Frequently Asked Questions About Dental Implants

Frequently Asked Questions Dr. Steven Goldstein Dentist Scottsdale, AZ

Dental Implant Procedure

These are Frequently Asked Questions (FAQ) about a dental implant procedure, dental implants, dental terms and other important dental implant questions. Read more about what a dental implant procedure is and all that is involved below.

1.    Pediatric Dentistry
2.    Periodontics
3.    Prosthodontics
4.    Oral and Maxillofacial Surgery
5.    Oral and Maxillofacial Pathology
6.    Dental Public Health
7.    Orthodontics
8.    Endodontics
9.    Oral and Maxillofacial Radiology
[Note] There is NO specialty for dental implants. What does that mean? It means any dentist with a license can place and restore dental implants with or without any specialized training.

•    DDS – Doctor of Dental Surgery
•    DMD – Doctor of Dental Medicine
•    PC – Professional Corporation
•    MS – Master of Science
•    FACD – Fellow, American College of Dentists
•    FICD – Fellow, International College of Dentists
•    FAGD – Fellow, Academy of General Dentistry
•    MAGD – Master, Academy of General Dentistry

There are many organizations and associations to which dentists can belong. Each one has its own agenda and goals. Some are educational, some are political, and some are specific to a speciality or a common interest. Some organizations only require a valid US dental degree and a membership fee. Others require the dentist to pass a test in order to join or to receive an award. Always ask your dentist what his or her affiliations mean. Some of the more common dental associations and their web addresses are listed below:

•    ADA – American Dental Association
•    AAP – American Academy of Periodontology
•    AAOMS – American Association of Oral and Maxillofacial Surgeons
•    AAMP – American Academy of Maxillofacial Prosthetics
•    AO – Academy of Osseointegration
•    AAID – American Academy of Implant Dentistry
•    ABOI/ID – American Board of Oral Implantology
•    FACD – Fellow, American College of Dentists
•    FICD – Fellow, International College of Dentists
•    FAGD – Fellow, Academy of General Dentistry
•    MAGD – Master, Academy of General Dentistry

Yes and no. Just because a dentist is a member of an organization or completed a certain course of study does not mean he or she is a good clinician or has the experience and skills to treat you. The title “Fellow” or “Master” are awards given to dentists from their respective organizations. They should not be confused with post-graduate degrees or specialist certification. Remember, dentistry is an art and a science. The only way to pick an artist is to see his or her work.

A Board Certified Specialist is one who has completed a certified American Dental Association Accredited Speciality Program and has passed the appropriate exam (board) for that particular speciality. Unfortunately, it does not mean they will perform any better than a non-board certified specialist.

Let me give you a personal example. I completed a three-year post-graduate program at the University of Pennsylvania in Periodontics and Periodontal Prosthesis. My periodontal program was accredited by the American Academy of Periodontology, which means that after graduate school, I was eligible to take the periodontal board. If I passed the board, I would be a board certified periodontist. My prosthetic program, however, was not accredited by the American College of Prosthodontists. This means I am not eligible to take the prosthetic board and I cannot be a board certified prosthodontist.

All this means is that the particular dentist limits or performs only implant dentistry. It has no significant meaning. You could limit your practice to eating turkey sandwiches if you choose to do so.

This answer may surprise you. None! Any dentist with a license is allowed to perform implant dentistry, with or without any formal training. This includes the surgical phase (implant placement) or the prosthetic phase (tooth replacement). Specialists in periodontics, oral surgery, and prosthodontics usually have two to four years of additional training from their post-graduate dental program. Each advanced training program has different requirements for implant dentistry.

Most undergraduate dental schools today expose the dental students to implant dentistry. However, not all students are able to experience an implant case.

Post-graduate dental programs in oral and maxillofacial surgery, periodontics and prosthodontics offer advanced training programs. These programs are full-time, and span two to four years where the graduates do many implant cases. There are residency programs that offer implant training as well.

Many practicing dentists will take courses on implant dentistry to learn how to place and/or restore implants. The courses are usually sponsored by implant companies, implant organizations, or individual dentists and usually offer CE (continuing education) credits to the dentist. Training courses range from one to ten days. The concerns I have with some of these courses are that after a single day of watching a slide presentation and practicing the surgical technique on a plastic jawbone, some dentists will perform implant surgery on their patients the next day. Even if a dentist goes to a live course, where he or she watches an implant surgery, or assists in an implant surgery, in my opinion this is not enough training to begin practicing implant dentistry. I have recently seen a brochure by a top “practice management group” touting that “implants are not complicated” and that “in simple cases they can be placed in 30 minutes without any suturing.” This kind of marketing is very misleading to dentists, and in my opinion, unethical. Any dental or medical procedure that involves cutting and bleeding should not be taken lightly. While I appreciate and commend the desire for any dentist to learn new techniques and procedures, I do not believe it is in the best interest for the dentist or the public to learn any surgical technique from weekend courses. The only way for dentists to learn complex surgical techniques would be for them to leave private practice and return to school full time in order to be supervised by experts in the field. It is up to you, the consumer, to find out the experience level and educational level of your prospective implant dentist. Assume nothing.

Most restorative and general dentists typically utilize a specialist to perform the actual implant surgery. The most common specialists are oral surgeons and periodontists. These specialists perform many surgeries, and usually have the knowledge and experience that is required to place implants into the jawbone, as well as handle any complication that may arise.

As with all technology today, things keep getting more complex. It is often easier for a team to treat a single patient since each team member brings his or her own unique qualifications to the table. For example, I treatment plan implant cases with my laboratory technician. After the case is planned in the dental laboratory, I show the case to the surgeon and ask if my proposed treatment is surgically possible. If the answer is yes, then the patient is scheduled for surgery. If the answer is no, the case goes back to the laboratory for a different treatment plan. Until the entire team agrees on the treatment plan, the patient is not touched.

Each dental specialist has various knowledge and skills. What really matters is the individual dentist’s knowledge and experience as well as his or her ability to put together a good team. The only way the consumer can evaluate a dentist’s clinical skills is to see actual patients or photos of completed implant cases.

There are some general dentists that are very talented, have a lot of implant experience, are good surgeons, and are quite capable of performing dental implant therapy. Of course, the opposite is also true. So how will you, the patient, know if you should allow your general dentist to treat you? What really matters is the individual dentist’s knowledge and experience. Again, the only way the consumer can evaluate any dentist’s implant skills is to see actual patients, or photos of completed implant cases.

If your dentist is good and meets all of the above mentioned qualifications, then, yes, he or she can do the entire procedure, however, you really need to ask a lot of questions before allowing anyone to operate on you.

Which dental specialist should I see first? Typically, you should see the restorative dentist who is going to insert the final case. That dentist usually works with the dental laboratory and is best suited to plan your case.

The cost of the implant components are very expensive. Each implant case requires a lot of time to treatment plan as well as to coordinate with the various people involved. Additionally, the laboratory fees are higher than normal crown and bridge fees due to the complexity of the implant fabrication process.

Many times the insurance company will pay for a portion of the restoration (crown), but not for the surgery. The only way to be certain is to have a predetermination of benefits submitted to the insurance company prior to starting treatment. This will allow the patient to know exactly what is or is not covered by his or her insurance company.

Yes they can, however, the surgeon will have less control for obtaining the precise location of the implant. This is because the hole in the bone from the extracted tooth usually dictates where the implant will be placed. Sometimes this site is not the optimal location for the implant. The other problem is that a guide stent usually cannot be used, thereby bypassing the planning stage with the restorative dentist and the laboratory, and possibly compromising the final result. I personally do not do this procedure anymore, because I want to have total control in choosing the precise location of the implant.

Typically, no. This is because, in most cases, the surgeon is operating in a completely healthy area, meaning there is no infection or inflammation present. This allows the body to heal quickly and usually without pain.

They feel the closest to real teeth as possible. Most patients report they don’t feel anything. After awhile you will forget about them and go on with your life.

When an implant fails, it usually becomes loose. Often, there is little to no pain associated with a failing implant. Once an implant fails, it should be removed. Sometimes a second implant can be placed in the same site; other times a different restorative approach will be required.

Implants usually fail due to bacterial infection or from being subjected to excessive force. It is usually within the first year that most implants fail. Other causes may be surgical errors (heating the bone while drilling) or restorative errors (excessive forces from biting). Luckily, it is not common for implants to fail, especially after the first year.

Most patients are good candidates for dental implants, as long as they are medically healthy. A detailed evaluation of your jaw(s) by X-rays and clinical measurements will determine if your anatomy is right for implants. The major contraindications are smoking, uncontrolled diabetes, alcoholism, irradiated jaws from cancer therapy, as well as poor oral hygiene.

Yes. Periodontal disease is not a contraindication to placing dental implants as long as it is controlled. Prior to implant placement, all local infections should be eliminated by conventional periodontal therapy (such as scaling and root planing). Of course, good oral hygiene will help in the healing process.

When the proposed implant site has insufficient bone (quantity), a bone graft may be required. These are additive procedures in which bone (real bone from the patient or synthetic bone) is used to provide an adequate site for the implant(s).

A sinus graft is a bone graft placed into the (hollow) sinus cavity, thus providing a solid recipient site for an implant fixture to be placed. Today, it is considered a routine and predictable procedure.

There are many different implant systems on the market today all touting their virtues. Some earlier implant companies have gone bankrupt or have been taken over by some of the larger implant companies. Sometimes it is hard to get replacement parts from some of the older, non-existent implant companies. I would recommend having your team use any of the more popular name brand implant systems that will provide you with the specific results required for your case type.

This type of implant is used in situations when there is minimal thickness of jawbone present in the patient. It is a titanium framework that is placed on top of the jawbone versus into the jawbone. The gum tissue lies on top of the framework, holding it in place while metal posts or bars extend through the gum tissue supporting the restoration (usually a denture). Due to the success of bone grafting today, these are not as popular as they used to be.

A blade implant (also made of titanium) has a wide flat shape and comes in various heights and lengths. Like the subperiosteal implant, these are not very popular today. They were used in the early 1980’s in patients with very narrow jawbones.

Absolutely. The laboratory is an extremely important team member. Remember, the laboratory technician is the one who fabricates your restoration. The only way to know if the laboratory is good is to see their work. This can be accomplished by seeing another patient’s case or by seeing detailed photographs of other cases.

In my opinion, as well as in the majority of the dental literature, implants should not be attached to natural teeth. What this means is that the dentist should not make a bridge utilizing a natural tooth and a dental implant. The reason is that natural teeth are suspended in their bony sockets by a ligament which allows some movement. Implants are fused to the bone and have no movement at all. When something rigid is attached to something moveable, it can break. We saw this occur many times in the late 1980’s. Please note this doesn’t mean that if you have this arrangement it will fail (I don’t want to alarm anyone). Most dentists just don’t treatment plan this design anymore.

Yes they can and this is done routinely. I have made many implant bridges successfully over the last ten years.

In many parts of the country, a CAT scan (Computerized Axial Tomography) is the standard of care. It offers the surgeon very detailed information with respect to the actual shape of the jawbones. Other anatomical structures, such as the mandibular nerve, and the maxillary sinuses are often looked at in detail for their location and size. There is no down side to ordering a CAT scan; the choice is up to the individual clinician.

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