Helaine Smith DMD

Dental Implants: The Five Questions to Ask Your Dental Professional – Download now. No registration required.

As the “new” thing in dentistry, dental implants have received considerable press of late. And it’s no wonder. With implants, dentists can replace patients’ missing teeth with strong, stable devices that look and feel just like real teeth.

Many medical procedures are now marketed directly to consumers, including liposuction, laser eye surgery and cosmetic surgery, which means you need to do your homework in order to safeguard your health.

The same is true for dental implants as having one or more placed in your mouth is not a trivial matter.

Dental implants require know-how and expertise that can’t be obtained in a weekend continuing education course. In an effort to educate you, Dr. Favaloro, a board certified periodontist, and I developed this e-book.

In it you’ll learn the technical details about dental implants and how the procedure is performed. Most important, we give you the five questions you must ask your dentist before agreeing to dental implant surgery, including:

• Am I dental candidate? – Not everyone can accept dental implants. You’ll learn why.
• What is your training? – Not all dentists are qualified to perform implant surgery. We tell the differences between the various dental specialties and the training each type of professional received in order to help you choose the right professional.
• Where will the CT scan be performed? – Qualified dentists use CT scans to properly place your implant — we tell you why they’re important.
• How many implant procedures have you performed? – You’ll learn the difference between those who took weekend “mill” courses and those who really know what they’re doing.
• Do you have pictures of previous cases? – A picture speaks a thousand words – and we tell you why you shouldn’t settle for “smile” photos.

Download your copy of Dental Implants: The Five Questions You Must Ask Your Dental Professional, forward it to your friends, and post it to your blog. It’s information you need to make good medical choices.

If you like this e-book, please let me know. And, if you have questions about dental implants or other procedures, please post them below and I’ll answer them.

Missing teeth not only make you feel less than confident, they also make it difficult to chew and can lead to other oral health problems, such as shifting teeth.

Dental implants replace your missing teeth — and unlike a crown and bridge restoration, dental implants don’t shift over time and they’re just as strong as your natural teeth.

If you’ve been considering replace a missing tooth or lost teeth — or you have dentures and want to learn more about implant-supported dentures, please consider calling our office.

We’re offering all patients $200 off their dental implant procedure. Just call the office to schedule your complementary consultation and if you decide to have me and Dr. Favaloro perform your implant procedure, we’ll take $200 off. It’s our way of helping you achieve the smile of your dreams.

In a recent NY Times article, A Dental Shift: Implants Instead of Bridges, reporter Jane E. Brody discussed why dental implants are now the new standard of care.

The reasons dental implants are growing in popularity include better materials, advanced technology, and more experienced dental professionals.

And unlike crowns, dental implants don’t decay and can be maintained just like your regular teeth — through daily brushing and flossing.

What I like best about this article, however, is that Brody re-emphasizes the point I made in an earlier post about choosing dental professionals trained in dental implantology:

Just as any physician can legally perform surgery, any dentist can legally do implants. Be sure to choose someone thoroughly trained in the technique. Taking a weekend course in implantology is rarely adequate. There are risks involved in placing implants, including damage to a nerve or sinus cavity, which are magnified when the practitioner lacks adequate training.

Thank you, Ms. Brody, for an informative, fact-filled article that educates consumers!

I recently took a course on how to restore dental implants (or fix a broken or infected dental implant), since restoring an implant is very different from restoring a real tooth. It was a great course (and intense). I learned a great deal — namely that the principles of implants must be respected when attempting to restore an implant!

This Implant Prosthetics program offered by the Misch International Implant Institute was developed for dentists whose primary interest is the restorative phase of implant dentistry. The “Team Approach” is emphasized and many surgeons and periodontists find this program enhances their relationship with their referring doctors.

I attended specific lectures on implant diagnosis, treatment planning and patient evaluation, as well as all prosthetic phases of implant treatment. The course was divided into three sessions consisting of lectures and hands-on laboratory sessions for both removable and fixed prosthodontics.

The Misch International Implant Institute was developed in 1984 to help set and elevate the standard of care in implant dentistry using a hands-on approach. Now world renown, the Institute’s goal is to remain at the forefront of implant dentistry through research, education and its unique clinical applications. Using these tools and a well-trained faculty, the Institute is able to provide its students with the most progressive and documented information.

I’m very happy to have taken the course. As you know if you read my blog regularly, it’s very important to me that I offer my patients the very best in care. Continuing education is just one way for me to accomplish this goal.

In my last post about dental implants, I discussed the difference in training between general dentists and periodontists as well as how to choose the right dentist to perform your implant surgery.

In this post I”ll discuss the dental implant procedure and what you can expect when you have an implant placed.

Typically, your dentist will suggest the implant procedure if you’re missing a tooth or teeth. Dentists can also use implants to support dentures (also called “mini dental implants” or “implant-supported dentures”).

The first step is to ensure that you are a candidate for the procedure. If, for example, you’ve been missing a tooth or teeth for years, the bone below the gum may have receded too much.

(Advanced procedures now include bone grafting. Most general dentists can perform basic bone grafting procedures but as with anything, you’ll want to ask how often your dentist performs this type of procedure, how often his/her skills are updated through continuing education, etc.

Next, your dentist (or periodontist) will do a CT scan of the head and face in order to determine proper placement of the implant.

CT scanning instruments are quite expensive, so most general dentists don’t have the ability to do scans in office. Instead, you’ll be referred out.

Here at my office we use XPresscan, a company located right in our neighhborhood.

From this scan, the dentist or periodontist can locate nerves and arteries, the shape of the jaw and gums, placement of teeth and any potential issues or challenges.

Placing the implant itself is fairly straight-forward. The periodontist places a hollow titanium post into the gum.

Nobel Biocare Dental Implants

After the post is placed into the jaw bone, the dentist places a healing cap into the top of the post, which is an open hole, while the gum tissue heals and the bone begins to adhere to the implant. This process can take 3 to 6 months.

Once the healing process is complete, the periodontist then removes the cover of the implant and puts in the abutment using a special torque wrench. This process actually requires skill as it takes some real torque to ensure the abutment is screwed into the pin and won’t come loose.

After watching Dr. Favaloro do this, I’ve realized that most general dentists don’t know how to apply torque properly. The first time I saw him place an abutment, I was shocked at the amount of force it takes to torque it down. This is where the periodontist’s training really comes into play!

Once your abutment is placed, your dentist then makes the new crown which covers the abutment.

The beauty of a dental implant is that it doesn’t shift over time (the way a crown and bridge will) as it’s placed directly into your bone. (The crown that covers the abutment will need to replaced in about 20 years, however.)

For implant-supported dentures, the periodontist places “mini” implants into the bone and the dentures are then “snapped” into them. Implant-supported dentures give you the support and confidence you’ve always wanted as they don’t move around like ordinary dentures.

The following Today Show clip shows a facial and jaw scan — as well as the denture that gets “snapped” in once the implants have been placed.

Do you have questions about dental implants? Feel free to leave them in the comments section and either I or Dr. Favaloro will answer them.

As the next “new” thing, dental implants have received considerable press of late. And it’s no wonder. With implants, consumers can replace missing teeth with a strong, stable device that looks and feels just like a real tooth.

Mini dental implants also let dentists give patients with dentures a new lease on life as they hold dentures in place — eliminating the goopy denture adhesives and ill-fitting devices of yore.

As with any medical procedure, however, consumers really need to do their homework before agreeing to an implant.

In an effort to educate you, the consumer, I’ve written this two part-article about dental implants and what you need to know before you have anyone work on your mouth. In Part One I’ll cover who is trained to place dental implants. In Part Two I’ll cover the procedure itself.

The dental implant defined

A dental implant is simply a hollow titanium pin that is surgically placed into your jaw. An “abutment” or piece of metal is screwed into the pin once healing is complete. Dentists then place the “tooth” or crown on this abutment — giving you a very natural looking tooth.

Dentists often use implants instead of crowns and bridges as implants last longer and are much stronger.

General dentists don’t learn implants in dental school

Although the procedure itself sounds relatively straightforward, placing a dental implant does require surgery in the mouth — and as such, anything can go wrong, including hitting (or severing) cranial-facial nerves, drilling into the sinus cavity, and or severing the mandibular artery, which can cause death.

As a dentist myself (and one with advanced training), I would not even consider having another general dentist place an implant in my mouth.

This is because general dentists do not receive much dental implant training in school — nor do they receive surgical training! Having a general dentist place a dental implant is akin to having your family doctor replace your knee.

In the dental world, periodontists are now the recognized dental implant experts as they receive an additional three years of training on top of   their general dentistry training. They also spend one full year of this extra training on dental implants.

Periodontists are trained to conserve gum tissue and bone and can also perform all types of reconstructive surgeries such as sinus lifts and bone grafting.

Periodontists also know the facial and cranial bone structure inside and out and are trained to consider the entire structure of the cranium and face when placing an implant. These considerations include: surrounding teeth and roots, nerves, the sinus, shape of the jaw, and blood vessels.

In short, placing a dental implant is a very complex procedure — which is one reason I don’t do them and instead rely on Dr. Favaloro, my in-house periodontist. (After Dr. Favaloro places the titanium pin and abutment, I then place the crown which sits on top of the abutment.)

Can oral surgeons do the same work?

Many dentists will work with oral surgeons who place the titanium pin into the jaw bone. Many good oral surgeons exist, but their training is mostly geared toward extractions (e.g. wisdom teeth), biopsies, and cancer surgeries. So while an oral surgeon can competently perform implant surgery, they don’t receive the intense implant training the way periodontists do.

(And to define other dental specialties, an endodontist performs root canals while a prosthodontist does crowns and bridges.)

Dentists can take continuing education courses but . . .

General dentists, oral surgeons, and endodontists can all take continuing education courses and learn how to do implants. The quality of these courses varies, however. You can take months of coursework from the Las Vegas Institute in Nevada, which is the gold standard as far as advanced dental training goes.

Or, dentists can take what I refer to as “mill” courses — those one- or two-day courses that allow the dentist to then hang a “certificate” on the wall announcing he/she is now a dental implant expert.

So, how can you tell the good from the bad and the ugly? If  you’re considering a dental implant, ask your dentist the following questions:

1. Am I even a dental implant candidate?

Not everyone can accept dental implants, especially if the jaw bone has receded or if the person has other medical issues. If you’re going to be undergoing open heart surgery, for example, I would advise you to wait until after you receive the “ok” from your doctor as the medications you take can pre-surgery (on the heart) can cause serious complications during your implant surgery.

2. What is your training?

Using the information above, ask your dentist point blank where he or she learned how to do dental implants — and how intensive was the training?

Be very wary of the dentist who brushes off this question. Surgery is serious stuff. You don’t want someone who doesn’t know what he/she is doing drilling around in your jaw bone — trust me.

3. How many dental implant procedures have you performed?

Sure, a dentist can tell you he or she is “certified” to perform implant procedures but what if he or she took the course 18 months ago and hasn’t performed one implant? Scary!

4. Do you work with a periodontist or oral surgeon or do you do the surgery yourself?

Knowing what you now know, it should be pretty obvious that having a periodontist perform your surgery is preferable to a general dentist performing it.

Which do you prefer? A periodontist with three years of advanced training . . .  or a general dentist who “graduated” after 16 hours?

5. Do you have references?

Always ask for at least three references, and then call them! You can also do a bit of detective work on your own: do a search for the dentist online and see if he/she has any negative reviews as well as calling the Better Business Bureau.

In Part Two I’ll cover how the implant procedure is performed and some of the questions I’m often asked about dental implants. If you have any questions about periodontists or the training general dentists receive, please feel free to ask them in the comments section.

An article in the Boston Globe talks about a new technology from SensAble Technologies that helps dental labs design partial sets of false teeth using 3D technology.

SensAble issued a release about the new technology at the Chicago Dental Society midwinter show last Friday.

Dentistry is quickly moving to 3D technologies — yet many labs employ technicians who use non-digital techniques they’ve spent decades perfecting. According to SensAble, their new technology will help labs “ease into” digital restorations.

For dentists, it will decrease the number of chairside adjustments that have to be made to partial restorations that come from the lab.

3D technology is already in use in the dental office. In my office, for example, I’m able to develop crowns in one visit using Sirona’s CEREC machine, which employs 3D technology.

You can view the CEREC machine via the virtual tour of my office. (Click on “treatment room” once you enter the virtual tour, and then click the “info” button at the bottom of the treatment room page.)

You can also learn more about how this machine is benefiting patients.