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Must I Have Bone Grafting Done in Order to get Dental Implants

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My dentist and I have been planning on me getting four dental implants soon. I am so excited about the idea of having teeth again and no longer feeling (and looking) like a hillbilly. He mentioned I need some bone grafting done. I was totally fine with that. However, since then, I have done some research and learned that they do the bone grafting with cadaver bone. I have to admit that really gives me the heebie-jeebies. Is it at all possible for me to have the dental implants done without the bone grafting?

Jennifer

Dear Jennifer,

Illustration of a dental implant next to a natural tooth

While you will need bone grafting done, I have good news for you. Let’s start with why the bone grafting is important first. The dentist recommended this procedure to you because you do not have enough bone in the areas where you are getting your dental implants to actually retain the implants. If you go forward without it, you will end up with dental implant failure and possibly even a cracked jaw. It is essential.

Cadaver Alternatives

Now for that good news I mentioned. Cadaver bone is not the only option for bone grafting. It may be that your dentist never intended to use that option. There are bovine options, and even synthetic bone, mixed with some organic materials. It is even possible for them to harvest and use your own bone, though that would entail an additional procedure.

I would start by talking to your dentist about what type of bone he planned on using for your case. If he says cadaver bone, then tell him your concerns and ask for an alternative option.

About Cadaver Bone

Before you decide against it, you should know a few things about the process. First, the bone was lovingly donated by people and/or their families to go to people in need after their or their loved ones’ death. The bone is thoroughly tested in order to make sure it is healthy and then goes through processing and sterilization.

Either way, it is up to you. Just have a conversation with your dentist to learn his plans and express your desires.

This blog is brought to you by Philadelphia Dentist Dr. Michael Weiss.

Sinus Perforation with a Dental Implant

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I had a dental implant placed on one of the teeth adjacent to my front teeth. The dentist told me at the time that the sinus cavity was perforated by just a few millimeters, which he said is fairly common. He did not put me on an antibiotic at the time because he said it was unnecessary. Just six months after the implant was placed it had to be removed because he said the bone was not developing properly. After the removal, he again gave me no antibiotics because he said everything went fine.  My instructions were to wait a year for the bone to fill in and then we’d start again. He also said there was no need to repair the sinus perforation. A few weeks later, I started having problems. First, I was having crackling in my ears and congestion. I called and they said to use Flonase. I did but things seemed to get worse. I went in and they insisted everything looked fine. I disagreed because it felt like I was developing an infection. He reluctantly agreed to give me some antibiotics. Since then, everything started to clear up and I feel better. My question is should I have gotten an antibiotic from the beginning? Am I going to have any better luck the next time I go for the dental implant?

Cathey

Dear Cathey,

Diagram of a dental implant

 

You’ve been through a lot. I’m impressed you are willing to give it another go to get your dental implant. Good for you! It definitely is the best tooth replacement option. Before you do, I want to make sure some things are addressed by your dentist. However, let’s start with your question. It was not really needed to give you an antibiotic from the beginning, but when you started having problems, that would have been a good time. Believe it or not, that isn’t the real issue with your case.

Two Big Mistakes with Your Dental Implant Procedure

The first issue I would want an answer about is the depth of the perforation. While some oral surgeons say sinus perforations happen sometimes, all of them would say that a few millimeters is too much. In the dental field, that is a huge amount. Huge! I would want an answer for that.

The second big issue is diagnostics. My suspicion is that he did not do adequate diagnostics in preparation for your procedure. This may also explain why the bone did not integrate properly.

There should have been a number of x-rays done, including a 3-dimensional one such as a CT scan. The CT scan is especially important so that there isn’t a sinus perforation, such as what you experienced. Additionally, those diagnostics let the dentist know if there is enough bone structure to support the dental implant.

Can You Still Get a Dental Implant?

The short answer to the above question is yes…but. It is not as simple as your oral surgeon made out. First of all, the bone is not just going to fill out on its own. You will have to have a bone grafting procedure done. Once that is completed, you will need a time of healing before starting over.

While you can have the dental implant done, I do not recommend you use the same dentist/oral surgeon unless they can tell you what they are going to do to prevent this issue in the future. Another important point is that it should be the dentist who determines the placement of the implant, not the oral surgeon. Make sure you visit the dentist first.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

 

I Can Smell My Husband’s Dental Implants

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My husband has received his dental implants for some implant overdentures. Currently, he has temporary acrylic dentures but will be getting porcelain ones soon. The problem is I can smell this awful rubber smell coming from his mouth and I am certain they are his dental implants. I even have to sleep under the blankets with my face to avoid smelling them while we sleep. I would like him to remove them and get some non-metal ones, but his dentist says that the implants are not causing any smell and doesn’t want to remove them. Is there a way to prove it is the implants?

Alison

Dear Alison,

Implant overdentures

Implant overdentures

 

I am inclined to agree with your husband’s dentist. The metal used in dental implants is titanium. These are very inert and are unlikely to release any smell. You can even ask the dentist to let you see an implant so you can smell it. You will see it does not give off a smell. Switching out implants is not as simple as just taking some out and putting in some others.

When the implants are removed, they will take bone with them. That bone is necessary in order to retain the new implants. That will mean a second surgery for bone grafting before a third surgery for the new implants. That is a lot to put your husband through unnecessarily.

If there is a smell, the most likely culprit will be food and other bacteria getting caught under his acrylic overdentures. I would try having him use a Waterpik for his flossing. It will help him to get that debris out better and will clear up any smell. Once a week, it wouldn’t hurt to rinse with some peroxide. I wouldn’t do it more than once a week though or it could lead to him getting an oral yeast infection.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Botched Implant Case

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A little over a year ago, I had four dental implants placed after a car accident left me with a lot of lost teeth. Since then, the crowns have broken or fallen off and the implants themselves are there but I don’t know how healthy or secure they are. I tried calling the office for quite a few weeks and they kept giving me the run around. Now I have discovered this dentist has left the country and no one can reach him. At first, I was worried about him, like maybe something happened to him on vacation, but it turns out he literally skipped the country. He’s emptied the practice account and they are closing the doors. What do I do now?

Andrew

Dear Andrew,

woman covering her mouth with her hand.

 

I am sorry this happened to you. First, the accident and then an unethical dentist. In all honesty, the only thing you can do now, is to have someone who is skilled with dental implants to look at your case and see how stable the implants are and what went wrong with the dental crowns. Hopefully, the implants themselves are fine and the dentist who did your case just did not bond them on properly.  Then, you will only have to replace the crowns. If it does turn out that your implants are poorly placed and at risk, you will have to replace them. Unfortunately, that will also mean getting one additional procedure, known as bone grafting, so that you will again have enough bone structure to retain your new dental implants.

There is an upside to these tragic circumstances. First, you can make any changes you want. If there was something you didn’t like about the earlier results, now is your chance to completely remake your smile. Make it gorgeous. Another opportunity is for you to whiten your teeth. If you decide to do that, do it before your new crowns are made. Whatever color they are fashioned with is permanent.

A second upside is that I am willing to bet that most dentists who hear the series of events that happened to you will be more willing to work with you on paying this out instead of having to pay up front, which is the typical requirement.

Again, I am sorry this happened to you. Hopefully, this next dentist will be just what you need!

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

 

Bone Grafting Failed

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I am not sure what to do. I had planned on getting a dental implant. My dentist has placed many of them for other people so I felt okay going to him instead of a dental implant specialist. When he first attempted the surgery he had to stop and told me he thought that I needed some bone grafting done for the dental implant to work.  I went along with his assessment. He did the bone grafting and then after the appropriate period, we went in for the second attempt at the implant surgery. Again he informed me that there isn’t enough bone and we weren’t able to complete the procedure. Now his suggestion is I get a dental bridge. I am finding myself wishing I had gone to a specialist. Is it too late for me to get this implant? If so, is there a better option?

Misty

Dear Misty,

Three stages of a dental implant

The first thing I will say is while there isn’t a recognized specialty in dental implants, there are dentists who have invested in more training and have more experience than others. While you were able to get the care you needed with your family dentist. You have two great things going for you with this dentist.

First, he appears to be a dentist who is taking his field seriously and is consistently learning new skills. This is a great quality for a dentist. They will not just be stuck in a rut. Instead, their patients will benefit from their learning all the latest advancements and procedures in the field.

Second, your dentist has integrity. When he saw the potential for failure in the first attempt, he stopped the procedure in order to give you your best chance of a positive outcome. Then, after you followed his advice, but it didn’t work, he admitted it. Some dentists would have just placed the implants and not said anything about the bone grafting not working, in order to save themselves embarrassment. Then, a year or so down the line, the dental implant will fail and you would never know the real reason behind the failure.

Would this have happened if you had gone to a more experienced implant dentist? No. But, every dentist that is starting a new skill has some failures.

You can still get a dental implant if you still want one. It will require you to have the bone grafting rebuilt before you move forward.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Titanium Versus Zirconia Implants

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I have two traditional titanium dental implants in my mouth. I recently read in a natural health magazine that they are discovering titanium can have a negative neurological impact. It’s got me worried about the current implants I have. Should I switch them to the zirconia implants? Are the zirconia better?

Carol

Dear Carol,

metal-free dental implants

First, I want to assure you that you are safe. There is a lot of information swirling out there. Much of it causes unnecessary panic. Before believing anything, ask yourself if they cited the studies. When you looked at those studies were they done scientifically? I once read an article which cited a “study” where there was only one patient who suffered the negative effects discussed. To top that off, there was no direct correlation.

Titanium has been used as biological replacements, including joint replacements, for decades now and is one of the most biologically compatible materials out there. I’m am aware of no legitimate studies indicating there are any negative neurological effects.

I rarely recommend replacing dental implants which are thriving well. The reason for that is you will lose bone structure as a result of removing the implants. In order to place new implants in, you would have to add an additional bone grafting procedure to build back up the bone. Then, after that heals you’d need another surgery with the zirconia implants. In my opinion, that is too great a risk. However, that is not my decision to make. You have to do what makes the most sense to you.

As to whether or not the metal-free dental implants are better, there isn’t a way to answer that…yet. While we have decades of data on titanium implants along with their longevity, zirconia is in the newer stages of use in dental restorations. Therefore, we don’t have long-term data on them yet. It doesn’t mean they are better or worse. Just that we don’t know.

The bigger key to any dental implant success is the training and experience of the dentist doing the procedure. I hope this helps.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Gross Dental Implant Incompetence

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I am not sure where to go from here and need some advice. I had a dental implant placed. It felt like the crown was loose so I went to see my dentist. He said the crown was loose and needed to be re-cemented. When he tried to take the crown off he had a bit of trouble. His next step was to use a special tool, but when he got the crown off the dental implant came with it. What do I do now?

Phylicia

Dear Phylicia,

Three stages of a dental implant

Can you get a dental implant while on Fosamax?

I hate to be the one to tell you this, but your dentist is completely incompetent. First, if a dental crown is loose, it is incredibly easy to remove them. Most often, they fall off of their own accord. What was actually loose was your dental implant. If your dentist wasn’t incompetent then he was incredibly dishonest. Neither scenario bodes well for you as his patient.

Some Reasons for Loose Dental Implants

If the implant came loose right after the dental crown was placed, then it means the crown was placed prematurely. Before you can place an implant crown there has to be sufficient osseointegration. Without that, the crown will pull the implant loose. Another option is there wasn’t enough bone support to begin with. Doing implants requires substantial diagnostics. A dentist should determine how healthy the bone structure is. Then, if there isn’t enough, suggest bone grafting to make sure you have the best chance of a successful outcome.

Some implants fail because of an infection. You didn’t mention either pain or a fever. In most cases of infection, one or both of those would be present.

Fixing a Failed Dental Implant

The first thing you need to do is demand the dentist who botched this so badly pay to get it fixed by a dentist you choose. That is important. Fixing this involves more than your original procedure, so just getting a refund will not be enough. You also want it to be a dentist you choose, so you can make sure they have the expertise to do this right.

It will require significant post-doctoral training. For instance, Dr. Weiss trained at the esteemed Dawson Academy. He’s also an instructor at the Academy of Osseointegration. This is what you want to look for. Not only that, he’san AACD accredited dentist which means he can create a beautiful crown.

I’m sorry this happened to you. Hopefully, this can be rectified soon.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Are Implant Overdentures Permanent

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I need to replace my dentures, but this time I’m looking for something that stays put and is permanent. My dentist only does dentures and can’t help me figure out what’s best. I keep hearing dental implants are better than implant overdentures, but overdentures are more affordable. Are the overdentures permanent like the implants?

Morgan

Dear Morgan,

Implant overdentures

Implant overdentures are a combination of dental implants and dentures

I’m afraid you are getting some mixed information. Implant overdentures use dental implants. The reason they are considered more affordable is because with a traditional dental implant you are using a single implant with a dental crown on top. You are talking about replacing every tooth, as I’m assuming you had complete removable dentures. To put a dental implant and crown on every single tooth would have an astronomical cost, as it would require 32 implants.

To make that more affordable implant overdentures use around six dental implants per arch. Then a set of dentures are anchored to the implants. They are definitely permanent and stable. Like all dental implant procedures, their biggest benefit is that they protect you from facial collapse.

Implant Overdentures and Facial Collapse

When your teeth were removed for your dentures, your body recognized you no longer had any teeth roots in your jawbone. In an effort to be efficient, your body begins to resorb the minerals in your jawbone to use elsewhere throughout your body where it perceives the need to be greater.

This has the unfortunate result of shrinking your jawbone. Eventually, you won’t even have enough jawbone left to even keep your dentures in. Getting dental implants prevents this because the implants themselves stand-in for your tooth roots, allowing your body to recognize there are still “teeth” there.

Depending on how long you have had your dentures, you will have lost some jawbone. There is a chance you won’t have enough jawbone left to secure dental implants. If that is the case, you can still get that treatment option; however, you’ll need to have one additional procedure done. Bone grafting can build up the bone loss in order for you to get the best procedure.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.