Dental Questions: Who Places Dental Implants?

Implants represent a new shift in how dental offices can replace missing teeth. Never before have dentists been able to reproduce one or more teeth in a non-removable fashion without altering adjacent teeth. In the midst of this new treatment trend, many different general practices and specialists are placing implants. In this article, we hope to make sense of who offers implant surgeries and why they do so!

For starters, almost any licensed dentist can become trained to place implants. There is no specific requirement for a specialist to place them, and training programs are very common. As such, our office places implants on healthy, long standing patients in uncomplicated scenarios. We feel that any case beyond these parameters requires the expertise of a specialist.

Many times, an oral surgeon will place implants. They benefit from years of surgical training and managing medically complex patients. Most offices will offer various sedation options when providing the surgery. Periodontists also frequently perform implant treatment. Here, their specialized knowledge of gum tissue, bone characteristics and healing allows them to place implants in highly esthetic areas. They also typically offer sedation as a part of treatment. Other specialists, such as prosthodontists and endodontists may place implants on a case-by-case basis.

No matter who places your implant, know that your referral from Thousand Oaks Family Dentistry was made with the highest quality care in mind. We take surgical treatment very seriously and only refer patients to our trusted network of specialists. If you want to know more about implants and how they might improve your treatment options, please give our office a call!

Dental Questions: What is a flipper?

With the rise of dental implants, many patients are electing to have teeth extracted rather than spending time and money on a losing battle. Since implants can take months to heal before a crown is placed, there is now a question on what to do with the missing spaces in the meantime. While you can elect to leave these areas open in the interim, this is not an option when the implant is placed in the smile zone. For these situations, you may be made a flipper- or temporary denture. 

Flippers are also known as stay plates or temporary partial dentures. They are made of a hard, pink acrylic resin that supports the prosthetic teeth. They may also have a series of metal clasps that hold the frame firmly in place. Flippers differ from permanent dentures primarily in the way they rest on the teeth and gums. Partial dentures are fitted to the mouth so that the teeth serve as the primary supporting structures. If the gums have to be utilized in holding the denture, very specific areas are used, as to not cause any lasting damage. In contrast, flippers rest entirely on the gums and soft tissues. Over time, the constant pressure on gums can cause the underlying bone to resorb or irritate the periodontal tissues. With this in mind, they are inappropriate as permanent appliances. However, they can be a great interim solution in implant placement. 

Flippers are created by a dental laboratory and take about two weeks to complete. They typically blend seamlessly with the natural tissues and aren't noticeable as "denture teeth." If you would like to know more about flippers and how they can be a part of your implant treatment, please give our office a call!

Dental Questions: What do I do if my implant crown comes loose?

Do you have a dental implant? Have you ever noticed that the crown feels loose or that you can move it with your tongue? This sensation can be quite alarming and seems as though the entire implant is wiggling out. However, looseness is usually the result of the implant crown coming separated from the actual implant. 

Although there are a few different implant designs, they all include two pieces of metal screwed together. Over time, the forces of biting and chewing can cause these screws to work themselves loose. This is typically a issue on older implant designs, but can affect any generation.

Your best bet in solving this problem is returning to the dentist who placed the implant, or obtaining a record of what type of implant they used. This information is crucial in tightening the crown back down. Tools, hardware and design are not the same between companies and using incompatible components could ruin the implant.

After identifying the type of implant used, the treating dentist will evaluate wether or not the crown can be saved. Dental Implants are comprised of three components: the actual implant, an abutment, and an overlying crown. The abutment is essentially a metal post that the crown is screwed or cemented to. Depending on which part of the implant has failed, the entire crown may need to be removed to tighten everything back up. However, most crowns are savable and only need to be repaired or recemented once the procedure is over. If you would like to know more about implants or their maintenance, feel free to give us a call! 

Cone Beam CT Technology

Here is a series of images assembled using CBCT technology. They are being used to visualize a tooth treated with a root canal. 

Dental X-rays are very useful in diagnosing a number of conditions. Decay, abscesses and bone structure can easily be seen using standard technology found at any dental office. However, X-rays are inherently limited: they can only show you a two dimensional image of a three dimensional object. In many instances, X-rays can visualize part of a problem, but leave out "the whole picture." How deep is that crack? Which tooth is draining to that abscess? Are there one or two canals in that root? For these questions, many dentists and specialists use Cone Beam CT technology. 

Cone Beam CT (CBCT) is based on a principle called Computerized Tomography. Here, a series of low-radiation exposures are used to take "slices" that can assemble to a 3D image. Imagine looking at a apple, cut widthwise many times. If you saw each slice consecutively, you could easily surmise the 3D shape of the original apple. This is the same idea behind CBCT- many individual images are used to create a 3D representation of hard tissue. While a traditional X-ray might miss small problems (like a cracked root) or misrepresent sizes or shapes (like superimposing two root canals as one), a CBCT excels at giving us a more complete picture.

Many of the specialist we refer to utilize CBCT technology. For example, Doctors Bollinger, Cobin and Stoop at Conejo Simi Endontics use it to diagnose cracks, visualize root canals and determine the prognosis of treated teeth. CBCT is particularly useful for endodontics, as many problems are difficult or impossible to locate, even with high powered microscopes. Likewise, Dr. Wilgus at Camarillo Periodontics uses his CBCT machine to plan implant placement. Being able to see the height and width of bone along with any associated structures adds extra predictability to his surgeries. 

It's easy to see how CBCT technology has made diagnosing dental conditions easier and more reliable. When we make referrals to our specialist network, we have these capabilities in mind- that these doctors have the technology to visualize problems that normal X-rays can't. If you would like to know more about Cone Beam technology and how it is used in dentistry, just give us a call!

Dental Questions: Can Any Tooth Be Replaced With An Implant?

Here, you can visualize how important bone space is in placing an implant. 

In theory, an implant could take the place of any tooth position in the mouth under ideal conditions. However, not every tooth will be a good candidate for replacement with an implant. The main limiting factors are space, bone size and bone health. For an implant to function properly, there needs to be enough distance between the adjacent teeth so that it can be placed without damaging the roots (which would necessitate both the implant and the tooth to be removed). Additionally, there needs to be ample bone height for the implant to sit in and integrate. This becomes a particular problem on the upper jaw, where the maxillary sinuses can encroach on potential bone space. Finally, the bone needs to be completely healthy. Patients with bone density disorders, recent infection or a history of taking certain medications may not be eligible for an implant. 

While we can accommodate a number of conditions with special implant shapes and grafting, there are some instances where placing an implant would be unpredictable or dangerous. In any case, a proper examination (with x-rays) is the only way to determine if you are eligible for a dental implant. If you would like to know more about implants, when we can place them and if you are eligible, please call our office!

The Bottle Opener Implant

Warning: the above video includes footage from a dental surgery. Please be advised. 

Here is a service we WON'T be offering at our office! Salta, an Argentinean beer company, decided to support their local rugby clubs in a unique way. Players who lost teeth due to gameplay injuries were sponsored to receive dental implants. However, these were no normal implants. As you can see in the video above, the players' new teeth incorporated working bottle openers- a truly wild idea! While the procedure is "questionable" at best, it does underline the importance of mouth guards and dental safety in contact sports. Implant or not, we never recommend trying to open a bottle (or anything else) with your teeth! 

Dental Tourism

With the economy in recession, many people are (rightfully) trying to save every penny they can. From entertainment to groceries, families across the nation are looking for a “good deal.” Some have discovered the increasingly popular medical tourism industry- where individuals travel internationally for discounted surgeries, treatments and medications. While the prices may seem great, our office would like to take a moment to show you that some of these deals may be “too good to be true.”

For starters, we are addressing dental tourism as the act of traveling to a specific office in a specific country for cheaper treatment. We are not discounting the standard of dental care in any country; you can find a great dentist in every part of the world. However, when patients travel specifically to seek out cheaper treatment, they often find themselves in unsafe situations.

In the United States, healthcare is not “cheap.” Fortunately, dental treatment has remained on the lower end of the cost spectrum, where some patients may still find it viable to receive great regular treatment even without insurance. While there are a number of issues that play into this high cost, one of the most important factors is regulation.

For a dental office to open its doors in America, it has to satisfy hundreds of qualifications, standards and licensing requirements. Our dentists have to hold a valid license, which can only be renewed if they have received the proper number of yearly credits for continuing education. The instruments and materials we use have to be approved safe by the FDA. Even our sterilization systems are subject to testing and supervision from the state dental board. However, the most important part of all this regulation is that it is strictly enforced. Between HIPPA, OSHA, the California Dental Board, the local dental society and the Food and Drug Administration, there are a number of “safety nets” that keep our patients out of harm’s way. Likewise, this excellent system of care comes with a fair share of taxes, specialized equipment and additional work to meet requirements; all of which can increase the cost of care.

Beyond extensive regulation, dental offices are simply expensive to run. In an office like ours, seeing patients daily would be impossible without a complete staff of front office coordinators, hygienists and assistants. In fact, nearly 25%-35% of an office’s typical overhead goes to pay the clinical staff (excluding the dentist). When you include lab fees, utility bills, insurances and disposable products, this number grows very rapidly. As you may imagine, these costs go hand-in-hand with regulatory measures, as to assure the office runs in complete compliance.

When you travel internationally for dental tourism, think about why the office you are visiting can offer cheaper care. Are they using proper sterilization techniques? Are their instruments licensed as safe for dental use? Is their equipment subject to strict scrutiny from government inspections? At some point, there must be a “missing piece” that allows them to offer cheaper care. Maybe it is simply the result of an overall lower cost of living in that country. However, it is often difficult to discern what you are (or aren’t) getting with this type of international treatment.

Perhaps you have found a great clinic with low fees that comes highly recommended from a friend or coworker. You checked their website, where the “American standard of care” is guaranteed by the head dentist. You may travel to this clinic, receive great treatment, and make it home while saving some money. Unfortunately, dentistry (like all of biology and medicine) can be unpredictable at times. Even the most skilled practitioner using the best techniques and equipment will occasionally have imperfect treatment outcomes. With a local office, these problems can be easily remedied by the treating dentist or through close communication with a specialist or associate. However, having international treatment amended can be expensive or impossible, depending on your situation. Often times, American dentists cannot provide follow up treatment to international care, as they are not familiar with (or cannot identify) the materials or techniques used. This may require a return visit to the treating international dentist, negating any potential savings.

At Thousand Oaks Family Dentistry, we are extremely proud of the transparency and standard of care we offer our patients. We understand that some of our patients may be tempted by lower prices in international offices, but we urge you to have a consultation with us first. You may find that our fees are competitive, with the added peace-of-mind from highly regulated local dental treatment. If you have any questions regarding our fees or practices, please give us a call!