Category Archives: Dental Implants

Will Metal Wings Be a Better Solution on a Maryland Bridge?

My daughter had orthodontic treatment to make room to replace a genetically missing tooth. We needed a temporary tooth replacement in order to keep the space open for a dental implant a few years from now. Her dentist provided a Maryland Bridge with zirconia wings to blend better. Unfortunately, that fell off. She decided to try again but when it fell off the second time, she has decided we are going to have to switch to the metal wings in order to get it to stay better. I have a couple of questions. Will the metal show? Will the metal damage her teeth?

Andrea

Dear Andrea,

First, I’m going to say I’m glad you have chosen a dental implant for your daughter’s permanent tooth replacement. Great job in picking the top of the line replacement for her. Unfortunately, your current dentist isn’t top of the line. I don’t know the name of your dentist so none of this is said out of malice. She doesn’t understand the bonding procedure for a Maryland Bridge. Nor does she understand what a temporary replacement means.

Let’s start with the problem with her bonding and then I will answer your questions. She tried her traditional bonding method and it didn’t work. Rather than question the method, she questioned the material. Maybe I need metal instead of zirconia. Nope. That’s not the problem.

example of preparation for a Maryland Bridge

Maryland Bridge’s require some tooth preparation in order to stay bonded properly. Without that, the bridge will fail regardless of the type of wings your dentist uses. Grooves will need to be cut into her adjacent teeth, like what you see in the picture I’ve posted directly above. My guess is she didn’t do this type of tooth preparation, which is why it keeps falling off.

Now, to answer your questions. Will the metal show? Yes. It will darken the tooth structure. This is one reason dentists who use a Maryland Bridge are moving to the zirconia wings, which will keep the color unaffected. Your second question is will it damage your tooth? Yes, if she makes the grooves to properly attach the wings.

You could have her go back and do the grooves, but I’m going to recommend you switch temporary replacements here. One of the many benefits of dental implants is that the adjacent teeth aren’t impacted. To me, when you have to remove any structure from a tooth to use the replacement, it is no longer considered temporary. Instead, I’d like you to get a dental flipper for your daughter. This is truly a temporary replacement that she can take in and out at will. Good news for you is it is significantly less expensive than any type of dental bridge.

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

Should Dental Implants be Postponed Due to COVID-19?

I’m wondering if the coronavirus pandemic will impact or should impact my appointments for dental implants. To be clear, I started the process more than a year ago and I had all sorts of procedures already done. We started with bone grafting and had the implant placed already. I’m coming due for the appointment where I can (finally!) get the crown added to the top and have a full smile again. I was really looking forward to it. But, as I understand it, all non-essential appointments are supposed to be a no-go right now. Technically speaking, I’ve been living without these teeth for ages, so it’s not urgent. Should I reschedule my dental appointment a few months out or is it okay for me to go in for my dental implants now?

Thanks,

Mark

Dear Mark,

illustraition of a dental implant next to natural teeth

This is a great question. It seems everyone these days is trying to figure out what qualifies as essential and non-essential excursions during the coronavirus outbreak.

You Should Skip Non-Essential and Elective Visits

You’re on the right track with exploring what’s really essential. The latest from the CDC indicates anything that’s not urgent be postponed until the outbreak subsides. The problem is, they don’t actually outline what they consider to be non-essential. That’s why a whole lot of companies that provide personal services, like salons, are keeping their doors open, depending on the state you live in. Some states have even closed down barbers.

If you had an issue like a toothache, this wouldn’t even be a question. You’d need that taken care of right away. Ignoring a toothache, which could be a sign of infection, can be fatal. This is why they are considered dental emergencies. However, this isn’t a toothache and, as you noted, you’ve been in the healing phase for quite some time. Waiting for a few weeks wouldn’t hurt.

Dental Implants Restore Form and Function

On the flip side, dental implants aren’t just about making your smile look nice (although they do that too). They’re replacements for your natural teeth. Chances are, you’ve had to change your eating habits and perhaps more since you lost those teeth. Are you able to eat a normal, healthy diet without them? If not, then you’re also impacting your health and immune system. There are lots of nuances like this in the decision of whether to keep your appointment or not, but don’t assume that, just because you’ve been waiting, that it’s a good idea to keep waiting.

Talk to Your Dentist

The reason why the CDC and other agencies are so vague is because each case is different. What’s urgent for one person might not be for another. In your case, an argument could be made for either decision—to keep or not keep the appointment. Your dentist knows your situation better than anyone else. As such, he’ll be the best source of personalized information for you. Additionally, each state is in a different place with this virus and will need different levels of lock-down as a result.

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

Should My Dentist Pay for My Bone Grafting for My Dental Implant?

I lost a tooth almost 12 years ago. I plan on getting a dental implant now that finances are better. However, when I went in for my consultation, my dentist mentioned I’ve lost bone in that area and will need some grafting done. My sister told me that he could have done a socket preservation procedure when he first took out my tooth and I wouldn’t need the grafting now. She recently had a tooth out and her dentist recommended it. Should my dentist pay for my grafting? I’m pretty sure he never offered that option to me when my tooth was removed.

Melanie

Dear Melanie,

illustraition of a dental implant next to natural teeth

The socket preservation procedure your sister referred to was fairly new back when you had your tooth removed. We didn’t have much data at oll on how well the procedure worked. The cost was often prohibitive for patients. Even today, not all dentists offer the treatment option.

The procedure is quite similar to a bone graft and is done by placing bone material in the socket which can fill in the gap over the years. There is still very little data on the longevity of the procedure. Even some successful cases had to have some bone grafting done later anyway, though less than they would have if they hadn’t done it.

Bone Loss after Tooth Extractions

When any teeth are removed, your body recognizes that. In an effort to be as efficient as possible with your body’s resources, it will begin to resorb the minerals in your bone to use elsewhere. 40-60% of your bone is lost within the first three years, though the rate of absorption slows significantly after those first few years.

I don’t think you have a case to get your dentist to pay for your bone grafting. Even if he didn’t offer the procedure to you at the time, which in all honesty there is no way to know, because it was a procedure just getting started he didn’t do anything wrong not suggesting it.

You Don’t Have to Pay for Dental Implants all at Once

You can pay for the bone grafting, then take a break. The implant procedure is paid for in two phases. First, the dental implant itself. Then there is a period of healing while the bone integrates with the implant. This is an imperative step. Without it the implant will fail.

Once that is completed, then the second half of the procedure will commence along with the second payment. That is when the dentist will place the dental crown on top of the implant.

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

Getting Dental Implants after Years with Dentures

I’ve had dentures for close to 30 years. I now can’t even keep them in. Is there any hope I can get dental implants at this point?

Cassidy

Dear Cassidy,

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

What you’re dealing with is facial collapse. When your teeth were first removed, your body recognized that. As an effort to be efficient with its resources, it begins to resorb the minerals in your jawbone that were previously used to support the roots of your teeth. This slowly begins to shrink your jawbone and is the reason you are no longer able to return your dentures.

As to whether you can get dental implants at this stage, the answer is yes…but. In order to have implants which will stay secure in your jaw, that missing bone structure will have to be rebuilt. There is an outpatient procedure, called bone grafting, which can build back up your missing bone structure. Then, after a period of healing, you can begin the dental implant process.

Dental Implant Overdentures

You won’t get a one to one ratio of dental implants to teeth (or in your case dental crowns). It would be prohibitively expensive to do it that way. Instead, I suggest you do implant overdentures.

dentures about to be secured to six dental implants
Implant Overdentures

This utilizes between four and six dental implants and then, when osseointegration has taken place, your dentist will anchor a new set of dentures for you to them. These will be much more secure and comfortable than the dentures you had previously. Because they’re anchored, there is no slipping or falling out. You’ll also find your chewing capacity significantly increases, improving your quality of life.

Your Chance for a Dazzling Smile

This is a fantastic opportunity for you to get the smile of your dreams. If you go to an expert cosmetic dentist, they can not only fashion your dentures, but they can do it in a way that makes you look years younger and thrilled to share your new smile.

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

How Long Can I Wait for a Dental Implant?

I have a tooth where decay grew under the crown. My dentist doesn’t feel he can get it all out and recommended I see an oral surgeon to pull the tooth and then come back for a dental bridge. I’m not too keen on that so I’m thinking of seeing someone else about the decay. I’ve also been doing some research and it looks like a dental implant will be a better option for replacing a missing tooth. I’ve got fairly new dental insurance which has six more months of a waiting period before I can get any coverage for work done. If I pull this tooth, how long can I wait before there are problems?

Catherine

Dear Catherine,

illustraition of a dental implant next to natural teeth

I’m going to be blunt and tell you that you are not being well served by your dentist. Most skilled dentists will do everything possible to save a tooth. What does he mean he can’t get all the decay out? Has he tried and failed? Based on what you said, he didn’t even bother trying.

Next, he suggested a dental bridge instead of a dental implant. Your research is correct. Yes, it is a much better tooth replacement than a bridge. The one exception to that would be if the adjacent teeth already need dental crowns. If they don’t, then you are just grinding down healthy tooth structure.

I’m sorry, but this dentist seems too willing to get rid of teeth. You can do better. I’m going to highly recommend you get a second opinion on this tooth.

Don’t Wait before Getting a Dental Implant

If, after getting a second opinion, it turns out the tooth cannot be saved, I wouldn’t recommend waiting more than a week or two (at the most) with that space empty. The teeth around it will start to drift or tip into the space, making a replacement difficult.

In fact, it can lead to serious bite problems, which can cause TMJ Disorder. Just like cleaning out the tooth properly with a root canal treatment before getting your original dental crown would have saved you the problems you are facing now, making sure that space is kept open will save you a lot of pain down the road.

I’d recommend something simple and inexpensive, such as a dental flipper, to hold the space for you until your insurance will cover your dental implant. Truthfully, even if you received the implant today you’d need a temporary tooth anyway. The site where the implant is placed needs both time to heal and for the bone to integrate around the implant before it can support an implant crown anyway, so this isn’t an unnecessary step.

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

Will Dental Insurance Cover Dental Implants

I am losing my teeth and would like to get dental implants. I think I’m a candidate but wondered if dental insurance will cover it?

Ben

Dear Ben,

Three parts of a dental implant
The three parts of a dental implant

It’s good that you’re looking at dental implants to replace your teeth, especially if you’re talking about replacing all your teeth. While dentures are much less expensive, they have quite a few problems.

Problems with Dentures

  • They’re removable so there will, out of necessity, be times you won’t have teeth.
  • They slip and slide allowing food to get underneath them.
  • No matter how well fitting they are, your chewing capacity is reduced by 50% or more.
  • It causes facial collapse.

Dentures and Facial collapse

A woman's profile twice, one with facial collapse, one after
Wearing Dentures Leads to Facial Collapse

When your teeth are removed, your body recognizes there are no longer any roots of your teeth and concludes you don’t need that bone to secure them. In an effort to be efficient, your body will begin to resorb the minerals in your jawbone to use elsewhere. This causes your jawbone to slowly shrink. After about 10 or so years, you won’t have enough jawbone left to even retain a denture and they will constantly fall out. This is called facial collapse.

Having dental implants placed will prevent all of the problems faced with dentures. They secure your dentures restoring your ability to chew. Because they’re permanently secured, you’ll never have to go without teeth. Their most important benefit is the prevention of facial collapse. Because you have prosthetic roots placed, your body interprets that as your teeth still being in place and it will leave the minerals in your jawbone alone, keeping it completely intact.

Dental Insurance for Dental Implants

One thing to remember when it comes to any type of insurance is they are a business. The goal of any business is to make money. While many plans will cover a portion of dental implants, it is not likely to be much. They generally only cover the basic replacement for your teeth. That would mean a partial denture or full removable dentures depending on the number of teeth you’re losing.

It sounds like you don’t have insurance yet and are looking for a plan in order to get your implants. One thing to be aware of is many plans will only cover your checkups and cleanings at first and have a certain number of months you have to wait until you can claim any coverage for other services.

Most dentists expect payment in two different stages when it comes to dental implants. The first installment is paid during the surgical portion. The second installment won’t be expected until it is time to get your implant crowns/dentures.

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

should I have to pay for a dental implant again after two years?

I had a dental implant placed a couple of years ago. It’s feeling loose and I’m kind of worried I’ll have to pay for another one. I heard these were supposed to last a long time. Will I have to pay all over again?

Tracy

Dear Tracy,

You’re right that it shouldn’t be loose after this short a period of time. However, there can be a lot of reasons for this to happen. Some of them are easy fixes. Before you give up, contact the dentist who placed your dental implant and let him know what is going on.

Why a Dental Implant Can Be Loose

Three parts of a dental implant
The three parts of a dental implant

Not every loose dental implant is a disastrous fix. Sometimes it is something simple. There are actually three parts of a dental implant which can struggle for one reason or another.

The Implant Crown

Sometimes it can just be the porcelain crown, which your dentist placed over the implant which has come loose. Repairing that is just a simple matter of re-bonding it on again. Many dentists will even fix this without charge.

The Abutment

This is a piece which fits between the implant and the crown. Maybe it has come loose . If it turns out the abutment was faulty, the dentist can contact the manufacturer and get a replacement at no cost to you.

The Implant Fixture

If it is the dental implant fixture which is loose, that can be more serious. Sometimes it is coming loose because of an infection. There is a chance that can be saved, but you need to get to your dentist right away. Even when a dental implant isn’t a factor an infection is considered a dental emergency.

If it is loose because it hasn’t integrated with the bone, there isn’t much that can be done. Even when everything is done perfectly, a dental implant procedure can fail. When done by an experienced, skilled cosmetic dentist it’s a rare occurrence, but they can still fail through no fault of either you or the dentist.

This blog is brought to you by Salem Dentist Dr. Ruandall Burba

snap on dentures: a middle ground

I have been struggling with my dentures. Really struggling. I talked to my dentist about it and he suggested dental implants, but the price was way over anything I can afford. I don’t really want to continue with the dentures, but I just don’t like how they move around. I do use adhesive. It helps some. Not a lot. Unfortunately, it also feels kind of gross. Is this just something I’ll have to adjust to or is there another treatment option I’m overlooking?

Diana

Dear Diana,

Salem Snap on Denture
Snap-on Dentures

I hate to hear that patients are left grappling for answers when their dentists should be giving them all their options. And, you do have some options here.

While some people adjust to dentures, others never do. You didn’t mention how long you’ve had your dentures. If they’re fairly new, they shouldn’t be sliding. Your dentist needs to adjust them. Free of charge.

However, if you’ve had them for several years, you could be at the early stages of facial collapse. The longer you wear dentures, the more your jawbone shrinks. Eventually, you won’t have enough jawbone left to even keep dentures in.

This is why your dentist mentioned dental implants. The implants provide prosthetic tooth roots which your body interprets as you still needing your jawbone, leaving it intact.

Alternatives to 1 to 1 Dental Implants

I don’t know if the price quoted to you for dental implants was a single implant for every missing tooth or for implant overdentures. However, implant overdentures are significantly more affordable.

This uses four to six dental implants on each arch and anchors your dentures to them. They are completely secure and will also prevent facial collapse.

In some cases, even implant overdentures are still out of reach. That’s okay. Everyone has a different budget to work with and dentists should never pressure patients to extend themselves beyond their means.

In those cases, we often recommend snap-on dentures. They are a good starting place. There is a picture of them at the top of this post. It uses just two dental implants. While there is some movement, they will not fall out. The snaps keep them in place.

This also allows you to save up to get more implants at a later date if that is what you desire. It will also protect against bone loss, but just in the areas there are implants.

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

traveling for dental Implants

I know the dangers of dental tourism when you’re talking about leaving the country. I’ve read the horror stories. But, what if you’re not traveling to save money, but to find a really good implant dentist? I need to replace two teeth in the upper right part of my mouth. The dentists in my area aren’t that great when it comes to dental implants. However, my best friend from college lives near one of the top dental implant dentists in the country. She said I could stay with her. In that case, is it a safe option?

Pepper

Dear Pepper,

Illustration of a dental implant

Dental implants are a fantastic option for replacing teeth. It also sounds like you’ve done some great research as far as what dentist to use. That is the number one factor in a successful outcome.

When you are talking about this type of travel for dental care, it is a totally different story than the dental tourism horror stories you’ve read about.

However, there are some things which need to be handled differently for this to go smoothly for you.

Considerations When Traveling for Dental Implants

One of these you’ve already done, but I’m listing it for the benefit of others.

Research the Dentist

As I said above, the dentist is a very important factor in the success of your case. You’ll want to know:

  • The type of implant training he or she has had
  • How many cases they’ve done
  • Percentage of successful cases
  • Always check reviews

Budget Carefully

You’ll need to be prepared for six or more visits spread out throughout the year. Some of these include:

  • Consultation
  • Implant surgery
  • Post-op checks
  • Impression appointment
  • Crown placement

Accommodations for after surgery is important too. You have this arranged, but others may not have your support. They’ll need to have someone travel with them and plan on staying somewhere comfortable at least overnight.

Discuss Emergency Protocols

Even when everything is done right, something can go wrong. You’ll want emergency protocol information up front. Will he insist you come in or will a Skype visit be fine for a triage of sorts?

Do all this and you should have a positive experience.

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

Blade Implant Not Healing?

I don’t know what’s going on. I had a blade implant placed over 12 months ago and it still isn’t healed. Is something wrong or is this normal? Do I just wait it out?

Catherine

Dear Catherine,

Illustration of a dental implant

I’m curious as to why your dentist decided on a blade implant. While they have been in use for many years, there are better options in current practice. It’s generally used for people who don’t have a thick enough jawbone to retain a traditional screw implant but don’t want to do bone grafting.

Unfortunately, while traditional dental implants (pictured above) have a 98% success rate, blade implants only have around a 50% success rate. This should have healed within twelve months. At this point, something is wrong. You need to return to your implant surgeon and have them look and advice you.

Dental Implant Options

A woman's profile twice, one with facial collapse, one after
Wearing Dentures Leads to Facial Collapse

Bone loss in your jaw is usually the result of having missing teeth with no replaced root. For instance, if you removed your teeth but didn’t replace them or replaced them with removable dentures, the minerals in your bone start to resorb into your body. The result not only ages your appearance years, but it will also make you a denture cripple, forced onto a liquid diet the remainder of your days. This is known as facial collapse.

If you want to replace those teeth with an option which provides a prosthetic root, thereby preventing facial collapse, you need to have enough jaw bone. If you don’t, you have two great alternatives to blade implants.

Bone Grafting

This is a simple outpatient procedure which adds bone structure back into your jaw. The biggest benefit to this is it allows you to get screw implants which have a significantly higher success rate to the blade option.

All-on-4 Dental Implants

This doesn’t require grafting. Instead, the all-on-4 implant procedure places the implants at an angle helping them retain with less bone structure.

Cosmetic Considerations with Dental Implants

While it is wonderful to have a full mouth of teeth. If they’re not attractive teeth, you might not smile nearly as much as you would if you were provided with a stunning smile. Whether you are getting all new “teeth” or just a couple of implants, you’ll want a dentist who can make them match your teeth. You don’t want natural teeth next to obviously fake teeth.

One or Two Implants

I recommend before your implant crowns are made, you whiten the rest of your teeth. It’s an inexpensive way to drastically improve the aesthetics of your smile. But, the real reason for doing it before getting your crowns is the permanence of your crown color. Even professional teeth whitening only works on natural tooth structure. That means if you get the crowns first and then decide to whiten your teeth, your natural teeth will whiten. Your tooth replacements will not. Doing the whitening first means your implant crowns can be made to match the beautiful new color of your teeth.

A New Smile with Implant Overdentures

If you are getting a new smile with your implants, you want an expert cosmetic dentist to do the work. You are talking about a complete smile makeover made from dental crowns. Finding an expert cosmetic dentist is a lot easier than it used to be. The American Academy of Cosmetic Dentistry has an accreditation program which helps patients to know who can give them a stunning smile.

Just go to aacd.com and click on find a dentist. Just make sure you put a check by “accredited dentist”. This way you get a list of those who are experts in their field.

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