The Cosmetic Dentistry Blog

March 25, 2013

A case of implant dentistry incompetence from the U.K.

Dr. Hall,
I had implants fitted and the crown came loose. I went back to the dentist and he x-rayed my mouth and reassured me that the implants looked fine and that it was just a case of cementing the crown back in place. When he tried to remove the loose crown it would not come away and he had to use a special tool, when it came away the implant came with it ! is it possible that he pulled it out accidentally or would an implant not succumb to force?
- Ann Marie from the U.K.

Ann Marie,
Clearly your crown was not loose – it was the implant that was loose all the time. And I’m sitting here trying to imagine the gross incompetence of the dentist not being able to figure out that the crown was not loose, when he was not able to remove it. Now I realize that standards of health care in the UK are not very high, but even with that, I’m having trouble reconciling this that happened to you with incompetence. It kind of seems like the dentist wanted to go through the motions of recementing the crown to cover up that the implant was loose. A loose dental implant is serious. A loose crown is easy to fix.

A loose dental implant can happen for several reasons. You didn’t tell me the time frame of when this came loose, but if it is right after the crown is placed on it could be an indication that the crown was placed prematurely – before osseointegration was complete. Or it could be that the stress on the crown was too much for the situation, that the implant was not substantial enough to take the stress, or that the quality or amount of bone support of the implant was inadequate.

It’s also possible that the implant became infected. However, that would probably have been associated with pain, so I’m going to put that further down on the list of possibilities.

Fixing this is not a simple matter. It’s more complicated than just replacing the implant. The bone will have to be filled in again – the bone that was removed before the implant was placed. It’s possible that more bone will have to be grafted in because what was there may not have been adequate in the first place, and with what has happened in the loss of the implant, there is likely to be some shrinkage. And then, of course, you need to find someone that will do this right. I wouldn’t go back to the original dentist – no way.

If you were in the United States, I would advise you to demand that this dentist pay whatever it costs you to fix this right. You would have excellent legal leverage. In the UK, however, you have different standards of care and a different system, so I don’t know what to advise you about that.

- Dr. Hall

Links: Read our page about dental implant mistakes. Read more blog posts about dental implant horror stories.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 12, 2012

Should I go to Clear Choice or Costa Rica for my dental implants?

Your website only discusses Clear Choice as a provider of the all on 4 implant procedures. I went in for a 3d x-ray and initial eval at both Clear Choice (CC) and EON. My experience with CC was consistent with the experiences of others reflected on your website. EON seemed much better. In particular, the head of the EON clinic spoke with me. Apparently he used to be associated or partnered with CC. He stated that he left CC because he did not like the practice of abandoning the patients once they had the procedure done. Also according the the “evaluation done at CC and reported to me by the sales rep, I was a fine candidate for the procedure. The dentist from EON referred to the x-ray and mentioned several consideration that needed to be evaluated. Ultimately he stated that they could make the necessary modifications to allow insertion of the implants without bone grafting. If any of this seems odd or false, please let me know. I figured you might benefit from my description of the initial meetings with the 2 local competitors in Chicago area. Thank you. Mike Burke My next step, in addition to scouring the internet for justification and knowledge is to consider going out of the country to have the implants put in. Costa Rica?

Mike from Chicago

Mike,
I don’t understand. You are unhappy with the idea that you would go to Clear Choice and get dental implants and they wouldn’t have any follow-up. And for THAT you are going to Costa Rica? What kind of follow-up do you think they have in Costa Rica? Do you think THEY will call you for a checkup and a cleaning?

Having dental implants placed, even in the United States, is a risky procedure. We are seeing so much malpractice in this area. Dentists are getting into it without adequate training, and the standards of care are not well established because it isn’t a recognized specialty and is fairly unregulated.

But take the worst dentists you have in the United States, and remove ALL quality control standards that even they have, and that’s what you’ll have when you go to Costa Rica. If you are a brave soul, you could try getting crowns or bridgework done in Costa Rica, because you could always have those re-done if something goes wrong. But when something goes wrong with implant dentistry, you could end up a dental cripple, maybe with practically no jawbone. They could accidentally place implants in your nerve canal, in your nasal sinuses, they could perforate the bone. Infection could set in. The implants could be too short or too thin. They could be placed under load prematurely. They could come loose. If they place cheap fixtures, they could lack precise tolerances, which would leave openings for infection and coming loose. The fixtures could corrode. You could get peri-implantitis. There are so many things that could go wrong with dental implants. At least in the United States you might have some legal recourse if things go bad.

I am not a fan of Clear Choice. As you were told, they do not have any follow-up contact with you. We have numerous reports of high-pressure sales tactics. To see some of those reports, check our Clear Choice reviews page. Clear Choice costs are high. And the all-on-four is a risky procedure – if anything goes wrong later with any one of the four implants they place, the entire case will have to be re-done. But you are far better off having this done by Clear Choice than going down to Costa Rica. If you want the best care, my recommendation would be to find a solo practitioner with expertise in dental implants. Look for credentials from either the International Congress of Oral Implantologists or from the American Academy of Implant Dentistry.

There are other dentists who do the all-on-4 procedure in the Chicago area. Dr. Anthony LaVacca in Naperville is one. He is a board-certified prosthodontist and is also implant surgery trained. If you are leery of the all-on-4 procedure, which I am, you may want to get a second opinion from Dr. William Cohen in Glenview, who used to be my dentist when I lived in Iowa.

But please, please, don’t go down to Costa Rica for dental implants, not if your quality of life is important to you.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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