Dental Implants While Using Fosamax

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I had to have a lateral incisor removed. I wanted to get a dental implant, but my oral surgeon said that I might want to consider something else like a dental bridge because I am on Fosamax. Do you know if I should get something like an Encore Bridge or a Maryland Bridge. I don’t know if I can have a normal bridge with the anchor tooth being a front tooth. Are you aware of situations like this? I will admit that I am disappointed about the dental implant. But, what can’t be helped, can’t be helped. I need to figure something out, though, because I am using a dental flipper right now and hate it.

Percy

Dear Percy,

An image of both titanium and zirconia dental implants

I have some good news for you. If you really want a dental implant, it is possible with some precautions taken and an understanding of the risks. First, the risks. There is a slightly increased risk of bone problems when you have oral surgery while on Fosamax. While I said a slightly enhanced risk, don’t discount the risk because if they happen, they will be serious. A way to get around this is to temporarily suspend taking the Fosamax for the surgery and then resume it at the appropriate time. It would take coordination between your dental implant dentist and the oral surgeon. Also, make sure it is your dentist who plans the dental implant placement and not the oral surgeon.

If you decide you do not want to take the risk with the dental implant or suspend the Fosamax, then a dental bridge is your next best option. I would let your dentist choose which type of bridge, though. This is because you want him or her doing the type of bridge that they are the most comfortable with. That way you know they are skilled at doing it. You can get a regular bridge. A front tooth has been used as an anchor tooth many times. Though, obviously, the dental implant is the better option.

One other consideration. If you are unhappy with the color of your teeth, the time to get teeth whitening done would be before you get either the dental implant or the bridge. This is because the color of your dental crown cannot be updated once it is completed. This way the crowns can be made to match the updated color of your teeth.

This blog is brought to you by East Cobb Cosmetic Dentist Dr. Cristi Cheek.

Preventing Facial Collapse with Dentures

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I have an impending disaster. I’ve recently been diagnosed with a severe calcium deficiency. My dentist is suggesting that I remove all of my teeth because they will just give me problems from here on out. My concern about that, aside from the whole not having teeth thing, is facial collapse. I am willing to go to the dentist every month if need be to try and save my teeth. However, if it really won’t be possible to save them, is there any way to avoid facial collapse?

Stacey

Dear Stacey,

Before you allow your dentist to remove any of your teeth, I am going to highly suggest that you get a second opinion. Dentists have different levels of desire to work to save teeth. Some dentists will do everything possible to save teeth. Others prefer to just remove and replace teeth. I feel confident that you will be able to find a dentist who is willing to help you save as many teeth as possible.

I also have some doubts about what your dentist told you. Having a calcium deficiency in adulthood should have no impact on your teeth. Your teeth are fully developed as an adult. What a calcium deficiency can do is lead to cramps, nerve pain, and osteoporosis. It will not deteriorate your teeth.

Dealing with Facial Collapse

Before and After Facial Collapse

Before and after facial collapse.

Let’s say, however, by some fluke every dentist just wants to remove all of your teeth or something else happens to destroy your oral health. Facial collapse happens when you wear completely removable dentures. Your body, sensing that you no longer have any roots of your teeth, will resorb the minerals in your body in order to use them elsewhere in your body. The reason it is called facial collapse is because that resorption shrinks the jawbone. Eventually you would not have enough of your jawbone to use in your body.

The way to prevent this is by having dental implants placed and then anchor your dentures to them. These are often called implant overdentures. The implants serve as prosthetic tooth roots, signaling to your body that you still need the minerals in your jawbone to support them.

I truly do not think you are going to need this. Get that second opinion. You’ll probably find you will be better served with a different dentist.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Getting My Implant Crowns to Look

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I had two dental implants placed on front teeth. My dentist plans on doing the crowns soon, including two additional crowns on the adjacent teeth in order to get everything to match. I want it to look beautiful and have some things that are worrying me. I have a high smile that shows gums. Is there a way to address this? I haven’t heard the dentist mention anything about this. After looking some things up, I think I need to avoid porcelain fused to metal crowns and I would need to get my teeth whitened first, not after. Is that correct?

Misty

Dear Misty,

An image of both titanium and zirconia dental implants

I am glad you are writing before your dentist does this. I am not sure you are with the right dentist to give you the aesthetic result you are hoping for. I see four red flags right off the bat. First, that your dentist did no building up of the gums in preparation for this. Second, he hasn’t discussed with you the crown options. Third, that he is adding two unnecessary crowns in order to get everything to match. Finally, he didn’t address the teeth whitening with you.

I’m going to start with the third one first. Your dealing with front teeth that are particularly tricky to get to look beautiful and natural and it takes a great deal of artistry and experience. If he needs to add crowns in order to just get the color to match, he does not have those qualifications. Why would you want to remove structure from healthy teeth unnecessarily?

Looking at the type of crown you would use. Yes, you will want an all porcelain crown. However, depending on the type of dental implants you received, you may already have a metal base. My guess is your dentist did the traditional titanium implants, which are metal. There are zirconia ones that have a ceramic base, but if your implants are placed, you don’t want to switch them out. This does not mean that you cannot have a beautiful result. What you’ll need is a dentist who knows both how to conceal the border between the implant and your crown, as well as mimic the translucency of a natural tooth while making it opaque enough to cover the base. I’m concerned that your dentist is not the one to do this.

As for the teeth whitening, absolutely you need to do that before your dental crowns are made. The color of your crowns cannot be changed once the are completed.

You found all this information out on your own, without a dental degree. Why hasn’t your dentist? I am going to recommend getting a different dentist for this part of your procedure. Someone who is an expert cosmetic dentist. Don’t try to teach your dentist what to do. It won’t work.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

A bad ClearChoice review from Benson

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We read on a dental blog (mynewsmile.com) about an experience reported from a patient they called Benson at the ClearChoice Dental Implants Center in Metairie, LA. He said he had asked to be sedated. So they sedated him for the appointment, but he woke up in the middle of it. Instead of giving him more medication, they just held him down and pushed their way through the surgery. The trauma of the experience has left him having nightmares about it ever since.

But even beyond that, when he got done with the procedure, he said that he wasn’t able now to comfortably close his lips together because the top teeth are too far forward. As a result, he dribbles saliva down his cheeks at night, and there is a terrible odor in the morning on his pillow. Further, he reports still having considerable pain. What have they done? Nothing beyond telling him that this is normal and he just has to get used to it, and he has to eat soft food now.

Of course, we’re only getting Benson’s side of the story and not ClearChoice’s, but this sounds pretty bad. We have said in an earlier post here about ClearChoice that we have heard that they have competent surgeons and prosthodontists. But quality care in dentistry is more than having a dentist who has adequate skills and knowledge. Caring about the patient is a key ingredient, and without that, there won’t be quality care. If we believe this account of Benson’s there was a serious lack of compassion here. We imagine part of the dentists’ side of the story could be that Benson was thrashing around during the appointment which make it extremely difficult to do quality work. That could easily be true. But we don’t think that excuses them from making more effort to keep their patient comfortable.

We’d like to philosophize a little here. Dentistry, as a whole, is a highly ethical profession populated by truly caring professionals. Women and men go into dentistry, to a large extent, because they want to help other people. However, there is a growing amount of what we call corporate dentistry. These dental corporations exist for the purpose of making money. We believe there is a tendency for the corporate owners to put profitability above quality care—they may cut corners and won’t have the same level of compassion for the patient. This is what we think we are seeing with this incident at the Metairie ClearChoice Dental Implant Center.

This blog is brought to you by the implant dentists at Cheek Dental in East Cobb, GA.

The dentist says I need my implant replaced

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So I had an upper molar that cracked and my dentist said it couldn’t be saved. So she took the tooth out and put in an implant. Then she later put a crown on it. This is last summer. That’s when the real trouble started. When she screwed on the crown, it hurt so much that I could barely stand it. After the appointment I had this burning in my gums and on my tongue. I told my dentist and she said that it was thrush and prescribed this rinse. I followed the instructions, rinsing with it and then swallowing it, but it didn’t go away.

Now I spend the winters in Florida. Soon after I got down there, the crown began getting loose and finally just fell off. I found a dentist in Florida who told me that my implant was infected and would have to be removed and I would need a new one placed. I haven’t done anything yet about this, because I have a couple of questions.

First, I don’t want to have anything more to do with implants. My mouth still has this burning feeling and I’m afraid of making this worse. I’m guessing I can just get a bridge to replace the tooth. Is that right?

Second, I’m really upset, but I went to a lawyer and he didn’t want to help me – told me I didn’t have a good case. Is there a way I can make my dentist do this for free?

– Lydia from New Jersey

Lydia,
Boy, I don’t know where to start. There are several problems here.

One problem in bringing dental malpractice lawsuits is that the dollar amounts aren’t enough to make it worthwhile for some lawyers, so that may be the problem with the lawyer. If you can’t get a lawyer to help you, you can always threaten to make a complaint to the dental board. That can get a dentist’s attention.

Then, after the problems with your home town dentist, I wouldn’t want her to do any more work on me. I had to chuckle when she tried to blame the burning in your mouth on thrush. I guess you’ve figured out that was a misdiagnosis since the medication didn’t help any. This sounds like burning mouth syndrome. While officially there is no known cause, there is a website we’ve seen that has gathered stories from people suffering from burning mouth syndrome and in each case it began with a traumatic dental experience. You’re fitting that pattern.

So we have the misdiagnosis by your dentist. Added to that is the crown coming off. Added to that is the dental implant failure – the implant getting loose. The implant is supposed to fuse to the bone and shouldn’t ever get loose. Below is a drawing of an implant. Over a period of about three months, a process called osseointegration fuses the bone to the titanium implant. It sounds like this didn’t happen in your case, which is what led to the failure.

a drawing of five lower teeth, showing the middle tooth replaced with an implant, and an arrow pointing to the osseointegration between the implant and the bone.

Implant failure occurs when there is a failure of osseointegration.

From the story you told, it sounds like it could be possible that the dentist put too much stress on the implant when she was installing your crown. That could break the bond that had just barely formed. There are special torque wrenches that dentists are supposed to use so that they don’t exceed a certain amount of force when putting on the implant abutment and the crown. Once the implant was a little loose, bacteria could get into the space between the implant and your bone and start an infection, which would lead to the implant getting loose and eventually falling out.

If you went to a dentist who knew what he or she was doing, you should have no problem getting a new implant placed. But if you don’t want to do that, a bridge is an acceptable alternative. It wasn’t that long ago when a bridge was the only fixed option for replacing a tooth.

We wish you the best in getting this resolved.

This blog is sponsored by Marietta cosmetic dentists Drs. Cristi Cheek and Christina Chandler.

 

MRI and Dental Implants

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I have severe shoulder pain. The next step in finding out what is wrong is for me to get an MRI. I was so relieved we were getting a test that might get to the bottom of it, that I didn’t even think about what it means with me having a dental implant. I know it is made of metal and that is a bad idea for MRIs. Do I need to cancel the test? If so, is there another test I can use to get to the bottom of this pain issue?

Martha

Dear Martha,

illustration of dental implants being placed.

You have asked a great question. The good news is you will be safe to have an MRI, even with a dental implant. It helps to understand how an MRI works. After creating a strong magnetic field, it then uses radio waves and digital software to obtain cross-sectional images of the soft tissue of your body. The danger comes when you have ferromagnetic material in your body.

Dental implants are either made of titanium or zirconia. Most patients are not worried about zirconia because they are metal free. You mentioned yours were made of metal which would mean that they are titanium. Thankfully, titanium is not ferromagnetic. That means you are perfectly safe to have an MRI to find out what is going on with your shoulder.

I hope you get answers soon and can get out of pain. This is one less thing you have to worry about as you look for a prognosis.

This blog is brought to you by Marietta Dentist Dr. Cristi Cheek.

Getting a Diamond in Your Tooth

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Is it possible to get a diamond in your tooth the way Drake has or do you need to pull the tooth and put a dental implant with a diamond in there? How much does this cost?

P.

Dear P.

Montage of Drake with close ups of his smile

I am going to confess right up front that I had to look up Drake in order to understand your question. I came across this image that shows a pink diamond in one of his teeth and what looks like a clear diamond in another.

Is Drakes Tooth Natural or a Dental Implant?

Dentists are doctors and one of their maxims is to do no harm. Many dentists would not want to drill into a natural, healthy tooth. However, when it comes to cosmetic work, there are some gray areas. We want the tooth to look the way the patient wants it to look. Drake does not appear to have given much information on the procedure.

I don’t think it would be a dental implant unless he had to have the tooth extracted for some reason anyway. If it is not a natural tooth, my strong suspicion is that it would be a dental crown that had the diamond placed in it.

How Safe is the Procedure?

As long as it is done by a dentist, it would be fairly safe. If he tried to do it on his own, then there are a couple of risks. The first is that he permanently damages the tooth. The second is that he creates an area for breeding bacteria.

Is it Expensive?

Pink diamonds, like all diamonds, are priced on a few factors including intensity of the hue, its clarity, and the number of carats. This diamond, for a cursory glance, looks to be graded as “fancy” or “fancy light”. That would be less expensive than those with a more intense hue. Even so, he probably had to shell out a few thousand dollars, plus the cost of the dental crown or implant.

This blog is brought to you by Marietta Dentist Dr. Cristi Cheek.

Dental Implant Allergy?

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I had a dental implant placed. It went well. However, since then, I have had bumps inside my mouth near the implant and tingling in the area. Is this just part of the healing process or am I having an allergic reaction to the dental implant? If it is an allergy, is there anything I can really do about it?

Penny

Dear Penny,

Titanium and Zirconia Dental Implants

Congratulations on getting a dental implant. These are the best tooth replacements available. Traditionally, titanium is considered biocompatible. According to the National Center for Biotechnology Information, an allergy to titanium is considered quite rare. Though, it does happen. Here are some of the symptoms of an allergic reaction to your dental implant.

“An allergic reaction can be reasonably suspected after dental implant placement, on the basis of signs or symptoms associated with allergy, such as rash, urticaria (a raised, itchy rash), pruritus (itchy skin), swelling in the orofacial region, oral or facial erythema (reddening of the skin), eczematous lesions of the cheeks or hyperplastic lesions (an increase of the number of celss) of soft tissue.[1] In these cases, allergy testing should be performed.”

Most allergists do what is known as patch testing, however, that has not been very effective with titanium. Instead, if you and/or your dentist decide to have this allergy tested, I suggest you do a MELISA test (Memory lymphocyte immuno-stimulation assay), which is done through a small blood sample.

If it does turn out to be a titanium allergy, that does not mean that you cannot have a dental implant. You will need to remove the titanium implant and replace it with a zirconia implant. These are metal free. Between the removal of the first implant and placement of the second implant, you will need a bone grafting procedure in order to build back up the bone structure lost during the removal process.

My suggestion is you have a conversation with your dentist about your symptoms and see if he or she can arrange a MELISA test for you.

This blog is brought to you by Marietta Dentist Dr. Cristi Cheek.

Will Dental Insurance Cover Dental Implants?

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I’ve lost a tooth and would like to get dental implants. Would dental insurance cover this if I get a dental plan? If so, are some plans better than others?

Justin

Dear Justin,

a dental implant diagram

If you already have dental insurance, then your plan will usually help you pay for some of it. Don’t expect it to be much, though. Most dental insurance plans prefer to cover the less expensive treatments, which all are removable appliances.

However, it sounds like you don’t have dental insurance. Are you just planning on getting insurance specifically to get the implants? That’s probably not going to work out for you. You will find most of them have a rider where you have to have the insurance for a certain amount of time, say a year or so, until you can use it on things other than general dental care.

If you really want a dental implant, you’re just going to have to save up and get it the old fashioned way. I’m sorry you are in this situation. If money is too tight at the moment, you could always pay for a removable option for now while you save up for the ideal solution.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Sinus Perforation with a Dental Implant

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I had a dental implant placed about six months ago that was recently removed. My oral surgeon suspected there was some bone loss because things weren’t progressing as expected. I haven’t even gotten to go to the dentist yet for the restoration part. Though he perforated the sinus cavity, he said that was normal and it was only a few millimeters. Instead, he believes the problem is the fact that no bone integrated with the implant, which isn’t normal. He said the good news is that it made it easy to remove the implant. He wants to do bone grafting and then try again. Is there anything you think I can do differently this time to improve my odds?

Karen

Dear Karen,

a dental implant diagram

There are a few problems here. The first is that the oral surgeon did not have the dentist determine the placement of the dental implant. It is always the dentist who should determine placement. Before doing anything else, I want you to see a dentist with post-doctoral training in dental implants to look at your case.

A second issue here is the perforation of the sinus cavity. I know he said it was “only” a few millimeters, but that is a HUGE amount in the dental world. It sounds to me like he did not do adequate diagnostics to prevent this. He should have taken x-rays as well as a CT scan to get a good view of the landscape, including a 3-Dimensional view.

Bone grafting can be a good solution if you do not have enough bone to retain a dental implant. Again, though, he should have known this ahead of time by doing adequate diagnostics. Had he done that, your dental implant failure could have been avoided altogether. See a good implant dentist and then you should have an idea where to go from there.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.