Category Archives: Dental Implants

Sinus Perforation During Dental Implant Procedure

I need to ask about something that happened with my dental implant procedure. First, some minor backstory. When my dental implant was placed the oral surgeon perforated the sinus by a few millimeters. He said this is fairly common. The problems started six months later when the gum would not heal and he suspected there was some bone loss. He removed the implant which went pretty smoothly because there was no bone integration with the implant. He stitched the gums and asked me to wait a year to see if the area fills back up. Here’s one thing I am frustrated with. He did not give me any antibiotics, just Flonase and some instructions on things like not blowing my nose for a while, etc. Five days later I went in for a follow up. I’d had pressure and felt yucky since the procedure. While he thought everything looked great, I didn’t feel that way and insisted he give me an antibiotic. He did and I started feeling better. Did he put me in danger by not prescribing one to begin with?

Margie

Illustration of a dental implant

First, I will answer your question, but there is a much bigger concern here that I want to address after. As to your question, no, he did not put you in danger by not prescribing antibiotics as a preventative measure. It is better for your body’s health in the long run if there is not already an infection, to try and allow the body’s natural defences to keep one away. It helps to strengthen your system. Having some medication jump in and do your body’s job when it doesn’t need help ends up weakening its ability to fight infection over the long haul. Think of it like a parent who always steps in to help their child climb the monkey bars by lifting them when it is hard. Sure, they get up the monkey bars, but it did nothing to develop their muscles. Waiting until your body needed the boost was the right course of action.

Two Problems with your Dental Implant Procedure

I see two really big problems with your situation. First, is the sinus perforation itself. Yes, it does happen. I certainly would not call it normal. Plus, the amount of the perforation is a big deal. A few millimeters is HUGE in dentistry. I am really concerned that he blew this off. This could only happen if he did not do adequate diagnostics. He should have done quite a few x-rays and preferable a CT scan also. The dental implant procedure is a 3-dimensional procedure and does require a 3-dimensional map.

The second real concern I have is that your bone never integrated with the dental implant. This leads to dental implant failure. This also indicates to me (again) that he may not have done adequate pre-surgery diagnostics. It’s possible you would have needed a bone grafting procedure to make this work.

My opinion– get a different dentist or surgeon to do this when you’re ready.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Replacing Baby Teeth with Dental implants

I am 16 years old and none of my canine teeth have come out. I had the bottom ones removed but the adult teeth behind them grew pretty far behind and it looks weird. I don’t want that to happen with my upper teeth. They show when I smile and that would be too embarrassing. I was thinking maybe I could remove those teeth and put dental implants in their place. Would that work?

Avery

Dear Avery,

I am impressed by how you are handling this. Though, I will admit I’m sad that you are having to do this on your own. Any decent pediatric dentist would have dealt with this years ago.

How you proceed with this will depend on what is actually going on with the adult teeth. If they are there but just impacted, then your dentist can do something to open the area. However, dental implants will not be an option. These only work to replace missing teeth. If you have teeth there, then you need a different solution.

If they are in a position where they’d come in crooked like the bottom teeth were then I suggest you see an orthodontist who can help them erupt properly.

If you have congenitally missing teeth, meaning that the baby teeth never came in, then dental implants are a possibility. However, you will want to wait until your jaw is completely developed in order for it to be a successful treatment.

That doesn’t mean you will have to go with baby teeth or missing teeth until then. You will need time to get the remainder of your teeth moved a bit anyway in order to make room for your replacement teeth. In that case, I would get something like Invisalign. Then, you can use a dental flipper to temporarily replace the missing teeth until your jaw is ready for the implants.

The best thing you can do is get to a dentist who can help you work through this.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dental Implants and HOckey Players

My son is a hockey player. Most of his teammates have lost teeth but he’d been lucky up until last month when he had a tooth knocked out. We’d arranged for him to get a dental implant and have already had the implant placed. Now his teammates are telling him a dental implant is a bad idea in case he gets hit in the same place again. So, what should we do? I don’t want to leave him with a gap there.

Elle

Dear Elle,

hockey player with a tooth knocked out

That is interesting hearing what his teammates have said, but it makes sense. Your tooth has give. A dental implant is bonded. If the implant crown was knocked out, it would take some to the bone and possibly some jaw with it. That would require reconstructive surgery.

My suggestion is you leave that implant in. It will be good for his bone retention. However, you do not want to have the crown bonded on until he is done playing hockey.

Instead, I will suggest that he gets a temporary tooth replacement, such as a removable partial denture or a dental flipper. Either of these will give him a tooth while keeping him from damage to his jaw.

If he loses other teeth, I’d follow the same porcedure. Get the implant, use a temporary tooth replacement. Don’t just get the flipper without the implant.

When teeth are lost, your body recognizes that and in an effort to be as efficient as possible with its resources will begin to resorb the minerals in your jawbone in order to use them elsewhere in your body. This causes the jawbone to slowly shrink. People who wear dentures end up with facial collapse as a result.

Dental implants are how you prevent that. The implant serves as a prosthetic root and signals to your body that you have a tooth there and it leaves your bone intact.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Disastrous Dental Implant Case

I need some help. Close to three years ago, I had a full mouth reconstruction done that cost me $38,500. One by one, crowns and implants starting falling apart. I mostly have a mouth filled with implant screws sticking out of my mouth. I’ve contacted the office for a while and kept getting the run-around. Now I find out the dentist has fled the country and is currently in Egypt with no plans to come back. What do I do?

Kelly

Dear Kelly,

Illustration of dnetal implants being placed in three stages.

This is a tough position to be in. If this dentist has fled the country, it is nearly impossible for you to get your money back. Instead, what you will need to focus on is finding a dentist who has the skills to fix these dental implants.

Just having dental school training is not enough. You really need someone with advanced post doctoral training.  For example, Dr. Burba completed Dawson Academy in Florida which teaches full mouth rehabilitation, complex restorative dentistry, and occlusion.

Before you see anyone, ask them what training they have in dental implants. Don’t just go based on fees. Cheap is not affordable. Cutting corners in dental implants tends to lead to disastrous failures in the case.

Which leads me to a second issue. Make sure your second dentist is very thorough with your diagnostics. I would insist on a CT scan. Dental implants are a 3-dimensional procedure and you really need 3-dimensional x-rays. Without them, your dentist could risk placing an implant on a nerve or perforating your sinus cavity.

Finally, check the online reviews. You want to make certain their follow-through matches their credentials and that patients have had a good experience with them.

Because you want someone with artistry as well as technical expertise in order to make sure they can create a gorgeous result, it will help if they are AACD accredited as well.

On that note, please leave a review both about the dentist who did this to you and then fled the country and the practice he was with that is refusing to refund your money. This will protect other potential patients from experiencing the same lack of adequate dental care you went through.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dental Implants are Falling Out

I had dentures for a while and just really hated them. After doing some research, I decided to get implant overdentures, with eight implants total. This has cost me about $12,000. Yet, in less than a week three of them have fallen out and today a fourth one came out. Should I get a refund for those? Is there a way to get them back in? I really hated the removable dentures.

Penny

Dear Penny,

Implant overdentures

You should absolutely get your money back on those failed implants. To be honest, I wouldn’t have too much confidence in the ones that are left either. The current estimated failure rate for dental implants is 5%. Your dentist’s failure rate is 10 times that in just a week.

Most dental implant failures come from poor surgical placement. However, you mentioned you have been in dentures for a bit. You didn’t mention how long. When your teeth are removed, your body begins to resorb the minerals in your jawbone. It is possible, depending on how long you were in dentures that you did not have enough bone to retain the dental implants. That is something your dentist should have caught with his diagnostics.

My first recommendation to you is to see a dentist with real dental implant training, such as with Dawson Academy or the Las Vegas Institute of Advanced Dental Studies. Have them look at your implants and see if they can tell you what went wrong. If you had adequate bone support and it was a problem with the dentist’s surgical placement, then don’t just ask for a refund. Instead, ask for him to pay to have the new implants replaced by a dentist of your choosing.

This is because it will cost more to repair this than it did originally. Losing or removing dental implants takes bone with it. The missing bone structure will have to be replaced in order to have a succesful outcome the second time around. That can be done with bone grafting, but your dentist should cover that if you had enough bone to begin with.

If you didn’t have enough bone to begin with, then you would only need a refund. You would have needed bone grafting to begin with in that case.

You should not have any trouble getting a refund on this, especially if you have a second dentist advocating for you.

Best of luck. You can still get the implant overdentures you want!

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

cLEAR cHOICE OR cOSTA rICA FOR dENTAL iMPLANTS?

I am trying to choose between Clear Choice Dental Implant Centers for all-on-4 dental implants or going to Costa Rica for traditional implants. A dentist here said I am not a candidate for the traditional implants because of my bone structure. Clear Choice said they can work around that, but I’ve heard Costa Rica will place implants when dentists here won’t. Do you have any experience with these scenarios?

Ben

Dear Ben,

Implant Overdentures

You are asking me to choose between the lesser of two evils. Here are my problems with both of those options. Let’s start with Clear Choice. They pretty much do the all-on-4 dental implant procedure for most patients. However, while the procedure can be useful in certain situations, it is also risky. If one part of it fails, the whole thing has to be completely re-done. A second issue with Clear Choice is there is no significant follow-up care. This puts you at risk of post-procedural complications.

One of the problems with the dental implant procedure is it isn’t adequately taught in dental school. Dentists have to take post-doctoral training in order to develop the skills necessary. Too many dentists are delving into this for the income stream, but without adequate training. It is one of the leading causes of malpractice cases at the time I write this post.

Now, take the worst dentist in the United States and you will still be better off than if you went to Costa Rica for this procedure. You say they are willing to do cases that dentists here will not. Of course they are! They don’t have to worry about your dental implant failure. You will be back in the States with zero recourse, and they will be raking in their profits. It is a no-lose proposition for them and a total gamble for you.

And what will you be gambling? Here are just some of the complications you could deal with.

  • You could lose a large portion of your jawbone, leaving you a dental cripple.
  • They could place the implant on a nerve, leaving you either in constant pain, no feeling at all, or even paralysis in the area.
  • They could perforate your sinus cavity.
  • Infection could set in.
  • The implants could be too short or too thin to retain properly.
  • They could be loaded prematurely leading to dental implant failure.
  • They could come loose.
  • You could end up with peri-implantitis.

Your safest option is to go to a solo practice here in the United States where there are standards of care and patient recourse if something were to go wrong. Look for a dentist with post-doctoral training.

I know your dentist said your bone structure would preclude you from receiving the implant procedure you want. However, with a bone grafting procedure, you will build back up the lost bone structure and can get the best replacement possible. Instead of an all-on-4, I would look at getting implant overdentures.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dentist Pulled My Implant Out

I had a dental implant placed on a front tooth. I wasn’t thrilled with how it ended up looking. It was obviously fake next to the other teeth. However, it was better than having a gaping hole in the front of my mouth. A week after the crown was placed, the implant felt loose. I called the office and they told me to come on it. The dentist said the crown was likely loose and he would just rebond it. He had a little trouble getting it off until he got a tool, but when he did, the implant came out with it. Does this normally happen? He said they can re-implant it but I’m nervous.

DeeAnn

Dear DeeAnn,

No, this does not normally happen. However, in your case I am going to call this a blessing in disguise. I am having a hard time fathoming the level of incompetence this rises to. First, when a dental crown is loose, it is easily removed. He would not need a special tool at all.

It was obviously the dental implant that was loose the entire time. Because this implant was defective and unattractive, it is fortunate that your dentist accidentally pulled it out. Now you have the right to demand he pay to have it repaired properly.

Do not just ask for a refund. Instead, I want you to insist he pay to have it replaced by the dentist of your choice. This is because it will be more complicatted to replace the implant and dental crown. You lost bone when he ripped it out. That bone is necessary in order to retain your implant. In order to place it, you will need bone grafting done to build the area back up.

Finding the Right Implant Dentist

Dental implants aren’t really taught in dental school so you need a dentist who has invested in post-doctoral training. You also want to make sure that they have a high success rate with their dental implant procedures.

At the time I’m writing this dental implant failure and the consequences of poor placement is one of the leading dental malpractice suits. Ask about their success rate. I’d like you to see someone with a 95% or higher rate.

In addition to their implant training, you need to consider how skilled they are in cosmetic dentistry. You are replacing a front tooth. As you’ve discovered, getting a perfect match is essential for a beautiful, natural-looking smile. In your place, I would want an AACD accredited dentist to work on my implant crown.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dentist Won’t Give Me Dentures

I am 45 years old and losing my teeth due to extensive chemo treatments over a period of 15 years. I have no money. None. My husband left me two years ago and I just can’t afford anything but dentures. My dentist said I am too young and he can only give me dental implants. What do I do, go without teeth? How is that better for me?

Pamela

Dear Pamela,

Let me start by saying I am so sorry for all you have been through. That is so much hardship. I am equally sorry that your dentist isn’t willing to work with you at all. This is unfair of him. Though he has legitimate concerns with your age, you are in an untenable situation and there are ways of working around this.

Let me start with his concerns so you understand what you’ll have to confront at some point.

Dentures and Facial Collapse

before and after side images of a woman suffering from facial collapse
Years with Dentures will Lead to Facial Collapse.

When you lose or remove all your teeth, your body recognizes that and immediately begins to resorb the minerals in your jawbone to use elsewhere in your body. While it does this in an effort to be as efficient as possible with your body’s resources, it has the unfortunate side effect of shrinking your jawbone.

After about ten years or more, depending on your body’s response, you will no longer have enough jawbone left to retain your dentures. This is known as facial collapse.

Having Dental implants in your jawbone, signals to your brain that there are still teeth there so it leaves your jawbone intact, preventing facial collapse.

Affordable Dental Implants

Full-sized versus Mini Dental Implant

If you can’t afford traditional dental implants there are two other options for you. The first is to help stabilize your denture with mini dental implants. You’d only really need to do it on the bottom arch because that is the one with the more serious repercussions to facial collapse.

This won’t be as secure as using full sized implants, but it will cost significantly less and will preserve your jawbone. Additionally, you’ll never have to worry about your dentures slipping or falling out.

Another option in affordable dental implants is to get snap-on dentures. This uses just two dental implants, If your dentist isn’t willing to work with you, believe me, there are plenty of caring dentists who will!

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dental Implants with Diabetes

I have type 1 diabetes and want to get a dental implant for a tooth I lost. I asked my dentist and he said I am not a candidate because of my diabetes. Is there any chance I can do some special extra procedure or something to make this possible?

Benny

Dear Benny,

Having diabetes doesn’t preclude you from getting dental implants. It does, however, make you high risk. My guess is your dentist told you that because he is not comfortable placing dental implants. Given your situation, he felt even less comfortable.

I would see a dentist with significant training in dental implants. Additionally, they’d need to have a great deal of experience with a success rate of at least 98%. No one will have a 100% success rate. Like any medical procedure, some times everything can be done perfectly but the body rejects it.

Your diagnostics will be especially important to give you the best chance of success. Don’t skimp on any of them or go to a dentist who tries to cut any corners for you.

Some dentists do the surgery and the implant. Others will refer you to an oral surgeon. If whoever you see refers you out for the surgery, make certain it is the dentist who decides on the placement of the implant, not the oral surgeon.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Bone Grafting Didn’t Work

I have a dentist who has done many dental implant procedures in his career. When he went to do mine, he decided there wasn’t enough bone structure for it to be a viable case. He told me we’d need to do some bone grafting to be certain the case wouldn’t fail. I agreed because I wanted the best chance of a successful case. We did the bone grafting, waited for healing, then attempted to do the dental implants again. Again he felt that I didn’t have enough bone structure. Now I’m three procedures in and still have nothing. He’s now suggesting we just do a dental bridge. I will if I have to but is there any way I can still get a dental implant? Should I have gone to a dental implant specialist?

Melissa

Dear Melissa,

illustraition of a dental implant next to natural teeth

You’ve certainly been through the ringer with these procedures. While there isn’t actually a detnal implant specialty that is recognized by the American Dental Association . However, there are obviously going to be dentists who invested more in training (which all has to be done post-doctorally) and have more experience as well.

It sounds like your dentist may be experienced at the dental implant procedure but new at the bone grafting part. The good thing this tells me about your dentist is he is continuing to learn the new technology and add to his skill set in order to better help his patients.

Another thing I like about your dentist is his integrity. Some dentists, not wanting to embarrass themselves over a failed procedure would have just gone ahead and placed the implant without the ideal amount of bone in place. The dental implant would have lasted for a while and eventually failed, you would never have known it was because of the bone. Your dentist cared more about the quality of your care than his own pride.

Can you still have a dental implant? Yes. If you’ve got the stamina to try again, I certainly think you can. But, in all likelihood, you will need to have the bone grafting done with a different dentist. I don’t think your dentist will be at all offended about that given what I’ve learned of his character and ethics thus far.

If you decide you don’t want to go through all of that again, then getting a dental bridge is an acceptable option.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.