Implants and Dentures
This patient, as you will see in the videos, has struggled with horrible dentistry his whole life. I take it as the greatest honor when people who have gone through this much still find it within themselves to trust me when they have every single reason in the world to never trust anyone again.
After video coming soon!
I try so hard to save teeth but the main thing that can prevent me from being able to do that is bone loss. When we start getting into extensive bone loss the problem becomes: what is there to build on? Even with advanced biomimetic technology, the tooth is not stable inside the bone and jaw any longer. I work closely with the oral surgeon in a situation like this and we find the perfect placement for the teeth, bite, etc. Honestly, I hardly do cases like this these days but, since I have been a dentist for a long time, I have done over 12,000 dentures so this is not a problem for me and I do enjoy giving someone an awesome smile using dentures (even though most of the time people just want to be able to chew! Which, of course, is the main factor).
This is one of the most challenging cases I have ever worked on. This patient had some mini-implants done in Mexico and they were failing because they were poorly done. Also the angles of the way in which they were placed was very poor. To top off the problem, there was no way to find the bite for this patient so we had to locate the bite completely in the dark. This process took over a year and was quite difficult but 99% of dentists would not have touched a case like this or would have simply had all the implants removed, jaw rebuilt and new implants placed. But even then, finding the bite would have been difficult. You will see in these photos all the different sets that were made to try and crawl through the darkness to find not only a great look but great functionality without having to completely redo all of the implants.
Treatment Process 01
Treatment Process 02
Treatment Process 03
Treatment Process 04
Treatment Process 05
Treatment Process 06
Treatment Process 07
After - happy and handsome!
Implants: What you Need to Know:
If you have missing teeth and we cannot do a bridge or you have an area of too many missing teeth to secure a bridge properly, we will need to start getting into implants.
Also, if you are experiencing massive bone loss, we will need to start moving into implants as well as other handlings to turn this desperate situation around.
But ideally we will stay away from implants as much as possible. But we DO use them if there is no other options available.
One of the things I like to do is give patients an option between either high-end titanium or Zirconia implants. But the problem is that there is a lot of false information spread about implants on the internet and many uneducated people have an opinion about these materials.
It's VERY important that you get lots of information on these subjects prior to getting involved in treatment, because turning back the clock with implants is very costly and painful.
First off, metals in the mouth operate mainly on the basis of a battery.
**IMPORTANT NOTE: Zirconia, technically, is a "transitional metal" - keep that in mind while reading this section!**
The building of a battery has to have the following elements in order to create flow or exchange:
- Two terminals of different potentials (positive and negative)
- A base that holds the two terminals apart despite efforts to magnetize together
- An acid or some sort of medium that can carry the exchange
If you have a metal crown in one area of your mouth and a mercury filling in another area of your mouth, this is a perfect storm for electrical exchange.
- You have the two terminals of metal of different potentials
- You have a base holding them apart from each other (and even worse that distance is constantly changing when your mouth opens and closes)
- The saliva in your mouth is acidic and will carry the energy from one tooth to the other (teeth on the lower arch are even worse-off because the saliva is much more abundant on the bottom than on the top arch)
So if you have a situation where all the metals in your mouth are exactly the same and they are made of high-grade metal, this will reduce the problems in the mouth DRAMATICALLY (but is obviously still not the ideal situation of no metals at all).
I specialize in metal-free but you need to know that by trying to go entirely metal-free, when moving into implants, may cause you more problems than you realize.
And here is why:
The implants are put into your bone.
Zirconia implants are VERY dense. More so than titanium. Also they have very little flexation.
What that means is that the implant body can act as a lever and when you chew or grind or use your teeth, that energy is going straight into the jaw bone without the dissipation effects and suspension available to the titanium implants.
That can cause much additional stress to the jaw and to the implant body and even to the complex systems of the surrounding teeth.
This is much more important when we get into something like a bridge.
So let's say you have a space and you have good teeth on one side to build a bridge and you want to place an implant on the other side in order to hook the bridge to.
Now you have a situation where the directions of the pressure and impact down on that tooth go in all different directions because of the way the bridge is. That implant will be under more stress in general because of the bridge and the various directions and forces coming down on it.
I'm not saying you can't do Zirconia when building a bridge, I'm just saying you need to understand all angles of the situation so that you don't make a decision based on a few select pieces of information, then wind up with a bigger problem.
My mentality is "teeth for life," not "teeth for a few years and if your mouth falls apart, that's your problem" - which is how many dentists operate. Without biomimetic it's hard for a dentist to really care because he/she doesn't have the technology to really create healthy and long-lasting restorations.
If we're going to get into implants we need to look at 3 areas:
- How can we get the longest-lasting restoration?
- How can we make sure there won't be reactivity problems from the materials or metals used?
- How can we do the minimum-amount of invasive surgeries and services in order to achieve the maximum restoration for you, the patient?
For #1 this is why sometimes, when a tooth is in just horrid condition, I may recommend an extraction and implant over trying to save the tooth.
This is rare, but sometimes it's better than rebuilding the tooth and being worried it will fail in a handful of years and then your money is wasted.
Plus I'm trying to achieve PEACE OF MIND. We can only get that from long-term solutions.
For #2 we can use a Clifford Blood Reactivity Test - www.ccrlab.com
- easy solution.
For #3 we need to make sure that whatever work we do requires the least amount of hacking and cutting, etc. This is why I often try to place one implant and a bridge rather than 2 implants with crowns on them (if possible). Because I can get a very healthy and long-lasting restoration without doing more surgeries than absolutely required.
Many oral surgeons just want to yank teeth and start throwing in implants all over the place. I do not think this is right. Each and every tooth needs to be carefully preserved and rebuilt and nurtured back to health.
All-On-4 and Full Dentures:
Right away I want to tell you that I'm not thrilled about this situation.
IF THERE IS ABSOLUTELY ANY WAY I CAN KEEP YOU AWAY FROM THIS SERVICE I WILL DO IT.
There is only one circumstance where I start looking at this as a real option: SEVERE bone loss.
The reason why is because I can't rebuild on quicksand.
What I mean by that is I'm not going to rebuild your teeth if they are simply going to fall out in a handful of years; this would be a huge waste of time and money.
RARELY do I suggest this but if I see SEVERE bone loss all over your entire mouth or on an entire arch, I will recommend All-On-4 or All-On-6 because that is how we will achieve peace of mind for you in the long-run. Sadly.
Implants I Like and Why:
I only work with very high-end materials.
There are cheap, watered-down titanium options out there that I will not touch under any circumstances.
I like the following companies:
I like Straumann more overall and I'll tell you why:
Straumann has something called a "Switch Platform" - which, essentially, means that the area where the gums heal around the top of the implant body is less protrusive.
What this allows is that the gums can heal around the implant body more thoroughly, creating a more natural looking gum line around the implant.
It's a fairly minor detail, but, as you have already learned from my free course and also my website, my middle name is "minor detail." When you're spending this much money on your mouth, no detail is ever truly "minor."
Here is the very simple answer on what other services I do:
1. If I need below-the-gum surgeries done on you, I will refer you to a specialist with VERY SPECIFIC
instructions in order to get the highest quality restoration that is also healthy.
I know how to put a holistic spin on a lot of these services but the honest truth is a jack of all trades is
a master of none!
I do what's called "quarterbacking," which is where I use my advanced training and experiences to carry your
case to the end making sure that each and every step is top-notch.
2. I keep notes of all places that I send you in the computer and also the notes that I make for each
specialist. It might seem annoying to run around to different doctors, but it REALLY works in your favor because
this is one of the ways we get such amazing results from our patients.
Basically, no matter what you need, myself or my staff will have a referral for you.
Even if you just need an implant or only need gum recession handled, you can call into my office and my staff
can give you a referral straight to the other office.
We have referrals for nutritionists, root canal specialists, implant specialists, orthodontists, chiropractors,
etc. A whole network of people that we work with.
Becoming my patient means you are VERY SERIOUS about your health.
So I am too.
3. I perform basically any above-the-gum restoration in my office.
We do dentures, deep cleanings, etc. We don't really do orthodontics or Invisalign, but again, if we are doing a full-mouth
reconstruction on you or something then we can refer you and I will oversee your case, but if you ONLY want orthodontics
then you can call into my office for a referral over the phone.
We are going to continue to build our network of professionals because we want to be connected with like-minded
practitioners who are honest, do not recommend unnecessary work and are very skilled.