General Dental Implants
What are dental implants?
The implants themselves are tiny titanium posts, which are surgically inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. The bone bonds with the titanium, creating a strong foundation for artificial teeth. We then attach small posts to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.
Who actually performs the implant placement?
Implants are a team effort between one of our oral and maxillofacial surgeons and a restorative dentist. While we perform the actual implant surgery, the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.
What types of prostheses are available?
A single prosthesis (crown) replaces one missing tooth and each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants you need depends on the type of complete prosthesis (removable or fixed) you receive. A removable prosthesis (overdenture) attaches to a bar or ball in socket attachments, whereas a fixed prosthesis is permanent and removable only by a dentist.
Why would you select dental implants over more traditional types of restorations?
There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a “partial” at night may be inconvenient, and dentures that slip can be uncomfortable and rather embarrassing.
Am I a candidate for implants?
The vast majority of people qualify for implants despite being told otherwise. If you are considering implants, we must thoroughly examine your mouth and review your medical and dental history. If your mouth is not ideal for implants, we may recommend ways of improving your outcome, such as bone grafting.
What type of anesthesia will be used?
We perform the majority of dental implants and bone grafts in the office under local anesthesia, with or without general anesthesia.
Do implants need special care?
Your implants will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.
All-On-4® Dental Implants
How do All-On-4 implants work?
By tilting two of your dental implants at a significant angle, we create a tripod effect across a total of four implants, providing the best possible stability. In fact, recent studies demonstrate that the bone surrounding the tilted implants is as strong or stronger than the bone surrounding conventionally placed implants. On these four implants, we place a permanent complete prosthesis to replace all the teeth on either your upper or lower jaw.
How do I know if I am a candidate?
Most patients are candidates! Our surgeons must perform a thorough dental and medical evaluation to determine if this procedure is right for you.
Can implants be placed at the time of tooth extraction?
Absolutely. In fact, this is how we perform most All-On-4 procedures. We understand that patients want to transition from their old teeth to their new teeth in as little time as possible. After we remove your old teeth and place your dental implants, your dentist can attach your new teeth that day or within 48 hours. This first set of teeth is temporary. After the dental implants heal, your dentist will secure a final prosthesis that looks and feels natural, and is made of the highest quality materials.
What if I don’t like the temporary prosthesis?
Think of your temporary prosthesis as a trial run. While your dentist will do everything to make you happy and comfortable in your temporary prosthesis, there are qualities that you may feel need improvement. Therefore, while your implants are healing, we want you to be picky and notify your dentist of anything you don’t like, including the shapes of the teeth, the color, etc. Your dentist will then fabricate your final teeth to suit your preferences. This is the advantage of a temporary prosthesis!
How will my final teeth be made?
After your implants have healed, your dentist will take molds of them. He or she will then send these molds to the Nobel Biocare® dental laboratory. They will design your All-On-4 prosthesis using a computer program, and then craft your new smile with their patented computer-aided milling system.
Can I be asleep for my All-On-4 procedure?
Yes! We encourage it. Within our office, we’ll perform your procedure in one of our six state-of-the-art operating rooms. Together with your family dentist, we will perform the entire procedure while you sleep. We can’t think of a better way to receive dental care than while you sleep. However, if you prefer to be awake, that’s fine too. We will use local anesthesia (novacaine) to perform your procedure. During your initial consultation, our surgeons will review your medical history and determine if you are a candidate for outpatient, office-based, general anesthesia.
Is the All-On-4 procedure painful?
Rarely. Most patients have a hard time believing that removing all of their teeth, placing implants, then placing teeth onto the implants isn’t painful… but it usually isn’t. Your temporary teeth act as a bandage, reducing your pain and swelling.
How long should I allow for recovery?
We recommend allowing 4 to 5 days for recovery. Although most people will have minimal swelling, everybody responds differently.
What can I eat after my All-On-4 procedure?
For the duration of your implant healing phase — typically 4 months — your diet will consist of soft food, such as oatmeal, scrambled eggs, and tuna salad. There’s an adjustment period, but all of our patients quickly adapt. Once your implants have integrated (fused with your jawbone), your diet may return to normal.
How will my home care differ with my All-On-4 prosthesis?
As you will see during your consultation, the prosthesis fits intimately onto your gum tissue. Food rarely sneaks under your prosthesis. However, if it does, we recommend a floss known as “super floss” to clean under the prosthesis. It’s hygenic and easy to use. Also, your dentist and dental hygienist will provide a quick and easy home-care regimen to keep your prosthesis sanitary.
Dental Implant Surgery
Is it normal to be swollen after my dental implant procedure?
Yes, swelling peaks 48 to 72 hours after surgery, and ice has a minimal effect after 36 hours (besides easing pain). Maintaining an upright position and sleeping with three to four pillows may help to decrease the amount and duration of swelling.
I can see a silver cap in my gums where the implant was placed. Is that normal?
Not to worry. Some silver caps are placed above the gums intentionally and some become uncovered during implant healing. If you see a silver cap, make sure you keep the area clean by rinsing with mouthwash for 1 minute, twice a day. These silver caps can collect plaque, so please use a cotton swab to clean them. Avoid damaging the implant site during cleaning.
I have a “bubble” or abnormal swelling and pain in the site of my implant(s), is that normal?
No! Successful implants heal without complications. After the initial surgical swelling and discomfort have subsided, call the doctors if you notice a “bubble”, drainage, or anything out of the ordinary. Do not wait.
When can I eat on the side of my mouth where the implant was placed?
For the first 6 weeks, please eat a soft diet on the opposite side of implant placement. If we placed implants on both sides, then you must restrict your diet to pureed soft foods (such as eggs, tuna salad, egg salad, cottage cheese, soft pasta, flaky fish, etc.).
The silver cap that my surgeon placed is loose, what should I do?
Call for an appointment immediately. If left loose, gum tissue may grow between the implant and silver cap, necessitating an additional minor procedure under local anesthesia.
Bone Grafting Surgery
When can I eat on the side of my mouth that the bone graft was placed?
For 6 weeks, limit your diet to soft foods and avoid chewing on the side of the bone graft.
I wear a denture or partial denture. Can I use them after the bone graft?
Each bone graft is different. Please ask your surgeon before placing a denture onto a site that contains a bone graft.
I had a tooth removed and bone placed in the tooth socket, and now I see a hole with white material. What is that?
When we place bone in a tooth socket after extraction (socket preservation), we also place a white sheet of material over it to provide protection. This initially protects the bone and then dissolves and is replaced by your native gum tissue. This event occurs 3 to 5 days after the extraction, leaving a crater-like appearance in the tooth socket. This is normal. Be sure to eat on the opposite side, and do not hesitate to call if you have any questions.
What does the term distraction osteogenesis mean?
Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments to allow new bone to grow in the gap.
Is the surgery for distraction osteogenesis more involved than traditional surgery for a similar procedure?
No. Distraction osteogenesis surgery is usually done on an outpatient basis with most people going home the same day of surgery. The surgical procedure itself is less invasive than similar, more traditional surgeries, so there is usually less pain and swelling.
Will my insurance company cover the cost of an osteogenesis surgical procedure?
Most insurance companies will cover the cost of the osteogenesis surgical procedure provided that there is adequate and accurate documentation of your condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.
Is distraction osteogenesis painful?
Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort.
What are the benefits of distraction osteogenesis versus traditional surgery for a similar condition?
Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for bone grafts, and therefore, another surgical site. Lastly, distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments is involved.
What are the disadvantages of distraction osteogenesis?
Distraction osteogenesis requires you to return to the surgeon’s office frequently during the initial two weeks after surgery. This is necessary because in this timeframe your surgeon will need to closely monitor you for any infection, and teach you how to activate the appliance. In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.
Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?
Yes. Recent advances in technology have provided us with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.
Does distraction osteogenesis leave scars on the face?
No. The entire surgery is performed within the mouth and the distraction devices we use remain inside the mouth. There are no facial surgical incisions, meaning no unsightly facial scars.
Are there any age limitations for people who can receive osteogenesis?
No. Distraction osteogenesis works well on people of all ages. In general, the younger the person, the shorter the distraction time and the faster the consolidation phase. Adults require a slightly longer period of distraction and consolidation because their bone regenerative capabilities are slightly slower than those of adolescents or children.
What are wisdom teeth?
Wisdom teeth are the third and last set of molars, which typically erupt between the ages of 15 and 20.
Why do we have wisdom teeth?
The current consensus is that our ancestors required an extra set of molars for chewing large amounts of plant matter. However, most people don’t have room for them and must have them removed.
Why should I remove my wisdom teeth?
Wisdom teeth require extraction when they cannot erupt properly within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted wisdom teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.
Tooth Extraction Surgery
Is it normal to be more swollen a few days after my tooth extractions?
Yes. After surgery, swelling peaks in 48 to 72 hours, after which it starts to go down. Ice has minimal effects after 36 hours, except to ease the pain. Maintaining an upright position and sleeping with three to four pillows during the night may help to decrease the amount and duration of swelling.
How long should I expect the bleeding to continue?
Bleeding will generally subside in 24 hours, although oozing may continue off and on for a few days. If bleeding continues, bite on a cold, moistened piece of gauze in 45-minute increments (without removing) for 1 to 2 hours. If it still continues, biting on a moistened teabag may help. Do not hesitate to call your surgeon if you feel your bleeding is abnormal.
Pain medication is not relieving my pain, what can I do?
If you’re able to take ibuprofen (Motrin® or Advil®), you may begin alternating your narcotic medication (Tylenol® with codeine, Vicodin®, Percocet®, Darvocet®) and ibuprofen every 4 hours. These medications help to decrease inflammation and thereby pain. If you are unsure if you can take ibuprofen, please call the doctors before initiating this alternative pain regimen.
The teeth near the extraction socket are sensitive. Is that normal?
After a tooth is removed, the surrounding bone, soft tissue and nerve become inflamed. Therefore, other teeth in the area or distant from the area may become sensitive due to the phenomenon known as “referred pain”. This will resolve by itself. If you are concerned, or if symptoms continue, please call your surgeon.
It has been 3 to 4 days after my extraction and the pain is getting worse, what should I do?
Make an appointment to see your surgeon. A very painful condition known as “dry socket” may develop 3 to 4 days after tooth removal. Common symptoms include a steady increase in pain, throbbing at the extraction site, ear pain on the side the tooth was removed, and a bad taste or odor in your mouth. Treatment involves placing medication into the socket that will ease your pain until the body heals itself. Other causes of pain may be infection, a problem with a neighboring tooth, sharp edges of the tooth socket, and bone exposure through your gums.
Is it normal to have a fever after my extraction?
After any surgery, patients may experience a low-grade fever. Do not take your temperature in your mouth after oral surgery, as it will naturally be higher. Preferably, take your temperature in your underarm. If fever continues or is elevated (>101.0°F), please call the doctors.
The stitches have fallen out and it has only been a few days after my extraction, should I be concerned?
Not to worry. Stitches often fall out at various time intervals for various reasons, which is why we often place multiple stitches. Other oral surgical procedures, besides dental extractions, require stitches to have a successful surgical result. If your stitches fall out early after a non-extraction procedure, please call our office.
I am pregnant, is it safe to have oral surgery?
If you are pregnant, we’ll only perform emergency oral surgery (not elective surgery) and use local anesthesia. You will be required to bring clearance from your OB-GYN doctor or have it faxed to our office (215-322-7832).
I take Coumadin (Warfarin), do I need to stop?
If you take Coumadin, you may not need to stop. You must call our office to determine the proper treatment. Bloodwork (INR) is often required. If you have had bloodwork performed in the previous month, please obtain the result from the prescribing doctor before calling our office.
I take Plavix (Clopidogrel) and/or Aspirin do I need to stop?
Not necessarily. Often it is based on the procedure you will be having, so please call our office to determine if stopping these medications is necessary. If you must stop, please do so 7 days prior to your procedure, as this is the time required for the medication’s effects to be inactive.
I have a joint replacement, should I take antibiotics prior to my surgery?
This decision is to be left to your orthopedic surgeon. Please contact your orthopedic surgeon to determine if antibiotics are necessary.
I breastfeed, is it safe for my baby if I undergo general anesthesia?
The anesthetic agents used for general anesthesia are quickly metabolized and excreted from your body. Therefore, we recommend that you pump and store enough breast milk to be used for 24 hours after your anesthetic.
How long prior to my general anesthesia must I not eat or drink?
You may not eat or drink anything for 6 hours prior to your general anesthesia. If you must take medication, do so with a tiny sip of water 2 hours or more prior to your procedure. If you require antibiotic prophylaxis, you may take the medication with a tiny sip of water 1 hour prior to your procedure.
What medications may I take the day of my general anesthesia?
Most of the medications you take daily can be continued the day of your general anesthetic. Any medications you normally take in the morning should be taken prior you procedure, especially blood pressure medications, GI reflux medications, seizure medications, thyroid medications, etc. If you have any questions, please call our office the day before your planned procedure.
How soon after the general anesthesia can I drive?
You should not drive a motor vehicle or operate dangerous machinery for 24 hours after your procedure. This time is necessary to allow your body to metabolize the anesthetic agents.
I’m nauseous and vomiting, is that from the general anesthetic?
It may be, but most of the general anesthetic medications used today do not cause nausea and vomiting. Rather, narcotic pain relievers, swallowed blood, pain, etc., may all be culprits. Please call our office if nausea and vomiting continue, as we can prescribe medication to help.