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.

 

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.

Should My Husband Get an All-On-Four Dental Implant?

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My husband needs to replace his teeth. Our dentist said that he has lost quite a bit of bone structure and is recommending the all-on-four dental implant procedure. I’ve heard this is a bit of a controversial procedure. Would this be okay for him to get? My husband likes the idea because it means he won’t need the additional procedure of bone grafting. I’m worried because of the controversy behind it. Can you please advise?

Olivia

Dear Olivia,

illustration of the all on four

All-on-Four Dental Implant Procedure

 

One of the problems with the all-on-four procedure is that if one part of the appliance fails, the whole thing has to be redone. This is not an issue with an implant overdenture. If one of your dental implants fails then only that implant will have to be dealt with. If it were me, then I would encourage your husband to go ahead and get the bone grafting procedure done and then get implant-supported dentures instead of the all-on-four.

No matter what he chooses, it is important that the dentist he goes to has post-doctoral training in dental implants. This is quite an advanced procedure and it is not adequately taught in dental school. If something goes wrong, the complications can be quite serious.

Three of the top schools for this are:

  • The Dawson Academy
  • The Las Vegas Institute of Advanced Dental Studies
  • The Kois Center

There are others, but those three are among the most reputable. Make certain the dentist has that training. There are countless dental implant horror stories.

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

 

CT Scans and Dental Implants

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I had a tooth that was lost and am replacing it with a dental implant. My dentist wants to do a CT scan, but I feel like we’ve had enough x-rays at this point. Is the CT scan really necessary?

Penny

Dear Penny,

dental implant diagram

I would recommend you get the CT scan. One thing to be aware of is that a CT scan takes 3-dimensional images. This is important. Your mouth, jaw, and nasal cavity are not flat, like traditional x-rays. Think of it as the difference between a photo and a sculpture.

We get countless inquiries from other dentist’s patients who had their sinus cavity penetrated during the dental implant placement. This is a real risk which is totally preventable. Some dentists try to save money, thereby having lower prices than the next dentist, by skipping the CT-scan. These are often the dentists who end up making an error in judging the depth available to the implant. Some try to get away with this problem by using shorter implants. The problem is those rarely last as long and the patient won’t know why it failed.

If you are going to invest in the best tooth replacement, you want to make certain it has the tools to give it the greatest chance of success. Shortchanging yourself on diagnostics will sabotage those efforts.

There are quite a few causes that lead to dental implant failure. One of them is poor placement on the part of the dentist. Another is poor bone support. This is another issue that can be prevented if proper diagnostics are made.

As you can see from the image above, your dental implant is surrounded by bone. In order for the implant to stay in place, it has to integrate with that bone, which essentially grips it and holds it in place. Without adequate bone, the implant will come loose and fall out.

When you lose a tooth, your body immediately begins resorbing the minerals in the bone where the tooth was. It does this in an attempt to be as efficient as possible with your body’s resources. Depending on how long between the time you lost your tooth and the replacement, you could lose too much bone. For patients who get dentures, this ends up being devastating and ends in facial collapse.

I know it is tough when you have the option of not doing a diagnostic. However, if you were going to skip something, this would not be the test I would skip.

What if you have the CT scan and your dentist tells you that you do not have enough bone support? The good news is that doesn’t mean you cannot get dental implants, you will just need to add one quick additional procedure, bone grafting. This is an outpatient procedure that will build back up the missing bone, enabling you to get the support you need for your new tooth replacement.

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

He Yanked Out Her Dental Implant

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I had a dental implant placed and the crown came loose. I called the dentist who placed it and he did an x-ray. He felt the implant was fine and thought the crown was loose so he decided to remove it and rebond it. Unfortunately, when he went to remove it, it stuck so he needed a special tool. When he used that he had to pull pretty hard and the implant came out with it. Is it possible the dentist messed up here? I don’t know how to fix this.

Cammie

Dear Cammie,

Illustration of a dental implant surrounded by natural teeth

Yes, your dentist definitely messed up. I am actually having a hard time figuring out how he could have been so clueless as to pull out your dental implant. If a crown is loose, it would practically fall off. You certainly aren’t going to need a special tool for it. It should have been obvious to him that it was the implant that was loose the whole time.

Reasons for a Loose Dental Implant

There are a few reasons your dental implant could have been loose. One of the main reasons is because an infection developed. However, you didn’t mention any pain, nor did you have a fever. I’d expect one of those to be present if that was the issue. Another reason for a loose implant is premature loading. That could mean that the dental crown was bonded on before the implant was ready. A third reason could be there was never enough bone support to even place a dental implant.

Your dentist should have done diagnostic x-rays, including 3-dimensional ones, to determine that. I am a tad concerned about his diagnostic abilities as he did an x-ray when you mentioned it was loose and he couldn’t tell the implant was the problem.

Getting this fixed will require you to re-do the procedure. However, it will take more than just doing it again. Before another implant can be placed, you’ll need bone grafting done in order for there to be enough bone to retain the implant. Without that, you will end up with another dental implant failure.

In your place, I would demand your dentist pay to have this done correctly. Don’t let him re-do it himself and don’t just agree to a refund, because it will cost more to fix than you paid him. He needs to pay the new dentist and YOU need to be the one who picks the new dentist. You want someone who has done significant post-doctoral training in dental implants. If they need to refer you to an oral surgeon, make sure it is the dentist who determines the placement of your implant.

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

Dentist Placed My Implant Knowing it Would Fail

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I wanted to replace a tooth. My dentist told me I could get a dental implant, which was the procedure I was hoping for. Apparently, when he went in to place the implant he realized there wasn’t enough bone. He placed the implant anyway. When the surgery was over he told about it and said he doesn’t expect it to last and he thinks it should be removed and then he can give me a dental bridge. I really wanted a dental implant though. Also, I don’t think it is right I should be charged for a surgery he knew was going to fail. Am I overreacting?

Callie

Dear Callie,

dental implant diagram

No, you are not overreacting. In fact, your dentist could be in some trouble here. Let’s talk about the legal implications. He said he’d provide a service, which in any reasonable contract would be expected to actually not fall apart. If it does, you’d get a refund. In legal terms, this is called an implied warranty. In a dental implant, this would mean that the implant would be expected to support the crown. He placed the implant knowing it wouldn’t. So, yeah…he owes you a refund.

There are malpractice issues here too. How did he not know there wasn’t enough bone before doing the procedure? There are diagnostics that should have been performed, such as x-rays in order to make certain you are a good candidate. Either he didn’t do proper diagnostics or he didn’t know how to read the diagnostics he did. Then, when he saw the true “landscape”, he still went ahead and placed an implant he knew would fail. That is malpractice.

That isn’t the only problem here. You’re not bound to getting a dental bridge just because he blew the procedure. There is the option of getting some bone grafting done to build up the bone structure you are missing. Then, your jaw will be ready for that dental implant you wanted.

Bottom line. Yes, ask for a refund. If he gives you a hard time, tell him you are happy to speak to the dental board and an attorney about his malpractice. That should change his tune.

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

Implants Fell Out After a Few Days

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I had six dental implants placed. In the week since they’ve been placed, three have fallen out. These are expensive. Should I have to pay for ones that fall out? Do you think the others will fall out? I’ve already paid for 75% of the fee.

Kenneth

Dear Kenneth,

Illustration of a dental implant surrounded by natural teeth

No, you should not have to pay for these dental implants. While it is true that there are times a dental implant will fail for unknown reasons, in general, dental implants have a 95% success rate. Thus far, your dentist is down to 50% and I have little confidence the others will stay in either. Most of the time when an implant fails it is after the load has been placed on them. Yours failed before there was even a load placed on them. The first thing I would want to know is why these three have failed. I’d like you to see another dentist for a second opinion. Do NOT tell them who the dentist was that placed them. Just let them know you have lost them in under a week and want to know if they can diagnostically tell you why.

Some Causes of Dental Implant Failure

  • Lack of bone support. As you can see from the image above, dental implants require bone support for them to be retained. Your dentist should have done enough diagnostics to determine whether or not you had enough bone support. If you didn’t, a bone grafting procedure would have been necessary before proceeding.
  • Incorrect placement of the dental implant fixture. This can also be the result of poor diagnostics.
  • Infection. This can be because of poorly fitting fixture.
  • Using substandard implant fixtures. Some dentists will try to save money by purchasing their dental implant fixtures overseas which have fewer regulations. This usually results in dental implant failure. Though, most often this happens further down the line where the patient may not know it was because of substandard materials.
  • Premature loading. This is when the dentist puts stress on the implant before it has properly integrated with the bone.
  • Medical issues the patient has, though this is not as common and your dentist would warn you ahead of time of any real risk factors.

How to Get this Fixed

Tell your dentist you want a refund. You have a very good case. If he gives you any guff about it let him know you will be speaking to the dental board. That should sober him up some. Unfortunately, you will also need some bone grafting at this point. Take any diagnostics he did with you and the dentist can let you know if you didn’t need the grafting before. If you were good to go and he messed up another aspect of the implants, then he should have to pay for the bone grafting as well. If you already needed it ahead of time, then you’ll just have to go ahead and pay for that.

When you go to have this redone. Look for a dentist with significant dental implant training.

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

Problems with Dental Implant Procedure

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I wanted to get a single dental implant. My dentist felt there wasn’t enough bone in the area after doing his diagnostics and told me I could either get bone grafting done to have the implant or get a dental bridge. I really wanted the implant, plus I didn’t want to crown two healthy teeth so I opted for the bone grafting. We did that and after the healing time we went to do the implants. But, he told me the bone grafting didn’t work and is now suggesting I go ahead and get the bridge. Two surgeries later and I’m still without a dental implant. He actually has a good reputation for implants so I’m kind of surprised. Should I have gone to an implant specialist?

Stacey

Dear Stacey,

A dental implant diagram

Technically, there isn’t a recognized specialty in dental implants. It is up to the dentist how much training they receive as well as whether they’ll do the whole procedure or divvy it up with an oral surgeon. It is possible your dentist is very good with the implant procedure but just now learning how to do the bone grafting aspect. It is tricky and everyone starts somewhere.

What I like about your dentist is his integrity. Some dentists, with more pride than integrity, would have gone ahead and placed the implant so you wouldn’t have known they don’t have bone grafting down yet. Then, after a period of time, your dental implant would have failed and there’d be no way to tie it to his error. He kept that from happening to you.

Getting Your Dental Implant

You basically have two choices at this point. You can go ahead and get the dental bridge or you can do the bone grafting and dental implant procedure again. Getting a dental bridge is a perfectly acceptable solution. However, as you noted, it does require placing crowns on two perfectly healthy teeth in your particular case.

If getting the implant is important to you, I’d ask your dentist for a recommendation for a good oral surgeon to re-do the procedures for you. One word of caution. After your bone grafting procedure is done and healed, visit the dentist again for him to decide on the best placement of the implant. He and the oral surgeon need to communicate before the implant surgery in order to ensure it gets placed in the correct position.

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

Do You Have to Quit Smoking for Dental Implants?

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I want to get dental implants to replace some missing teeth. My dentist said he won’t place them unless I quit smoking. Is this really necessary or is he trying to force his own agenda on me?

Kevin

Dear Kevin,

An image of a dental implant crown being placed in three stages

I don’t think your dentist is trying to force an agenda on you. Instead, he’s trying to give your dental implants procedure the best chance at success.

The Risks of Nicotine with Dental Implants

  • The Reduction of Blood Flow

Any form of tobacco, including cigarettes, vaping, smokeless tobacco, or dipping restricts your blood vessels. In some cases, it cuts off the blood flow completely.

  • Poor Osseointegration


    • One of the keys to a successful dental implant procedure is when the implants fully integrate with the bone. With reduced blood flow, this hinders healing which slows down the integration. This will lead to a loose implant which will fall out.

    • Increased Risk of Infection

    Because your reduced blood flow hinders healing, it increases your risk for infection at the implant location. The leading cause of dental implant failure is an infection.

    Options for Dental Implants When You Smoke

    Obviously, you can accept the risk and move forward. You will be able to find a dentist willing to provide the procedure even while you smoke.

    On the other end of that spectrum is to quit smoking. You can talk to your doctor about options to aid you in that process. There are options to help with the withdrawal symptoms.

    Another possibility is to meet somewhere in the middle. You can quite for several weeks before the surgery and during the healing time. Then, when everything is secure, you can smoke again. However, you may find during that time period that you don’t really need that tobacco as much as you thought you did.

    A Cosmetic Consideration with Dental Implants

    Smoking causes serious tooth stains. Often, patients want to get a whiter smile when they’re replacing their teeth. You may want to consider getting your teeth whitened before having your implant crowns made. This way they can match the porcelain crowns to your new, whiter tooth color. Giving you a youthful, healthy looking smile.

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

Is Peri-Implantitis Causing Swelling around Your Dental Implant?

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Peri-implantitis is rare. It is even more unsual for it to occur around a dental implant that you’ve had for years, but it can happen. Usually, an infection around an implant occurs within the first few months of placement, but not every infection is caused by peri-implantitis. What should you do if you think your implant is in danger of failing?

What Is Peri-Implantitis?

Peri-implantitis is a rare infectious disease that causes bone loss and infection around a dental implant. Many specialists agree that dental implant complications are often prematurely diagnosed—or misdiagnosed—as peri-implantitis.

Signs and Symptoms of Peri-Implantitis

Some of the signs and symptoms of peri-implantitis are listed below. If you are experiencing some of them, it doesn’t necessarily mean that you have peri-implantitis; the disease is rare. Most often, swelling and infection around a dental implant are caused, not by an infectious disease, but by poor planning, improper placement, cheap fixtures, or implant mistakes.

  • Bleeding gums
  • Red or swollen gum tissue
  • Bone loss around the implant
  • Pus around the implant
  • Loose implant fixture
  • Pain

Risk Factors

According to the American Academy of Periodontology, there are several risk factors:

  • Smoking
  • Plaque accumulation
  • Diabetes
  • A history of periodontal (gum disease)

Why Get Prompt Treatment?

It’s important to have a highly skilled implant dentist take a look at the implant site. You’ll need an examination for accurate diagnosis and treatment. If the disease is left unchecked, there are several risks:

  • The infection can worsen.
  • Your jawbone can become infected or begin to dissolve.
  • The implant can completely loosen and need to be replaced.

We recommend that you promptly schedule an appointment with an experienced dentist or periodontist (specialist in gum disease and dental implants). The sooner you act, the less time and money it will cost to correct the issue.

This post is sponsored by East Cobb dentist Dr. Cristi Cheek.