Dental Implants Archive - Dr. Mitchell A. Josephs' Blog

Archive for the ‘Dental Implants’ Category

Temporary Teeth During Implants

Posted on: March 20th, 2013 by Dr. Mitchell Josephs No Comments

Q: I need some more teeth removed and implants placed. One is right in the front of my smile. I don’t want to go the whole summer without a tooth and I don’t want to have to use those bulky pink dentures with the metal clips other dentists have made for me. What else can I do? Miriam in Delray

Sounds like you are describing what we call in the tooth biz a “flipper”. Not the most appetizing of dental temporaries; not even if ordered with the house dressing. The fact is most implants cannot have any teeth attached to them until the bone- healing phase, called osseous integration, has past. This is usually 3 to four months.

Other options to discus with your doctor to provide temporary teeth during this time: 1. A bonded tooth pontic: a fake tooth is adhered to the sides of the adjacent natural teeth. 2. A cantilevered, two-unit acrylic temporary: removing an old adjacent crown and having a two-tooth temporary bridge cemented in place. 3: An Essex retainer: a clear bleaching tray, similar to an Invisalign retainer that has acrylic teeth embedded in it to fill your empty spaces. For great photos of the Essex retainer and free info, drop us an email or call us.

Note: Dr. Josephs’ FREE seminar on Hi-Tech Implant, Cosmetic and General Dentistry is available for your next meeting. His multi media presentation is perfect for country clubs, community centers, churches and synagogues, private groups, hospitals and healthcare facilities. Please contact 561-832-2917 to book your next event.

Dr. Mitchell Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry and completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.

Short Implants are OK

Posted on: February 21st, 2013 by Dr. Mitchell Josephs No Comments

Q: After moving to Florida, my new dentist looked at my X-rays and criticized my previous dentist by claiming he used “too short an implant to support my crowns and bridges”. I have no pain and nothing is loose. Should I be worried? Anne in NYC and SOFLA

A: Time to find a new dentist. BEWARE of the dentist who plays Monday morning quarterback and criticizes you existing dental work. He does not know the exact circumstances that were present at the time the work was done. He is obligated to diagnose active disease and recommend treatment; PERIOD. If he is so insecure that he needs to bad-mouth your dental work to make him feel superior, then his so -called bedside manner is about as tolerable as hemorrhoids. (Not to mention completely unethical and in violation of ADA rules.)

As far as “short implants”, a recent study in the Journal of the American Dental Association showed that in select sites, short rough-surfaced dental implants are as successful as long dental implants. These special “rough” coatings allow implants less than 10 millimeters in length to be placed successfully, especially near vital structures such as below the sinuses, nasal cavity and away from important nerves that supply sensation to your lip, cheek, chin, teeth and tongue.

Teeth Options Over Implants

Posted on: February 13th, 2013 by Dr. Mitchell Josephs No Comments

Q: I read your column all the time. What is the difference in having implants in the lower front jaw, with full dentures that clip on vs. implants that have crowns connected to them? Which is better? I just had implants and a full denture that clips on and off the implants. D. In West Palm

A: Thanks for reading my column and not using it strictly for spray paint projects in the garage like I did this weekend. Boy, I look a lot younger with a tad of Krylon Burnt Sienna in semi-gloss.

You have what is called a removable implant- supported overdenture. This is basically a regular denture made of fake plastic pink gums and white colored fake teeth. The implants, usually four, are only keeping the denture from being pushed side to side and up and down.

If you do 6 to 10 implants, if you have enough bone and finances allow, you can have a series of porcelain crowns that much more closely resemble real teeth, usually with little or no pink fake gums. These are permanent, non-removable. Some or all of the teeth will be individual, and allow flossing in between just like real teeth. This is the most expensive way to go.

A mid priced investment would be a “hybrid” or “fixed-detachable” prosthesis. This is anchored to 4 to 8 implants and gives you a full set of permanent teeth all connected together, yet still looks like real individual teeth when you smile. You cannot floss in between the teeth, but water picks and dental yarn allow cleaning around the implants, underneath the teeth. This is in no way a denture. No big hunks of pink plastic and nothing covering the palate or intruding bulkiness under the tongue.

Note: Dr. Mitchell Josephs’ FREE seminar on Hi-Tech Implant, Cosmetic and General Dentistry is available for your next meeting. His multi media presentation is perfect for country clubs, community centers, churches and synagogues, private groups, hospitals and healthcare facilities. Please contact 561-832-2917 to book your next event.

Fractured Implant Screw Fix

Posted on: January 16th, 2013 by Dr. Mitchell Josephs No Comments

Q: I read with great interest your column on fixing a loose crown, attached to an implant. Although removing the crown and tightening, what you called, the abutment screw solved the problem, I have a more complex issue. My doctor told me my “little screw’s head has fractured off” and that he has no way of re-attaching the crown unless I have the implant cut out of my jaw bone, replaced by a new implant and new crown over an eight month period of time. Help! Jerome in Palm Beach

A: “You gottem some problem Kimosabe.” Lucky I stay abreast with the dental literature. (Sometimes two breasts.) In the January Journal of Oral Implantology, a nifty article described a method of removing broken implant abutment screws. A small notch is cut into the top of the broken surface of the screw, almost creating a flat-head screw top. Then, an ultrasonic scaler tip that some hygienists use to remove tartar is inserted into the slot and moved counter clockwise, unscrewing the little bugger. A new screw is then inserted, salvaging the whole kitten caboodle. More on implants LIVE at my next seminar, below.

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving a FREE SEMINAR on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers, Choosing a Dental Office and NEW TOPICS: “Laser Lip and Gum Treatment” and “Why Botox at the Dental Office?”, Friday February 1^st at 10:30 AM at the Boynton J.C.C. on Jog Rd. Call 561-259-3016 to register.

Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited; these seminars fill up rapidly; call today. Dr. Josephs practices Implant Cosmetic and General Dentistry and hosts “Tooth Talk” on WBZT AM123.0 Dr. Josephs is on staff at West Palm Hospital (Formerly Columbia Hospital) and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry and completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.

Physics and Implants

Posted on: January 2nd, 2013 by Dr. Mitchell Josephs No Comments

Q: I had an implant placed with a crown attached two months ago. Today I noticed the tooth (crown) is loose. I have no pain, but am worried. What has gone wrong? S.S. in Boca

A: Back in college, I had physics professor who looked like Grouch Marx. His eyebrows looked like to pieces of black electric tape. As a big Marx Brothers fan, I nailed an “A” in the class. The “secret word” today is TORQUE; a force applied in a rotary motion. A precise amount of torque is used to drive the screw-like titanium implant into the jawbone after a threaded tunnel is created with special drills. Over torqueing can cause the implant to fail and loosen (among other reasons). An X-ray and examination will verify if this has happened to you.

Three to four months after an implant is placed, an abutment post, which attaches the crown to the implant with a tiny screw, is driven into the hollow implant with a special torque wrench. If not enough torque is applied, 32 NCM’s (Newton Centimeters), the screw can reverse itself causing the crown to become loose. This is more easily fixed than the former, as the screw just needs to be re-torqued.

EDITOR’S NOTE: Dr. Mitchell Josephs will be giving two FREE LECTURES on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers, Choosing a Dental Office and NEW TOPICS: “Laser Lip and Gum Treatment” and “Why Botox at the Dental Office?”, at the West Palm Beach Downtown Library on Clematis St. on Thursday January 10th at 6:30 PM. To register, call 561-868-7701. And, on Friday February 1^st at 10:30 AM at the Boynton J.C.C. on Jog Rd. Call 561-259-3016 to register.

Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited; these seminars fill up rapidly; call today.

Not All Root Canals Need Posts

Posted on: November 28th, 2012 by Dr. Mitchell Josephs No Comments

Q: After reviewing my dental bill, I noticed that each tooth that received a root canal also had a charge for a “post and core”. What is this and is it always needed? Deborah via email

A: Don’t worry. It is has nothing to do with your doctor’s kid’s college tuition coming due this month for the spring semester. After a root canal, very often the tooth is quite hollow and fragile. Often they need a reinforcement much like a concrete wall needs “re-bar” rods placed before they pour the concrete. The post goes 2/3rds down the nerve-free canal, while the other end protrudes up beyond the tooth, above the gum line to allow the doctor to build up a stump, called a core, out of composite.

However, if you don’t have at least 5 millimeters of healthy, solid tooth structure left above the gum line, it is best to AVOID ROOT CANAL, extract the entire tooth and replace it with a dental implant, abutment and crown. Going the root canal, post and core route on these teeth have limited long term success.

EDITOR’S NOTE: Dr. Josephs will be giving two FREE LECTURES on Incision-Free Dental Implant Surgery, Digital Crowns & Veneers, Choosing a Dental Office and NEW TOPICS: “Laser Lip and Gum Treatment” and “Why Botox at the Dental Office?”, at the West Palm Beach Downtown Library on Clematis St. on Thursday January 10th at 6:30 PM. To register, call 561-868-7701. And, on Friday February 1^st at 10:30 AM at the Boynton J.C.C. on Jog Rd. Call 561-259-3016 to register. Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited; these seminars fill up rapidly; call today.

Dr. Mitchell Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and hosts “Tooth Talk” on WBZT AM1230 (www.radiotoothtalk.com) Dr. Josephs is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry and completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.

Temporary Teeth During Implant Healing

Posted on: November 20th, 2012 by Dr. Mitchell Josephs No Comments

Q: I am in need of having most of my natural teeth removed and then replaced with dental implants and permanent porcelain crowns. I was told that I must where a set of removable temporary dentures for several months. I am in a profession that will simply not allow me to have anything removable in my mouth, and yet I must have some type of temporary teeth to look and speak normally. What can I do? Glenda in Boca

A: If we were playing the classic game show: “What’s my Line?”, I would guess that you are a musician in the woodwinds or brass section. (Clarinet, trumpet etc. ) My first instrument was trumpet, but when I realized that I could not play any Van Halen songs on it, I changed to guitar 35 years ago.

In a FEW scenarios, patients can avoid a “flipper” (transitional removable denture) by adding what I call: “sacrificial implants”; i.e. the placement of small diameter implants in areas that would not be good for the permanent implants, but would offer enough support for a non-removable, horseshoe arch of acrylic teeth. These implants, destined to fail, would be removed when the final, permanent implants are healed and ready to have their permanent crowns attached.

Attendees will receive a FREE copy of his book: “Tooth Talk”. Seating is limited; these seminars fill up rapidly; call today. Dr. Mitchell Josephs practices Cosmetic, Implant and General Dentistry in Palm Beach and hosts “Tooth Talk” on WBZT AM1230 (www.radiotoothtalk.com) Dr. Josephs is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry and completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.

Shade Matching Implant Crowns and Veneers

Posted on: November 14th, 2012 by Dr. Mitchell Josephs No Comments

Q: I have a potpourri of dental work in my mouth made up of veneers and crowns. I now need to have a couple of front teeth removed and replaced with dental implants and am worried that these teeth wont match my existing dental work. Maude in Boynton

A: If you attend one of my free lectures to the public, one coming up in January and one in February, you will see this great slide I have titled: “Ransom Note Teeth”. This is when each tooth in a patient’s smile has a different shade; nothing matches; just like words made up of a mixture of font types cut and pasted from various newspapers, used in old movies for a ransom note.

Solution: The teeth being replaced with dental implants should have tooth-colored abutments vs. metal ones. These will prevent an unsightly gray hue from shining through the all-porcelain metal crowns built to match your existing veneers and other crowns. The abutment is the post-like connection between the implant imbedded in the bone and the actual crown (the “tooth part” that you see in your smile.) We also recommend the patient visit our lab for a face-to-face custom shade match by our head ceramist.

Call or email us to be notified of the exact dates and location of our next FREE seminar to the public.

One Dental Implant or Two?

Posted on: October 17th, 2012 by Dr. Mitchell Josephs No Comments

Q: I am missing my last three molars on the right side of my mouth. My dentist wants to place three implants and attach three crowns to each of the implants. To save money, can I just have two implants spread apart and connect a bridge of three crowns connected together? RBJ in Palm Beach Gardens

A: Like anything else in life, there is usually a trade off when lower cost is factored into the equation. Caterers, restaurants, kitchen cabinets and fake Louis Vuitton bags that smell like plastic diapers.

It is acceptable to spread the placement of two implants apart, BUT only if the space between them is no bigger than one tooth. Although you are saving the fee for one implant, the downside is you will have great difficulty trying to snake a floss threader underneath the fake ‘floating’ tooth that is connected to the two adjacent crowns. You will also lose bone over time in the area that does not have the implant, causing a saddle -like depression that will trap food under the fake middle crown. This can result in having to replace the bridge down the line, costing more money. Three individual crowns attached to three implants are better as it allows for flossing exactly like natural teeth. Implant hygiene is extremely important to prevent gum recession and bone loss around the implant.

Replacing an Implant that Failed

Posted on: October 10th, 2012 by Dr. Mitchell Josephs No Comments

Q: My dentist placed an implant four months ago to replace a missing upper front tooth. He had attached a temporary crown to the implant the same day. Three months later, the implant fell out of my gum along with the temporary. He wants to “try again”. Should I bother?…C.B. in Lake Worth

A: Remember when you were a kid playing a game and that annoying friend who would lose a point, strike out or drop the ball would exclaim: “Do-over!”

Occasionally, in implant dentistry an implant will fail due to the unpredictable biological nature of the human body. Implant failure is when the bone does not grow intimately against the titanium implant surface resulting in a loose implant, which must be removed. This usually occurs within the first three to four months after the implant has been placed, but before any permanent teeth (crowns) have been attached.

Your dentist can simply clean out the infected site, add synthetic bone graft material and place a new implant of a larger diameter and sometimes longer length. To be on the safe time, he may choose to have you where a removable tooth (called a flipper) vs. attaching a temporary crown to prevent any movement of the implant during the three to four month healing phase. For a free consumer guide on implants, contact us.

Editor’s Note: Dr. Mitchell Josephs is available for FREE lectures and book signings at your organization’s next meeting. Residential communities, service clubs, charitable organizations, recreation and community centers, churches, synagogues, hospitals, universities and country clubs are just a few of the venues Dr. Josephs has lectured. Call Debbye, his patient care coordinator to book your next event at 561-832-2917.