Lower Incisor Implant Restoration

The top photos show the shade guides used by the lab to match the adjacent teeth. The metal pieces indicate the location of the implants for the impressions. The bottom photo highlights the great job Opus One Lab did in matching the colors of the teeth and gums!

Bet you've never seen implants like this! Today's patient came to us after having lost their lower anterior incisors due to periodontal disease. Periodontal problems are common in this area due to a combination of plaque buildup, poor access due to crowding and (sometimes) tension of the lower lip on the gum tissues. Unfortunately, losing these teeth can have many undesirable effects, such as problems tearing food and lack of esthetic support for the lower lip. 

In treating this patient, two implants were placed by a specialist next to the lower canines. Once the surgical sites were healed, impressions were taken and sent to Opus One Dental Laboratory. At the lab, Four prosthetic teeth were created in a bridge from implant to implant. To correct for the missing bone, pink porcelain was added to the bottoms of the teeth to simulate gum tissue. The result is a very functional and natural looking replacement! If you would like to know more about amazing transformations we can achieve with dental implants, 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!

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!

Dentures

One of the greatest aspects of modern dentistry is our ability to replace missing or extracted teeth. Today, patients typically seek out implant crowns and bridges as quick and safe methods of restoring their smiles. But what about dentures? The name alone might conjure up pictures of older relatives and seltzer tabs, but they are still an excellent way to fix a gap in your dentition. At Thousand Oaks Family Dentistry, we offer a number of denture options for patients needing everything from temporary single tooth replacement to permanent appliances for entire arches. No matter what your needs, there is likely a denture solution to fit it!

Patients who still have some existing teeth are typically eligible for partial dentures. These appliances bridge one or more empty spaces between teeth to recreate a natural smile. They usually require healthy molars or premolars to snap on to and give them rigidity. Some partial dentures are made entirely out of acrylic. These are commonly referred to as “flippers” and typically serve as temporary solutions until an implant can be placed or a permanent denture can be made. Because they are plastic, they need to be made thick for rigidity. Likewise, flippers can feel bulky and uncomfortable and are prone to becoming brittle. Still, they are an excellent interim esthetic solution for patients missing teeth.

a full acrylic partial denture or "flipper"

Partial dentures can also be made using a combination of acrylic and cast metal. These devices are stronger, thinner and typically more comfortable than flippers. When you smile or open your mouth, pink and enamel colored acrylic hide the metal framework beneath and the appliance looks like natural tissues. Rigid metal partial dentures are appropriate for long term use and are often the most comfortable option. If you have enough teeth to anchor the device, they can fit snugly and comfortably in your mouth.

A partial denture with metal framework

If you are missing all teeth on an entire arch, you are likely eligible for full dentures. Full dentures are made out of acrylic and stay in your mouth using the suction created between your gums and the denture base. Since they rest on your gum tissue, full dentures can take some time to get used to. Many patients will feel sore spots or an uneven “rocking” sensation until they become accustomed to the feeling of the appliance. Our office can make small adjustments to dentures to better accommodate your mouth, but they will never feel as natural as something anchored to your teeth. Still, they are a great alternative to smiling, chewing and speaking with no teeth.

a full upper and lower full denture

A final subset of dentures are implant supported dentures. Here, an acrylic appliance is mounted to 2 or more implants (depending on the number of teeth replaced) through rubber snaps. These are typically the most comfortable denture style for replacing whole arches of teeth. However, this treatment option is both costly and time consuming; Implant placement can take up to six months to become healed and sturdy enough to support a denture. Still, many patients are extremely satisfied with the resulting product, as the implants keep the appliance rigid and out of contact with gum tissue.

A diagram of how implant supported dentures are mounted

No matter what type of denture we are making, our office needs three types of impressions: one impression of the teeth (or gums) on which the dentures will be made, one of the opposing teeth and one of how the teeth come together when you bite down. Once we take these impressions, we send them off to a lab along with instructions on tooth color, transparency and brightness. From there, the lab will either fashion your permanent denture, make a wax try-in (a soft, denture lookalike used by our office to ensure fit and esthetics), or send us custom trays. Custom trays are impression trays that precisely fit the dimensions of your mouth. These instruments insure a perfect impression (and a better fit) for the final denture. Once we are ready to deliver your appliance, you will return to our office for a short fitting appointment where we can make minor adjustments.

The true scope of dentures extends into many different devices, materials and mounting styles. We like to have a lengthy discussion with every patient prior to taking impressions, to make sure they will satisfied with the final product. Only a consultation between you and Dr. Hong can show us what kind of denture is appropriate for your specific needs. If you would like to know more about dentures or any other type of appliance offered at our office, please give us a call. We are always happy to walk you through any and every procedure!

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!

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