Category Archives: Dental Implants

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.

Can I Get Dental Implants if I’m Allergic to Some Metals?

I have some metal allergies, but I am losing a couple of teeth, in different places. I could get a dental bridge, but that would mean crowning four healthy teeth. I’d really like to get dental implants for those two teeth but don’t know if that is possible with them being made of metal. What do you think?

Benny

Dear Benny,

The Type of Metal Allergy Makes a Difference.

illustraition of a dental implant next to natural teeth

When you said you had a metal allergy, you didn’t mention which metal or metals you are allergic to. That will make a difference in which way you go. Some metal allergies are common, like an allergy to nickel.

Dental implants are made from titanium unless otherwise specified. We’ll get to the non-titanium implants in a moment. Titanium is highly biocompatible and serving in various prosthetics for decades. Very few people are allergic to this particular metal. If your allergy is not specific to titanium, you can just get dental implants without any worries. But, what if your allergy is to titanium?

Zirconia Dental Implants

Metal-free Dental Implants

If it does turn out that you have a titanium allergy, boy do I have good news for you! There are now metal-free zirconia implants. Zirconia is dubbed ceramic steel. They are well witin the requirements to be strong enough to serve as a prosthetic tooth root.

It’s a little trickier to find a dentist who provides these, not because they are sub-par, but because they are newer. Many dentists like to wait until something has been around a LONG time to start incorporating them into their practice. However, it will be worth it to you to find a dentist who does provide them so you don’t have to get those dental bridges. It’s rarely a good idea to place porcelain crowns on healthy teeth. I always recommend keeping as much healthy tooth structure as possible.

Planning Ahead Saves You Money

Another thing I always recommend to someone needing dental work such as a dental crown, whether for an implant, stand-alone, or dental bridge, is they think long term.

If you are ever going to whiten your teeth, the time to do it is before your crown is made. Because the color you choose for your crown is permanent, if you choose to do teeth whitening later, your natural tooth struture will whiten but not the crown. The only way to get your teeth to match then is to replace the crown and have it made the newer color.

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

Dental Implants After Ten Years?

I’ve had full removable dentures for a little over ten years. I really don’t like how they feel or look, plus I haven’t been able to eat normally since getting them. Is it too late for me to get dental implants? Will they look better than my dentures?

Andrea

Dear Andrea,

side by side comparison of dentures and a dental implant

You can get dental implants after any period of time, with one caveat, which we will talk about in a moment. In fact, it is actually important that you do. As you can see from the image above, your lower dentures just rest on the ridge of your jawbone.

You have already experienced that it makes it harder for you to eat. Even the best fitting dentures reduce your chewing capacity by 50%. However, there is an even bigger issue.

When you first removed your teeth, your body recognized that and began to resorb the minerals in your jawbone. Everntually, there isn’t enough of your jawbone left to retain your dentures. This is known as facial collapse. You are probably already starting to experience some of this.

Dental implants are different. They serve as prosthetic tooth roots, which signal to your body that you still have teeth. As a result, it leaves your jawbone completely intact.

Bone Grafting

Without enough bone, you won’t have a way to retain the implants. They’ll simply fail and fall out. Depending on how much jawbone you’ve already lost, you may need some bone grafting done first. This will add the missing bone and enable you to have the implants placed in a way that will be successful.

When you’ve lost all your teeth, it is more financially feasible to do implant overdentures. With these, you have 4 to 6 dental implants placed and anchor dentures to them. They will be completely secure.

Getting Beautiful Dental Implants

Whether or not they are beautiful will depend on the dentist who creates your new dentures. Creating beautiful smiles isn’t taught in dental school. Instead, a dentist has to invest in cosmetic dentistry training in a post-doctoral setting.

The best cosmetic dentists have reached accreditation with the American Academy of Cosmetic Dentistry. Any one of them will be able to create a stunning smile for you. You’ll be getting new teeth and a smile makeover at the same time.

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

Dentist Feels I’m Too Picky

I had to get a dental implant on a front tooth. The implant itself has done fine but I’ve had the crown replaced three different times. My dentist hasn’t been able to get it to match the adjacent teeth. She said it’s because my teeth are between two shades and I’m being too picky. She also said if I keep having her remove it, I risk losing the implant itself. That scares me. Am I being too picky? Should I just accept that false teeth can’t match perfectly?

Lanie

Dear Lanie,

Woman covering her mouth
Your dental crowns can match

One thing I want to tell you right up front is that you are not being too picky and it is possible for your implant crown to match the adjacent teeth. That being said, it may be above the skill set of your current dentist.

Matching a single front tooth is challenging even for the most expert of cosmetic dentists. They often have to do several try-ins before they are satisfied it matches properly. Notice I said “try-ins”. There is a temporary try-in paste your dentist could have been using this entire time instead of permanently bonding it on and then having to pry it off.

Don’t buy into the fear your dentist hinted at. Your dental implant will be safe having the crown replaced. However, you may have to go somewhere else to have it done.

Matching Your Dental Implant Crown

It’s very possible the color of your teeth is between two standard shades. That happens a lot. However, the tooth can still be made to match. While using one of the standard shades is fine for a back tooth, front teeth need some artistry. Below is a color map a dentist would provide for a ceramist to show them what tints to place and where in order to shade the tooth properly and get it to match seamlessly with the teeth beside it.

color map for a cosmetic tooth
Color Map

Your best bet at this point is to ask for a refund on the crown portion of your dental implant procedure. Then, find an AACD accredited dentist. They’ll be able to provide you with a beautiful, natural-looking porcelain crown that matches perfectly.

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

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.