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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.

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.

Bone Grafting Didn’t Work. Now What?

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I don’t know if third time can be the charm for me or if I should just give up. My dentist has placed many dental implants over the years so I felt fairly confident going into my dental implant procedure. Unfortunately, once he got in there he realized there was some problem with my bone structure and did not place the implants. He suggested we do a bone grafting procedure and then try again. I agreed and off we went to the bone grafting procedure. After the specified period of time, we went in for a second stab at the dental implants. Again, he said there was still not enough bone and he thinks I should just get a dental bridge. If I absolutely must, I supposed I must. However, I’ve invested so much in there and really wanted an implant. Is there any chance I can get one?

Kevin

Dear Kevin,

illustration of a dental implant next to a tooth

I believe it is still possible for you to get a dental implant, however, you may have to do it with another dentist. One with stronger implant credentials and experience. I don’t want to be hard on your dentist. He actually sounds like one who has integrity, a passion for getting it right, and is upgrading his skills. Those are fantastic things to have in a dentist.

Some dentists, with less integrity than your dentist, would try to save themselves the embarrassment of saying their procedure did not work and just go ahead and place the dental implant. Then, in a year or so, the implant would fail. You would have no idea it was because of something your dentist did wrong. Instead, your dentist did what was best for you in the long run.

It sounds like, though he has done many implant placements, he is new to doing the bone grafting. This is also a good quality in a dentist. It means that he is actively working to learn new skills and have more options for his patients. Most dentists who do dental implants don’t even try bone grafting and will just have you get a dental bridge just saying you don’t have enough bone for an implant. I would not give up on him as your dentist. You definitely have a keeper. I just think this one procedure needs someone a bit further along.

So, who should you get? I would look at the implant credentials on Dr. Marion’s bio to give you some idea of the type of training and experience you will need for this.

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

Titanium Versus Zirconia Dental Implants

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I have concerns about metal being used in a body. I already have two metal implants and now found out that I will need another one. My understanding is there are now non-metal implants. But my dentist doesn’t feel these have been around enough yet to warrant using them yet. Is there a reason why I shouldn’t? Should I switch out my older implants for these newer ones?

Carol

Dear Carol,

metal and zirconia dental

I am going to start with your last question first. Unless there is something wrong with the dental implants, I would not switch them out. Here is why. When your dental implants are removed they take some of the jawbone with it. That bone is essential for you to have a successful implant procedure, so before you can put the new implants in, you will have to have a bone grafting procedure in order to build back up that bone. Once that is healed, you can then have another surgery to place them. That is three additional procedures to replace successful dental implants. Each of those three procedures carry the risk of complications and failure. I would leave the succesful implants in place for as long as possible.

It is likely that your dentist’s concerns over the zirconia implants has to do with the lack of data we currently have on their longevity. The reason for that lack of data is they haven’t been around as long. We have tons of data on the titanium implants because they have been in use for decades. The zirconia are likely just as enduring, they just haven’t been around long enough to say that. Zirconia, nicknamed ceramic steel is certainly strong enough.

So, which should you get? Honestly, whichever one you want. However, I don’t want you thinking that the ones you have are dangerous to you. You mentioned concern over having metal in your body. Not only is titanium, the metal your current implants are made of, extraordinarily biocompatible, but our bodies need and use metals every day. One major example is our blood. If it doesn’t have enough iron, you become anemic, which can cause serious health problems.

If you do decide that you want the zirconia implants, my suggestion is that you do it with another dentist. Your current dentist does not seem comfortable wtih them and it is never a good idea to push a medical provider outside of their comfort level. You are better off finding a metal-free dentist who will have done this procedure quite a bit.

This blog is brought to you by Dr. David Marion, who tries to be the best dentist in Duluth, GA.

Losing Teeth Like Crazy

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I have pretty advanced gum disease and have already lost seven teeth. Is it possible for me to get dental implants to replace my teeth or will I be stuck with dentures?

Joe

Dear Joe,

Implant overdentures

Implant Overdentures

Dental implants are a great solution when you’ve lost your teeth. Anyone in good general health can usually get them. However, your gum disease will be an issue that will have to be addressed in order for this to be a successful option for you. In order to retain your dental implants, you need to have enough bone to integrate with the implants. Gum disease eats away at your bone structure, which is why you’ve been losing your teeth.

Here is my suggestion to give you the best outcome possible. Get serious about your gum disease treatment. Once that is handled, you will need to build back up the bone structure. There is an outpatient procedure known as bone grafting which can do that. Once you’ve healed from that, it will be time for your implants.

I know you’re probably thinking that is a lot of trouble to go through to get those implants. Maybe it would be easier to just get dentures? While it may seem easier at first, you will not feel that way with your quality of life. Even the best fitting dentures reduce your chewing capacity by 50%. Then, because there are no roots of your teeth any longer, your body will begin to resorb the minerals in your jawbone. This shrinks your jawbone to the point where you will no longer be able to keep your dentures in. The implants are worth it. They are like having healthy, natural teeth once again.

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

Implants after Dentures

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I have been in complete dentures for twelve years. I have never really liked them. Is it still possible for me to get dental implants or is it too late?

Mariella

Dear Mariella,

Implant overdentures

Implant Overdentures

Technically, it is never too late to get dental implants no matter how long you have been wearing dentures. The only issue may be how much bone structure you have lost in your jawbone. There is a nasty side effect with removable dentures that I hope your dentist warned you about. Once your teeth were removed, your body recognizes that you no longer have any teeth roots. In an effort to be as useful with your body’s resources as possible, it begins to resorb the minerals in your jawbone in order to use them elsewhere in your body. After ten to twenty years, you will have lost so much jawbone that you are no longer able to retain your dentures. This is known as facial collapse.

When you see a qualified implant dentist, he should do a round of diagnostics in order to determine how much bone structure you have. If you have lost too much, hope is not lost. There is a bone grafting procedure that will help to build up the bone in your jaw and allow you to get the dental implants you want.

It is important that you find a dentist who has the qualifications necessary to do this right. There are way too many dental implant horror stories. This is likely because dental implants are not really taught in dental school. It is such an advanced procedure that dentists really need to invest in significant post-doctoral training. Without that, you are at a much greater risk of serious complications.

I would look at some of Dr. Marion’s qualifications to get an idea of what type of implant dentist you need.

What your dentist will provide you with is between four and six dental implants. Then, once your bone has had time to integrate with the bone your dentist can anchor a denture to them. These are known as implant overdentures (pictured above). You will find that your quality of life goes up significantly once you have your implant overdentures. Not only will your teeth be more secure, but you will find your ability to eat skyrockets. Even the best fitting dentures will reduce your chewing capacity by 50%, but once you add those implants, you can eat steak if you want to.

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

Clear Choice or Costa Rica for Dental Implants?

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I was planning on going to Clear Choice Dental Implant Center to get my dental implants, but I have some concerns. First, they want to do the all on four procedure and I was hoping for implant overdentures. Then, I read some reviews that said they don’t really have any follow up with their patients. This worries me as well. I was thinking it might be better for me to go to Costa Rica to get these implants done. I hear they do a lot of dental work for people from other countries and there is a whole dental tourism industry there. Do you think I’d be better off with Clear Choice or Costa Rica?

Kevin

Dear Kevin,

Implant overdentures

Implant Overdentures

Do you have an option C by any chance? Here is the thing. Dental tourism is very popular in some circles. When it goes okay, it goes okay. When it doesn’t, it goes very badly. If you think there is no follow-up with Clear Choice Implant Centers, what type of follow-up do you think there will be from a dentist in another country?

Dental implants are an advanced procedure. It takes significant post-doctoral training. In the United States, we have high standards and strict laws with regard to the materials dentists are allowed to use along with the standard of care dentists have to provide. In some of these popular dental tourism destinations there are not even laws about sanitation. It is up to the dentist what type of standards he adheres to. I’m not sure that is work the risk. If you get an infection in your jaw it can be very serious.

As for Clear Choice, while the all-on-four procedure is useful for those who do not have enough jawbone left or who are not a candidate for bone grafting, if you can have implant overdentures, it is better. If one dental implant of the all-on-4 procedure fails then the whole unit has to be replaced.

My suggestion to you is invest in a good dentist instead of a chain clinic or going out of the country. Your best bet is to find someone who is a fellow with the International Congress of Oral Implantologists. These are the most qualified implant dentists in the country.

This blog is brought to you by Dr. David Marion, who tries to be the best dentist he can be.

Dentist Placed My Implant Knowing I Had Bone Issues

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I had been saving up for this dental implant for some time. My dentist knew this. I was so excited to finally have a permanent tooth there. I was horribly disappointed when I woke up from the surgery and my dentist told me he doesn’t think the implant would last. He also said he knew there wasn’t a ton of bone there to begin with but he thought he could “work around it”. Now he’s giving me the choice of taking it out and going with a dental bridge or leaving it there and seeing how long it lasts. I’ve completely lost faith in this dentist and wonder if you know what the best option is for me. Any advice will be appreciated.

Steve

Dear Steve,

illustration of a dental implant next to a tooth

What your dentist did is completely unacceptable. If I understand you correctly your dentist knew ahead of time there wasn’t enough bone and placed the implant anyway. If that is correct, it is malpractice. Especially because there is a procedure that could have been done ahead of time to ensure you would have had enough bone to secure the dental implant for many years.

The good news is, you don’t have to settle for either of the options your dentist provided you with. If you still want a dental implant, you can get it. However, like you, I do not have confidence in your dentist. What I am going to recommend is you ask for a complete refund. He placed a dental implant knowing full well it would fail.

Then, I want you to see an experienced implant dentist. For instance, Dr. Marion is an Associate of The American Society of Implant & Reconstructive Dentistry (ASIRD). Whoever you choose, make sure they have post-doctoral training in implant dentistry. It’s not something adequately taught in dental school.

The procedure I mentioned earlier is called bone grafting. Once that is done you will be ready for that dental implant you have been saving for all this time. And this time, it should work.

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

Implant Bridge Misaligned My Teeth

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I need some advice. I had an implant bridge placed on the bottom right side of my mouth. Before that, all of my teeth lined up, even though the teeth had some problems. Now, I have a problem with the side with the bridge lines up and touches, but the other side does not. Not only are they no longer touching, but my jaw seems to be on a slant there. I don’t think this is normal, but my dentist seems to think it is nothing to worry about. Is he right? It just doesn’t feel comfortable to me. Though, my dentist says I will adjust to it. Will I? Right now it doesn’t seem like it.

Caryn

Dear Caryn,

woman holding her jaw in pain

No, this isn’t okay. It is always frustrating to me when medical practitioners say, “You’ll adjust”. Maybe you will get used to being uncomfortable and in pain, but you shouldn’t have to. Plus, if this is left untreated, it will very likely lead to TMJ Disorder.

When dental crowns or bridges are done correctly, the bite should line up perfectly and they should not be noticeable at all. Your dentist should know this. My guess is he recognizes there is a problem, but doesn’t know how to fix it. Implant dentistry is not a recognized specialty. Dentists have to choose to invest in enough dental implant training to become skilled. Not many do, which may be why is it is one of the procedures leading the list of dental malpractice suits.

Here is my suggestion. I want you to look at Dr. Marion’s qualifications. Then, I want you to find a dentist in your area with similar qualifications to look at your case. If it is as bad as I think, they can help get it repaired. Because the implants may have to be removed, I don’t want you to just get a refund. The repair will very likely cost more than the original procedure. Because if your implants have to be removed, they will take bone with them. You will need some bone grafting done if your new dental implants are to be properly secured. This will require a bone grafting procedure. Instead of a refund, I want you to tell the dentist you want him to have it repaired by a dentist of your choosing.

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