Lowell Cosmetic Dentistry Blog

Dental implants can be a lifelong solution for replacing missing teeth. But care must be taken to ensure precise placement and adequate bone support. Sometimes sinus perforation occurs during dental implant surgery. What can be done to prevent it? And what should you consider if it’s already happened to you?

1. Is Perforating Sinuses a Big Deal?

• • Some oral surgeons say perforation of your sinuses during dental implant placement isn’t a big deal. They say that if it happens, the site usually heals well and the patient is fine.
  • Other oral surgeons will mention cases where, after perforation, an infection from the sinus cavity spreads around the dental implant. Sometimes, chronic sinus infection results, making it difficult to keep the tissue around an implant healthy.
  • The issue of sinus perforation during dental implant placement also raises the question: If the dental implant pokes into the sinuses more than one or two millimeters, is it adequately supported by the jawbone? And will inadequate bone support by the bone contribute to dental implant complications or failure?

2. Dental Implant Surgery – Standard of Care

Dental implants need enough bone to fuse to and remain stable.

High-quality implant surgery requires the surgeon to take x-rays. Most successful oral surgeons use three-dimensional x-rays to ensure there is enough bone density to support dental implants and maintain stability.

3D x-rays will also reveal your facial structure, nerves, and sinus cavities and assist in performing surgery with precision. 3D x-rays help anticipate the need for sinus lift, or sinus floor elevation, and bone grafting before dental implants are placed. A 2010 article in the Journal of Oral implantology reports that in one study of patients who received minimally invasive sinus lift surgery, there was a 97% implant success rate.

3. Have You Experienced Issues?

If you’ve received dental implants and are experiencing problems from sinus perforation, don’t ignore it. Your oral surgeon or implant dentist should communicate to you a clear plan to ensure the problem doesn’t get worse or result in dental implant failure. If you lack bone density to support dental implants, the solution will likely include a sinus lift, or sinus floor elevation, and bone grafting.

4. Consider a Second Opinion

After you speak with your dentist, we suggest that you consider scheduling an appointment for a second opinion. A dentist with advanced training and experience in implantology, an oral surgeon, or a periodontist can review your x-rays, and examine your implant site to determine the issues involved and recommend treatment.

This post is sponsored by Lowell, MA dentist Dr. Michael Szarek.

I am an avid hockey player, and I had a facial hit during practice last month so I am doing some research on tooth implants. Although I didn’t lose any teeth, the ligaments loosened in one of them. My dentist stabilized the tooth. She said that if I have another impact on my face, there is a chance I might lose that tooth. She also said that my dental insurance probably won’t pay for an implant. As a teenager, I wore braces and my teeth are straight and I’ve even had them whitened. I still wear a retainer every night. I’ve never had an impact that loosened a tooth, so I’m concerned how much this might cost me if I really do need a dental implant. Other than a mouth guard, is there something I can do to protect my tooth? – Chanz

Chanz,

A dental implant fuses to the bone and a crown is attached

As you likely know, losing teeth is common for hockey players. Many players who have lost a tooth have obtained a removable form of cosmetic tooth replacement. They take the appliance out before games. Some only use it for special occasions.

Contact your insurance company and ask if limited benefits are offered for dental implants. Generally, insurance will provide benefits for the least expensive form of tooth replacement. Dental implants are the most effective and most expensive form of tooth replacement.

• Partial denture – A partial denture has one or more teeth attached to a gum-colored base. It clasps onto adjacent teeth. It is the least expensive form of tooth replacement.
• Dental bridge – A dental bridge requires shaving down the natural tooth on either side of the missing one. The replacement tooth is suspended in the middle of the bridge, and a dental crown is connected to the right and left of it. The crowns on the ends are placed over the shaved down natural teeth.
• Dental implant – An artificial root form, usually made of titanium, is surgically implanted in the jawbone. After a healing period of three to four months, a dental crown is attached to the implant. If you play contact sports and experience an impact to your face, the dental implant can loosen and fail. This is the most expensive form of tooth replacement. And What Can You Do?

Do what you can to avoid needing a dental implant. Consider the follow precautions.

• Customized mouth guard – Wearing a customized mouth guard can help. It’s important that you receive a mouth guard from your dentist. Impressions of your teeth will be taken to make it. But a mouth guard has limited benefits if a hockey puck or stick makes an impact with your mouth.
• Full-cage mask – With a highly-interactive sport like hockey, only a full-cage mask attached to the helmet will prevent objects from impacting your face. This is not a popular option among players, but it provides maximum protection for your face and teeth and can help save a tooth and avoid the need for a dental implant.
• Keep the tooth moist – If you lose a tooth, keep it moist with saliva or milk. Of course, if you’re in the middle of a game, milk probably won’t be within reach, so use your own saliva and see a dentist right away.

This post is sponsored by Michael Szarek, DMD, a Lowell, MA accredited cosmetic dentist.

If you have missing teeth that you want to be replaced with dental implants and you also need braces, which should come first?

Dental implants fuse to the bone and won’t move with orthodontic treatment

Here are a few facts about dental implants and orthodontic treatment. They will help you understand the priority for your smile.

Dental Implants

• Usually made of titanium
• Surgically implanted in your jawbone
• Require bone grafting if you don’t have enough jawbone density
• Require a three to six month healing period so the implants fuse with your jawbone
• Feel and function like natural teeth
• Permanently in place and don’t contain ligaments like natural teeth to allow them to be repositioned during orthodontic treatment

Orthodontic Treatment

• Correctly aligns your teeth
• Often needed to move teeth that drifted into empty spaces where teeth are missing and to make room for dental implants
• Will move your natural teeth, but the implants won’t budge

Dental Implants After Braces

Orthodontic treatment

Most often, orthodontic treatment should be completed before you receive dental implants. Otherwise, as your teeth shift, the implants can damage them because braces are unable to move dental implants along with your teeth. The rigid implants can damage your teeth as they move to the correct position.

Schedule an appointment with an orthodontist to discuss your goals for your oral health. He or she will work with your implant dentist to ensure you get quality tooth replacement and alignment.

Implant placement

Find at least two skilled implant dentists to discuss your need for tooth replacement. Before you schedule an appointment for a consultation look for the following:

• Advanced training
• Extensive experience
• Implant credentials

Implant restoration/crown

An experienced cosmetic dentist can provide you with lifelike dental crowns for the implants. And if you’re considering teeth whitening, it should be completed before you receive dental crowns. This ensures the crowns will match your bright smile.

This post is sponsored by Lowell, MA cosmetic dentist Dr. Michael Szarek.

Snap-on dentures

When dental implants are used to support dentures, the results can greatly improve your quality of life. Many common concerns about wearing dentures can be reduced or completely eliminated, including:

• Difficulty speaking
• Difficulty chewing
• Loose dentures
• Dentures that lift or fall out
• Bone shrinkage and facial collapse

When Dental Implants Won’t Hold Your Prostheses

If your denture doesn’t fit properly onto dental implants, won’t snap onto them, or dislodges from them, there are several possible causes. Three of them are discussed below:

• Dentures – It is possible that your prosthesis wasn’t correctly made. Before you receive dentures, impressions of your mouth are taken. Inaccurate impressions can result in poor fit. Additionally, incorrect locations of the attachments in the denture base can cause them not to fit correctly on the implants. And, depending of the age of your dentures, the attachments might be difficult to place, or they can be worn and need to be replaced.
• Implants – The position and angle of your dental implants are crucial for your dentures to fit correctly. Proper planning is required for accurate placement. This includes a three-dimension CT scan to identify the best location for maximum support. Sufficient bone density is needed for your implants to remain stable.
• Communication – Close communication is required between the implant surgeon and the restoring dentist to ensure precise placement and comfort. If clear instructions are not provided, either the implants or the denture can be incorrectly placed.

What Can You Do?

If you are experiencing problems with the fit of your denture and dental implants, speak with your dentist and implant surgeon. You can also consider scheduling a second opinion with an experienced implant dentist. He or she will examine your denture and implants to determine the reason for the poor fit.  Further diagnostic studies might be required to identify the cause of the problem and resolve it.

This post is sponsored by Dr. Michael Szarek, a Lowell, MA accredited cosmetic dentist.

I’m going to have my remaining teeth extracted and get 6 dental implants put in. I need dentures and I am finding that there are more types of dentures than I knew about. It’s good in a way because I am hoping for something that will look half way like natural teeth and that won’t leave me walking around toothless. It is also a little scary because I want to be sure that I make the right choice for dentures. Can you give me information on an immediate denture? What is involved? Should I ask for an immediate denture for my implants? – Robin

Robin – An immediate denture is received on the same day that your natural teeth are extracted, or on the same day you receive dental implants. In advance of the extraction, the denture is made. The denture is crafted based on an impression of your mouth. It will be secured to your dental implants as a form of temporary tooth replacement.

What to Expect with Dental Implants and Immediate Dentures

Bar-retained implant overdentures

The advantages of an immediate denture are that it will look natural because it is based on impressions of your natural teeth. Of course, you can request a different look for your final prosthesis. Also, the dentures are placed immediately, so you don’t have to go without teeth for any period. Whether it’s a temporary denture or your permanent prosthesis, it will be immediately loaded on your dental implants.

If your immediate denture will be your permanent denture, it will cost more than conventional dentures because it will need to be adjusted as your jawbone shrinks after your teeth are extracted. The denture will need to be refit and relined. It is possible that you will need a new denture altogether. It is wise to receive dental implants because they slow the progression of jawbone shrinkage.

If you need a complete set of dentures, your molar teeth may be extracted before the dentures are made. This will give the extraction site time to heal, and it will help the denture fit better. Sometimes, implant overdentures are recommended, because they can be placed over your remaining natural teeth.

We recommend that you visit a dentist who is experienced in restoring dental implants with dentures and in cosmetic dentistry. The teeth of cosmetic dentures will look natural, and a cosmetic dentist will customize the dentures to match your preferences and facial features. He or she will also thoroughly explain your options for dentures, as well as which options will be most compatible with your needs.

This post is sponsored by Dr. Michael Szarek, a Lowell, MA accredited cosmetic dentist.