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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.

Should I Switch Implant Dentists?

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I am getting two dental implants. I’m paying a LOT of money for this and am concerned that my dentist may be in over his head for reasons I am about to explain. I have had the teeth extracted and some bone grafting done. Then, my dentist provided me with two different Maryland Bridges as temporary replacements. They’ve fallen off several times each. This has made me wonder if he understands esthetic dentistry. Should I switch dentists in the middle of my procedure to a dentist who has more experience?

Misty

Dear Misty,

Maryland Bridge Diagram

For those who do not know, a Maryland Bridge is a false tooth that is attached to the adjacent teeth with either metal or ceramic wings. I would not consider this a temporary tooth replacement because the adjacent teeth have to be etched and bonded on. If your dentist does not understand how to adequately place this, then I have concerns about two aspects of this. First, I have the same concern you do. If he doesn’t understand how a Maryland Bridge works you are not likely to get an attractive aesthetic result. A second concern is just the dental implant procedure itself. This is quite an advanced procedure. If he cannot do the Maryland Bridge, then I would have concerns about the implants.

You can switch dentists in the middle of a procedure. Your current dentist is ethically obligated to cooperate with your new dentist, including providing him with all the necessary diagnostics and notes that he has on your procedure. You will want to make certain that whichever dentist you go to has post-doctoral implant training. Some training to look for is someone who has been to the Dawson Academy, the Kois Center, or the Las Vegas Institute for Advanced Dental Studies. He will want to examine your implants and make sure they’re placed properly before moving forward. Don’t be surprised if the dentist suggests a different temporary tooth replacement. A dental bridge is the most common recommendation. The good news is that it is much less expensive than the Maryland Bridge.

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

 

Are All On 4 Dental Implants Okay?

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My husband is losing his teeth and we went to see our dentist about some options for him. He said we should get the all-on-4 dental implants. Are these as good as the regular ones?

Esther

Dear Esther,

Illustrations of all on 4 dental implants

All-on-4 Dental Implants

 

First, I want to check something. Was this the ONLY option he discussed with you? If so, I’d be wary. There are many options for tooth replacements. I’d be careful with any dentist who does not give you all of y our options. It means they are pushing a procedure on you. Where the all-on-four procedure is useful is when a patient has lost bone structure, but is not a good candidate for a bone grafting procedure. If he has plenty of bone structure, then this would be a stupid option for him. Instead, I would get him the traditional dental implant solution.

I am unclear from your question if he is losing all of his teeth or if he is just starting to lose some teeth. If he is only losing some teeth, then getting an individual dental implant for each of the lost teeth will be fine.

Implant overdentures

Implant overdentures

If he’s lost all of his teeth, then the more affordable option would be to get implant overdentures. This will use four or more dental implants and then, after the implants have had time to integrate with your bone, a denture will be anchored to them. These are very secure. Another way these are superior to all-on-4 implants is in failure. If one dental implant fails, you will replace that implant. With all-on-4, if one implant fails then the entire unit needs to be replaced.

What I would like you to do is get a second opinion from a dentist with good post-doctoral training in dental implants. To get an idea of the type of training you want, look at Dr. Weiss’s bio. This is important because dental implants are an advanced procedure and they are barely touched on during dental school. That additional training can make the difference between a successful case and a dental implant horror story.

There is an additional consideration. This is his smile. You want to make sure the dentist has some decent cosmetic skills. I would either go to an implant dentist who is AACD accredited and/or recommended on the mynewsmile.com website. They will be able to give them a smile he will be proud to share.

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

Dental Implants for Hockey Players

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My son lost a tooth in a hockey game. Our dentist suggested we get him a dental implant to replace it, but his coach said that is a bad idea because of the chance of re-injury. What is the right choice? I want to do what is best for him, but the mixed messages are confusing.

Kami

Dear Kami,

Hockey player with a missing tooth

 

In a way, they are both right. Dental implants are the absolute best tooth replacement option. However, there is a risk for re-injury if he is continuing to play hockey. A dental implant consists of a prosthetic root form and a dental crown bonded on top of it to serve as the visible part of the tooth. If he is re-injured with both parts completed, there is a good chance he will lose some bone with the injury (and possibly even some of his jaw).

Here is my recommnedation. First, get the implant placed, but just the implant. This will allow him to get the benefits of the dental implant without having to worry about extra damage being done in case the tooth is lost again. You won’t want him going “toothless” in that area, so I suggest an inexpensive temporary restoration, such as you would get with a dental flipper. This gives him the best of both worlds.

Having the root form placed, ensures his jawbone can stay healthy and will not suffer any effects of the structural loss that normally occurs when you lose or remove some teeth. Having a dental flipper means if he is hit in the mouth again, the flipper will come out with ease and he won’t risk additional injury.  When he is done playing hockey, that will be the time to have the permanent dental crown placed on his implant.

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

 

I Need Options for My Tooth

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I had an accident on my tooth when I was a child. Over the years it has turned more and more brown. It’s causing me to not want to smile. I went to see my dentist about it and he said there isn’t a root there anymore and I should just remove the tooth and put a fake one there.  Is there a way to have a pretty tooth if it is fake?

Rebecca

Dear Rebecca,

What you are suffering from is root resorption. It is a shame your childhood dentist didn’t give you a root canal treatment when you had the injury. That could have prevented the resorption. It isn’t a guarantee, but not doing anything definitely leads to resorption. He is right that at this point the tooth cannot be saved. It doesn’t sound like he spoke to you about any of your options.

The top of the line option is to get a dental implant. This places a prosthetic root in your jaw and once the bone has integrated with the implant a dental crown will be placed. It has the benefit of being the most secure option and the closest thing to having a natural tooth. However, it is the most expensive option.

If that isn’t for you, the next step would be to get a dental bridge. This suspends a false tooth between two dental crowns. This makes sense if either of those teeth already need crowns. If they don’t, you may not want to grind down healthy tooth structure unnecessarily.

There are less expensive options as well such as a removable partial denture or a dental flipper. Neither of those will be secured to your teeth, so just be aware they come out.

Is Your Dentist Serving You Well?

I’m a tad concerned that your dentist isn’t taking adequate care of you. This is especially true if this is the same dentist that didn’t deal with your tooth injury to begin with that is especially concerning.

It also sounds like he’s leaving you to figure out what to do about replacing your tooth. In reality, he is ethically bound to give you all your options. It may be time to ask why he isn’t doing that.

Will a False Tooth Look Attractive?

As to your concern with how the false tooth will look, that depends completely on the cosmetic dentistry skill of the dentist doing the work. Creating beautiful smiles is an art form. The best cosmetic dentists are AACD accredited, which is completely different from membership, which any dentist can do.

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