Dental Implants Dentistry Blog

Upper Molar Dental Implants to Replace Missing Teeth - Case Study -Dr. Amin, Burbank

Here is a nice basic case to follow from beginning to end.

This man's upper molars on one side were in bad shape:

The teeth were extracted and replaced with three dental implants in my office in Burbank.  He also had a deep cleaning.

The color denotes the size of the implants.

Standard abutments were able to be used rather than custom abutments.  This helps reduce cost, but most implant surgeons don't know how to place implants to prevent having to use custom abutments. 

Final Teeth: 

He was really happy to have teeth again.  He can eat anything he wants!

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com 
 

Unusual Broken Dental Implant Corrected By Dr. Ramsey Amin in Burbank

Tom had a strange situation.  He had two implants placed by another dentist in the 90's.  The problem was that the two dental implants were too far from the adjacent tooth.

This caused a pocket to form and he was always catching food there.  Worse yet, the pressure from the bite on the area that was "hanging" over caused the implant to fracture! 

 

A fractured implant is extremely rare! 

The broken implant and the bridge removed.

Removing this implant could have been very risky due a risk of nerve damage so I opted for an unusual fix. I placed one skinny implant in front off the broken implant using IV sedation.  It was a VERY tight spot!  Just wide enough for a very small dental implant. I did a bone graft on top of the fractured implant and let the gums heal over it.

The implant healed for 3 months.  After it was healed, I made a new bridge using one of the old implants and the new, small one. 

He was thrilled to have this solution.  It was less risky, and very affordable compared to removing and replacing the broken implant.

Any questions?

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

 

 
  

Burbank Dental Implant Update - Photo Series Shows an Implant Fusing to the Upper Jawbone

This is a great visual example of an implant fusing or "osseointegrating" to the jaw.  You can easily see the difference.

This lovely elderly woman came to see me with a tooth that broke down to the gum.

In one appointment. I extract the remaining root and placed an immediate dental implant into the socket and made a tooth also.

 ***Note the spaces around the newly placed implant***

 
After 2 months of healing, the space around the implant is gone! (see below)   

Healing time varies, but a successful dental implant should look like this.  In fact, over time, the bone will look better and better.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

 

Burbank Implant Dentist on Extraction Defects...Relation to Dental Implants and Bone Grafts

Teeth are removed for several reasons, including periodontal (gum) disease, extreme decay, and for orthodontic reasons.  Once a tooth is removed, the shape of the ridge (i.e., the supporting bone and gum in which the tooth was situated and retained) changes. If there has been extensive bone loss, or if the tooth needed to be surgically removed (bone had to be cut away to gain access to the area), the change will be more dramatic. The ridge shrinks, collapses into itself, and over time decreases in width and height. As more time passes after the extraction, the more change occurs.

This is an extraction site defect. Look how skinny the bone is compared to the image next to it!

   

The extraction site defect presents a problem when the area is to be restored with an implant.

When the ridge architecture has significantly changed, the replacement tooth will have to deviate from the ideal shape. This could easily make the area more difficult to keep clean, difficult to restore, and cosmetically quite unsightly.

Perhaps the cosmetics may not matter to you when there is a back tooth being replaced one that is not visible when you speak or smile. An extraction site defect in an area visible when you speak or smile will create a severe esthetic problem.  The more the ridge has changed, the more your tooth will need to be either longer, wider, or fatter in order to fill up the extraction site. If you have a smile line that shows the tooth or gumline, the replacement tooth will be very obviously misshaped. It will never look right and will be a cosmetic failure.

Here is a dental implant on a patient from Burbank that I did:

2004
2009

It is clear that for the dental implant replacement tooth to have a normal appearance, the extraction site must be rebuilt. The closer it can be made to the ideal, the better the replacement tooth will appear.  The site (or ridge as it is really named) can be restored through gum tissue grafting and/or bone grafting.

If the ridge needs only a small amount of augmentation, only soft tissue procedures may be needed. If there is a large defect, the underlying supporting bone will have to be replaced as well. If the site is especially visible or needs an extensive amount of rebuilding, more than one augmentation procedure may be necessary. My goal is to make the replacement tooth appear to be growing out of the extraction site, not merely lying against the gum.

If a dental implant is to be placed to act as an anchor for the replacement tooth, the extraction site must have enough bone thickness and height to properly surround the implant.

Here is an example of a 20 year old girl from Los Angeles that I had to do an onlay bone graft and gum graft to fill the major bone defect from a roller-skating accident.

 Major bone loss.

After a onlay block bone graft, implant and custom Abutment. Note how there is no longer a depression of bone after the bone is built back up.

 Final result. Restored Dental Implant!

As you can see, extraction site bone or gum defects are really important.  Choose the right dentist for your implant! 
 

Ramsey Amin, DDS
 

Tony H. - Dental Implants and SInus Lift - The Patient Perspective

Tony is a patient that referred to me by another dentist in Burbank.  He was missing three back teeth and wanted to replace them.  He had a regular bridge that failed and said it had a bad smell too.

Here is Tony on video sharing his experience.  The photos and x-rays of his dental implants are shown below.

If you can not see the video click here is the link: http://www.youtube.com/watch?v=EdojCEX3WDk

Here is how he started:

  Dental Implants after 4 months of healing.

Teeth!

 

Thank you for your kind words Tony...you are too funny!

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

4-Tooth Bridge Failure - Dental Implant Bridge Replacement

A dental bridge is a fixed (non-removable) appliance and is an older way to replace missing teeth. 

There are several types of bridges. The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  This type of bridge consists to two crowns that go over two anchoring teeth and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.

My 83 year old patient from Hollywood had pain from a large bridge that spanned 4 teeth.  When a bridge is that long, it flexes in the middle when you bite.  It caused the front anchor tooth to split and cause a bone infection. That root canaled tooth had to be extracted.  It also caused a bone pocket and bone loss on the back anchor tooth. It is very common for a bridge to get a cavity also!

The bridge is so long it can only be seen on two x-rays! (see pictures below)

 

The new three tooth implant bridge was designed with large implants to withstand his strong bite.

It has been working great.  You are never too old! 
 
  

Immediate Front Tooth Dental Implant Example -(Difficult Case)

***If you cant see the pictures in your reader, click the link to see this case series***

Here is a great example of a front tooth dental implant with gum shaping.

Follow along:

My patient from Burbank, California had a "dead" yellow tooth in the front.  It started to twist and move also.

The x-ray shows a condition where the root is dissolving! A bridge would have been a bad option since the neighboring teeth which are perfect, would have to be irreversibly ground down to nubs.

The tooth was extracted, and on the SAME day an immediate dental implant was placed.  This is a picture taken at the time of surgery.  ***NOTE there is almost no bleeding!***

This is the temporary tooth I made for her on the same day the tooth was extracted.  She will wear this for 3 months and is not allowed to chew with it until the bone heals completely.

This how the gum looks after the gums have been cosmetically shaped properly. What made her situation very difficult is she has VERY thin gums and they have a high "scallop." Her tooth must be done exactly right to avoid a black triangle or a long tooth!

 
  

Here is the final tooth. Close to perfect.  The gum is well filled in and the color is great. She wanted the tooth to be straight, but did not want braces to correct the other teeth.  She was very happy with the result!

Here is the x-ray! Great bone levels!  She should have this tooth for a long time!

Front Tooth Bone Loss and Dental Implant Replacement

These x-rays tell the story:

Her original two front teeth were in bad shape and had severe bone loss.  They were even loose!

Both center front teeth were extracted and a bone graft was done.  The teeth were replaced with dental implants. 

 
I was able to rebuild the lost bone.  She was told by her dentist that it was not possible and that she had to have a bridge!

Final Result!

 

Do I Need Custom Dental Implant Abutments?

There is a lot of confusion with patients that have come to me for 2nd opinions. The question is whether or not their dental implants need custom abutments or not.

 

I will try to make this as non-technical as possible. If you are confused, comment below and I will reply.

Most implants have three pieces. The implant that goes in your bone, the abutment the holds the tooth, and the crown tooth that attaches to the abutment.

  

 

In my practice the additional expense of a custom abutment is only necessary about 10% of the time. It can increase the cost of the dental implant by about 10%.

 

The best way to avoid making a custom abutment is for your implant to be placed correctly. Many implants are placed incorrectly at a incorrect angle and require a custom abutment to make it straight again.

 

Nothing beats a well-placed implant!

 

A well-placed implant allows me to use a pre-fabricated abutment and reduce cost to the patient. This type of abutment also has a better fit than a custom one since the titanium mating surfaces was manufactured to fit very tightly. Well made dental implants have a very tight connection between the implant and the abutment. This is very important for the long-term maintenance of your bone around the implant.

 

Here is case of the back molars replaced with dental implants and prefabricated abutments:

 

I use custom abutments for the following scenarios:

• An implant for an upper front tooth where the gum may be thin and the titanium would show through. (White zirconia abutment)
• The space between your upper and lower teeth is really small and the implant need to be held by a screw instead of by cement.
• Multiple or full mouth bridged dental implants.
• Overdentures that have a bar to hold them in.
• Excessively thick or thin gums.
• Excessively "scalloped" gums.

Here is a picture of a custom white zirconia abutment and the final crown that I made:

 

Sometimes the way the gum heals from the surgery may change an original plan for a prefabricated abutment to a custom one.

 

I teach classes to other dentists about dental implants. Most dentists are not aware when you should use a custom or prefabricated abutment.

 

As a Diplomate of the American Board of Oral Implantology (the highest certification acheivable), dentists and patients seek me out for education and opinions on what is the best treatment.

 

My goals are to simplify and streamline the procedure for patients. I do see an overuse of customized abutments when the prefabricated one would have been just as good or better.

Dental Implant Case Example For Back Teeth

This patient thought she could never have dental implants.  She was so fearful of the procedure. I used I.V. sedation anesthesia so she could sleep through the surgery.

The x-ray shows that she is missing her lower molars on one side. She also has a cracked root canal tooth supporting bridge on the other side.

Here is a before picture:

Here is the after!

In the final x-ray you can see the dental implants really clearly.  I had to add a little bone to the side that was missing teeth for so long.

Now she can eat what she wants!

Dental Implant Maintenance...OVER-DENTURE VS FIXED BRIDGE

Fixed bridges are attached to your dental implants much like your natural teeth are connected to your bone. Because they are most similar to teeth, they do require some maintenance.

Most importantly is your daily routine at home. You must brush and floss your implant fixed bridge. You will also need to have regular x-rays to monitor the level of your bone. The bite needs to be checked routinely also. These are all things done during your cleaning appointments.

Overdentures are held in place by attachments that are embedded in the underside of the denture.

 

These clips are made of plastic and they do wear out. You will know when they wear out because the overdenture will feel much looser. They wear out about every 18 months to 2 years on average. They are easily replaced my office in about 45 minutes.

The actual teeth on an overdenture will wear out. The teeth hardly wear at all on a fixed bridge. This is strictly due to the material that the teeth are made of.  Porcelain fixed teeth can chip, but generally are rarely replaced.

Overdenture teeth are made of plastic and wear out about every 5-8 years. When they wear out, they need to be replaced. If left to wear for too long, your face will begin to look older because the distance from your nose to your chin has gotten smaller.

The entire overdenture will probably need to be replaced at 10 years.  Although, overdentures are great solutions, they do require replacement.

A fixed dental implant bridge requires much less maintenance than an overdenture.

Fixed Dental Implant Bridge vs. Implant Denture - What is the REAL Difference?

There is a common mistake that I hear from patients on a regular basis.

Often times, I see patients for second opinions for dental implants to replace all of their teeth. They tell me they are having all their teeth removed and having a "bridge"

When I dig deeper or reference their paperwork, they are actually getting an overdenture!

Whoa! Yikes! Wait a second!

There is a HUGE difference between a "fixed bridge" and "overdenture" which some falsely call a "removable bridge"

Look at these pictures:

Note the size of the two.

An overdenture is just that...a denture that goes over implants and it is removable. It must be taken out at night and cleaned underneath.

Don't get me wrong, overdentures are fantastic for the right situation. Nine times out of ten, the right situation is a person that has had dentures for years and needs extra hold and security with their dentures. They can be made to look great.

Fixed bridges are cemented or screwed to the implants and cannot be removed by you. Unlike dentures that have pink acrylic and plastic teeth, fixed bridges are porcelain fused to metal.

You will not have anything touching the roof of your mouth going over your gums with a fixed bridge. The teeth "emerge" from the gums and are not plastic like dentures.

Overdentures can be made with porcelain teeth, but that only makes the dentures look better.  It does not make them smaller or feel more natural.

Fixed bridges have a gold substructure underneath them. Hence the name "porcelain fused to metal." Because they have gold they are very strong compared to their overdenture counterpart.

If you are missing a little bit of gum, I usually make pink ceramic porcelain near your natural gum line. This will make it so the teeth don't look too long and square. Having that little triangle of gum between the teeth makes all the difference when you smile.

These are fixed porcelain bridges that I made for the whole upper jaw.  These patients lost all of their upper teeth:

 

 

The cost of dental implantsand a fixed bridge is more than an overdenture. A significant amount of gold is needed to make your implant bridge. Gold is about $900 - $1000 an ounce and it takes a several ounces to make a full upper or full lower bridge with 12 teeth. Of course, the fewer the teeth, the less the cost will be.

This is a picture of a patient of mine without his overdenture in place.  The implants are connected to a bar that the removable teeth snap onto.

 

The inside of the denture looks like this.  It has clips that attach to the bar and make it snap in.

A fixed bridge requires much more precision to make than an overdenture and typically more appointments. The implants also need to be much more precisely placed, whereas an overdenture has some leeway.

What is right for you? It really depends on what you want, your budget, and how much bone you have.

The position of your lips and how much space you have between your top ad bottom teeth is CRITICAL. This is often overlooked by your average dentist. Your face and lips can end up looking too bulky or caved in if this is not determined in the photographic assessment before anything is done.

 

You typically need more bone and more implants to make a solid fixed bridge than an overdenture. Depending on your situation, bone grafting may be necessary. These are things I can only determine by evaluating you in person.

If you are missing all of your teeth, a CT scan is almost always necessary to have a safe surgery.

The fixed bridge is the best long term solution and requires very little maintenance. An overdenture may be upgraded in the future to a fixed bridge.

Bottom line... A fixed bridge is the best and an overdenture is meant for people that already have dentures.

Video Essay of A Dental Implant Patient

This short video depicts a single man in his 50's who I treated. 

He was missing a lot of back teeth and was embarrassed that he used removable dentures.  He told me he had to go to the restroom when dining out, to take his teeth out and wash them in the sink.  Food would get stuck under the partials and made him very self-conscious.

I placed six dental implants and a sinus lift bone graft.  He has been thrilled...and never again does he have to remove his teeth!

Understanding Sinus Bone Lifting Done Simultaneously with Dental Implants

There are two ways to "lift the sinus" if you are missing bone for an upper back tooth.

Read this post first  and watch this sinus graft video to understand the two main techniques and understand why this procedure is needed.

"Internal Sinus Lift Procedure"

This procedure is used when the bone loss of the upper back tooth area is minimal. In this minimally invasive procedure, the sinus bone is actually moved up through the implant site at the same time the implant is placed.

The black hole above the missing tooth is the sinus:

 

This is my plan measured on the digital x-ray below.  The yellow object is the proposed implant.

So the bone is not "tall" enough to place the implant without puncturing the sinus.

The squiggly area is the proposed area that I will add bone. This will "lift" the sinus membrane and allow the implant to be anchored in more bone.

It is important to have a long enough implant so it does not move. An implant, like a screw in the wall, needs to be tight.  When an implant is tightly held in bone from day one, it has a very high success rate.

 

In this x-ray you can see the bone added to the sinus through the implant. It looks like a "cloud" at the end of the implant! 

For this patient I used 100% bovine (cow) bone. I have a very high success rate with it for this procedure. The bone is CAREFULLY "pushed"  through the implant socket and into the maxillary sinus.

In about four months, the new bone will fuse with my patients bone. At that point, the ceramic crown can be made.

This is a very delicate, technique sensitive procedure that works very well when you just need a little extra bone and are only missing 1 or 2 teeth.

If you are missing 3 or more adjacent teeth in an area that the bone is not tall enough, a traditional "lateral" window sinus bone graft will probably be necessary. I would need to do a detailed exam to be able to tell you which way would work best.

If this technique is possible in your situation, it can really decrease the cost and time of having a dental implant.

Most of my patients will use tylenol or advil after this procedure. My personal techniques, combined with sedation actually dramatically decreases pain AFTER the procedure too.

Two Lower Front Teeth Dental Implants

Here is a case that was just completed today! 

His lower front teeth were not savable and needed to be extracted. They were replaced with two dental implants and crowns.  Pink porcelain was used to replicate the missing gum tissue and make the gum-line look more natural and easier to clean.

This is the before picture and x-ray:

 

 These are the two implants placed in a very tight area without any incisions or bone grafts.

 

These are the final teeth!

 

This is what the implants look like on x-ray:

 

Hence to say, he was ecstatic with the result!

Front Teeth Dental Implant Samples

These are all real patients of mine.  I performed the surgery and made the final teeth. These pictures are a mixture of many different cases.  In some cases, the patient has all the ideal parameters to make the teeth near perfect.  In other cases, the patient is informed in advance should there be an aesthetic compromise.

None of these pictures have been altered.

Please comment and tell me which tooth or teeth you think is the implant(s)!

This post is relevant if you are considering a dental implant for a front tooth. I suggest you look it over.

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

The Triangle of Gums Between Teeth and Implants

The little triangle of gums between your front teeth.  Did you ever notice it? Look closely. Between each tooth should be a little triangle of gum called a papillae.

That little tiny triangle of gum is of ultimate importance when having an implant in the front of the mouth.

When you smile big you probably see these triangles. When an implant is ideal it should have a triangle of gum on each side. If it does not, it may look funny. In fact, it may be missing all together leaving a black hole.

There are ways to regenerate these papilla but the best way is to

Dental Implant X-rays

I often get questions as to what implants look like.  Here are a few examples: