Dental Implant Dentistry Blog

Molar Dental Implant X-ray Series - Ramsey Amin, DDS -Burbank Dentist

 
Dental implants are excellent for replacing molarswhich are located in the back of your mouth.  Your molars are CRUCIAL to your long term dental health.  Even missing just one molar will set you up for problems to come.  Multiple missing molars create dental disasters that can become costly to reconstruct.

Molars with root canals are often lost. Sometimes you just lose root canal tooth because it fractures; splitting down the middle.  Other times, the crown of a root canal tooth, breaks off, leaving the root only.  The root often does not have enough left to make a new crown so a dental implant to replace the molar is best.

Always replace missing molars with dental implants as soon as you lose one either on the same day of extraction or within 2-6 months after the loss.

Here is a female patient from Glendale that I treated in Burbank: 

Here is that same tooth a few months later after the crown broke off.

 
 

 

Finished dental implant!
 

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

 

3 Myths About Tooth Implants -Pain, Expense and Time - Burbank Dentist Explains

Dental tooth implants have been in use for more than 40 years!  Even though they are quite common, there are three "myths" that I hear potential patients describe all the time.

1. Dental implants are painful!

2. Dental Implants are expensive!

3. Dental implants take a long time!

1. Dental implants are painful!

FALSE!  In my more than a decade of placing dental implants, most of my patients say, "that was much easier than I thought!"

There are three things that will predict whether this procedure will hurt. 

The ease or difficulty of your unique situation is first.  The second factor is your ability to heal well.  And third, the skill and training of your implant dentist.

Pain should not be a factor in your decision making process.  Choose the treatment that will give you the best result.  Although I do write narcotic prescriptions such as Vicodin, most of my patients end up just using tylenol and/or advil.  IV sedation is highly recommended as it will reduce post-operative pain too!

2.  Dental implants are expensive!

FALSE!  Dental implants do not cost much more than an average 3 tooth bridge! In my office in Burbank, the cost is almost identical.  The long-term cost for having an implant versus a bridge is much lower, since a bridge will be replaced every 7 -15 years.  Your dental implant will most likely never need to be replaced!

If you have a bridge, your adjacent teeth will be irreversibly ground down into little nubs. This fact alone is worth it.

3. Dental implants take a long time!

FALSE! Having an implant usually takes 2 - 4 months on average.  A bridge takes 3 - 6 weeks.

It is a short term sacrifice for a long term benefit!

Bone by nature, takes a while to heal.  Have you ever broken a bone and had to wear a cast?  I'm sure you had to wear it for a several weeks!  The bone around a newly placed implant has to mend, just like the bones in your arm would have to. 

A bone graft, may or may not extend the amount of time it takes for healing.

In my Burbank office, you will always have a temporary tooth!  You don't have to walk around with missing teeth during the process!

Here what my patients have to say: http://www.burbankdentalimplants.com/VideoTestimonials.aspx

Burbank Dental Implant Specialist Case Example - Lower Front Tooth With Temporary on Abutment

This 24 year-old female came to see me at my Burbank office.  She already had an implant, a custom abutment and a temporary crown on her lower front tooth. She was ready to be fitted with the real crown.

The temporary on the dental implant custom abutment did not look very good at all.  Neither the patient, nor I really liked it.  Besides being dark and black at the gum line, it lacked other the right shape of gum.  It looked to "set back" towards her tongue.

The tooth was further complicated by the implant being about 0.3mm to 0.5mm too large.  Yes...that tiny amount makes a HUGE difference in the final result.

I reshaped her temp and "trained" her gum to fill in between the teeth and make them the same length. This took a few weeks for this to occur and is done by modifying the temporary...NO surgery is done.

Below is the photo series of the dental implant restoration using her existing custom abutment.

This is how she came to me with her existing temp in place:

Here is the abutment after I reshaped it:

The final porcelain crown and corrected gum line appearance:

Final x-ray:

I was able to help her control the cost of the restoration by using the existing titanium metal custom abutment rather than starting from scratch.  A narrower implant and abutment would have made this much easier.

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

Abutments -Burbank Dental Implants Expert -Dr. Ramsey Amin - Case Follow up

Here is some follow up pictures to this case posted a few months ago:

In my office in Burbank, the final abutments were placed on these four implants that I placed.  The process takes me about 45 minutes to complete.

Impressions can be made, and teeth fabricated directly on the dental implant abutments.  These are not custom abutments.

 

These abutments can be shaped in the mouth.  This method can greatly reduce cost if you are considering tooth replacement.

 

Notice the perfect alignment of the implants.  This is critical for the best long-term success.

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

Dental Implants With Just One Surgery? - Expert Dentist, Dr. Ramsey Amin Explains

Traditionally most dental implants were placed using a two stage surgical technique.  That means you would have two surgeries for just one implant!

The first surgery would be to place the actual implant in the bone.  At that time the dental implant would be covered by the gum so it is not visible.  That is the part that people refer to as the "screw."

Here is an x-ray example of short implants that had to be buried due to the patients medical condition:

 
The second surgery would happen a few months later to "uncover" the implant from under the gums.  This allows the gum to heal around the implant as it is newly exposed in your mouth.

In my office in Burbank, nearly 95% of my patients do not need the second procedure.  Not only does this prevent you from needing a second procedure, but it helps reduce the cost.  It increases the price, when you have to have two surgeries rather than one. One stage implants help me decrease the cost to patients.

Here is an example of a one stage surgery (note that the implants are taller so they are visible in the mouth):

 
What makes the determination for one or two stage?  It varies, but I find that many dentists and surgeons still do two stages because that is the way they have "always done it." There is  a lot of scientific proof to allow the implant to be done in one stage.

The other determination is mostly in how "tight" the implant is when it is first put in.  That tightness is very much controlled by the skill and experience of your implant dentist.  This is especially critical for dental implants in your upper jaw, where the bone is usually very soft.

I do on occasion use the two stage technique when it is better for your situation.  I may do it if I am doing a large bone graft at the same time the implants are being placed.

The most common area of the mouth to use the two stage surgery is the upper back molars. This area has very soft bone so implants in this area may not get as "tight" when first placed.

Having a tight implant also positively relates to the long term success of your implant.  I accurately measure how tight or loose your implant is using a torque wrench.

So there you have it... One stage, one surgery if it is predictable for your particular situation.

Please ask questions in the comments section below this post.

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

Does Insurance Cover Dental Implants? - Burbank Implant Dentist Advice

Usually not.

It is really unfortunate that dental insurance usually does not cover this very common procedure.

What most patients don't know is that dental insurance has a "cap" or "ceiling" of money (benefit) on a yearly basis.  Unlike medical insurance, most dental insurances max out at $1500 per year!  That means anything above that amount is owed by you.

Medical insurance may cap off at the 1 - 2 million dollar mark!

This maximum of $1500 has been the same since the 1970's! If it would have kept up with inflation, the maximum yearly benefit would be about $8800.

Dental insurance just has not kept up with the times!

About 75% of my patients in Burbank do not have dental insurance for their dental implants or bone grafting procedures.  They seek me out as an authority of the dental implant procedure. I do not suggest you "shop" around by price, but rather pick the best implant dentist and check out their credentials very carefully.

That said, I have had written extensive narratives for my patients and got their insurance to pay for implants many times over the last ten years.  I have also gotten them to pay for it when it wasn't even a covered benefit.

Bottom line...don't let your insurance dictate the proper treatment you need or want.  You control your health care.

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

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 
 

The Process of Having a Dental Implant - Video by Leading Burbank Dental Implant Dentist

The process of having a dental implant is very unique for each situation.  This video, that I made in my office in Burbank, will help you understand the basics of what is involved. It explains how the procedure is done and sequenced.

A dental implant can be completed in as short as one single appointment in one day, or it may take a few months.Depending on the process, the cost can vary.

The process is illustrated on my website.

If you cant see the video, watch it here:  http://www.youtube.com/watch?v=DlDRhHH8tsM

A related topic is "immediate dental implants" which is something I have done very routinely for about 10 years.

Your comments and questions below will be answered!  (No need to sign up, just click the "comments" tab below)

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

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 or Root Canal - Cost and Value Comparison

Although I am considered a dental implant specialist by a credentialing board and my peers let me first start by saying that saving your natural teeth is my FIRST priority.

 

Dental implants are fantastic, but they are a close “second” to your natural teeth.

The question is more about “restorability” of your remaining tooth when deciding whether to have a root canal and keep your tooth, or to extract it have a dental implant replacement.

 

A root canal is a procedure to treat a dead or dying tooth.  It is usually a result of a deep cavity touching the nerve or coming very close to the nerve.  Some root canals are done to save a tooth that has suffered trauma like a hit to the mouth from a bike accident.

 

The inside of the tooth and roots are hallowed out and the nerves removed.  This leaves the tooth weak, brittle and prone to fracture so a crown or onlay is made to “cap” over the tooth.  A crown or onlay prevents your tooth with a root canal from breaking. So the crown is EQUALLY important as the root canal.

 

A crown or onlay’s longevity is mostly based on how much of your own tooth remains.  So if your tooth had a huge cavity that went under the gumline and then a root canal, you have very little tooth structure left.  A tooth post or build-up does NOT add strength to the tooth.  It just gives the crown a bit more to grab onto.

 

Too often I see root canals done on near hopeless teeth.  They have a crown made on a hopeless tooth, and it falls out or fails very prematurely.

 

That to me is just not right.  You may have invested $2000 -$3000 for the root canal, crown, post and build up only to have it extracted in just

a few years!

 

When your tooth is badly damaged, the cost of a dental implant makes a lot more sense than having a root canal and crown on your tooth that does not have a good long-term prognosis.

 

Can the really bad tooth in this picture be predictably saved?

 

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.

Don’t Wait Too Long To Extract A Bad Tooth!

The absolute worst thing you can do is wait to pull a bad tooth. 

Many times a really bad tooth is painful, but then it gets better! You know and have been told that it needs to be extracted but you decide to wait because the pain is gone…for now.

In the old days, "keep it until it falls out" was the mantra.  The exact opposite is true today.

If the tooth needs to be extracted due to gum disease, which causes bone loss, the situation only worsens.  Your body is trying to “self-extract” your tooth by dissolving the surrounding bone and making it loose. 

Eventually, it will fall out!  All that time, it has dissolved all the good bone around it that would have supported a dental implant.

Dental implants need great bone support.  Waiting to remove a tooth only compromises the bone and makes having a dental implant more expensive than it needs to be.

In this picture below, you can see how the gum disease has dissolved away the gum and bone making the teeth longer.

Look at this x-ray.  Do you see how the bone is missing from gum disease?

 

Extracting the bad tooth will reduce the need for bone grafting or sinus lifts making it a very easy procedure for you.

Here are some examples of simple dental implants:

 

Feel free to share your thoughts on waiting to remove a bad tooth.

The Cost of Dental Implants Related to Crown Materials.

The cost of making teeth for dental implants is usually equal to or more than the actual implants in the bone.

This fact is commonly mistaken. It is of utmost importance to have the right type of teeth made on the implants.

For example, a whole upper jaw of missing is usually replaced with 6 - 9 dental implants even though there are usually 14 teeth. Those few implants can usually support 10 to 14 teeth.

When a ten to fourteen tooth bridge is made there are two basic materials, plastic resin or porcelain. The porcelain is the better choice and generally costs 35% more.

Plastic resin implant bridges are very common. The teeth are actually teeth for dentures. They greatly reduce cost because they are premade and not custom. They can look beautiful. This is one I did many years ago:

The problem with the plastic resin fixed bridges is that the teeth wear out, stain and break off routinely. They are not "permanent teeth" as some advertise on the radio. Expect to replace the teeth every 5 - 7 years. 

This is one that did exactly that:

A fixed porcelain bridge is completely custom made. It is all gold alloy metal underneath the porcelain for strength. It rarely wears out and does not stain. It also maintains the vertical dimension of the face of the long term. This prevents the "aged" look.

Porcelain can chip or break...it is not indestructible. If you have a really strong bite, grind your teeth or have really short teeth, I may recommend a blend of materials. The outside part that shows is made in white porcelain, while the biting surface is made in metal.

Here is a picture of two implants restored in this fashion:

I agree, they are not pretty from this angle, but some people need this or they will break the implant teeth.

From the side view that is visible:

This is one part of your treatment that you really want to know the details.

The cost of the implant treatment is highly dependent on this. You don’t want corners to be cut by choosing the wrong material or worse yet, not even knowing what you got.  Many times I hear patients say they got or are getting and implant "bridge" but it is actually an overdenture!!!

Please feel free to comment if you are uncertain about materials!

I have seen many patients that thought they were getting a deal.  But like anything else: if it sounds too good to be true....

How to Choose an Implant Dentist

You may have noticed that there are many dentists who claim to be “experts” in dental implants.  Even if they do not claim to be “experts,” many dentists still say they do implants.  The average dentist may be involved in 1-2 implants per year.  I typically see 4-5 cases per day.

Most dentists receive very little formal training in dental implantology.  Many dentists take a couple of weekend crash courses and start surgery from there.

Be sure to ask specifically about the dentists experience…even if it is just one implant.  A minor error can have long term consequences.

Most dentists only do one part of the implant.  They either do the surgery or  they make the teeth.  I do both.  This makes me very unique.  It also helps to reduce cost and the teeth turn out nicer since the all factors are in control of one person.  You must go to two different offices when your dentist only does one part.

I am a Diplomate of the American Board of Oral Implantology/Implant Dentistry (ABOI/ID)

The ABOI/ID is a certification agency that serves independently to protect members of the public who seek dental implant care. The designation signifies that these dentists have met the highest criterion in oral implantology - they have met educational and experiential standards; and, they have reached an in-depth level of knowledge and acquired the highest level of skill and ability.

Since 1969, only 359 dentists in the United States have passed this rigorous Board Certification process.  This honorable title makes me extremely well qualified in all dental implant and bone grafting procedures. This is implant dentistry’s “Hall of Fame.”

In addition,  I am a Fellow of the American Academy of Implant Dentistry.

Fellows have been certified by their peers and have met national standards of education and practice in oral implantology. Due to the more extensive experiential requirements for Fellow Membership, Fellows are required to demonstrate advanced knowledge and experience in implant dentistry.

There are 150,000 dentists in the U.S. to choose from…you are in good hands with me!

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

 

 

Dental implants...How Much Do They cost?

For obvious reasons, this one of the most common questions I hear.  Dental implants are the best thing that has happened in dentistry. It allows me to save good teeth and provide teeth where the only option used to be a removable denture or a bridge. Dental implants can be affordable.

It is very common for me to replace a whole set of teeth. When you replace a whole set of teeth, you do not need one implant for every missing tooth. Implants are stronger than your own teeth so usually only four to nine implants can replace a whole upper or lower. The new implant teeth may have twelve to fourteen teeth supported by eight dental implants. In general, the more implants you have, the more stable it will be. The last thing you want to do is "under-engineer" the foundation by using an absolute minimum number of implants.

 

Dental implant treatment can be priced as low as