Dental Implants

Where did you receive your dental implant training?    

Surgical placement of dental implants is an integral part of formal training curriculum for oral & maxillofacial surgeons and periodontists educated in the last 10-15 years. This kind of surgical training is generally not part of education program for general dentists and prosthodontists.

The currently prevailing standard is that surgically trained specialists, such as periodontists and oral surgeons perform dental implants placement, whereas general dentists and prosthodontists perform dental implant restorations. Dental professionals who are capable of performing both restorative and surgical components of dental implant treatment with equal degree of proficiency are extremely rare.

Which dental implant system do you use?     

Not all dental implants are the same. Just like any manufactured product, some products are better than others. Low-end dental implants may be purchased for $50-70 per fixture, whereas dental implants produced by the industry leaders typically cost between $300-$500.

We use high quality dental implants such as: 3i implants (American made) and Zimmer Swiss Dental Implants. These implants have long term studies at prestigious Universities and are worldwide recognized. According to empirical observations, the rate of dental implant failure and complications is significantly higher for patients receiving low cost implant components. This is due to the limited amount of R&D spent by the low end manufacturers on implants design, as well as the fact that established dental implant specialists will rarely (if ever) expose their patients to the risks of placing second-rate, under-researched dental implant components.

How many dental implants have you placed or restored?     

While the total number of implant cases that a dentist or a specialist had performed is important, the more important (especially in complex cases) is the number of previous cases that were similar or identical to yours.

When evaluating the competence of your dental implant professional, keep in mind that single tooth replacement cases are a lot more common than full-mouth or full-arch teeth replacements.

Also, if sophisticated soft tissue or hard tissue augmentation procedures are necessary, you may need to consider whether your specialist is best qualified to perform those. For instance, in some cases a cosmetic periodontist may be preferred to an oral & maxillofacial surgeon, while in others the exact opposite may be the case.

When placing dental implants, what is your success/failure rate?     

Dental implants may fail for a variety of reasons, including poor bone quality, poor health or compromised immune system, high stress, heavy smoking or putting too much pressure on the newly placed implants with excessive grinding of teeth.

Studies show that dental implants have a 90-95% success rate. If your dentist’s or specialist’s success rate is below that range, consider getting a second opinion from another specialist.

Will there be an additional charge for second stage implant uncovering?     

If upon placing an implant your surgeon had elected to leave your implant covered by the gum, a second stage implant uncovering procedure will be necessary in order to attach an implant abutment and to proceed with implant restoration.

The second stage surgical procedure usually takes between 15-30 minutes for each implant fixture that had been placed. Some specialists have an additional fee for this procedure, whereas others do not. If you would like to know the total cost of your implant surgery remembers to ask your surgical specialist whether there will be an additional charge for the second stage implant uncovering.

What happens if my implant fails?     

If your dentist or specialist has determined that a dental implant had failed to integrate with your jawbone, it will need to be removed and replaced.

Normally, a replacement implant will be placed at no additional charge. However, this can depend on exact circumstances of your case, and it may be appropriate to confirm this with your dentist or specialist before your dental implant procedure.

If your dental implant restoration (crown, bridge, denture or appliance) breaks from accident, trauma or regular wear and tear, you may have to replace it at your own cost.

What will the final result look like?     

This is an important aspect of dental implant treatment which often gets overlooked during the initial consultation stage by both specialists/dentists and patients. This is because at the initial consultation stage more emphasis is usually placed on the discussion of how the “missing teeth can be replaced”, rather than on “what new teeth would look like”.

The esthetics of your final result is clearly more important if you are replacing your front (particularly upper) teeth. In those cases it is imperative that you examine “before and after” photographs of your specialist’s previous implant cases that were similar to your situation.

The discussion of the esthetics of your case supported by before-and-after photos of prior cases should set a clear expectation for both yourself and your specialist as to the final appearance of your implant.

What if I am dissatisfied with esthetics of the final result?     

Because both surgical and restorative specialists both contribute to the esthetics of your final result, responsibility for the poor esthetics of an implant case is often not an easy question to determine. A lot depends on whether you have received a clear set of esthetic expectations from both the surgical and restorative specialists before your case had started.

Endodontics

How much will the procedure cost?     

The cost varies depending on how complex the problem is and which tooth is affected. Molars are more difficult to treat, therefore the fee is usually more. Most dental insurance policies provide some coverage for endodontic treatment.

Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with a bridge or implant to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration. With root canal treatment you save your natural teeth and money.

Will the tooth need any special care or additional treatment after endodontic treatment?     

You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.

Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, redoing the endodontic procedure can save the tooth.

What causes an endodontically treated tooth to need additional treatment?     

New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover additional very narrow or curved canals that could not be treated during the initial procedure.

Can all teeth be treated endodontically?     

Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth.

Odontopediatrics - Dentistry for Children

Why should I take care of my child´s baby teeth if they are going to fall out anyway?     

Baby teeth are helpful in your child´s speech learning process because:

  • They help your kid chew naturally.
  • They are important for your child´s physical appearance.
  • They help as natural space maintainers for the permanent teeth.

How should I clean my child’s teeth?     

Start cleaning your baby’s gums with a clean cloth, even before he or she has any teeth.  That way you keep his/her gums clean without milk residues, and she/he gets used to her/his mouth getting cleaned.

When the first teeth come out, they can be cleaned with a finger brush, always brushing from the gums to the tooth, in the exterior and internal parts (the part towards the palate in the top teeth and the part towards the tongue in the bottom teeth). Once the molars come out, they should be brushed with a soft toothbrush, making the above mentioned movements in the molars plus circular movements over them.

When should I take my child to his/her first dental appointment? Why?     

As soon as the first tooth erupts so that the pediatric dentist can show you how to take care of them take proper care, explaining the appropriate brushing techniques: when to brush, use of dental floss, what type of toothpaste to use or explain why it may not be used.

Why should my child see a pediatric dentist instead of our regular dentist?     

The Pediatric Dentist  is a general dentist that has studied for at least two more years, getting trained in the dental management of children, and their proper emotional treatment in the dental office.

If my child gets a cavity in a baby tooth, should it still be filled?     

Definitely.  Cavities in baby teeth can cause pain, nerve problems and infections, and pulling the tooth out prematurely, can cause space maintenance problems for the permanent teeth that will occupy that place later in life.

What should I do if my child knocks out a permanent tooth?     

Is highly recommended to consult your dentist as soon as possible.  There are different severity levels but sadly, a trauma that seems simple may present long term complications if appropriate measures are not taken.  A big trauma can be treated in a better way if less time goes by between the time of the trauma and the time when the dentist saw him.

Periodontal

What is Periodontal (Gum) Disease?     

Periodontal literally means “around the tooth.” Periodontal diseases, more commonly known as gum disease, are a family of serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. Left untreated, these diseases can lead to tooth loss.

Periodontal Disease is characterized by many unpleasant side effects: gums that are swollen, red, and frequently bleed during tooth-brushing, bad breath, and tooth sensitivity. In its early stages, gum disease is called gingivitis. During these early stages, gum disease is more easily treatable than when it has gone unattended for a period of time.

Gum disease is usually a slow, painless, progressive disease. Most adults with periodontal disease are unaware they have it. If diagnosed and treated early the teeth can be saved.

It’s easy to do a “Self Evaluation” to find out if you have any of the Warning Signs of Periodontal Disease.

Good oral care not only helps prevent gum disease, it may also help prevent serious medical diseases as well. Studies have shown that gum infections increase the risk of heart disease by up to 170%, fatal coronary disease by 50%, strokes by 300%, and pre-term births by 700%. They also increase the risk of diabetes and rheumatoid arthritis. A healthy mouth, free of periodontal disease is an investment in your overall health as well.

What causes Periodontal Disease?     

The main cause of periodontal disease is the accumulation of plaque bacteria. Plaque is an often colorless mass of bacteria that sticks to teeth, crowns and bridges, and other tissues in the oral cavity. Plaque is constantly forming on the teeth. Plaque irritates the gums, causing them to become red, tender, and swollen.

If not removed daily, plaque becomes the hard material known as tartar or calculus. Calculus cannot be removed by brushing and flossing alone. A dentist, periodontist, or hygienist must remove it manually to stop the disease process.

With time, the tissues that attach the gums to the teeth are destroyed by plaque and its by-products. The gums “pull away” from the teeth and pockets begin to form between the teeth and gums. Plaque and calculus continue to fill these pockets until eventually; the jawbone supporting the teeth is destroyed.

What are the stages of periodontal disease?     

Gingivitis

  • Gums appear red and swollen.
  • Bleeding may occur when gums are touched.
  • Teeth are still firmly in place with no damage to supporting bone structure.

Periodontitis

  • Loss of gum/tooth attachment occurs.
  • Pockets form between teeth and gums.
  • Tissue that binds teeth to bone is inflamed.

Bone loss occurs
Advanced Periodontitis

  • Gums recede dramatically from teeth.
  • Pockets deepen severely and may hold pus.
  • Teeth become extremely loose and may fall out or need to be extracted.
  • Severe bone loss occurs.

How is it treated?     

Chances are that if you have been diagnosed with periodontal disease, periodontal surgery sometimes known as pocket elimination may be recommended. Surgery is indicated when non-surgical methods are not enough to stop the disease process.

Depending on how advanced your particular case is, treatment may involve any of the following:

  • Scaling and root planning. Scaling involves the removal of the plaque and calculus deposits on the tooth surfaces, while root planning is the smoothing of the root surfaces in order to promote reattachment of the gum tissue to the tooth.
  • Flap/Osseous Therapy allows the periodontist to gain access to the root of the tooth for removal of plaque, calculus, and diseased tissue. The gum is then carefully sutured back into place. Flap therapy may sometimes be accompanied by minor osseous (bone) shaping or removal in order to ease tissue positioning, facilitate home care, and simplify your maintenance appointments.

Guided tissue regeneration (GTR) involves the use of a biocompatible membrane material, often in combination with a bone graft that promotes the growth of lost tissue and bone around your tooth.

Prosthodontist

What is a prosthodontist?     

A prosthodontist is a dentist who specializes in the restoration and replacement of teeth. Most prosthodontists receive two to three years of additional training after dental school in a program accredited by the American Dental Association based either at a hospital or a university. The training includes reviews of the literature, lectures, treatment of patients and laboratory experience in fabricating restorations.

What dental procedures does a prosthodontist perform?     

Prosthodontists are the experts in dental rehabilitation and have mastered many procedures including: crowns, caps, bridges, veneers, removable partial dentures, dentures and dental implants. In addition to restoring dental implants with restorations, many prosthodontists are surgically placing implants as well.

Is a prosthodontist different from a “cosmetic dentist”?     

The American Dental Association recognizes nine dental specialties, and the ADA does not include “cosmetic dentistry” as a specialty. Prosthodontists receive extensive training and experience in dental esthetics and cosmetics during their graduate programs which currently last three years. Many cosmetic dentists receive training during seminars or a series of courses, but this training is usually limited to weekend or possibly weeklong courses

Will the prosthodontist complete all of my required treatment?     

The prosthodontists are best viewed as “architects” of your dental project. They have the vision of your final outcome, both the esthetics of your smile and the improved function of your bite. Often other dental specialists may participate in your treatment to help establish a solid foundation for your restorations. Every prosthodontist develops a treatment plan customized for each individual patient, and they will determine if adjunctive procedures by another doctor are necessary.