Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Tooth Replacements for Hockey Players

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My son is on a hockey team. They just finished their season. However, in the last game he took a direct hit and lost a tooth. We were planning on getting it replaced with a dental implant because I wanted him to have something permanent. However, one of his teammates said that a dental implant is a bad idea in case he gets hit again. What do you recommend? His appointment is coming up soon and I want to make sure he’s getting the right treatment.

Katherine

Dear Katherine,

Dental Implant Diagram

I’m glad you wrote. First, in normal circumstances, dental implants are the absolute best tooth replacement available, so you choose well. I was thinking about his teammate’s comments and believe I have a solution. Go forward with his appointment to have the dental implant placed. Having that implant in there will prevent him from having bone loss in that area.

The part I want you to put off is having the dental crown attached to the implant. If he were to get hit in that area again and the crown was secured to the implant it could cause some bone damage as the implant is ripped out.

Instead, what he needs is a temporary replacement to fit in the space above the implant. You could do a removable partial denture, or even a dental flipper. Either one of those will be inexpensive and provide him with a tooth until he can have a permanent crown safely placed when he’s done with his hockey career.

Thank you for writing about such an interesting problem.
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My Dental Implants Fell Out

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I got eight dental implants in order to not have removable dentures. I’ve paid for about 1/2 of the procedure and am supposed to pay the remaining 1/2 soon. After just a few days, three of the dental implants fell out and another one feels loose. I have two questions. First, should I have to pay for the ones that fell out? Second, should I be worried about the other implants, especially the loose one.

Susan

Dear Susan,

Dental Implant Diagram

Your choice of getting implant supported dentures was a good one which, when done properly, will prevent facial collapse. Obviously, your dentist did not do it properly and I am sorry to hear this happened to you. You have very legitimate questions and concerns. First, you should not expect to have to pay for the dental implants that fell out. A basic tenant of dental work is that it actually stays in your mouth. Most dentists with dental implant training have a 95% success rate. Your dentist is looking at a an abysmal 50% success rate, with that fourth one already loose. Not only that, most cases of dental implant failure that do happen would take at least a year. Your dentist’s work didn’t even last a few days! As to the other implants, I would not hold out too much hope that they are going to stay in.

Reasons for Dental Implant Failure

  • Infection at the implant site. This is often because of poorly fitting fixtures.
  • Poor bone support. This can be completely avoided by your dentist doing adequate diagnostics.
  • Cheap dental implant fixtures.
  • Incorrect placement of the implant fixture.
  • Premature loading of the denture or dental crown. This happens where there was not given enough time for the bone to integrate with the implant before putting stress on it.

Do not pay any more money to this man. You need to get these looked at by another dentist who can tell you what has gone wrong. Don’t let your dentist choose who gives you the second opinion. You want someone with dental implant experience. However, you might want to choose a dentist from a different city. That way there will be less of a chance that they are friends. The dental world is a small one.

If the second opinion dentist wants the diagnostics and notes from your current dentist, he or she is under an ethical obligation to provide them.

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Dentist Placed Implant Knowing It Would Fail

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I had a dental implant placed. Before the surgery, my dentist assured me that we were good to go. However, when the surgery ended, the dentist told me that after he went in there he discovered that there was not enough bone support for the dental implant. He went ahead and placed it, but said my best option is to remove it and get a dental bridge. Why in the world would he place the implant knowing he would just tell me to take it out? Should I have to pay for this? Am I able to still get a dental implant or am I stuck with a bridge? I could have saved myself a lot of time and money if I would have gotten a dental bridge in the beginning, but my dentist assured me that I was a good candidate for implants.

Corrie

Dear Corrie,

Dental Implant Diagram

I am beyond puzzled how your dentist thinks this is acceptable. I want you to imagine ordering a stove that you have been told by the store that it is a fantastic stove that will be perfect for your house and will cook delicious food. Then, it charges you for the stove, delivery, and installation. But, after it is installed in your home, they turn right around and tell you, “Oh, by the way. This one doesn’t work. Why don’t you pay me to take it out and then I’ll get you a grill or something.” This is beyond the pale. Your dentist not only needs to give you a refund, but he should remove the implant without a fee.

In reality, if your dentist would have done the proper diagnostics to begin with, he would have noticed the condition of your bone and whether or not you had adequate support for the dental implant. Then, preparation could have been made to build up the bone, which would have enabled you to get the dental implant.

All you can do at this point is remove the implant. The good news is that, as long as you are in good general health, you can still get a dental implant. You will need some bone grafting done. Then, after a period of healing, you can start over with the dental implant. It goes without saying that I am going to suggest you see a different dentist to place the second implant.

I’m sorry this happened to you.
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Is It Possible That I Can Smell My Husband’s Dental Implants?

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My husband is in the process of receiving “all on 4’s” dental implants on the top front, where he has temporary teeth until the permanent can be implanted. I suffer from chemical sensitivity, and whenever I am close to my husband, his mouth smells like rubber. The smell is so strong.

The posts are made from titanium, and the teeth that he has in now are acrylic. My husband isn’t thrilled about having the screws in his jaw removed, but I can’t live with this chemical exposure long-term. His oral surgeon said the titanium posts were the best option for him.

Is there a less toxic material that the titanium could be replaced with?

-Rose

 

Rose,

I don’t believe that the titanium posts have any smell, especially when embedded in the bone. However, you can certainly ask your dentist to let you smell one of the implant fixtures to see if that is indeed what you are smelling.

Is it possible that you are smelling the acrylic in his temporary teeth because acrylic does give off a very slight smell. Another possibility is that he has food debris stuck somewhere that you are smelling. If that is the cause using a Waterpik is helpful, or rinsing with hydrogen peroxide can clean out the food debris. However, make sure only to use the peroxide for a couple of weeks because it could cause an oral yeast infection.

It would involve several surgical procedures to replace the titanium posts. It would involve removing some of the attached bone, which would mean bone grafting would have to be placed to grow some bone back. They would have to make new holes in the bone for zirconia posts, but there could be a reaction to the zirconia as well.

Are you having an actual sensitivity reaction, or is it that the smell is bothersome?

I wouldn’t recommend replacing the titanium posts as it could be risky, and I really don’t believe it is the smell’s source. Instead, I would recommend talking to your dentist and maybe see if it’s food debris caught in his mouth.

Take Care

 

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Where Should Permanent Dentures Be Placed?

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I am wondering if the all-on-4 implant dentures should be placed 2 to 3mm from the gumline, or should they follow the gum line? Is this how it’s typically done or different for each dentist? Because of where the dentures were placed, I now have bulky lips.

Steve from Idaho

 

Luis,

First, let’s discuss the terminology because the word gumline means the edge of the gum that meets the tooth. If your teeth are extracted, then you no longer have a gumline there. When the teeth are replaced with dentures, the gumline then refers to the edge of the pink acrylic on the denture where it meets the false tooth. In other words, the gumline is determined by where the teeth are placed, so the teeth are always placed right at the gumline.

picture of teeth and where the gumling is located

I believe what you mean is the placement of the teeth in relation to the ridge of the jawbone under the denture. When you have removable dentures, they need to be placed directly over the bony ridge because if they are placed too far forward, the denture will tip up in the back of your mouth whenever you bite anything with your front teeth.

All-on-4 dentures are implant-retained and they won’t tip when you bite. So it’s not as important that they be placed right over the ridge. The teeth being 2 to 3mm from the ridge is within normal range, so it sounds like their placement is fine from a functional viewpoint. However, they should also consider the appearance of your lips, and there should be a wax try-in of the dentures before they are finished. For quality dentures, the dentist should have had the teeth set up in pink wax on a plastic plate and then it can be tried in before it is processed in acrylic. Then you and the dentist should evaluate their appearance, speech, fullness of the lips, vertical dimension, and the bite to ensure everything looks good before the dentures are completed.

Your dentures are already finished, but there may still be an easy fix by having the dentures unscrewed from the implants and the teeth re-set. It can be done fairly easily to have the front teeth cut off and re-processed, and if your dentist doesn’t want to do this for free, it shouldn’t be expensive. But I should add that there may be other reasons the teeth have to be where they are placed. Nevertheless, you shouldn’t have bulky lips. If you feel like your dentist isn’t listening to  your concerns about the appearance of your face, get a second opinion.

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Dental Implant Perforated My Sinus

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I’m not sure what to do. I had implant surgery, but the oral surgeon seems to have perforated the sinus. He noticed this six months later, when the implant still hadn’t integrated. He removed the implant, started me on Flonase and told me not to blow my nose until he gives me the all clear. He said this was normal and happens all the time. He also said it only perforated a few millimeters and we can try again when I’m ready. My questions are as to whether I should try again if this is normal. Would I be better off with a dental bridge?

Sara

Dear Sara,

A side by side comparison of a dental bridge and a dental implant

While some oral surgeons may consider it normal, it is preventable. I’m also quite concerned he said “only a few millimeters.” Really? In dentistry, that is a significant amount. When a dental implant is removed, it leaves a deficit of the bone necessary to support a dental implant. In order to have an implant successful, you’ll have to have bone grafting done.

Dental Implants versus Dental Bridge

You asked if you should try again or get a dental bridge. It would help to know the differences between the two so you can know what each requires.

With a dental bridge, both adjacent teeth have to be ground down to fit dental crowns. Then, a false tooth is suspended between the two crowns. If one (or both) of those teeth need crowns, then it makes sense to get a dental bridge. However, if those teeth are healthy, you may not want to grind them done unnecessarily.

With dental implants, as you know, you can replace a single tooth or multiple teeth. It does require surgery, but it is most like having your own natural tooth again.

Getting this Dental Implant Done Right

It’s up to you which procedure you decide on. If you decide to go with a dental implant again, I wouldn’t go anywhere near the oral surgeon you used last time. My suggestion is you find a good implant dentist and ask them for a different surgeon. It is always better to see the implant dentist before the surgeon anyway. This way you can make sure they communicate with one another clearly so you know the oral surgeon will properly place the implant where the dentist needs it. They should also do adequate x-rays, including three-dimensional ones. This will help prevent sinus perforation.

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