Category Archives: Dental Bridges

Ramsey Amin DDS Case Review – Replace Loose Long Bridge With Dental Implants And Bone Expansion

This Burbank patient had a loose lower bridge.  She had had the bridge for about only 8 years before it failed and became loose.  You know a bridge is failing when it feels painful to bite down or there is movement.  This unfortunately is a daily thing I see every day.  Teeth were never intended to be hooked to other teeth.  She came to me because she wants dental implants to replace the bridge.

The existing lower bridge was made with a metal biting surface because the patient has a VERY  strong bite.  She wanted to make sure that her new dental implants could withstand her bite force.  She has broken other bridges in the past. You can see in her photos that she has worn through some of the porcelain showing through to the old metal layer on the opposite side next to the yellow gold crown.

First day exam visit

First day exam visit – broken root under the bridge

First day exam visit –side view

First day exam visit -panoramic x-ray

First day exam visit — full lower jaw. Failing bridge is the one with the metal biting surface.

thin bone prior to grafting but after extraction of the broken root

Bone grafting showing webbing of Vicryl stitches

10 days of healing after bone grafting showing webbing of Vicryl stitches

Clay model of the patient after bone widening expansion bone graft. Please note how wide and square the bone is compared to how thin it was before.

3-D printed models showing abutment contours

3-D printed models of abutments from top view

top view final bridge on 3-D printed model

side view of final bridge on 3-D printed model. This patient happens to have very short teeth which makes it even more important to have the teeth connected to avoid food impaction between the teeth.

sandblasted abutments in the mouth showing very wide bone and excellent healthy thick gum tissue

postoperative panoramic x-ray showing three dental implants in the lower right jaw.

postoperative panoramic x-ray showing excellent fit of abutments and monolithic zirconia bridge.

final bridge seated over the abutments. The final bridge is on the right of your screen.

When I removed the bridge I found one of the teeth anchors broken.   That broken root canal tooth is not savable and will need to be extracted. The back wisdom anchor tooth is healthy in and of itself but is tilted towards the front.  This patient is unique in that she has very long roots as shown on her panoramic x-rays.

The biggest issue is that the bone in the area where the teeth used to be is super thin.  When you lose a tooth or a segment of teeth, the bone thins out because it is not being used.  This process is called atrophy (BONE LOSS) .  So even though her bone was tall enough, it was not wide enough to have implants properly placed in the center of where the teeth used to be.  If you try to have your implants done without a bone graft, the implants would have to be pushed towards your tongue side and the implants would be a very small diameter with minimal bone on the outer wall… a recipe for disaster.

In her case, I did a bone widening/expansion ridge split.  In this process, I actually purposely “break” the outer layer of bone towards the outside and push the outer layer of bone away from the inner layer of bone.  This creates a big trough which can then be filled with donor cadaver/cow bone and L PRF/PRP made from your own blood.   This is a very advanced bone grafting technique that is not just a typical mild expansion of bone.  It is a full repositioning of the outer wall of the lower jaw bone.

This bone graft was allowed to heal for 4-6 months prior to placing the implants.  In her case I would not advise placing implants at the same time of the bone graft although in many cases I do place the implant simultaneously.  Her case was special and that she was on a bisphosphonate medication in the past for cancer treatment.  The bisphosphonate medications can slow down bone healing and can have really detrimental complications so going slow was better than going fast.  I did some blood tests for her and also consulted with her physician prior to initiating treatment.  It is always best to be safe especially when dealing with dental implants and medications similar to Boniva and Fosamax.

After a few months of healing I decided to place 3 dental implants for a connected-splinted dental implant bridge.  Remember she wants the “strongest possible” solution so I advised her to have 3 implants and a 3 tooth bridge rather than 2 implants and a 3 tooth bridge.  Connecting the teeth is definitely the strongest way and helps prevent food impaction.

In the photographs, you can see how wide the bone is and how the implants are well centered and spaced now that she has the proper amount of bone.  The implants are long and of a really good diameter for a proper emergence from the gums for large molar teeth.

After 3 months of healing, I began to take my initial 3-D video scans of her mouth to fabricate her teeth.  I made 3 titanium abutments on the 3-D printed model in a virtual program.  This way the teeth are fabricated using a computer and not typical gypsum clay molds and messy impression material that gets stuck in your mouth!

The abutments were steam cleaned and sandblasted for proper cement hold and sterility.  This is a another important step which is commonly skipped.  The implant abutment junction must be super clean and the smooth metal must be roughened slightly for micro retention.

The implant bridge was then fabricated using monolithic zirconia.  This material is wonderful because it is white, strong and aesthetic for back teeth.  It is stronger than original bridge with the metal support.  I use this material quite commonly for my full mouth Prettau zirconia dental implant bridges.

Needless to say, she was very happy with the final result of her teeth. I am sure they will last a very long time. The best part was the big hug she gave me at the end. 

😉

Converting Bad Dental Implant Overdentures To Fixed Full Arch Bridges -Review Of Complex Case

Here is an interesting full double arch dental implant case that I took over from another dentist.  This patient desired full mouth dental implants.  When he presented to my office he already had 10 implants but could not use his teeth.  He paid a lot of money only to be disappointed with the removable over dentures that were made for him.

initial x-ray when I first met the patient--10 implants that would not work for over dentures

initial x-ray when I first met the patient–10 implants that would not work for over dentures

initial presentation when I first met the patient with his existing 10 dental implants and over dentures that would not work.

initial presentation when I first met the patient with his existing 10 dental implants and over dentures that would not work.

pre-existing condition when I met the patient-upper jaw

pre-existing condition when I met the patient-upper jaw

pre-existing condition when I met the patient-lower jaw

pre-existing condition when I met the patient-lower jaw

bulky, huge dental implant over dentures...poorly done

bulky, huge dental implant over dentures…poorly done

poorly made overdenture attachment connection

poorly made overdenture attachment connection

poorly made overdenture attachment connection

poorly made overdenture attachment connection

 after healing on the lower arch dental implants

after healing on the lower arch dental implants

after healing on the upper arch dental implants

after healing on the upper arch dental implants

after healing on the 17 dental implants--the Gold abutments aren't locators used by the previous dentist attempt at making teeth.

after healing on the 17 dental implants–the Gold abutments aren’t locators used by the previous dentist attempt at making teeth.

impression transfer on the upper 10 implants

impression transfer on the upper 10 implants

impression transfer on the lower 7 implants

impression transfer on the lower 7 implants

screw retained full arch temporary dental implant bridge

screw retained full arch temporary dental implant bridge

screw retained full arch temporary dental implant bridge

screw retained full arch temporary dental implant bridge

narrow gum the sulcus channelson the existing implants towards the front of the mouth

narrow gum the sulcus channels on the existing implants towards the front of the mouth

fully biting into full mouth fixed temporary implant Fp1 teeth

fully biting into full mouth fixed temporary implant Fp1 teeth

PMMA double arch full mouth dental implant fixed temporaries--other side

PMMA double arch full mouth dental implant fixed temporaries–other side

PMMA double arch full mouth dental implant fixed temporaries--side view

PMMA double arch full mouth dental implant fixed temporaries–side view

PMMA double arch full mouth dental implant fixed temporaries

PMMA double arch full mouth dental implant fixed temporaries

x-ray of the 17 implants during the process. Some of the implants were placed by me in some by previous dentist.

x-ray of the 17 implants during the process. Some of the implants were placed by me in some by previous dentist.

Handsome smile with temporary upper and lower full arch teeth.

Handsome smile with temporary upper and lower full arch teeth.

You can see on the preoperative x-ray that he had 6 upper dental implants and only all on 4 lower dental implants.

The implants were mostly well placed from a spacing standpoint and might have been able to be used for fixed dental implants such as a Prettau zirconia full mouth dental implant bridge.  Rather than having a fixed bridge or an all on 4 fixed bridge, the dentist chose to make an overdenture!! 

The overdentures never worked for him.

 They were way too bulky and had a tremendous thick pink area we call a flange.  The crazy thing is that there is no way overdentures could have ever worked because all the implants were placed way too shallow!  In order to have overdentures, you must have enough room from top to bottom (inter-arch space) to fit the dentures and plastic abutment attachments that make them snap into place.  The gold attachments are called locator abutments which typically work well on the lower jaw only.

He never wanted to have removable teeth but that is NOT what he got.  He was not able to wear the overdentures at all and came to me for a better solution.  He had gone 3 years like this.  The teeth were even made twice and then he gave up.  He told me I was his last hope. 

After evaluating him carefully I determined that the implants were placed in a shallow position more ideal for “regular implants.”  We refer to this in dentistry as an “Fp1” prosthesis.  That means there is no reason or room for the pink portion which most patients need because they are missing bone and gum.  This patient actually had excessive bone which is very rare and in retrospect if he really wanted an overdenture should’ve had a bone leveling alveoloplasty procedure.

This very well could have been a communication problem between the restorative, tooth making dentist,  and the implant surgeon.  In this case, there were 2 different people who started the procedure.  I am a strong believer that these complex dental implant procedures should be done from start to finish with a *single* skilled provider or a very tightly connected and experienced partnership duo.

The upper implants unfortunately were all squished in the front, without any dental implants in the molar back tooth positions with minimal inter-arch space.  On the lower jaw they were well spaced but there was too much space between implants for the regular/crown and bridge/Fp1 type teeth. 

The solution was to add four additional implants into the molar regions on the upper with some simple internal sinus lifting.  On the lower jaw I added 3 implants in strategic locations to shorten the spans of the bridges.  If the span is too long, and the zirconia material is not thick enough, the teeth will break…yikes!!!!   The additional implants will support the material.  This will allow him to have basically regular teeth back again without any of the pink porcelain or pink plastic.

In a single appointment, I added these additional 7 implants with minor sinus grafting under IV sedation at my office in Burbank, California.  The implants were allowed to heal for approximately 4 months prior to starting the restorative process.

Fabricating his teeth was very complex because of 2 different implant systems and at least 4 different proprietary screwdrivers and parts.  The locator abutments also had a very narrow “sulcus” which would be too small at the tooth neck for regular size teeth.  I actually had to custom alter make all of the special titanium implant impression transfers to fit into the overly narrow gum channels.

A verification jig was 3D print milled to be certain that all 17 implants had a very accurate impression so that there is no misfit of the new teeth.  I also created a screw retained wax rim teeth in order to  select tooth size, color, position, bite level and a host of other factors.

In these photographs what you are seeing is a temporary PMMA double arch bridge.  This is not the final although it may look like a final bridge! 

All teeth were designed using 3-D  3shape software.  I had my very skilled lab technician digitally create wider gum channels so the teeth at the neck appeared more of a normal size so they would not have mushroomed stalks.  At the delivery appointment for the temporaries I had to surgically open his gums to fit the teeth.  This will allow any papilla or gum triangles to fill in as needed and “groom the gum tissue” to fit the new teeth.  The PMMA is a milled plastic/acrylic material so the bite can be adjusted and refined.  I will then take all of this information and translate that to the final restoration.

I usually allow my patients to wear the screw retained PMMA full fixed implant temporary bridge for a few weeks to a few months depending on how much testing and adapting the patient needs.  Some people adapt very quickly with speech while others need a bit more time to learn where there teeth are in space.  This testing duration also allows the TMJ jaw joints an adaptation period.  Also the bone can progressively be given bite strength with this softer material and gradually get to the solid monolithic zirconia restorations.

Sorry for the blood in some of the photos as they were taken on the day of surgical delivery of these temporary restorations.  The finals will look very similar to this except even better 🙂

I hope this explain some of the highly complex procedures that go into recovering such a difficult situation.  Unfortunately a lot of what I do nowadays is correcting and redoing bad situations which could’ve been done right the first time with better planning.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

All On Dental Implants With Prettau Solid Zirconia Dental Implant Bridges ~A Case Explained

In this post I will try to detail the start to finish of full upper and lower dental implants with Prettau solid zirconia dental implant bridges.  This gives a general outline for what to expect if you were to have to lose all of your teeth and replace them with full arch zirconia implant bridges.

I will describe the rationale for treatment which may help those of you in similar situations.  Sometimes you have to have bone graft and sometimes you do not.  Sometimes the dental implants can be placed simultaneously with extractions and other times the extractions, implants and bone grafts need to be or should be done in phases.


before treatment x-ray showing failing teeth

before treatment x-ray showing failing teeth

IMG_0680
before treatment open retracted photograph

before treatment open retracted photograph

upper jaw

upper jaw

lower jaw

lower jaw

flipper stayplate for lower front teeth

flipper stayplate for lower front teeth

LEFT
RIGHT
1 week after upper jaw dental implants and extraction of all remaining teeth

1 week after upper jaw dental implants and extraction of all remaining teeth

lower jaw dental implants after one week

lower jaw dental implants after one week

upper jaw dental implant impressions

upper jaw dental implant impressions

lower jaw dental implant impression

lower jaw dental implant impression

conventional open tray impressions

conventional open tray impressions

wax pattern of teeth for try-in purposes

wax pattern of teeth for try-in purposes

verification jigs

verification jigs

PMMA temporaries.

PMMA temporaries.

IMG_4852
IMG_4856
IMG_4858
IMG_4866
Final x-ray with upper and lower solid zirconia Bridges on 12 implants. There are 24 teeth supported by these 12 implants.

Final x-ray with upper and lower solid zirconia Bridges on 12 implants. There are 24 teeth supported by these 12 implants.


What is unique about my approach is often procedure can be done in a single visit surgery without the need for “major” bone grafting such as lateral window sinus procedures or block grafting(although I routinely do these major grafts for other reasons).

he plan is to harness this patient’s existing good bone and avoid the areas where the bone is deficient, thin, risky and doesn’t have a lot of density.

Final x-ray with upper and lower solid zirconia Bridges on 12 implants. There are 24 teeth supported by these 12 implants.

Final x-ray with upper and lower solid zirconia Bridges on 12 implants. There are 24 teeth supported by these 12 implants.

ThisIMG_4858 patient is about 55 years old and as you can see has quite a substantial dental problem.  His upper teeth have a temporary bridge that is not well fabricated and was just put in so he could have “something there.”  The lower front teeth are missing.  The upper jaw is very small and narrow in comparison to the lower jaw which is wide.  This places the patient into a reverse cross bite which must be taken into account for both the surgery and the long-term with the teeth.  The mechanics of the bite can often destroy the fragile bone at the top of an implant.

I cannot emphasize enough that replacing all of your teeth with dental implants is a highly complex procedure that should be unique to your situation and not just the same recipe “all on 4” for every single patient.  I also believe that one implant dentist completing your treatment from start to finish has the most control of your result.  It also helps to save cost as compared to this procedure being done by 2 different dentist….A surgeon and a restorative dentist.

Your treatment plan and diagnosis is the most critical element which is done early in the planning phase.  For this patient I need to engineer his full mouth dental implants and solid zirconia bridges to be strong at the level of the teeth and strong in the bone so that he does not get bone loss or broken teeth.  This happens very commonly when these procedures are not well planned or discount parts and techniques are used.

On the preoperative panoramic x-ray we can see that the patient has had a substantial amount of dental work.  There is bone loss and decay on most of the remaining teeth. This patient was tired of investing thousands of dollars over the years into procedures that all failed and he did not feel that his smile was attractive.

In his case, while he slept under IV moderate sedation, I extracted all of the remaining teeth and placed all the implants simultaneously.  The procedure was planned by 3-D CBCT analysis which is essentially virtual computer surgery.  The bone had to be leveled in some areas so that all of the implants were approximately on an even plane leaving plenty of thickness for teeth.

These types of full arch solid zirconia bridges not only replace teeth but in his case were also replacing bone and gum.  This is why these types of restorations look different because without replacing the bone and gum on the bridge the patient’s face would look sunken in and his speech would be improper.

Prior to the surgery, upper and lower impressions were made to fabricate temporary upper and lower dentures.  These dentures will be used for several months while the implants heal and give us some idea of the patient’s facial aesthetics and bite needs.  Connecting the teeth to the dental implants on the same day in his case was not appropriate.  Immediate teeth can be made in some cases but should not be made in all cases.  Many dental clinics market this as being a solution for all patients but the reality is it is not safe and predictable for all patients but it is for ‘some.’

At no point will this patient ever be without teeth.  In my practice in Burbank,California, this is unacceptable for patient to walk around without teeth although I have had a few patients that preferred to do that.

On the upper jaw  6 dental implants were placed into the best possible bone.  The rear most dental implants were placed at a tilt facing backwards on purpose.  This will alleviate the need in this patient for right and left maxillary sinus bone grafts.  The teeth can be cantilevered about 1-1/2 teeth beyond where the implants end to give this patient teeth all the way to the first molar position.  This means that the 6 dental implants will support 12 teeth on the bridge.  This tilted concept is not always possible and depends on where God made your sinuses and nerves.  Sometimes the sinuses are too far forward for this to work.  Especially on the upper jaw you want implants going as far back as possible and as many implants as possible because the bone is soft.  The number of implants is critical and should never be compromised as this is the main structure that will hopefully make things last as long as possible because dental implants are not permanent!!

On the lower jaw, the 6 dental implants are scattered more evenly around the jaw because this particular patient had room above the nerve on the rear molar areas.  This places dental implants underneath all of the bridge without a cantilever which is a great approach.  In a patient that does not have bone in the rear molar area, the implants can be more centralized towards the front middle and teeth cantilevered towards the back.  In the latter scenario, you want to make sure that the implants are good and long and you have at least 5 of them.

It takes 3-6 months for the implants to integrate.  During that phase, I  begin to prototype the patient’s mouth so that they can see feel and test drive what their new smile will look like.  Adjustments will be made to the teeth and a wax pattern is fabricated.

In this patient, I made  conventional open tray impressions of his upper and lower jaw using a putty type of material.  Sometimes the impressions can be made digitally also using the 3Shape Trios 3 scanner that I have.  The impressions are then scanned in a physical and digital model is made.  I then fabricate what is called a verification jig.  This device verifies that your impression is accurate and your bridge *will* fit…no guesses or maybes.  This is not a step that should be skipped although I find many dentists that do.  This is the equivalent of the framing of a house… It needs to be perfect from the structural standpoint so that everything last a long time.  Panoramic x-rays are generally taken along the way in order to verify that the custom abutments are flush to the implants.

After the verification jig comes another try in to verify you like the look of everything and then we switched over to PMMA fixed temporaries.  The fixed temporaries are the closest prototype to the real one.  The purpose is for you to be able to test drive the real ones.  It also allows me to test  speech, facial aesthetics, dental aesthetics, bite, TMJ, hygeine and so much more.  You will go home wearing these great looking, stong temporaries and wear them for 1-2 months generally.  During this time life is good and transitioning to the final is really easy because it feels even better than the digitally fabricated and milled PMMA temporaries.

The final solid zirconia Prettau dental implant bridges are delivered and generally screwed into place.  The screw access holes were closed with a composite material after all of the abutments screws are tightened.

It is quite the process to replace all teeth with fixed solid zirconia dental implant bridges but it is so worth it.  I’m certain this is the best that dentistry has to offer as of 2016.  There are many clinics that advertised discounted procedures and techniques but you need to be very careful what you may end up with.  Sometimes people have problems and no dentist wants to fix them because treatment was so bad to begin with.  Sadly, I see this every single week.

This patient can chew whatever he wants an should not have any problem for a long time.  Total treatment time for this patient was approximately 9 months from start to finish.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

 

 

 

 

 

All On Four Dental Implant Procedure Review: Is It The Best? –Ramsey Amin DDS

The All on 4 dental implant procedure has become quite popular. You probably even hear about it on radio and TV advertising. Even many dentists don’t really understand it. It is sometimes advertised as the “smile and a day” procedure.   All on four is simply a treatment option for replacing all of your teeth on the upper or the lower with just four dental implants. It is possible to replace all of your teeth in just 1 day. In fact I have been doing this for the last 15 years.

You just have to be very selective that you are the right patient for this type of procedure. I don’t suggest that the final teeth are made on the same day because you will not be able to test the teeth for how they look, feel or bite.  There are many steps to achieve a really good result and a full mouth reconstruction.

The All on 4 Dental Implant Procedure Video Review

There is a lot of hype about all on four. What is perceived is not always the reality. In this video I will review several things you should know about total teeth replacement with “ALL ON FOUR”.

Some advantages are:

Some disadvantages are:

  • Under engineered–only four implants are supporting what 14 upper natural teeth would do.
  • Cost is reduced by making a “fixed hybrid.” These are essentially fixed dentures which have high maintenance and break very often.
  • No implants are placed in the molar areas of your mouth where the bite force is the highest

Here is a patient a decade ago:

 

Generally speaking, 6 dental implants on the upper and 5 dental implants on the lower are minimum number for stable long-term bone.

This should be combined with an all zirconia or metal ceramic bridge rather than a hybrid, which are plastic denture teeth fused to a base metal. Depending on the size your jaw and bite force, you may need up to 8 dental implants on your upper jaw and 6-8 on your lower jaw.

Sometimes bone grafting cannot be avoided and is necessary to obtain good long-term results for you. You may require sinus bone graft if your sinuses are farther forward in your mouth.

I would strongly suggest all porcelain teeth, preferably CAD milled Prettau, if you have enough space from top to bottom. Porcelain teeth don’t stain, chip and break like plastic hybrid denture teeth do. I would also suggest that all on four or all on 6 or 8 are held in by screws rather than cement, if at all possible, based on dental implant angulation. This video should clarify a lot of questions you may have.

The all on four dental procedure is really heavily marketed and is rarely the best option but **can work for some**.

Remember your teeth are your body parts. I truly believe a customized solution for your particular situation is best. Some dentists just plan all on 4 dental implants for all patients regardless of their unique situations.

It is the equivalent of trying to make your mouth fit the prefabricated teeth, rather than making teeth to fit your mouth.

If my mom or dad were to ever need to replace all of their teeth, this is not the way I would do it.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

The Process of “Permanent” Fixed Dental Implant Teeth -5 Steps to Replacing All Your Teeth

Having fixed “permanent” dental implant teeth is a process. This process can vary greatly from as short as one day and can extend up to two years. The average is a few months. Here is a 5 step summary of the process.

Upper Lower Fixed Dental Implants

Upper Lower Fixed Dental Implants

“Permanent” is in quotations because nothing is truly permanent.  Everything can be removed if needed and all dental work (crowns, fillings, root canals) wears out and needs to be replaced. 

I have written on numerous occasions about the wide array of differences you should ask about when having your teeth replaced with fixed bridges vs. overdentures. (Is it an All on Four economy plastic bridge replacement or is it fixed porcelain on a normal amount of dental implants?)

Why does it take so long…or short?  How much bone you have is the number one factor in determining your unique process.  If you don’t have enough bone, then the bone will need to be rebuilt with a bone graft.  If you have plenty of bone, there are many options and the process is much faster. You may have been told you don’t have enough bone.

If you are replacing ALL the teeth in one jaw, I may be able to help you avoid ‘major’ bone grafts. (Major bone grafts are lateral wall sinus bone grafts, onlay block bone grafts, large segment guided bone regeneration, and nerve repositioning.  I routinely perform these grafts when needed and they are not to be avoided)

There truly isn’t ever a one day process because you have 1-5 evaluation and preliminary records appointments before your actual surgery if you want this to turn out right.  Beware of what you see on TV and hear on the radio.

1. Initial Visit: X53953This is where I begin to understand your needs and wants.  Your medical and dental histories are crucially important.  Digital photographs, intra-oral, panoramic and/or 3D x-rays  3D Planning --Ramsey Amin DDSare taken in my office. Molds of your mouth may also be made. I will study your situation carefully between your first and second appointment.

2. Treatment Consult: This is where I review your options, risks, benefits, timeline and financial commitments.  This is a very important appointment for you to digest all the information. This is usually 30 minutes to an hour. 500 W Olive, Burbank_HI RES-62

3. Surgery or Additional information: IMG_8413 If your situation allows, your next appointment may be surgery.  This may involve extractions, bone grafting, and/or placing dental implants.  If more molds or temporary fixed teeth or dentures are needed 2-4 measurement and analysis appointments may be needed.  If you are having this process done with me, you will ALWAYS have temporary teeth!  You will not be without teeth during the process!

4. Making the teeth: IMG_8291 After the steps of the surgery/extractions//bone grafting are done it is time to start making the final teeth!  You and I will choose the specifics of how you want your teeth to look.  I will coach you on color, how much teeth/gum you should show when you smile, the length/shape and about 1000 other details.  This process includes digital and real molds, facial analyses and bite measurements.  Many of the Prettau dental implant bridges I make involve a digitized version of fixed temporaries to allow you to test drive the real teeth before they are made.

5. Deliver the final teeth:  The installation or delivery of the final teeth usually takes 1-3 hours.  The teeth may be screwed or cemented into place over custom or prefabricated abutments.  Your bite must be balanced carefully.  Post-operative x-rays will be taken.  I will train you on how to maintain your teeth and what to look out for.  It is crucially important that you know your part in the long-term maintenance.  I want to see your teeth last! fixed dental implant

That is the overall process to replace all your teeth.  Keep in mind it will vary greatly in your unique situation.  You will be seen for several follow up visits.  I personally perform every step of the process from start to finish. 

Having one implant dentist in charge, in my opinion, gives you the best result.  You don’t have to worry about any sub-contractors!

Ramsey A. Amin, D.D.S.

Diplomate of the American Board of Oral Implantology /Implant Dentistry

Fellow-American Academy of Implant Dentistry

Should I Pull All of My Teeth and Get Dental Implants?

This is a question I hear often. Worse yet, some people say should I pull all of my teeth and get dentures?

Most of the time the answer is no! BUT…sometimes it IS better to pull your remaining teeth and have full mouth dental implants.

Many times people present with either all of their top decayed and/or infected with gum disease. Many times these teeth have already had root canals, crowns, and tooth bridges in addition to bone loss.

Sometimes fixing all of those bad teeth costs more than replacing all of the teeth with a fixed porcelain dental implant bridge with gum colored porcelain.

IMG_0252This woman is a good example. She had cancer, and her lower teeth were a constant problem for her during chemo. Other dentists she saw suggested she try to save the lower teeth with crowns. She wanted to keep her upper denture, though. 

In the final result picture you can see the difference between what a typical denture looks like and the fixed porcelain bridge I made for her IMG_0255on 5 dental implants. Unfortunately, most dentures look like this after about 2 years because they are made of plastic.

IMG_3807 IMG_3811

Even more convincing than having a lower total cost is the fact that the teeth that were “saved” are likely to go bad again in just a few years. What many people do not realize is that crowns get cavities too! Root canals often leak and become infected. Unfortunately, even the best dentistry will eventually fail.

It comes down to predictability and how long each option will last.

The cost difference can be quite substantial most of the time. I am often able to save the patient between $5,000 to $20,000.

In this technique,Ramsey Amin DDS, Burbank dental implantssome bone grafting will not be needed. I can avoid some bone grafting with a unique positioning (this is not the all on four method).

Most of the time, I extract the remaining teeth, place the implants and make temporary teeth all on the same day. Of course, there are a few visits before this procedure so I can take molds of your teeth, take a 3-D x-ray scan and carefully plan the implant teeth. In fact, the final teeth plan is made before any teeth are even removed.

It’s not the scan, it’s the plan. A diagnosis and treatment plan is the most critical step of all.

Another factor for you may be your appearance. Rehabilitating the bad natural teeth may not look as good as the types of dental implant bridges that I make.

I’m sure you can see that the implants look much better than the upper denture!

Dental Implants Placed and Restored by Ramsey Amin DDS, Burbank, CA

Dental Implants Placed and Restored by Ramsey Amin DDS, Burbank, CA

Please comment below or ask questions.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

818-538-5718

 

Full Mouth Dental Implants – Burbank’s Ramsey Amin, DDS Review -Video

Burbank Dental implant specialist Los Angeles

Full Mouth Dental Implants – Gun Shot to the Face – Bullet Fragments

Full mouth dental implants can be very confusing and highly varied in technique and cost.  In this video, I explain the things you should know about having dental implants to replace all of your teeth.

Here is a recent x-ray of a patient that I placed 14 dental implants and upper and lower fixed dental implant bridges.  He lost his teeth to gum disease.

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14 Dental Implants and Fixed Bridges -Teeth Lost To Gum Disease

The other shows eleven dental implants for a full mouth reconstruction in a patient that had a gun shot to the face.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry

Fellow-American Academy of Implant Dentistry

Implant Bridges – Upper Back Teeth Case Example

Many people lose all of their back teeth on the upper or the lower jaw. Implant fixed bridges can replace your back teeth.

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My patient had broken the teeth on her upper bridge.  When that happens, the whole bridge fails and the teeth need to be extracted. The other side had no teeth at all.

What you are looking at are the broken, decayed roots.  The orange dots inside the teeth are root canal remnants.

The upper back teeth often time take the longest of all the teeth to replace.  This is because the bone is very soft in this area.  It is soft because the bone is full of bone marrow rather than the hard bone cortex.  Softer bone takes longer to heal around dental implants than harder bone. I highly suggest watching this short video. (if you cant see it click this link:  http://www.dentalimplantdentistryblog.com/2009/08/video-hard-or-soft-bone-what-is-better-for-dental-implants.html)

Her plan and timing were as follows:

        Extract the teeth and bone graft the sockets> Wait four months for initial healing > Place the implants with an internal sinus lift for the upper right back most molar> Wait four months for the implants to heal > Make impressions for the real porcelain teeth and send to the lab > Place the final abutments and cement the bridges.

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If you do the math, this turns out to be about 9 months.  Many areas of the mouth can be done as same day procedures without the wait.  In other instances, going slow with each step greatly increases the chance of success.  Each person and situation is so different.

In her case, two implants were used on each side to support "three unit bridges."  This means that three teeth are being replaced with two implants.

She was so happy.  She will be returning to have dental implants for her lower missing molars!

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

Connected Dental Implant Teeth or Separate Crowns …What is Best? Dentist –Ramsey Amin, DDS Explains

The best dental implant teeth crowns can be made in a variety of ways.  The teeth can be made separately, like natural teeth or connected as bridges. This post refers to having more than one implant next to another.

In my Burbank dental implant practice, I restore the crowns or bridges for dental implants in a variety of ways depending on your unique situation.

Everyone usually wants separate individual teeth. Separate dental implant crowns allow you to floss normally between your teeth. Another advantage is that if the porcelain crown breaks or is damaged, it is easily repaired or replaced as one isolated tooth rather than having to replace two or more.X52630

There are some disadvantages to individual implant teeth.  If your teeth are long due to vertical bone loss, you may get more food stuck between two implants right next to each other.  It sounds strange to get more food stuck if they are disconnected but it happens because implants don’t have a periodontal ligament which acts a shock absorber.  When your dentist adjusts the space between the implants which is necessary to install the crowns, a good or bad space can be created. Lastly, single unit implant teeth crowns are more likely to break porcelain than connected ones

 

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The above x-ray shows the best of both worlds. In this patient from Burbank, some of the implants are connected and some are individual.

Connected implant crowns are referred to as “splinted.”  Splinted implants have the huge disadvantage that they are connected but that is also their advantage in some ways.  Splinted implants are most commonly used in areas where the bone is soft and the bite forces are strong.  That area is notoriously the upper molars.  If your bone is soft and/or had to be grafted back, splinted implants distribute forces better to the bone.  That will prevent bone loss over time that can happen around dental implants that get overloaded with bite forces such as clenching and grinding.

You can’t floss normally around connected dental implants but that is ok.  If your teeth are designed well and a great lab is used, a floss threader, proxy brush and/or rubber tip works great.  Connected implants are less likely to fracture porcelain.

in general, connected dental implants are better if there is any question  about bone stability.

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So what is the best?  Each situation is very unique.  I recommend different ways for different patients and in different areas of the mouth.  This post is focused on back teeth.  Front teeth dental implants have many other concerns from the cosmetic standpoint far beyond this post.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com