Tag Archives: Dental Implants

Dental bridge before implant?

I’m a little concerned about what my dentist is recommending for a missing tooth on my 15-year-old daughter. We’re planning on getting her a dental implant when her jaw is developed enough for one. I was looking at some temporary replacements. I thought a flipper would be a good option, but my dentist wants to give her a dental bridge. I think that’s a bad idea, but he said flippers are too temporary. What do you think?

Mandy

Dear Mandy,

woman smiling with a dentist
It’s always okay to get a second opinion from another dentist

I’m glad you wrote about this. While a dental bridge is a more secure fit, I don’t think it is a good fit for a teen aged girl. There are two reasons for this.

First, just like her jaw is still developing for her dental implant, she will need new bridges. That is too expensive to keep replacing as she grows.

Even though the flippers are meant to be temporary, you can replace those in a much more affordable way than the bridge.

There is another reason too which has nothing to do with cost. A dental bridge requires her adjacent teeth to be crowned in order to support and suspend the false tooth. That will mean those teeth will always have to be crowned for the remainder of her life.

If those teeth are healthy, you won’t want to grind down the healthy structure.

It’s Okay to Get a Second Opinion from Another Dentist

A good dentist will give you all of your options. Even then, they will make a recommendation. if you don’t like their recommendation and they’re pressuring you to go with their option, I recommend getting a second opinion.

If your dentist refuses to do the treatment you want you can go to another dentist for that procedure. That means you could get your daughter a dental flipper elsewhere. You don’t have to switch dentists to do that, unless you want to.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Cosmetic Dentistry Tourism Disaster

I had porcelain veneers placed on my top teeth and a dental implant and crown on my bottom arch. In the U.S. it would have cost me over $60,0000 but I was able to get it done overseas for around $11,000. At first, I was pleased as punch, but now I’m four months out and the veneers are falling off. I’ve been cutting up the food the way he showed me and not eating with my front teeth at all. In fact, the last one fell off while eating spaghetti. That’s hardly anything to stress about. Three of the veneers have fallen off. They’re all intact. Do I need to have these re-done or can another dentist put them back on?

Catrina

A single porcelain veneer being held up by a dental tool

So, here’s the thing. Those instructions your dentist gave you about eating are a huge red flag to me. There is absolutely no reason why you should have any restrictions at all on what or how you eat. When properly bonded on, porcelain veneers will allow you to eat anything.

This dentist doesn’t know proper bonding technique. That alone, makes me question the skill of the rest of his work. For health and safety reasons, I’d like you to get a second opinion on the dental implant and crown you had done. This is especially important about the implant. If an infection develops it can lead to serious consequences.

Regarding your fallen porcelain veneers. You mentioned they’re still intact. In that case, it is possible an expert cosmetic dentist could clean them up and get them bonded back on properly. However, this is beyond the skill of almost all cosmetic dentists. You will need someone in the top 2%.

Finding an Expert Cosmetic Dentist

Cosmetic dentistry isn’t really taught in dental school so you’ll need to look for someone who invested the time and training into doing it well. In your place, I’d look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are in the top 1% of dentists. You can find them listed on aacd.com. Just make sure they’re accredited. They will know the right procedure to help you with your porcelain veneers.

The cost to get them bonded back on properly shouldn’t be too bad, if they can be saved. If they can’t be, these dentists will give you a list of options and let you determine which way you want to go.

This blog is brought to you by Louisiana Cosmetic Dentist Dr. Mike Malone.

Are CEREC Crowns Better for Anxious Patients?

I have never been crazy about going to the dentist. I had a toothache and decided to go in because it means something is wrong. It turns out I have a large cavity. Now I have to have a dental crown. I’m really nervous about this. What can I expect?

Belinda

Dear Belinda,

A tooth receiving a CEREC crown

It’s good that you went in. The fact that you did despite your dental anxiety means you are courageous. If you’d allowed your fear to get the better of you, you would have ended up with a dental infection. That would have meant an additional procedure of a root canal treatment. Or, possibly your tooth would not be able to be saved and you’d need to have it extracted and replaced. To get a great replacement, like a dental implant, requires surgery. Obviously, you made the right decision.

What to expect depends on the type of dental crown you’re getting. Did your dentist mention whether you’re getting a traditional crown or a CEREC crown?

What to Expect with a Traditional Crown

If you’re getting a traditional crown, it takes two visits. First, your dentist will have to remove any decay as well as grind down enough tooth structure to make room for the dental crown. You can see how small your natural tooth has to be in the image above. After that, your dentist will make an impression of your teeth and fit you with a temporary crown. The impression will be sent to the lab to make your permanent crown.

It takes a couple of weeks for the permanent crown to be made and sent to your dental office. Then your dentist will call you, fit you with the permanent crown and bond it on.

What to Expect with a CEREC Crown

Given your anxiety, this will be a better option for you. First, they can be done in just one appointment. That minimizes how often you have to come in. Second, many patients hate having to do impressions. The goo is messy and bad tasting. With CEREC crowns, you just have a digital image made and a computer designs the crown. Not only is this less nerve-racking, but it’s also faster and more accurate.

While you’re at the office, the computer will mill the crown immediately and your dentist can then bond it on before you leave.

This is a must simpler procedure. Plus, if you’re still nervous, it’s very compatible with a sedation such as nitrous oxide which can relax you.

A Front Tooth Requires an Expert Cosmetic Dentist

You didn’t mention which tooth is being crowned. If it’s a front tooth, there’s an additional consideration. It’s very challenging to match a single crown to a front tooth. You will need to find a dentist with both technical expertise and artistry.

In your place, I’d look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. Simply go to aacd.com and look for an AACD accredited dentist in your area. They can give you a beautiful crown that blends in perfectly with your other front tooth.

This blog is brought to you by Louisiana Cosmetic Dentist Dr. Mike Malone.

Is Orthly Equal to Invisalign?

I told a friend the other day that I wish I could afford Invisalign. I’ve spent a lifetime embarrassed about my teeth. She sent me this link to a company called Orthly. It looks like Invisalign, but it’s 70% cheaper. I just want to make sure it’s safe to do it and it’s similar to Invisalign.

Ellen

Dear Ellen,

Image top: A woman putting on her Invisalign aligners. Image bottom: a woman smiling with Invisalign on her teeth

It sounds like you have a friend who cares about you. It’s lovely to have friends like that. If you won’t hate me, I’m going to help you understand the differences taking you back to High School. Do you remember geometry class where you had similar triangles versus congruent triangles? As you recall, congruent triangles were completely equal to one another in both sides and angles. But, similar triangles were only that, similar but not equal. They had the same angles but not the same lengths.

That’s how I would describe Orthly to Invisalign. Similar but not equal. It will save you money. Unfortunately, it could also cost you some teeth.

The first thing you should know is it wasn’t founded by dentists or anyone with dental knowledge. The idea came to two students who wanted to get Invisalign but couldn’t afford it. Their company is very straightforward about that. They say, “Orthly does not practice dentistry nor do any employees in the company.” That alone wouldn’t make it dangerous. I’m sure they consulted with dentists and orthodontists as they followed through on their idea.

Where Does Orthly Fall Short of Invisalign?

The way Orthly saves money is by avoiding orthodontic appointments. You see a dentist a total of two times. They can request photos through the app, but that’s the extent of the “looking after” you get. You may think that’s no big deal, but here’s what worries me about that.

The reason dentists keep an eye on you throughout the treatment is to measure things like mobility, root absorption, periodontal disease, and oral hygiene. None of these can be tracked through a photo. If they don’t catch any one of these problems in time, it could lead to the patient losing their teeth.

Then you’re talking about a much greater expense then they’d have had if they’d done the best treatment to begin with. They’ll need to replace their teeth.

So, in your place, I’d weigh the benefits with the risks before you decide.

You could always talk to your dentist about your desire and ask if there’s a way he’d let you pay out “the real deal” in installments you can afford.

This blog is brought to you by Dr. Mike Malone.

Did the Oral Surgeon Lie to Me?

When I turned 18 my wisdom teeth began to bother me. We checked them and my dentist said, they don’t have to be removed, but if I wanted to remove them she’d give me a referral to an oral surgeon. We decided to just see what he had to say. He told me I really needed to removed them, otherwise, I’d need braces from crowding. If I had them removed, I’d not have to face that. I’m almost 40 now and suddenly my teeth are crowding. Did he lie to me or is something else going on? What can fix them at this point? I’m a little old for a mouth full of metal. Heck, I didn’t want that when I was young.

Tabitha L.

Dear Tabitha,

A woman placing in her Invisalign aligners

I don’t think the oral surgeon intentionally lied to you, though, admittedly I don’t know who he is or anything about his practice habits. He was, as we’re giving him the benefit of the doubt, overly generous of the benefits of removing your wisdom teeth. While it did prevent your wisdom teeth from causing crowding, it can’t stop other causes of crowding.

Reasons Teeth Can Crowd

There are numerous reasons for crowding aside from wisdom teeth which don’t fit. Here are just a few which could pertain to your situation:

  • Grinding

Most people who grind their teeth don’t even realize they’re doing it. Generally, it’s the dentist who first recognizes the signs of teeth wearing down due to the grinding. Believe it or not, that back and forth pressure can shift your teeth. A simple mouthguard can protect your teeth in these situations.

  • Sucking

I’m assuming you’re well past the pacifier and thumb sucking stage, but even some adults have an oral fixation. You see it when they always seem to need something in their mouth, pens and other things.

  • Losing a Tooth

If you lose a tooth and don’t get it replaced, your teeth will shift to close in the gap. This shifting can cause problems for the remaining teeth. At the very least, things will start to look off. This is one of the reasons it’s quite important to replace a missing tooth with something like dental implants.

  • Shoddy Dental Work

There are unskilled dentists out there. Poorly shaped crowns, bridges, and other work may change the bite or begin to push teeth out of alignment. Often the patient ends up with a serious case of TMJ Disorder.

  • Tooth Trauma

When there is an injury to your teeth it can affect them in a variety of ways, including shifting.

  • Tumors

Don’t panic about this if you get regular checkups with x-rays. Your dentist would have noticed this. But, if you have sudden huge changes in your bite, it’s worth getting another x-ray. It’s rare, but tumors can significantly change your jaw, teeth, and bite.

Repairing a Bite without Braces

There is a simple solution in your case. If it’s just a matter of your teeth shifting and crowding Invisalign is a perfect solution. This uses clear aligners to straighten your teeth. No one will know you’re wearing them, even at a conversational distance.

Talk to your dentist. Let he or she know what’s going on. They’ll help you get the smile you’ve always loved back.

This blog is brought to you by Dr. Mike Malone.

Help! My Front Tooth is Loose

I am terrified. I discovered my front tooth is loose. I don’t remember hitting it and I don’t think the other teeth are loose. Can a dentist fix this? What if it can’t be fixed? Do they make dentures for one tooth? Help me!

Samantha

Dear Samantha,

A woman with a gorgeous smile created by cosmetic dentist Dr. Mike Malone
A gorgeous smile created by cosmetic dentist Dr. Mike Malone

First, I want you to take a deep breath. You will not end up with a space where a front tooth should be for the rest of your life. The first thing you need to do is schedule an emergency appointment with your dentist. If the tooth is loose, regardless of the cause, it needs to be splinted to keep it secure.

Next, your dentist will need to determine why it’s loose. Do you have gum disease? Was there trauma? He’ll want to do some x-rays to see if the pulp was damaged. If so, you’ll need a root canal treatment.

Dental Solutions for a Missing Tooth

If you do end up losing this tooth, which would surprise me if this is the first sign of a problem and you don’t remember any trauma, there are solutions. We’ll go over each of them, from the least desirable (and least expensive) to the highest quality replacement, which is also more pricey.

Removable Partial DentureYes, there are “dentures” for a single tooth. It’s called a removable partial denture. It connects onto your other, healthy teeth, with a false tooth attached. It does put pressure on the teeth it hooks to so it’s not the ideal solution, but depending on your budget, you might use it as a temporary solution while you save up for one of the more preferable treatments.

Illustration of a dental bridgeThe next best solution is a dental bridge. This suspends a false tooth between two dental crowns. In reality, this makes more sense if your adjacent teeth (which will receive the crowns) need work anyway. In that case, it’s like knocking out two problems with one. However, if they don’t need work, I wouldn’t want to remove any healthy tooth structure.

Dental Implant DiagramThe top of the line replacement is to get a dental implant. It’s like having a healthy, natural tooth back. If your budget allows, this would be the treatment I’d choose. A prosthetic root is implanted where the natural root was, then a porcelain crown is placed on top. You can eat, brush, and floss just like you normally would. They’re very strong and last for many years.

Getting a Beautiful, Natural-Looking Tooth

You’re talking about replacing a front tooth, so you want to be certain the dentist is also a skilled cosmetic dentist. Whatever crown he creates for your front tooth needs to look just like the adjacent tooth. Above all else, make sure they give you an all-porcelain crown and not a porcelain-fused-to-metal crown.

This blog is brought to you by Dr. Mike Malone.

Can CEREC Crowns Handle Night Grinding?

My dentist recently purchased a CEREC machine he’s very excited about. I have a cavity that he feels is too large for a filling. He wants to me have a crown done using the machine. I just wanted to get a second opinion as to how they hold up as well as normal crowns. My dentist said I grind my teeth at night. I’m assuming he would only give me a crown that would hold up against that, but just wanted to double check.

Lizza

Dear Lizza,

Machine for CEREC Crowns

This is one of those yes and no answers. CEREC crowns are every bit as strong as traditional crowns. The biggest difference is they’re able to milled at the time of your appointment, eliminating the need for either a temporary crown or a second appointment.

However, I’m truly concerned about your grinding. When your dentist mentioned to you your teeth showed evidence of nighttime grinding, did he suggest anything to you, such as a nightguard? Your teeth need protecting. The stress of grinding will not only wear down the enamel of your teeth down, but can also lead to your teeth cracking and breaking.

When your enamel wears down it leaves you vulnerable to decay. With decay, you’ll be looking at a mouth full of fillings. Even worse, would be the possibility of losing a tooth. Then you’re looking at getting a tooth replacement, such as dental implants or a dental bridge.

While your choice of crown is fine, just like your natural teeth, it won’t stand up under grinding without you having some type of nightguard to protect both your natural teeth and your crowns.

This blog is brought to you by Dr. Mike Malone.

Can a General Dentist do Dental Implants?

I need to replace a tooth. Everyone says dental implants are the best replacement. Are there implant specialists or can a general dentist do them?

Max L. – Connecticut

Max,

First, I’ll say, yes, dental implants really are the top of the line tooth replacement. Be aware that not everyone is a candidate for dental implants. There are some conditions which are contra-indicative, like gum disease. Or, if you’re a smoker, you’ll be hard-pressed to find a good dentist willing to go forward with the procedure. If it turns out you’re not a candidate, there are other good options which we’ll discuss momentarily.

As to whether or not you need a dental implant specialist, that’s a yes and no. There isn’t actually a recognized specialty in implants, so any dentist who does them is a general dentist. However, it takes some additional training than what they get in dental school to be skilled in this procedure.

Dental Implants are an advanced procedure, with potentially severe complications if things go wrong. Because of that you’ll want to be bold in asking the dentist some blunt questions. Some things to ask are “What type of implant training have you had?” “How many implant procedures have you performed?” “What percentage of them are successful?”

So, what if you’re not a good candidate? Whatever dentist you go to should give you all your options. For instance, the next best procedure would likely be a dental bridge. In fact, if your adjacent teeth need a crown, a dental bridge might make more sense for you.

The important thing is you find a dentist you trust and then have them explain all the procedures you’re a candidate for.

This blog is brought to you by Dr. Mike Malone.

I Want an Implant and My Dentist Wants Me to Get a Bridge

I have two teeth that need work. They’re right next to each other. One needs a crown. The other needs to be extracted. I want to do a dental implant and a crown. My dentist wants to do a bridge. I’d think he’d be more excited about a dental implant because they’re more expensive, but he seems pretty insistent about a bridge.  Is there a real medical reason for this?  I’m not too excited about the idea of a bridge.

Brenda C. – Michigan

Brenda,

My guess is your dentist isn’t comfortable with dental implants.  It’s an extremely advanced procedure. I wouldn’t push your dentist if that’s the case. When it’s not done perfectly, there can be serious complications.  It’s a credit to your dentist that he’s not just taking your money and doing the procedure halfway.

A bridge is fine in your case. You already need work on one of the adjacent teeth, so it’s like getting two procedures knocked out in one—no pun intended. However, your other tooth is healthy so you might not want to grind down healthy tooth structure. I understand your desire to go with an implant and crown.

My suggestion would be to get the implant and crown, but with another dentist. I’m not saying leave your current dentist, just have this particular procedure done with someone else. Then, you can continue with your current dentist for general treatments and cleanings afterward.

This blog is brought to you by Dr. Mike Malone.

What are some decent tooth replacement options?

I have to get a tooth extracted. I wanted to get a second opinion on some good tooth replacement options. Money is no object. I want the best. What are your thoughts?

Martin C. – Albany, NY

Martin,

My initial thought is if you want the top tooth replacement option, than just about any dentist would tell you to get dental implants.  They’re the most like having your own natural tooth.  If you’re in good general health, than you are likely a candidate.

There are times when a dental bridge makes more sense. That’s generally if the adjacent teeth to the missing tooth happen to need dental crowns. If that’s the case, a dental bridge will take care of two procedures at once.

You didn’t say what your dentist suggested. If he’s not adequately trained in dental implants, then he wouldn’t be likely to suggest them.  But, it is the ideal treatment if you’re a candidate.

There are other options, as well, aside from implants and bridges, such as a removable partial denture, but you asked for the top treatments.

This blog is brought to you by Dr. Mike Malone.