Types of Implant Dentures

(Left): An Implant overdenture retained by two implants. (Right): A hybrid implant denture resting entirely on four implants. 

While we often consider dental implants as a solution to replace single missing teeth, they can also be used in conjunction with dentures to replace entire arches of teeth. Many of the aspects of denture use that patients find objectionable can be alleviated with the addition of implants. However, it is important to understand the different ways that implants are used to support dentures, and the benefits of the specific appliances. 

Most patients with “implant dentures” are using a system called implant overdentures.  Here, a fairly traditional denture rests “over” two to four implants on the top or bottom jaw. It is designed to be removable and snaps onto the implant anchors. This makes cleaning around the implants easy and convenient. When compared to regular dentures, implant overdentures have much more stability and retention on the soft tissue. This is particularly beneficial for the mandible, which does not benefit from the “suction cup” action that maxillary dentures have on the palate. It is important to note that the support for biting force with this system still relies on the gums and soft tissue. Thus, you will never be able to generate as much force as natural teeth. Additionally, some patients will still object to the removable nature and bulk of these appliances. However, they are an excellent compromise between usability, cosmetics, ease of cleaning and cost for denture wearers.

A newer system of implant dentures is the all-on-four or "hybrid" implant supported dentures. This appliance is permanently screwed or cemented on four to six implants on the top or bottom jaw. They are not designed to be removed, and thus are more difficult to clean versus implant overdentures. However, they function much more like natural teeth, as the entire arch rests solely on implants. They are much less bulky than traditional dentures and provide easier chewing and biting. Most all-on-four appliances are milled out of a single piece of zirconia. Thus, if any part of it chips or breaks, an entirely new arch of teeth needs to be created. The biggest drawback to this system is cost. Treatment for all-on-four dentures is typically two to three times the cost of implant overdentures. For this price, you are getting the best permanent replacement for natural chewing and eating.

Other factors, such as bone health, gum tissues, jaw relations and face shape will all play into your choice between implant overdentures and all-on-four implant dentures. Surprisingly, cosmetics varies from patient to patient, with some seeing more realistic results with implant overdentures. Making an informed decision relies on a thurough exam and consultation to create a comprehensive treatment plan. If you would like to know more about dentures, implants or other methods of replacing teeth, give our office a call!

Specialist Spotlight: Westlake Oral and Plastic Surgery

At Thousand Oaks Family Dentistry, we are proud of the network of skilled dental specialists we have created. Whether you are in our office or one of our associates’ offices, know that you will be treated with respect, kindness and experience. Today, we would like to highlight the surgical services offered by Westlake Oral and Plastic Surgery.

At Westlake Oral and Plastic Surgery, Doctors Donald Nikchevich, Michael Newton and Scott Bennion provide our patients with the best in surgical care. They approach every situation with years of experience and the latest in dental technology. We typically refer to Westlake Oral and Plastic Surgery for patients requiring dental extractions or implants. In both situations, technologies like cone beam CT scans and platelet rich plasma (PRP) applications ensure the best outcomes coupled with speedy and predictable recovery. 

With your referral appointment, be sure to check out the Westlake Oral and Plastic Surgery website to register with their office and add your medical history online. This helps streamline your surgical consultation and ensures accuracy of information. If you have any questions on your upcoming dental referrals or would just like to recap your treatment plan/options, feel free to give our office a call!

Website: www.scoms.com

Address: 911 Hampshire Road, Westlake Village, CA, 91361

 

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!

Case Presentation: Implant Crown

The advent of dental implants has made many procedures more predictable with better cosmetic results. Today's patients is a great example of the power of modern implants. They came to us missing two mandibular incisors and enough open space for one replacement tooth. Unlike the maxillary (upper) teeth, asymmetric midlines are much less noticeable on the lower arch. Using previous dental technologies, replacing this tooth would have required modifying the two adjacent teeth and creating a dental bridge. Preparing mandibular incisors for bridges is problematic, as the teeth are already so small that any reduction in size makes them very fragile. Additionally, bridges are harder to maintain than individual teeth and create food/plaque traps. 

For this patient, a single dental implant and crown created a perfect cosmetic solution to their missing incisor. They were fortunate to have enough bone level in that area to support the titanium anchor. Many times the bone around the mandibular incisors is too thin, requiring grafting or negating the possibility of an implant all together. This is why a proper consultation, exam and treatment plan is crucial in preparing for an implant procedure. If you would like to know more about dental implants, how we use them and who might be a good candidate, please give our office a call!

Case Presentation: Premolar Implant

Every day, our office sees patients with a wide variety of restorative needs, each of which we try to match on an individual basis. Today's patient came to us with decay in their second premolar that structurally compromised the tooth. Radiographs revealed that there was not enough healthy enamel/dentin left to do a traditional filling or crown, so we had to consider other treatment possibilities. After reviewing options with the patient, it was decided that the tooth should be extracted and replaced with an implant by one of our specialists. 

Take a look at how the decayed (darker appearing) tooth was removed and replaced with a titanium implant. 

After the implant was placed and healed, we took impressions to make a custom mounting for the final crown (called an abutment). Since the second premolar is far back in the mouth, we had our lab create a gold abutment matched to a porcelain and metal crown. This combination of materials allowed us to create a crown that was both durable and beautiful without risking damage to the opposing teeth. The patient gets all the structural benefits of a metal crown, but with no metal showing. Careful planning provided us with great results; both our office and the patient were ecstatic with the outcome!

The final product! Notice how natural the implant crown looks in the patient's mouth. 

Overall, dental implant cases typically take about 8 months from start to finish. The vast majority of this time is spent making sure the implant is healed correctly and properly integrated into bone. In the meantime, there are numerous other considerations and adjustments needed: the appearance of the surrounding gum tissue, the color/shade of the crown and even the shape/material of the underlying abutment. If you are interested in an having a dental implant placed or are just curious about what goes into making an implant, please feel free to call our office! We are always happy to walk you through any of our procedures!

Laser Dentistry

A dental laser in action.

One of the biggest developments in modern dentistry is the introduction of laser technology in the treatment of patients. 50 years ago, the idea alone would have sounded like something out of a sci-fi movie. But today, lasers have many applications in the maintenance of the teeth and gums, along with promising outlooks for the future. In our office, we use lasers for a number of treatments and want to show you why they are safe and effective dental instruments!

At it’s very core, a laser is specially concentrated beam of light that produces a small pinpoint of energy. Depending on the type of material used to create the laser beam, the energy can be optimized to cut a number of materials. For this reason, lasers have long been used in precision manufacturing for making extremely accurate cuts. In dentistry, these properties allow us to use lasers in a variety of procedures, often with less time and tissue damage involved.

The most common application of lasers in dentistry is the removal or recontouring of gum tissue. In treatments where the gums need to be adjusted, a dentist would classically utilize a sharp instrument like a scalpel. While these did a great job of cutting tissue, they would induce considerable bleeding and inflammation. Lasers match the cutting abilities of standard instruments, but also stimulate healthier healing patterns from your immune system. Because the laser “seals” the tissue as it cuts, there is less trauma to the gum tissue and shorter healing times.

At our office, we particularly capitalize on the incredible healing properties of lasers in restoring dental implants. After an implant is placed and has healed in bone, it needs to be “revealed” by cutting away any gum tissue that would interfere with attaching the crown. Traditionally, we would need one appointment to trim the gums and a second appointment to allow them time to heal before taking impressions for the lab. However, our laser system allows us to reveal the implant and take impressions in the same appointment, as the gums will heal right away with minimal inflammation.

Beyond soft tissue adjustment, lasers are utilized to provide a number of dental services, ranging from stimulating periodontal attachment to removing tooth decay. Research has also shown that lasers hold even more applications for the future. Currently, experts are working on developing a system called selective ablation, where hard tooth structure is treated by a laser that only removes demineralized areas. Although this technology is still in development, it promises a new form of extremely conservative cavity removal, as only decayed tooth will be affected by the laser.

The field of laser dentistry is still new and evolving. Likewise, information and products are being introduced to the market at a rapid pace. As with all new technologies, our office likes to evaluate the research and clinical results before incorporating them into our patient treatment. If you would like to know more about dental lasers, the types of lasers we use or why we use them, please give us a call. We pride ourselves in being knowledgeable in all the current topics in dentistry and dental services!

What's In an Implant?

If you are considering getting a dental implant placed, you have probably done some research and found out there are many options and variables associated with the treatment. You may have even seen the informational video our office produced on the topic. Because of their rise in popularity, we wanted to take a moment to address some of the common questions associated with implants and how they might play into your dental treatment. Take a look!

1. What is a dental implant?

An implant is a bioengineered screw that serves as an "anchor" for replacing one or more teeth. It typically sits below the gum level and creates a mounting point for a crown, bridge or dentures. Implants come in a variety of shapes and sizes to meet a number of demands and spaces to fill. 

An illustration of an implant vs natural teeth.

2. What is it made of?

Most commercially available implants are made of Titanium or a Titanium alloy. Titanium is an incredible material in that it resists corrosion while promoting bone growth. This factor allows your body to heal around the implant and create a strong bond. Some companies now make implants made from milled ziconia as well. These offerings are marketed as beneficial since they are metal free, but long-term research still needs to be done to confirm if they are as safe and predictable as titanium implants. 

3. Who is eligible to receive a dental implant? 

Implant recipients need to be generally healthy and have one or more teeth that need to be replaced. There are also certain restrictions on bone level height, bone health and extraction healing that need to be evaluated by a dental professional prior to implant placement. 

4. Who places the implant?

At our office, Dr. Kari Ann Hong places many implants in-house. However, depending on mouth location, health complications and patient needs, the expertise of a dental specialist may be utilized. Periodontists and Oral Surgeons are both extremely qualified and knowledgeable in the placement of dental implants. 

5. How is it used to replace a lost tooth?

After the implant is placed and heals, a small metal/zirconia flange (called an abutment) is screwed into the implant. Once the position of the abutment and the esthetics of the surrounding gums are approved, an impression is taken and sent to a dental lab. They will then make a crown that both fits on the implant and looks natural in your mouth. 

How the implant, abutment and crown work together. 

6. Does your office use a specific brand/type of implant?

Our office uses Straumann brand implants. These implants are made to meet very rigorous standards with the highest quality materials available. They manufacture a number of different sized implants that allow for many unique treatment options. Straumann is a very common and respected brand in implant dentistry, assuring that your implant will be serviceable for as long as possible. 

7. How is implant pricing structured?

Implant pricing is usually broken into three fees for the implant, abutment and final crown. Each fee will be for the procedure and the delivered "part." Naturally, this system will vary slightly office to office. 

8. Do I have to wait between having the implant placed and putting a crown on it?

In almost every circumstance, you will need to wait for your bone to heal around the implant before attaching a crown. This is to assure complete osseointegration before introducing stresses from biting and chewing. Some procedures/techniques allow for "immediate loading" of implants, but overall success rates are typically higher if you wait for the bone to heal first. The time you will have to wait varies person to person and needs to be evaluated by a dental professional. 

9. Will I be "awake" for the procedure?

At our office, we offer mild forms of sedations for implant patients with who have dental phobias. However, most people find the procedure both quick and very tolerable. If you do wish to be "asleep" for the procedure, there are a number of dental specialists who can arrange that treatment option. 

10. Will it look like a natural tooth?

Yes! Implants can be some of the most natural looking dental restorations available. Unlike a bridge, you can floss between the implant and the adjacent teeth, and unlike dentures, you will not need to remove it at night or before eating. Overall it is a great cosmetic and functional choice for tooth replacement. 

We hope we answered any questions you may have on dental implants. There are a number of options available in tooth replacement, and implants represent only one of them. If you would like to know more about implants, how they are placed and if they are appropriate for you, please call our office. We are always happy to answer any of your questions!

Dental Implants Thousand Oaks

Lost teeth can be replaced by a number of different dental treatments, including implants, removable dentures, and bridges.  Implants are the most technologically advanced treatment option and act the most like natural teeth.  Dental implants are bio-compatible titanium alloy cylinders that act as a root replacement for a missing tooth.   In their current form, dental implants have been around since the late 1970s when a Swedish orthopedist named Dr. Branemark developed them for dentistry. 

Today dental implants are the preferred course of treatment for replacing a single missing tooth.  They are similar in cost to doing a bridge and far more comfortable than wearing a removable appliance such as a partial denture.  In addition, unlike a bridge, dental implants do not require disturbing the tooth structure of surrounding teeth. 

According to the Academy of Osseointegration website, the long term success rate of implants remaining stabile in the bone is 90%.  A study published in Clinical Oral Implants Research (July 2010) showed a 16 year survival rate of 83%.  In either case, implants have an amazing long term success rate, that makes them a predictable option to replace a missing tooth. 

Implants have become a billion dollar industry.  Two of the leading implant manufacturers, Nobel Biocare and Straumann each reported yearly revenue in 2013 and 2012 respectively of over 780 million US dollars.  In my office I have been placing dental implants since 2007.  I have chosen to place Straumann implants, because they are an industry leading company that has been developing implants in Switzerland since 1974.  They produce a high quality and consistent product, including the implant and all of the parts that connect to the implant that allow us to restore the implant with a prosthetic tooth. 

As a general dentist, I enjoy placing implants in my office because I know where the ideal placement is so that I can restore the implant with an ideally fitting and functioning crown.  The actual surgery of placing the implant isn’t much different than drilling an ideal hole in a tooth to fix a cavity.  Implants are placed by surgically making a small incision in the tissue, followed by drilling a hole similar in size to the implant, and then using a torque wrench to screw the implant in place.  The entire procedure is done with local anesthesia in under an hour.  Patients have told me that having an implant placed is less traumatic than having a tooth removed, and the recovery isn’t much different than having a filling placed. 

After a tooth is lost, it is ideal to wait four months for the bone to heal before placing the implant.  It takes an additional four months once an implant is placed for it to osseointegrate in the bone and for the permanent crown to be placed.  So from the initial tooth loss it takes eight months for the procedure to be completed.

In restoring the implant, there are a couple of steps.  We take an impression of the location of the implant.  Then my lab fabricates a custom abutment, which replicates the missing part of the tooth that sticks above the gum tissue.  These abutments are made of either a high noble metal, titanium or zirconia and they are screwed onto the implant.  Finally a traditional crown is made to attach to the abutment.

Patients frequently ask about the cost and timeline for dental implants.  To restore a single missing tooth with a dental implant, abutment, and crown, the cost is approximately $3500.  Implants are most predictable in their long term success when they are given the proper amount of time for the bone to integrate and heal to the implant.  When advertisements are made for implants that cost less or take less time, it generally involves using less quality implants and connecting parts.  I believe in using industry leading parts, custom abutments, and quality local labs to complete all of my implant cases.

Kari Ann Hong, DDS
1000 Newbury Rd. #190
Thousand Oaks, CA 91320
www.thousandoaksfamilydentistry.com