solution either. It is actually easier to bond porcelain to natural tooth structure than it is to bond metal. So by switching, she is actually making it more difficult for the Maryland Bridge to stay on.

What Makes a Good Temporary Tooth Replacement?

The reason I do not consider the Maryland Bridge a temporary tooth replacement is because of the necessary tooth preparation. The structures of the prepared teeth are not permanently damaged. Once you remove the bridge to place her dental implant, those notches will still be there and y ou will need to fill the are with some composite bonding.

Demtal flipper

Instead, I am going to recommend you get your daughter a dental flipper. Because these are much less expensive, not only will you save a lot of money over a Maryland Bridge, but they will do no damage to her teeth, so it is a safer option as well.

My suggestion is you ask for a refund on the Maryland Bridge and get a dental flipper instead.

When it is time for your daughter to get her dental implant, make certain you research the dentist carefully. This is an advanced procedure that requires post-doctoral training. There are many dental implant horror stories that would have been avoidable if the patient knew to check the dentist’s implant training.

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Dental Implants

Dental Implants for Hockey players

Help! My son is a recent professional hockey player. He recently had a tooth knocked out. We’d done some research and read that dental implants are the best replacement. However, his teammates who have been in hockey longer have told him that implants aren’t a good idea. But, we don’t want to leave the space open because he’s getting married in a little over eight months. Do you have any suggestions?

Karlee

Dear Karlee,

I’m glad you wrote. What his teammates are trying to prevent is secondary injury. When you get a dental implant, a root is surgically placed into the bone of his jaw. Then, after a time of integration with the bone, there is a dental crown bonded to the root implant. Here’s the problem with that for your son.

If he has another puck or hockey stick to the mouth, which is likely in his sport, because of the bonding of the crown and implant, it will likely damage the bone in his jaw, requiring serious reconstructive surgery to fix. However, that doesn’t mean your son has to go without a tooth until the end of his career, and certainly not for his wedding.

Here is my suggestion. When a tooth root is missing in a jaw, your body begins resorbing the minerals from the bone in the area. This will lead to serious problems, so you don’t want to leave the area of the tooth root empty. Because of that, go ahead and get the implant surgery done. This will place the root form into his jaw and protect him from bone resorption. However, do NOT have the dental crown bonded.

Instead, he can use a temporary tooth replacement that is removable, such as a dental flipper. It will give him a tooth for the open space, but if his mouth is hit again, it will give without any consequences to your son’s jaw.

Once he is no longer playing hockey, then he can have the dental crown permanently bonded onto his dental implant giving him a secure tooth.

Best of luck to both of you and congrats on the upcoming wedding.

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Dental Implants

Zirconia or Titanium Implants

I have three titanium dental implants and recently read that the titanium can cause neurological ill effects. I am now in need of another dental implant. Should I get the zirconia kind this time? Are they better? Should I switch out the titanium ones as well?

Carolyn

Dear Carolyn,

zirconia dental implants

I’m not sure where you read that titanium causes neurological effects. As far as I know, there are no studies with data that supports that. On the contrary, there are decades of data that show titanium to be highly biocompatible in dental implants as well as a large number of other titanium prosthetics, such as knee and hip replacements.

If you want to get a zirconia dental implant, for your new tooth replacement that is fine. You may need to do a bit of internet searching and phone calls to find a dentist who does them. Because they’re considered new, not all dentists are using them yet. You will be able to find someone though. Zirconia is definitely strong enough to work and more dentists are starting to use them. The only concern you may run up against is we don’t have the same data on their longevity the way we do their titanium counterparts. That doesn’t mean they won’t last as long, just that we don’t have the data.

As to whether or not you should switch out your current implants, I wouldn’t recommend it without a good reason to remove them. It is not simply a matter of taking out the old implants and then putting in new ones. When you remove the implants, bone will come with it. In order to place the new dental implants, you will need to have an additional procedure known as bone grafting done. Then, once that has had time to heal, you can then have the new implant placement surgery.

It’s a lot to go through and a huge expense when your dental implants are probably just fine. Plus, there is always a risk the new implants will fail. I’m sure you will find a dentist willing to do the procedure. I just want to make sure you understand what you’re getting into before moving forward.

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