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.
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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.
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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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:
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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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
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
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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