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Preventing Dental Implant Failure

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I had a couple of friends who had dental implants done. One of them was successful and the other was a failure. The one who had the good case had a CT scan. The other didn’t. Is a CT scan the trick to a successful procedure? The other question I have is the type of implant. A dentist I am looking at uses Southern Venturi. Neither of my friend’s dentists used that. Is this a good implant?

Carlton

Dear Carlton,

An assortment of titanium and zirconia dental implants.

I do love it when patients do some research. Like you, they usually have good questions when they come to their consultation appointment. Let’s start with the CT scan. I would consider this a non-negotiable. It isn’t a guarantee of a successful procedure, but greatly improves the chances. The reason for this is the nature of dental implants. It is a 3-Dimensional procedure. Because of that it requires 3-Dimensional scans. Doing this ensures that your dentist knows if you have sufficient bone support. It is also a way to make sure that your dentist will not accidentally bump into a nerve or perforate your sinus cavity during to procedure.

As for the type of dental implant fixture, I am not familiar with Southern Venturi. It is important that these are manufactured to exact standards. There are some fixtures that the best implant dentists tend to favor. These are:

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

I’d like to also add that the most important part of the dental implant procedure is choosing the right dentist. This is an advanced procedure. It is also the leading cause of dental malpractice suits. Dental school training alone will not be enough. You will want to make sure you go to a dentist who invested in post-doctoral training in dental implants. You also want a dentist with a high success rate. I would expect it to be a minimum of 95%. You won’t find one that will be 100% because even if a dentist does everything right, there can still be some case failures. Sometimes, the human body just rejects a treatment.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.
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A Case of Dental Incompetence

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I had a dental implant placed. A few weeks after it was finished I noticed it felt a bit loose. I went back to the dentist. He felt that it was just the crown that was loose and all it needed was to be re-bonded on. That sounded like good news to me but he started having trouble getting it off. Then, he tried with this special tool. When he pulled on the crown, the entire dental implant came out. Is this normal? Is there a way to fix this?

Danny

Dear Danny,

metal and zirconia dental

I would love to hear how your dentist explained that! No, that is not normal. It was obviously not your dental crown that was loose, but the dental implant the whole time. When the crown did come off when he first tried, he HAD to know that it was really the dental implant that was loose. The amount of incompetence it would take to not realize that is almost unfathomable. Fixing a loose crown is simple. Fixing a loose implant is not. The thing to figure out is why was the dental implant loose to begin with.

Some Causes of a Loose Dental Implant

I don’t know the exact timeline of when your dental crown was placed, but one cause of a loose implant is from what is known as premature loading. This is when the dental crown is placed before the bone has had time to integrate with the dental implant fixture.

Another reason would be an infection. There would usually be pain and/or fever with that. You did not mention either so I tend to think that is not the problem.

Fixing this issue will not be as simple as just replacing it with another dental implant. Instead, you will need some bone grafting done first in order to build up the bone that was lost when the implant was pulled out. After that, then you have to start over with the implant procedure.

In your place, I would demand that your dentist pays to have this repaired, including the bone grafting. You should be the one to pick the dentist to do the repairs. Make sure you get an expert implant dentist to do the work. Take a peek at Dr. Marion’s bio to get an idea of the type of post-doctoral training and expertise you want in an implant dentist.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Temporary Tooth While Waiting on Dental Implant Crown

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I am getting a dental implant. I’ve had the implant part done and we’ve been working on the temporary replacement tooth while I heal. My dentist suggested a Maryland bridge. We used the ceramic wings because we thought that would be more esthetic. However, it keeps falling off. One of the adjacent teeth is a natural tooth the other is a porcelain crown. My dentist tried a stronger cement and that did not work either. Now he is considering the metal connectors. Will that cause discoloration to the tooth?

Evan

Dear Evan,

Two illustrations. One of a Maryland bridge being placed and another of the notch that has to be placed into teeth to hold it in place.

Yes, metal will cause some discoloration. However, there are even bigger issues to consider here. I don’t think your dentist understands how a Maryland Bridge works. It cannot simply be bonded to the adjacent teeth. That is why it is failing. It does require bonding. However, there also needs to be a notch made into the tooth in order to help retain it. You have an additional complication where one of your adjacent teeth is a porcelain crown and not a natural tooth. Bonding holds better to natural teeth, so that other one will be at a greater risk of failure.

Whenever you have to make a change to the structure of the tooth, I would not call that a temporary tooth replacement. Because you’d have to drill that notch and the replace the missing structure with some dental bonding, I would say that is permanent damage. Most dentists would suggest you simply use a dental flipper until the crown for your dental implant is ready to be placed. Not only will this not require any structural changes, but it is also significantly cheaper than what your dentist is currently using.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Will Dental Insurance Help with Dental Implants?

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I need to get some dental implants but am having some financial problems. Is there a dental insurance I could get that would pay for the procedures?

Jen

Dear Jen,

dental implant diagram

When it comes to dental insurance and dental implants, if you already have insurance it will likely pay for a percentage of the procedure. It will not cover the entire cost. How large a portion depends on the policy you have. In most cases, insurance is more likely to cover the least expensive option. In the case of a tooth replacement, that would be a removable partial denture, which has a lot of problems.

If you do not already have dental insurance, then don’t expect to purchase a plan and think it will cover any portion of your dental implant. Usually, with new policies, they’ll immediately cover things like cleanings, etc. However, big procedures, such as dental crowns or dental implants will have a waiting period. This is often about six months to a year. The reason for this is there are people who try to purchase insurance, get the super expensive procedure, and then drop the policy. Companies would go out of business quickly if they allowed that.

If they only cover a portion, is it worth it to you to get dental implants? Absolutely, if you can. They are the closest thing to having a healthy, natural tooth in your mouth again. They will be completely secure, protect your bone structure, and not require and structural changes to your other teeth.

If you cannot afford implants, there are other reasonable options. The next best choice for you would be to get a dental bridge. This suspends a false tooth between two dental crowns. This makes the most sense if you need a crown on one of those teeth already. But, if you don’t and can’t afford the implant, it is a good, sturdy tooth replacement.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Maryland Bridge Before a Dental Implant

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My preteen has a congenitally missing tooth. She’s getting to the age where it really bothers her. We’ve finished orthodontics to move her teeth in a way that makes space for the missing tooth. Our long term plan is to get her a dental implant, but know she is too young for that now. Our dentist suggested that we get a Maryland Bridge as a temporary replacement so that her teeth do not shift while we wait on the dental implant. She used non-metal wings for them, which I was grateful for, but the next day the bridge fell out. Our dentist then ordered some new, stronger cement, but again, it fell out the day after she put them on. Now, our dentist is wanting to use metal wings. I do have some questions though, given recent experience. Please advice me on this.

1. Will the metal bond well enough to last the six years we need for her to get the dental implant?
2. Will the metal show through much? This is a visible tooth?
3. Will there be any cosmetic damage to the tooth when we remove the bridge?

Martha

Dear Martha,

illustration of a dental implant next to a tooth

First, I want to congratulate you on making such a great choice for your daughter’s tooth replacement. Dental implants are the best option and will not only give her a secure tooth, but will also preserve the bone in that area.

I can tell that your dentist means well and is trying her best. However, I believe she may be out of her depth here. It does not appear that she has technical knowledge and skill which she needs to do cosmetic bonding.

Images illustrating the placement and preparation for a Maryland BridgeEven with metal wings, I do believe she will end up having the same struggles. Bonding on a Maryland Bridge is not simply a matter of cementing the wings onto the tooth. It requires some tooth preparation as well, such as the notch you see in the image directly above, to help secure it. This notch removes tooth structure and will have to be filled in with dental bonding after the Bridge is removed.

Anything that makes a permanent change to the tooth does not sound to me like a temporary tooth replacement. What you want is something easily removable that will not require any structural changes to the adjacent teeth. I recommend you get a dental flipper instead. These are inexpensive and are super simple to remove when she is ready for her dental implant. In fact, your daughter could pop it in or out herself if she wanted to.

I am a bit concerned that your dentist may not be qualified to do the dental implant, which is a much more advanced procedure than what she is struggling with now. In your place, I would recommend that you find a dentist with significant post-doctoral training in dental implants. Look at Dr. Marion’s bio to get an idea of what type of training your dentist will need.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

 

What are the Best Materials for Implants and Crowns?

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I am getting a smile makeover, which will probably include at least eight dental implants on my upper arch. I am trying to do my homework ahead of time and have some questions. First, as far as implants go, are the Astra Implants from the UK reliable?  I also wondered if zirconium was okay for crowns. I did read that porcelain fused to metal can leave a black line, but wanted something strong. I’m worried zirconium will be clear colored, though. Any help you can give will be appreciated, my appointment is coming up fairly soon.

Valerie,

Dear Valerie,

An assortment of titanium and zirconia dental implants.

 

I am glad you are trying to do research. However, I would like to steer you in a different direction. The most important thing to research is the dentist doing your dental implants procedure. That has a much greater impact on your result than the materials used. Before we get into what to look for, I want to ask you a question. You mentioned that the reason for your dental implants was a smile makeover. However, unless the teeth needed to be extracted, that is a gross overtreatment. The typical procedure for a smile makeover is porcelain veneers which hardly removes any tooth structure. A dental implant requires you to lose the entire tooth.  I just want to make sure the implants were necessary before you go through with this.

Dental implants are quite an advanced procedure. So advanced, however, that dental school is not enough training. It takes significant post-doctoral training to be able to do this the way it needs to be done. There is no way you can learn enough about the materials in the time you have. Plus, so much of it will also depend on your specific case. Look for a dentist with implant qualifications. As for the zirconium. That will be white, not clear. I hope that puts your mind at ease.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

 

Dentist Can’t Match My Implant Crown because I’m “Between Shades”

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I have a dental implant that was placed on a front tooth. While waiting for the healing time to take place I wore a dental flipper. It didn’t completely match the adjacent front tooth but I knew it was temporary and that the porcelain crown would be better so I tried not to think about it too much. Unfortunately, my experience with the dental crown hasn’t been much better. I’ve asked my dentist to re-do it twice and now he is getting frustrated with me. He said the problem is that my teeth are between the two shades offered for dental crowns. Is there no way to get an exact match on this? Am I being too picky? It would not matter to me nearly as much if it wasn’t a front tooth.

Cassie

Dear Cassie,

Color map for a tooth

You are not being too picky. It sounds like your dentist is used to doing a lot of general dentistry but does not have any extensive understanding of the aesthetic side of dentistry. There are shade guides that dentists use to match dental crowns to tooth color. However teeth are rarely exactly like the shade guides. On a tooth that is toward the back, this is not a big deal because close is enough with the shadows from our mouth hiding the minute differences.

A front tooth is different. A skilled dentist would not just send the lab a simple shade reference. They would send a color map along with it similar to what I have above. This uses different tints to help the lab mimic the variations that occur in our natural teeth. Your dentist may not be able to do this. It takes some skill and cosmetic training. He may not even have the material necessary to help him derive the correct color mapping.

So you know, when it comes to front teeth, even the most skilled cosmetic dentist will have to do several tries. They are harder than your other teeth because they are so exposed to the light. However, it sounds like your dentist isn’t trying to get an exact match and has just given up. In that case, you will be better served getting a refund for the crown part of your dental implant procedure and having that done by another dentist who is willing to put in the necessary work.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Will Metal Show On Front Dental Implant?

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I was playing football with some friends and was not wearing a mouthguard (or a helmet). I already know that was stupid so don’t bother getting onto me about that. I would like to get a dental implant to replace the tooth. I am concerned, however, that the metal from the dental implant will show through in the gums because it is a front tooth. Is there anything I can do about that?

Carl

Dear Carl,

An assortment of titanium and zirconia dental implants.

While everyone’s body is different, most people have no problems with their dental implants showing through. Your dentist will run tests to check all the factors involved in whether you are a good candidate for dental implants. Make sure your dentist includes a CT scan in the diagnostics. Dental implants are a 3-dimensional procedure and it requires 3-dimensional imaging. This will help with more than just bone density and gum depth. It will also help your dentist avoid your nasal cavity as well as any nerves.

The key to a successful dental implant procedure is a skilled implant dentist. Unfortunately, there is not a recognized specialty in dental implants. If a dentist wants to develop that skill set, they need to get post-doctoral training. You will need a dentist who has invested in that training.

There are way too many dental implant horror stories from patients who underwent the procedure with an underqualified dentist. I do not want that to happen to you. My suggestion is that you look at Dr. Marion’s qualifications to get an idea of the type of dentist you need.

One other consideration. Generally, an oral surgeon will do the surgical part and then the dentist will do the restoration. However, it is very important that it is the dentist who determines the placement of the implant. Go to the dentist first, then the oral surgeon.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Should I Update My Dental Implants?

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I have had my dental implants placed about ten years ago. I keep reading about these advances in the technology. I’ve got two on my bottom left and one on the upper right. I’m about to need another one and wondered if I should just go ahead and switch out the rest of them at the same time. If so, what are your thoughts on the zirconia dental implants?

Dean

Dear Dean,

An assortment of titanium and zirconia dental implants.

Most of the dental implants used ten years ago were made of titanium. There is abundant data that these are very biocompatible and will last for a lifetime if well cared for. The only part that will still need replacement, even with care is the crown that tops it. You may find that they need to be replaced every ten years or so.

Should You Replace Your Dental Implants?

Replacing dental implants is not as simple as taking the old ones out and putting in new ones. Because the dental implants integrate with your bone, there will be some bone loss when you extract the implants. That bone is essential to the retention of any new implant placed. In order to have enough bone again, you will need to do a bone grafting porcedure. That means a surgery to remove the implants. A surgery to get the bone grafting done. Then, a surgery for the new dental implants. That is three different chances for something to go wrong. At the moment your dental implants are just fine, so I am not sure it will be worth the trouble, expense, and risk of doing the multiple surgeries.

The newer implants are made from zirconia rather than titanium. Honestly, though, most dentists still use the titanium implants because they have been studied for decades and have a phenomal long-term success rate. Zirconia implants could be fine, but they have not been studied as long.

In your place, I would keep the current implants while they are still working fine and, if you want to, you can get the newer zirconia implant for the tooth you need to replace currently.

There are things you can keep an eye on for your other implants and if they show signs of failing, then you can go ahead and replace them then.

  • Discomfort and difficulty biting
  • Pain and discomfort around the implant
  • The implant shifting or loose
  • Gums receding around the implant
  • Swollen or inflamed gums

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Is a CT Scan Truly Necessary for All-on-4 Dental Implants

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I am considering getting dental implants, specifically the all-on-4 dental implants. I’ve done a ton of x-rays and such and now the dentist wants me to get a CT scan. Is this really necessary or is this more of a way for him to line his pockets? I don’t want to spend unnecessary money and I certainly don’t want more radiation than is necessary.

Billy

Dear Billy,

all-on-4 dental implants

I’m glad you wrote. It is great that you chose dental implants as your tooth replacements. They are top of the line and the closest thing to having healthy, natural teeth in your mouth. Generally, all-on-4 is used for people who are already dealing with some bone loss. If that ends up not being you, it may be in your best interest to get implant overdentures. With all-on-4, if one implant fails, the entire thing has to be redone. However, that is not the case with an implant overdenture. Now to your question.

Importance of a CT Scan

Diagnostics on Your Bone Capacity

In order for dental implants to stay in place, the surrounding bone needs to integrate with the implant in a process known as osseointegration. However, if you don’t have enough bone then, you need to look at your options.

Finding the Best Procedure

In some cases, there isn’t too much bone loss and you can still get the all-on-4 procedure. However, in some cases, there is enough bone gone that you would need to do a procedure to replace it known as bone grafting. This will enable you to get overdentures if you are interested or you could stick with the all-on-4.

Getting the Correct Landscape

Getting dental implants of any type is a 3dimensional procedure. X-rays alone will not give the dentist enough information. They need 3D images of your mouth and jaws, including close to the nasal cavity. This will give them adequate measurements for safe placement of your implants. Dentists who take short cuts will often end up misplacing the implants or puncturing the nasal cavity.

So, in your place, I would definitely get the CT scan.
This blog is brought to you by Duluth, GA Dentist Dr. David Marion.