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Three keys for patients to avoid dental implant failure

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Dr. Hall,
In your opinion is a CT scan necessary to have before placing a dental implant?
The tooth in question is a front upper tooth. My preference is not to have this scan because I have had many x-rays in the past both dental and non-dental.
Maybe you might have an opinion on my second question.
One of the dentists I have shortlisted uses implants from a company called Southern Venturi. My concern is that they are not widely used which could be problem in the future if a part was needed or if another dentist had to make some adjustment.
Thanks and regards,
Tim from Ireland
(See Dr. Hall’s answer below.)


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Tim,
You have some good questions, and have touched on two of the subjects that are critical to avoiding dental implant failure. I will answer those, and add a third criterion you didn’t address.

On the first subject, I would do the CT scan. I will tell you that a lot of dentists will place an implant without a CT scan, and it isn’t hard to find them. But there are a lot of implants placed to replace front teeth where the root form pokes through to the nasal sinus. Or the dentist will try to avoid that by using a short implant, which isn’t sturdy enough to hold up long term. So I would do the CT scan. There are some x-rays you could cut out, but I wouldn’t cut out this one. Placing an implant is a 3-dimensional activity and the dentist needs that 3-dimensional CT scan in order to assess if there is enough bone, in both depth and thickness, to accommodate the implant without poking through somewhere it’s not supposed to.

On the second matter, as far as the brand of implant fixture, the problem you want to be concerned about isn’t so much finding a replacement part or making an adjustment later–you should be most concerned about the quality control of the manufacture. I’m not sure about the quality of Southern Venturi implants. I interview many top dentists about their dental implants treatment and I’ve never interviewed a dentist who has used that brand, so I’m leery. These fixtures need to be made to very exacting standards, which is required to avoid dental implant failure. This is a big issue with implant dentists. A dentist can save a lot of money by going to cheaper manufacturers, of which there are many, but they sacrifice that precise fit that is required for long-term success.

Excellent implant dentists are very fussy about the brand of implant fixtures they use. The top two manufacturers are Straumann and Nobel Biocare. Also excellent would be 3i, BioHorizons, Zimmer, and Astrotech. Some dentists add Bicon to this list, but that company is controversial with some top implant dentists who question their long-term success rate. I would not go to an implant dentist who uses a cheaper implant fixture.

You have to be very careful with implants. This is the number one field for dental malpractice lawyers in the United States, and I have no reason to believe that the situation is any better in Europe. Since dental implantology is not an officially recognized specialty, a dentist can get into it here in the states without any specialized training. If you want to be really certain of your dentist, look for some credential (fellowship, diplomate status, or accreditation) from either the International Congress of Oral Implantologists or the American Board of Oral Implantology. (While these organizations don’t have many members in Ireland, both of them have some.) This is a third key to avoiding dental implant failure. Otherwise, you can walk out of the office very happy with your dental implant but then five years later be looking for a dentist who can put you back together because the implant came loose and the surgical site needs to be rebuilt with bone grafting. Or you could have any of a host of other problems with them. I should add that many quality implant dentists do not have one of these credentials, but if they do have one, it is a reassurance that you are in good hands.

I hope this is helpful.
Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Is diabetes a contra-indication for dental implants?

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Is Type 1 diabetes a contra-indication for dental implants? If not, what special procedures should be taken when implanting in a diabetic?
– Mel from Maryland

Mel,
Type 1 diabetes is not a contra-indication for dental implants, but it is a significant risk factor.

With diabetes, it’s not so much special procedures that are needed as much as careful diagnostic work, assessing other possible risk factors, and an extra level of care throughout the placement and restoration of the implants. If I had type 1 diabetes, I would be sure to go to a dentist with well-documented expertise in dental implants. I would go to the website of the International Congress of Oral Implantologists and look for someone in your area with diplomate status, or the same status from the American Board of Oral Implantology, which is the credentialing arm of the American Academy of Implant Dentistry.

With this caveat: If that refers you to a surgeon, I would make sure that no implants are placed unless there is close coordination with the restorative dentist. Some surgeons will place the implants, collect the fee, and then you see the restorative dentist and discover that they aren’t in the location that the restorative dentist needs for the restorative treatment plan and end up with a dental implant horror story.
– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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

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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. A loose crown is so easy to remove that it usually falls off of its own accord – it would never require any kind of special tool. 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

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Should I change dentists in the middle of my dental implant procedure?

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Good Morning Dr. Hall,
I recently visited my local Dentist to have a price quoted to repair a cracked #5 tooth (upper right first premolar), while at the same time, have the #7 tooth in front redone (upper right lateral incisor), which had been ground down and “capped” back in 1978. For the #5 tooth I was quoted a cost to me, the patient, of $4,736.00 which includes the extraction of the #5 tooth, the bone graft, to provide me with a Lava Crown and one custom implant abutment. This cost also covers the Implant Specialist and absorbs additional misc costs passed onto me, the patient as well.

For the #7 tooth I was quoted a cost to me of $4,736.00 also, which includes the same breakdown as above. I agreed to the price and the procedure began with the extraction of both my #5 and #7 teeth, including bone grafts completed on both teeth, immediately following with the installation of a Maryland Bridge to stay in place for a period of 3 months while both surgery sights heal. Once they have both healed properly,the Lava Crowns and Implants will be installed which will complete the procedure.

However, since I’ve had the Maryland Bridge installed 3 weeks ago, I’ve had to have it replaced 3 times and wonder if that’s unusual. If not, I would appreciate knowing if the reason is due to the fact that a neighborhood Dental Office, practicing General Dentistry did the work instead of a Cosmetic Dentist? If so, at this point, would you recommend that I find a Cosmetic Dentist to complete the procedure on both teeth, picking up where the General Dentist’s Office left off? Or would you recommend that I stick with the General Dentist and trust that aside from their not being able to perfect the Marilyn Bridge on the #5 and 7# teeth and keep one in my mouth for more than just a few days at a time without it breaking apart, that they are capable of completing the work and providing me with the professional results that a price tag totaling $9,472.00 should buy? I appreciate and thank you in advance for the time and effort(s) you put into providing me with accurate answers to the questions I’ve asked herein. My email address is: Hollywoodnights@cox.net and I look forward to hearing from you soon Dr. Hall.

– Holly from Arizona

Holly,

Yes, I would agree that the inability of your dentist to keep this Maryland bridge in place is troubling. And it would tend to indicate a lack of training or experience in dealing with esthetic dentistry technology. If I were in your shoes, I would switch dentists.

A Maryland bridge is made of a false tooth or teeth suspended between two metal wings. The wings are etched, and the backs of the adjacent teeth are etched, and then a bonding composite is sandwiched between the wings and the backs of the teeth. If it comes off prematurely, there is a flaw either in the design or the technique or both. The flaw needs to be fixed and then the metal needs to be re-etched by the laboratory for it to re-adhere. I’m guessing that your dentist doesn’t know that, and also may be clueless about the flaw that caused the de-bonding in the first place.

And not only are the esthetics of your case very important, but implant dentistry is not for beginners either. If your dentist had much experience replacing anterior teeth with dental implants, he or she would have settled on a reliable temporary technique. But no, it appears that he or she is in unfamiliar territory – a second troubling aspect to your case.

It is an ethical obligation of all dentists to cooperate any time you want to change dentists. So when you tell your dentist you want to switch, he or she should provide the new dentist with any information needed to properly complete the procedure. And since you are at a good stopping place in the procedure. there shouldn’t be any extra costs for anything having to be re-done. Except possibly for the cost of the temporary tooth. If the Maryland Bridge technique isn’t one that appeals to your new dentist, he or she may want to create a new temporary. Most implant dentists would probably lean toward a dental flipper as a temporary tooth replacement in this situation.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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

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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. And the all-on-4 procedure has some risks – 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. Another option could be 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 A. 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 advanced internet marketing for dentists.

A dentist is ethically obligated to give you all your options

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When I was a child I was hit in the mouth twice, once from falling out of a wooden school swing and the other time from throwing a croquet ball up in the air and catching it with my front tooth. Needless to say the older I’ve gotten the more yellow brown it has become. My dentist told me I would have to get an implant because there was no root but yet I still have the VERY UGLY BROWN TOOTH.

I also have several back teeth that need filings and at least 2 that need to be capped. I don’t have a lot of money to be putting into just one tooth when I have several others that need to be fixed, although the one that gives me an UGLY SMILE is the one everyone can see. PLEASE HELP ME.

Thank You so very much for your time.
Sincerely, THE GIRL WITH THE UGLY BROWN TOOTH
Danielle in Tennessee

Danielle,
I would switch dentists, and I will explain why.

One of these two traumatic incidents with your front tooth jarred it enough to sever the nerve and blood supply that go to the tooth. This would cause the tissue inside it to die, which would then cause it to become infected. It’s possible that if this tooth had received a root canal treatment at that time, it could have prevented the root of the tooth from being eaten away, but it’s also possible that would have happened anyway, as a side effect of the traumatic injury. The process is called root resorption, and it can happen because of an untreated infected tooth, or because of traumatic injury to the tooth.

But now that the tooth has no root left, you can’t save it.

There are three basic ways, however, to replace a missing tooth, and your dentist is negligent in only presenting one of them to you. He or she has an ethical obligation to give you all the options that would work. And while the implant option is probably the best choice for you, it is also the most expensive. Did you tell your dentist that this was too expensive for you? If you did, and you still didn’t get any options given to you, then it shows not only negligence but a lack of character on the part of your dentist.

A dental bridge is the traditional way to replace a single missing tooth. A bridge requires that the two adjacent teeth be covered with crowns (you may know them as caps), and then a false tooth is suspended between them. This is a little less expensive than an implant.

Another option is to use a removable partial denture that clips onto your other teeth and has a false tooth on it. While less comfortable than either a bridge or an implant, it is a fraction of the cost of a bridge. A flipper partial is the simplest way to do this, and it can cost as little as a couple of hundred dollars.

Find a dentist who is willing to give you all your options and who will work with you to keep the costs down. I don’t know everything that went on in your visit with your dentist, but just from the information that I have it doesn’t appear that you should trust this dentist.
– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

I’m 16 and still have my baby canine teeth. Can I get dental implants?

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Dr. Hall,
I’m 16 and I currently still have two baby teeth – my two top canines. Last year I found out that my two bottom canine were baby teeth as well, and had them removed. It was very embarrassing but luckily my right permanent canine was behind my baby tooth and over a year is somewhat in the regular spot but, my other canine tooth on the bottom(left) was removed and my permanent tooth is growing far behind and close to my lateral incisor.

I don’t know what to do, it is very embarrassing to have an empty spot in my teeth. My top baby canine teeth are still here though, I had to go to the dentist to remove them but I don’t want to have gaps in my smile, especially since I will be taking my senior pictures soon. I also don’t want to remove them because I’m scared that like my bottom canine they will grow far behind. What should I do? Are dental implants a possible solution to this?
– Cathryn from California

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Cathryn,
Are you having regular dental checkups? And if you are, why hasn’t your regular dentist addressed this? This is not an uncommon problem, and dentists are taught in dental school about how to address it. Knowing what to do requires good x-rays of your entire jaw.

If you still have your baby canine teeth at age 16, the most likely reason is that your permanent canine teeth are impacted. In order to do the right thing with your baby canine teeth, you need to know about the permanent teeth. Where are they? Are they impacted? Are they in fact behind your other permanent teeth? Or are they in front of them? And if they are impacted, then an orthodontist should be able to help get them erupted into the correct positions.

There can be permanent teeth that never form, but it is very rare for those to be the canine teeth. Lateral incisors are one of the most common teeth to not form, as well as lower premolars and sometimes wisdom teeth. When you still don’t see the permanent canine teeth at age 16, it’s usually because their eruption is blocked. The treatment for that is to help them erupt, usually by making a surgical opening in the tissue to expose the tooth and then possibly to attach a bracket to the tooth and help it erupt using braces. Though sometimes surgically exposing the canine is all that is needed to help it erupt.

If there isn’t room enough for the canine tooth to erupt into its normal position, then that is a question for the orthodontist to address. Since the canine tooth is an anchor tooth and an important part of your smile, it is usually best to remove the first premolar to make space for the canine and then straighten the remaining teeth.

Replacing the canines with dental implants won’t work if your permanent canine teeth are impacted, because the implants will run into those teeth. You can only place dental implants if there are no teeth under the surface where you’re putting them.

Having said all that, there is no rush to take out the baby teeth. Wait until after your senior pictures, for goodness sake. I hope your dentist wouldn’t be that insensitive.

I hope this is helpful.

Dr. Hall

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

My new dental implant bridge doesn’t line up with my bite.

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This is an exchange with Lilly from California. Here is her original question and my reply. Then she replied, and I answered again, and that is below:

Dr. Hall,
I have a new implant bridge, with two implants, replacing four teeth on my bottom right. I notice now that when I bite down on the right side, the bottom teeth and the top teeth line up, but my teeth on the left don’t line up. Is this normal? What can be done?
Lilly from California


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Lilly,
This is not right. All your teeth should come together at the same time. Something isn’t right here. And if this isn’t fixed, it could lead to TMJ disorder.

This gets me to a recurring issue, and that is the quality and standards of implant dentistry in the country. This is one of the top areas for dental malpractice. One of the reasons is that the dental profession has not made it a recognized specialty, so anyone can claim to be an implant dentist with no extra training whatsoever.

My recommendation would be to have another dentist look at this. Look for a dentist with credentials from one of the two major dental implant organizations – the International Congress of Oral Implantologists, and the American Academy of Implant Dentistry. Fellowship or diplomate status in either of these organizations would indicate a dentist who understands and practices quality implant dentistry.

There are two possibilities for what went wrong. It’s possible the implants were restored incorrectly. I think more likely is that the surgery placed the implants in the wrong position.

Sometimes, if the surgery is done by one dentist and the implants are placed by another, there is a communication problem and they are placed in a position that makes it difficult or impossible to restore them correctly. What should be done is that the restorative dentist should make some type of surgical guide that fits in your mouth and that fixes the exact position and angle where the implant should be placed. But a lot of dentists don’t do that.

I wish you the best,
– Dr. Hall

This is a reply that Lilly sent

Dr. Hall,
Thank you for the comprehensive answer. I am suspecting the problem lies with the surgeon. He insisted he was in charge. I never saw the restorative dentist he referred me to until after he was done with the implants.

I have an appointment with both the surgeon (periodontist) and the restorative dentist in two weeks. I am hoping that these implants don’t have to be redone. In that case, is it fair for me to request a refund? I don’t want to return to this periodontist and dentist. You would think the restorative dentist would have known better than to just go ahead and make the bridge and charge me when he knew it was wrong.
-Lilly from California

Lilly,
Very interesting, to get that additional information from you. In my humble opinion, you are within your rights to ask for a refund, assuming that we have this sized up correctly. It is an established principle of implant dentistry that the implants need to be placed according to a restorative treatment plan, and that a surgeon should not place them until the restorative dentist has examined the case and made the determination of where they need to be. Sounds like the surgeon skipped that step.

Get your independent opinion from an implant dentist with a credential from the ICOI or AAID, as I mentioned in my earlier e-mail, and if it is determined that the problem was in the location of the implants and that they need to be replaced, then yes, I would complain. And actually, rather than a refund, ask that the surgeon pay whatever the cost would be to fix the problem, because it will likely cost more to get this fixed right than it cost to do it in the first place, plus you have to re-do the restorative part. I think there is some legal liability here to get this fixed right.
– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Getting four front implant teeth to look right

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Dr. Hall:

I am missing my four front teeth. I have had a porcelain bridge and a removable partial denture, but I’ve just turned 50 and didn’t want to return to a partial. I wanted an esthetic and durable solution and something approaching the feel of natural teeth. I chose implants. Four separate implants for four separate crowns.

I’m about to have the crowns done and have some concerns. One, I don’t want the crowns to appear to ‘sit’ on the gums as the bridge did. I have a very high smile that shows a lot of gum. I thought there would be some sort of surgical step to shape the gums. Secondly, I don’t want anything fused to metal because, as above, I have a high smile and I’d be really disappointed after so much time and expense to have an obvious crown in the front of my smile. Or in my case, 6 obvious crowns. The dentist plans to crown the two next adjoining teeth as well in order to work more with size and color. I said Alberta but I also spend time in the southern US during the winter so location is not a barrier to having good work done. I have read here that all-porcelain is best but also that ceramic is preferred. So I’m confused. Your input would be most appreciated. From reading your responses to others, I realize I need to reschedule my ‘impression’ appointment in order to consult with my dentist on type of crown he intends to use. One thing that is clear to me is that I also need to whiten my natural teeth before having any crowns made or placed. Correct? Thanks in advance for any help you can provide.
Kelli from Alberta

Kelli,
You bring up some good questions about replacing your front teeth.

There are a lot of different issues to deal with when you are using dental implants to replace your four front teeth. I don’t know that I can deal with them all in an e-mail or a blog posting. But I can be helpful.

There are several things that bother me about what you told me your dentist has done or plans to do. The first is that he or she plans to put crowns on the two adjacent front teeth, the teeth adjacent to the space where your teeth were missing. You say it is in order to “work more with size and color.” I don’t know what that means exactly, but it sounds like it’s an appearance issue. And if your dentist is doing crowns on your canine teeth for appearance reasons, that says to me that he or she doesn’t know how to do porcelain veneers well, because, for appearance’s sake, that would be the treatment of choice.

I am also bothered that your dentist didn’t suggest whitening your teeth beforehand, that no building up of the gum was done in preparation for the implants, and that your dentist didn’t mention any options about the choice of crown.

Don’t think you can make up for deficiencies in your dentist by researching answers on our website. It won’t work out. I have a file full of horror stories of people who thought they could do that.

You’re asking me these questions about the type of crown. Yes, all-porcelain or all-ceramic is the best crown for putting on a natural front tooth. But you’re talking about putting a crown over a dental implant, so you already have a metal implant as a foundation for the crown, and the choice between all-ceramic (or all-porcelain – they are virtually the same) or porcelain fused to metal becomes less important and what becomes important is having this work done by someone who knows how to manipulate the color to mimic translucency and how to permanently conceal the border line between the implant and the crown.

But you’re seeming to think that I can give you a choice that will make this go right when you already have made the single determining choice in the outcome of this case, and that is that you have selected the dentist who is doing this. And I fear, from what I said above, that you have selected your basic, mechanically-oriented non-artist dentist. And if that is the case, there is really nothing I can do for you. Just reconcile yourself to the idea that you’re going to get a mediocre result, appearance-wise. It may be structurally sound, but fake-looking.

Here’s the bottom line. If your dentist is artistically inclined, he or she will care about your lip line and the appearance of the gums, and will have sought out the training necessary to get this to look right. If your dentist isn’t artistically inclined, which would be the case with 98% of the dentists, this is not something I can coach your dentist through. He or she probably won’t listen to me, for starters, and even if he or she did, this is a skill that is learned over years.

Additionally, it is asking for disaster to go to your dentist and specify that you want such-and-such a type of crown and a certain technique. The reason your dentist didn’t choose the type of crown or technique that produces a beautiful result is usually because these techniques are harder and require specialized training to use. And your dentist is trained in dental school to never let you think that they are unfamiliar or uncomfortable with any procedure they do, as it makes the patient very nervous. So they will either come up with an excuse as to why they think their way works better, which leaves you as you started, or they will bluff their way through, which is worse.

Think about this. YOU took the trouble to look up this information and found it on the Internet. So you know it isn’t that hard to find. So why doesn’t your dentist know this stuff? I’ll tell you why – it’s because it is low on his or her priority list. That tells you all you need to know.

So here is my advice:
1. Do NOT approach your dentist about the type of crown being done with the idea of asking him or her to do some other type than what they were planning. If he or she hasn’t given you any choices, there is a REASON for that.
2. Reconsider your choice of dentist. WHO does this work is critical. If the appearance of this work is really as high on your priorities list as it seems, you need to have this done by an artist, and you will not change your dentist into an artist by trying to direct his or her choices of materials. If you want help from me with this, share with me the name of your dentist, and I will tell you what I think, and, if necessary, I can refer you to an excellent cosmetic dentist. And let me know where in the US South you go during the winter.

– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

My dentist thinks these implant teeth look great, I hate them!

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Dear Dr. Hall,
In 2010 I had dental implants placed, it is now a year later and because the dentist had lab troubles I got my front and bottom bridge just this week – but they look so phony and out of proportion. She keeps telling me they look great I just need to get used to them but I know they are wrong. I am going to one of the cosmetic dentists you listed here Friday for a consult and hopefully a more successful outcome. I wanted to send you a pic to see your opinion but there is no place to attach. If that is possible I would really like your opinion. Thank you so much for your time.
– B.C.

Dear B.C.
Go ahead and send me the photos. I’ll take a look and say what I think. I see this response from dentists all the time when the patient isn’t happy with how the dental work looks – “You’ll get used to them.” But a good cosmetic dentist will never say that, and won’t contradict a patient by trying to tell them something looks great when the patient doesn’t think so.

From what you’re telling me, it sounds like this dentist has very little appreciation for esthetics and a low level of concern about whether or not her patients like the appearance of her work. A good cosmetic dentist will try in the work and if you have any misgivings about the appearance of it, will fully address those, even sending the work back to the lab if necessary, until you’re happy with how it looks.

Read B.C.’s follow-up e-mail and see a photo of her smile, of what she calls the phony-looking cosmetic dentistry.

 

 

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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