Q: I had a root canal on a tooth that fractured and now it has to be removed. Can it be replaced with an implant or do I have to have a bridge or a partial?

A: Teeth that have root canals can fracture more easily than other teeth because they are weaker and somewhat dehydrated. They can sometimes be as brittle as glass. In the past the best available treatment was to remove the tooth and file down the adjacent teeth and make a bridge – caps on the adjacent teeth with an attached “dummy” tooth in between. Sometimes this still is the only way. However, in many cases an implant can replace the fractured tooth and no teeth need to be ground down at all.

Q: I consulted a dentist several years ago about using dental implants to replace my lower denture and he told me that I did not have adequate bone available to place enough in-the-bone implants without danger of fracturing my now fragile jawbone. Are there any alternatives?

A: Because of the advances in the field of dental implantology, there are now more choices and techniques. It’s the rare person that cannot receive an implant or a combination of implants. Today we have available many types of implants designed to accommodate multiple problems. As an example, if adequate bone is not available in the front or the back part or the jaw for in-the-bone implants, an over-the-bone type implant can be placed in both areas and non-removable teeth can be made to attach to the implants. Over-the-bone implants have been used successfully in dentistry for over 30 years. An implant of this type also has the added advantage of strengthening a fragile jawbone, which can help prevent a fracture. The ability to utilize multiple implant techniques is an essential ingredient to the successful use of implants. No one design will cover all situations. Bone grafting techniques have improved remarkably and in many instances we can do these procedures in our office. Bone grafts can strengthen the jaw and supply additional bone for implant placement.

Q: I am missing all of my teeth and am now wearing a full upper and lower denture. I can no longer tolerate my lowers. Will I need an implant for every tooth I am replacing on the lower jaw?

A: It is not necessary to have an implant for every tooth that is being replaced. The number of implants necessary to provide support depends on the type of implants used and the type of teeth (removable vs. non- removable) that will be attached to the implants. For example in this case, if you’re a good candidate for endosseous (in-the-bone) implants, you may require between 2-8 implants, depending on the technique used to support a full compliment of lower teeth. A thorough oral exam and panoramic x-ray is all that is necessary in most cases, to determine which implant can be used and how many must be used. Sometimes additional x-rays or CT scans are used in more complicated cases.

Q: I have a full set of dentures. My uppers are fine, but my lowers are constantly a juggling act when I try to eat. Can I have implants on the lower and keep a full denture on top?

A: Absolutely. Your situation is a common one. The full lower denture is the most unstable prosthesis fabricated in dental practice. During chewing, the average lower denture moves five times more than an upper denture. The person with advanced bone loss has additional problems of poor muscle coordination, speech difficulties, and inability to keep the denture in place, all of which adversely influence a normal lifestyle. Dental implants can be the solution to all of these problems. Even in cases where a lot of bone loss has occurred there still is a good chance something can be done. In most cases, a thorough oral exam and a panoramic x-ray is all that is needed to determine if you are a good candidate for implants.

Q: I have been a denture wearer for many years now and use denture adhesives to hold my teeth in place and am getting tired of the constant bad taste and mess in my mouth. Could dental implants eliminate using adhesives?

A: A common complaint is having to constantly add adhesives to secure dentures, especially after drinking a cup of coffee or eating a meal. This can really be a nuisance when eating out at a restaurant and having to excuse yourself from the table to go to the rest room because your dentures won’t stay in. Laughing, sneezing and coughing can also cause trouble for people who depend on adhesives to hold their teeth in place. It may be funny to see another person having a denture fall out, but it is not funny to the person who has to deal with these embarrassing situations on a daily basis. Denture wearers with problems such as these are not alone. There are 30 million people in the United States with no teeth and 29% in this group chew only soft foods.

Q: I lost my upper back teeth on one side and have gone for years without doing anything about it. My sinuses always seem to bother me more on that side than on the side that I have back teeth. Could these problems be related to one another?

A: A phenomena that occurs in a large majority of people who have had their upper back teeth missing for a long period of time is the increasing downward growth of the maxillary sinus. At birth it is the size of a pea, and progressively grows as the skull matures. This growth is at the expense of the surrounding bone. If you are considering replacing those upper back teeth with fixed teeth that stay in all the time, it may be necessary to perform a sinus elevation procedure to allow room for placement of dental implants into this area to support those teeth. This involves placement of bone and/or bone substitutes into an area which was previously occupied by the lower part of the maxillary sinus. These bone graft materials act as a matrix or scaffold which is replaced by the patient’s own new bone. This raises the floor of the sinus, reduces sinus volume and may allow the sinus to drain easier. Most importantly, this procedure increases the available bone use to place implants and restore the missing back teeth.

Q: I am missing most of my back teeth and do not wish to lose any of my remaining front teeth. I’ve bee through several sets of removable partials and could not wear any of them. Could I have teeth that stay in all the time to replace my teeth missing in the back and keep my remaining teeth in front?

A: Your situation is very common. First of all we will do everything possible to help you keep your remaining natural teeth as long as their supporting structures are within an acceptable range. Supporting structures means the gum and bone tissues immediately surrounding the tooth. A thorough evaluation must be made to determine if a tooth is healthy enough to keep or not. We do not want remaining unhealthy teeth to compromise the success of any new treatment performed whether it be dental implants or other treatment. We must then decide what is best for your specific needs in order to restore your missing back teeth. If you have had problems with removable partials, then dental implants used to anchor new replacement teeth may be the best answer for you.

Q: I need to replace two missing teeth next to each other. Can I just have one implant placed and attach it to one of my natural teeth and make a bridge?

A: Generally, this is not a good idea-over the years we have learned that it is generally much better not to attach implants to teeth. We frequently attach implants to each other, which can improve strength and works well. So in a case like this, although it may be more expensive in the short term to place two implants instead of one, the long-term success is likely to be much better with the two implants.

Q: Why do dentures lose their fit?

A: In many cases, the pressure of dentures or partials on the tissues causes gums to get “flabby” and bone to shrink over time. When this occurs, the dentures usually become loose and awkward even when adhesives are applied, much like the way clothes become baggy when one loses weight, and this causes more bone loss and gum problems. With dental implants, bone loss as well as gum erosion are slowed.Unlike dentures, which put pressure and stress on top of the gums and jaw bone, endosseous (“in-the-bone”) implants are actually surrounded by bone and the chewing forces transfer pressures into the bone, much like teeth do. This actually can strengthen the bone and increase bone density, reducing the bone shrinkage seen regularly from dentures.

Q: I must have some teeth extracted and I intend to have implants placed to restore my ability to chew. Can a dental implant be placed at the same visit as the teeth are extracted?

A: Whether or not the dental implant can be placed immediately after extraction depends on the amount of available bone in the area and presence or absence of active infection. Placing the implant at the same visit helps preserve both width and height of bone and may prevent the need for placing bone grafts when bone naturally shrinks back after teeth are extracted. During the first year after teeth have been removed, as much as 40% of jawbone width can be lost. Sometimes, infection from a tooth or periodontal disease has destroyed the bone to such an extent that it becomes necessary to do a bone grafting procedure prior to implant placement. If it is possible to place the implant at the same visit as the teeth are extracted, this can save at least three months in healing time compared to waiting for an extraction site to heal before the implants can be placed.

Q: Does insurance pay for dental implants?

A: Yes and no –sorry to be so vague, but some carriers pay for them, some don’t, and some pay a portion of the costs. Most dental plans do not provide for the surgical placement of implants. However, many do provide some restorative benefits. Surprisingly, the best coverage often times can be through your medical insurance if you are missing all or most of your teeth. In this case the implant procedure may be considered jaw reconstruction with restoration of normal chewing function and sometimes medical insurance will cover all or part of the treatment. In many instances we have been able to help get significant coverage for patients, but unfortunately it is not very predictable. Our staff will work hard to see that you get the best possible benefit from your insurance.

Q: Is the placement of implants painful?

A: Implant placement usually does not result in much post-operative discomfort -usually the patient takes Tylenol or Advil for about 2-5 days. If more extensive treatment is needed, for example bone grafts or many implants, then the post-operative course may require more time and medication.Anesthesia during the surgery should make the placement procedure pain-free. We are conservative with anesthetic agents and our philosophy is to utilize the least amount of medication for the patient to comfortably tolerate the procedures. Depending on the complexity and number of implants being placed, the procedure can take between 30 minutes to 3-4 hours.

Q: Do implants require special care?

A: Presume that dental implants are natural teeth and treat them that way. Return for regular check-ups. Brush and floss. Realize also, that caring for the gums is the best way to care for one’s teeth. More teeth are lost as a result of gum disease than any other single cause.

Q: How long will implants last?

A: How long do teeth last? They should last a lifetime. However, we all can sight examples where teeth have not served for a person’s lifetime. We know that dental problems mostly stem from improper home care or lack of treatment when needed. The same holds true for implants. With proper care and routine dental check-ups they should last a lifetime. No one can give guarantees because the health of a person is dependent upon many factors which are out of the control of one’s dentist, e.g., proper nutritional needs being met, proper hygiene, genetics, disease processes which might occur. So, the answer to this question really is that no one knows how long each individual implant will last… one’s success can be influenced by the way you live and the quality of practitioner that you have chosen to do your implants… these things can tip the scales in your favor.

Q: What is the time-frame for Dental Implant restoration?

A: The first phase of treatment, after a detailed evaluation and treatment plan, usually is the actual placement of the implants. This procedure is generally done in the doctor’s office during one visit. Most implants will remain covered, underneath the gums, for 3 to 6 months. During this time, osseointegration –the biological bonding of the jawbone to the implant–occurs. Through this healing period, you will probably wear your modified denture or a temporary denture or bridge and maintain normal activities without restriction. You will need to follow a modified, soft diet for the first couple of weeks. There are occasions, one stage implant placements or when extensive bone grafting is to be performed, when patients may be asked not to wear their removable dentures for a period of time. When this is necessary we’ll do all we can to help our patient through this transition.

The second phase of the procedure is usually 3-6 months after implant placement. At this time, the top of the implants will be uncovered from under the gums and a small metal post or extension will be attached to the implant(s). Your periodontist or restorative dentist will make any necessary modifications to your temporary teeth to allow you to continue wearing them after post attachment.

In the third phase, which usually starts 2-6 weeks after the second phase, your new replacement teeth are created and fitted. This phase involves a series of appointments to make impressions of your mouth and to “try-in” your replacement teeth at key steps in their fabrication. The try-in sessions are necessary to ensure that the size, shape, color and fit of your new teeth will completely blend with and match your individual facial characteristics and remaining natural teeth (if any). The third phase is usually completed within 4 to 8 weeks. Total treatment time for most implant cases will usually be 5-8 months. It could be longer if bone or gum procedures are needed.

Q: What are the success rates of Dental Implants?

A: Dental implants have a long history of use and success. Implants are the most thoroughly researched procedure in the history of dentistry and, while no procedure is 100% successful, the current technology has resulted in very high success rates in the hands of well-trained and experienced clinicians. Dental implants are carefully regulated by the FDA and a number of implant systems have been approved by the American Dental Association.

Q: Am I A Candidate for Dental Implants?

A: Generally speaking, if a person is well enough to undergo the treatment necessary for fixed bridgework or routine tooth extractions, the same person can undergo dental implant procedures. Also, patients may have general health conditions that would contraindicate implant procedures, although this is unusual. The best form of implant for you is determined after a thorough examination and discussion with your dentist and periodontist or oral surgeon. The amount and location of available bone is usually the major determinant as to which implant system is to be used, or whether you are a good implant candidate.

Q: How much do Dental Implants Cost?

A: The average surgical fees range from $1,800 and up for a single tooth replacement (not including the Abutment & Crown) to $5,000 and up for replacement of multiple missing teeth. At The Dental Implant Center you pay from $1695 for the complete restoration (including Abutment & Crown) The cost of non-treatment can be considerably more expensive. Continual bone loss occurs from the wearing of full dentures (plates) and partials. This progressive loss of bone can eventually cause nerve exposure, jaw fracture and a complete inability to function with regular dentures. Correction at this point may be very expensive and can involve extensive bone grafts, which may require hospitalization and an extended recovery period. Placing implants before the bone loss becomes severe not only saves money in the long run, but also slows the bone loss process, increasing the likelihood of long term success.