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! 

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!

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!

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!

Crowns and Bridges

Hands down, dental crowns and bridges are the most versatile restorative tools at our office. Whether going on previously decayed teeth, root-canaled teeth or a dental implant, they offer convenience, beauty and excellent flexibility. Please take a moment and read why we love crowns and bridges at Thousand Oaks Family Dentistry!

In it’s simplest form, a dental crown is a hard, solid object that replaces the natural “crown” of the tooth. It can add structural rigidity, biting function or esthetic value to any damaged or decayed teeth. Similarly, bridges are three (or more) crowns made in tandem, were the outermost two units are attached to your natural teeth (or implants). The goal is to “bridge” the gap created by a tooth that was previously removed. Both crowns and bridges are prepared using the same techniques.

Crowns and Bridges are placed for a number of reasons. Crowns can be used to fix teeth that have too much decay to be rebuilt with a dental filling. They can also restore structure after a tooth becomes cracked (depending on the nature of the crack). Bridges are used to replace once-missing teeth in almost any area of the mouth. All that is required is that the gap is “surrounded” by viable teeth for the bridge to be mounted to. Likewise, implant crowns are the final restorative step in implant surgery and give the implant its beauty and functional ability.

The basics of how a tooth is prepared for a crown. (Read top left to lower right)

To prepare a tooth for a crown or bridge, we essentially remove a ~1.5mm gap from around all surfaces of the tooth, in addition to any defects or decay. The walls of the teeth are slightly tapered, so that the crown can be placed easily and has ample tooth structure to hold on to. At the gumline, a distinct ridge (called the “margin”) is created to give an explicit surface for the crown to be cemented against. In the case of bridges, this step is done on two separate teeth, with special care given to making both teeth completely parallel. For implant crowns, these steps and designs are built into the shape of the abutment, which is essentially a manufactured “undertooth” made at an off site dental lab.

1) A natural tooth is broken/decayed and cannot be repaired with a filling 2) The tooth is prepared for a crown, giving it clearance for the new unit and proper structure. 3) The final crown is cemented and delivered. 

Preparing and delivering bridges is done with much the same technique. However, a missing tooth is replaced in the process. 

After your tooth is prepared, we have a number of material options for making your crown or bridge. In nearly every case, we will use tooth colored materials and restorations. We can match almost any esthetic concerns, from color to matching staining patterns and the shape of adjacent teeth. For front teeth, we often use eMAX lithium disilicate crowns for their excellent esthetic properties and strength. In molars and back teeth, we typically place a material called Bruxzir. Bruxzir is an engineered zirconia that surpasses all other crown materials in terms of hardness and durability. We also have a number of more traditional crown materials at our disposal, ranging from gold to zirconia and porcelain fused to metal (PFM). Picking a crown material is a discussion between you and Dr. Kari that considers your whole-mouth condition and your specific wants and needs.

An example of an eMAX bridge/crown. 

At a crown preparation appointment, we start by getting you numb and taking an initial impression for our temporary crown. We then prepare the teeth, taking care to provide ample clearance for the new unit. Once the tooth is fully prepared, we take a final impression and make notes for the lab. Finally, we use our first impression to make an acrylic temporary. While this will not be as strong as your final crown, it will allow you to leave with a fully shaped tooth. This is important for esthetics, chewing function and for maintaining the space between the prepared tooth and the opposing tooth. After two weeks, the lab will deliver your crown, which will be adjusted, seated and cemented in a quick follow up appointment. The process for implant crowns is slightly different, but still requires appointments for initial impressions followed by the actual crown delivery.

If you have any further questions concerning dental crowns, please give our office a call. We place and deliver crowns almost every day and can walk you through your unique needs. There should be no confusion, fear or apprehension surrounding your crown or bridge treatment!

Specialist Spotlight- Periodontist Dr. Jeremy Wilgus

At Thousand Oaks Family Dentistry, we are proud of the incredible patient centric experience we have built at our practice. At the end of every day, our goal is to see every person leave happier, healthier and more satisfied with their oral health.  However, this experience does not stop once you walk out our front door. A major component of our unique patient care is the incredible network of dedicated and skilled specialists we work with.

One of these great specialists is periodontist Dr. Jeremy Wilgus at Camarillo Periodontics. As a periodontist, Dr. Wilgus’ emphasis within dentistry is the treatment of periodontal disease, gingival recession and replacement of missing teeth with dental implants. Gingival grafting, crown lengthening, implant placement and bone grafts all fall under his scope of dental treatment.

At his office, Dr. Wilgus offers a combination of state-of-the-art technology and compassionate treatment. We are always impressed with the clinical results of his work, while our patients have nothing but great things to say about him and his office staff. Among the modern techniques he provides is the use of a Cone Beam CT scanner. This device allows him to capture a true 3D image of your jaw to aid in implant placement, diagnostics and other sensitive situations. This technology proves to be more accurate and revealing than the two dimensional nature of traditional dental X-rays.

Dr. Wilgus grew up in Sacramento, Ca and received his DDS from UCSF in 2003. He went on to finish a periodontal residency at the Los Angeles VA in 2006. In his off time, he enjoys spending time with his wife and two sons. You can typically find him cycling, golfing, skiing or coaching his son’s sports teams.

Whether you need a gingival graft, crown lengthening, or a complex bone graft you will be in good hands with Dr. Wilgus. Our office is extremely selective with our referral network and are proud to extend his services to our patients. If you are curious about periodontics or want to know more about our specialist referral network, feel free to call our office!

Additionally, make sure to check out Dr. Wilgus' office website at http://www.camarilloperio.com/