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Advanced cosmetic and general dentistry

Should I choose zirconia or titanium implants?

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I have four missing teeth and am gradually replacing them with dental implants. My first two implants are titanium. But I read online that zirconia implants might be better because titanium can cause an allergic reaction or neurological issues. I will receive my next two implants in the fall. Should I ask for zirconia implants this time? Thank you. Oliver from RI

Oliver,

Thank you for submitting your inquiry to our office.

Titanium is one of the most biocompatible materials used for prosthetics in the medical and dental fields. Although people with specific metal allergies or sensitivities might benefit from zirconia implants, titanium is widely used. The human body contains various elements that help it perform essential functions, including zinc, iron, and copper. If a specific metal causes a reaction, it must be determined on an individual basis.

Are Zirconia Dental Implants Better than Titanium?

A December 2016 article, Zirconia Vs. Titanium Implants – Deciding Factors, was published in the Journal of Dentistry, Oral Disorders & Therapy. The report makes the following points:

Zirconia implants

Although zirconia is an ultra-strong ceramic, many implant dentists recognize its limitations:

  • An implant dentist or oral surgeon cannot usually leave zirconia implants to heal beneath the gums
  • Zirconia lacks the flexural strength of titanium and may crack under pressure
  • Adjustments to zirconia can lead to micro-cracks that can spread and result in dental implant failure
  • The small diameter of zirconia implants increases fracture risk
  • The one-piece design of zirconia implants is not conducive to using for full-mouth reconstruction

What If You Have A Titanium Allergy?

Photo of five dental implant screws. On both the left and right side is a single titanium implant, and three zirconia implants are between them.

Titanium (metal) and zirconia (white) dental implants

Although most people are concerned about an allergic reaction to titanium, only 6% of patients have titanium allergies. And some metal reactivity tests are unreliable. But if you have a confirmed titanium allergy—or if you simply prefer zirconia—zirconia dental implants may be an option.

Schedule a Dental Implant Consultation

We recommend that you begin with a consultation with a skilled cosmetic dentist who restores dental implants. He or she will explain your options for crowns or dentures on zirconia vs. titanium implants and the result you can expect.

Dentists who do not have advanced implant surgery training work with a periodontist (implant specialist) or an oral surgeon to plan for and place your dental implants.

 

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

New dental crowns for a gap make my jaw and neck hurt

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I received a dental implant on a left incisor and crowns on all front six teeth. I received the other crowns to close a large gap between my front teeth. Now my speech is slurred and lispy, and I have neck and jaw pain, dry mouth, and numbness in my lips. I regret closing my gap. Are the crowns causing this problem? If so, I want them removed, and I will keep my gap. – Dahlia from CT

Dahlia,

Closing your gap is not the issue, but the quality of your crown placement is the problem. Correctly sized and seated crowns do not create the symptoms you described.

When Dental Crowns Cause Symptoms

When dental crowns cause symptoms, including pain, numbness, or dry mouth, it could be that the crowns are too thick, too long, or both.

  • Oversized crowns – Oversized crowns can prevent your lips from closing naturally and effortlessly.
  • Lip incompetence – When your bite is correct and you put your teeth together, your lips should close naturally without thinking about it or trying to close them. Your lip numbness and dry mouth suggest you have lip incompetence—the ability to close your gaps naturally.
  • Thick crowns – Too-thick crowns can disrupt your bite (the way your upper and lower teeth fit together) and cause jaw and neck pain. Speech problems can result, too.

What to Do About Faulty Crowns

When dental crowns cause pain and dry mouth, you must find a cosmetic dentist to correct the issue. A dry mouth and lack of saliva breeds bacteria and promotes rapid tooth decay. Saliva contains antibodies to help fight decay, so don’t let the problems linger.

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Get a second opinion to check your implant crown and crowns on your natural teeth

We recommend that you find an advanced cosmetic dentist—preferably accredited—for a second opinion. It is challenging for a dentist to place multiple crowns simultaneously and balance your bite correctly. But a trained cosmetic dentist who understands occlusion and bite (how your teeth fit together and come in contact when you bite) can evaluate your case.

The cosmetic dentist will do the following:

 

Unfortunately, you may need new crowns. But your oral health is essential to your well-being.

Best wishes.

 

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

Jaw swelling is worse after a tooth extraction

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My bottom right second molar was hurting on and off for a few months. My jaw started swelling, so I finally went to a dentist. And a little over a week ago, the dentist extracted my bottom right second molar. Before I left the dental office, my doctor gave me an amoxicillin prescription. I’ve been taking the medicine, but the infection and pain are worse. The swelling in my jaw is large and hard. Do I need to ask for a stronger dose of amoxicillin before Io lose the tooth? Thank you. Reuben

Reuben,

Although amoxicillin often works well for tooth infections, your infection is not improving. It’s getting worse. Many infections have a bacterial strain with amoxicillin resistance. That is likely the case with your infection.

Infections in the jaw can become severe, spread elsewhere in your body, and become life-threatening.

Signs and symptoms that the infection is spreading:

  • Diarrhea
  • Dizziness
  • Fatigue
  • Fever, including sweating or chills
  • Headache
  • Nausea
  • Rapid heart rate
  • Stomach pains
  • Swelling that makes it difficult to open your mouth, swallow, or breathe
  • Vomiting
Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Treating a severe jaw infection is the priority. A dental implant can replace a lost tooth.

Call your dentist immediately and request a different antibiotic that will help your body fight the infection. Don’t delay getting the prescription filled and taking the new medicine right away. If your symptoms get worse, go to an emergency room.

The effects on your overall health are at risk. If you lose the tooth, you can visit an implant dentist to replace it. But for now, it is essential to get the infection under control.

Michael Szarek, DMD, of Lowell, MA, sponsors this post.

 

Dental implant crowns make my mouth and teeth burn

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Almost two years ago, I received four implant crowns. After getting the crowns, my teeth feel dry. And the way my upper teeth hit my lower teeth was uncomfortable. My bite was heavy in places, and I developed the habit of tapping my teeth together. I’ve seen my dentist repeatedly for adjustments. Now I think that I have burning mouth syndrome. By mid-morning each day, the backsides of my front teeth are burning. I chew gum all day to keep the saliva flow going. My dentist told me that I need a gum specialist because nothing is wrong with my crowns. Another dentist gave me a second opinion and said my crowns are well-positioned. If that’s the case, why can’t I stop clicking my teeth together? I don’t know what to do next. Stephen from CT

 

Stephen,

Your experience gives us the impression that your dentist doesn’t have the skill and expertise to place four implant crowns all at once on upper teeth. Although Dr. Szarek would need to examine your teeth for an accurate diagnosis, we will use your description to suggest what might be happening.

How crowns affect your bite

If your upper teeth are uncomfortably hitting your lower teeth, your crowns are disrupting your bite. When a dentist places crowns correctly, your bite will feel natural and comfortable without thinking about it. But your bite immediately felt awkward and is causing you to tap your teeth together.

Referral to a gum specialist

If your bite is off and your crowns are causing the problem, a gum specialist (periodontist) is not the answer.

Second opinion dentist

Although your crowns look perfect, your bite can still be off. When dentists place multiple crowns, they must follow occlusal principles. Your teeth must meet simultaneously and be positioned to ensure tooth function is not compromised. Although you had a second opinion, we recommend getting a third opinion.

Look for a dentist who has post-graduate training in occlusion and bite. Many dental schools don’t offer enough occlusion training for dentists to understand how to place multiple crowns at once. Find a dentist with post-graduate training in occlusion, bite, or full-mouth reconstruction from at least one of these training facilities:

  • Pankey Institute
  • Dawson Academy
  • Spear Education Center
  • Las Vegas Institute

Dry teeth and burning mouth

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Dental implant crowns can make or break yorur bite

Burning mouth syndrome might be the cause of your dry teeth and burning sensation in your mouth. The stress from your bad dental experience might be the trigger for your symptoms. According to the Mayo Clinic, stress is a secondary trigger for burning mouth syndrome.

After you find an advanced cosmetic dentist with training in occlusion and bite, you can receive implant crowns that look beautiful and function correctly. And your quality of life will improve.

 

Michael Szarek, DMD, of Lowell, MA, sponsors this post.

 

Root canal treatment again?

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In 2014, my dentist did a root canal on an upper right molar. Two months ago, the tooth started hurting, and it’s getting worse. Will I need an extraction and dental implant, or if I see a specialist, can they try a root canal treatment again and prevent an extraction? – Thanks. Noble R. from CT

Noble,

Root canal treatment is one of the least predictable treatments in dentistry. Even if a dentist performs the procedure correctly, it has a 5-15% failure rate.

Can Root Canal Treatment Be Repeated?

Root canal treatment can be repeated multiple times. But it doesn’t always make sense to do it. Still, there is an option before extracting a tooth and replacing it with a dental implant.

Why Causes Root Canal Failure?

Sometimes root canal treatment fails because the dentist could not completely remove the infection from a tooth. Canals in a tooth can twist and turn and make it difficult or impossible for a dentist to clean out the infection and seal out bacteria fully.

The pulp in your tooth contains living tissue, nerves, and blood vessels. A pulp chamber is in the crown of a tooth, and a pulp canal conducts blood supply and nerve in the chamber. If tooth pulp is infected, a dentist will clean out the chamber and canal and seal them to prevent bacteria from entering the tooth.

Molar teeth usually have three canals for each tooth root. But sometimes a tooth has a fourth canal that’s difficult to find and clean. Some canals have branches at right angles. A dentist has tiny, highly flexible files to insert in the tooth and remove the infected tissue, but the files cannot enter a side branch with a right angle. Although a minority of teeth have fourth canals and challenging angles, sometimes fourth canals exist and retreatment is needed. Retreatment has a 50 to 75% success rate. But if retreatment is completed by a dentist who is skilled in root canal treatment and it fails, a third treatment is likely to fail.

Root Canal Surgery

Root canal surgery is a procedure that enters the tooth through the root instead of the crown. A root canal specialist, or endodontist, performs root canal surgery, or an apicoectomy. The treatment is 50 to 75% successful. The specialist will take the following steps:

  • Make an opening in the bone
  • Cut off the root tip of the infected tooth
  • Place a small filling at the end of the tooth to seal it

But even with an apicoectomy, a specialist sometimes can’t access tooth roots, or a root’s location—such as near a nerve in the lower jaw and lip—makes surgery risky.

Extraction Instead of Repeat Root Canal Treatment?

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Repeat root canal treatment is an option before extraction and a dental implant

An extraction is an alternative to repeat root canal treatment. Although it’s not the first choice, sometimes even a specialist can’t save a tooth, and you’ll need an extraction and dental implant.

Schedule a follow-up appointment with your dentist to discuss your options. You can compare your dentist’s recommendation with a second opinion from a root canal specialist.

Michael Szarek, DMD, a Lowell, MA, cosmetic dentist, sponsors this post.