Category Archives: Dentures – Overdentures

Diabetes, Dental Implants and Bone Grafts…Is it Safe?

You may be reading this because you are at a diabetic in need of an extraction and bone graft or full mouth dental implants.  You are probably well aware that diabetes can cause slow healing from dental surgery or any type of surgery.  You can be at a higher risk of complications because of being a diabetic.

So how do I do dental implants and bone grafts on diabetics?  VERY Carefully!!!

bone-graft-squareDiabetes affects all organ systems.  Big fluctuations in blood sugar cause your healing to be impaired.  Diabetics are prone to problems with feet, eyes and kidneys but oftentimes develop periodontal disease/gum disease which has likely led you to this point to read about implants and extractions.  I tell all my diabetic patients that you must be extremely diligent in the care of your teeth even more so than someone that does not have diabetes.  This is because you are more prone to lose them and replacing teeth with implants is more difficult than your situation… difficult but not impossible.

In these photographs I show two patients that have had similar treatment at the same 7-10 day follow-up.   I treated both patients. You can see that the patient that  has diabetes that is not well managed is healing much slower than the patient that does not have diabetes.  This is not always the case but this is a great example! 

Diabetic that is not well managed is healing much slower

Diabetic that is not well managed is healing much slower

Non-diabetic with normal healing

Non-diabetic with normal healing

Neither one of these patients had bone grafting in addition to the implants they only had four implants placed in the same area for a lower dental implant overdenture.  They are both females in their 60’s.

You are probably familiar with taking your blood sugar. These numbers need to be as low as possible in the good range.  Blood sugar testing should be routine and a very important number called the “hemoglobin A1c” gives me an idea of how well you will heal after a dental implant/bone graft procedure.

Ideally the lower the A1c number the better because that gives me an idea over the last 3 months how stable your blood sugar control is.  If the A1c and daily blood sugar readings are high, then perhaps we need to consult with your endocrinologist to get it into better health.  Of course your diet and lifestyle have a lot to do with diabetes control.  Sometimes just switching meds does the trick while others need to be managed with an insulin pump.

In the weeks prior and at least 4-6 weeks after a dental surgical procedure, try to be as strict is possible with your diet and diabetes control.  It is in this critical early-phase that major complications can happen and failures or infections are most likely to happen.

diabetes-squareI use some special techniques to try to help my diabetic patients heal as quickly as possible.  For the last 14 years or so, I have used the patient’s own blood to make special concentrated versions that carry growth factors, which aid in the healing process.  Also a strict aseptic/sterile technique of placing implants, bone grafts helps reduce your chance of infection by having a very clean environment to start with.  Antibiotics are almost always necessary often in the IV and given by mouth for 7-10 days afterwards and occasionally longer.

Keep in mind that some implants and bone grafts are **far more** complicated than others.  The more complex the situation, the higher the risk of having some sort of complications.   For example, full mouth dental implants and block bone grafting is more complex than a single socket graft.

I would suggest that you work with a very skilled and experienced provider who has done hundreds of implants successfully on diabetics to figure out what is right for you.  Be very open and honest with your implant dentist so you can safely treated and have it done right the first time.  You can be succesfully treated!  Type 2 diabetes is better than Type 1 but both can be treated. You must be managed a bit differently to prevent implant failure and bone loss.

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

Bone Reduction Leveling For Dental Implants to Avoid a Bone Graft

Bone leveling is a procedure called “alveoloplasty.” Bone leveling is extremely beneficial in cases where a bone graft can be avoided altogether. Especially in the lower jaw when the bone atrophies, (melts away) what’s left of the bone is just a skinny spine knife edge type of ridge where the teeth used to be. That skinny knife edge ridge will not allow a normal size implant to fit inside of it.

stimulation of bone reduction leveling to take off the skinny part of the jawbone.  This is the jawbone in cross section.

stimulation of bone reduction leveling to take off the skinny part of the jawbone. This is the jawbone in cross section.

What’s interesting about our jawbone especially in the lower jaw and even in the upper jaw is it is shaped like a triangle if you look at it in cross section. The top of the bone is the apex of the triangle which is skinniest and the bottom of the bone is the base of the triangle which is the widest. So if your bone is really skinny at the tip and is wider at the base, a bone leveling alveoloplasty reduction procedure can take top of the triangle off leaving a wide base of bone to place the implants.  The procedure has minimal risks.

I do this very commonly when replacing implants in the lower jaw when all teeth are missing. This serves many purposes. One purpose for leveling bone is to avoid bone grafting. A second purpose would be to provide bone around the entire head platform of the implant. Finally, bone leveling for dental implants reduces cost to the patient and decreases the time until you get your final teeth… A win-win situation!

Bone reduction alveoloplasty example (1)

Before —note uneven bone that is higher in the front of the mouth where some broken roots remain

Bone reduction alveoloplasty example (2)

Before —note uneven bone that is higher in the front of the mouth where some broken roots remain

sample real case bone reduction for dental implants (1)

Before —note uneven bone that is higher in the front of the mouth where some broken roots remain

sample real case bone reduction for dental implants (2)

After –simultaneous extraction, bone leveling and placement of four dental implants….this is healing at one month

Bone reduction alveoloplasty example (3)

After -Bone reduction alveoloplasty example


Why don’t we just do this for all implants?

Why is this only limited to full arch replacement such as a Prettau dental implant bridge or when replacing large segments of teeth?

The reason is that it makes the teeth longer from the gum line to the top of the tooth. If you are missing all of your teeth bone leveling (as opposed to bone grafting ) can be extremely beneficial because it provides thickness to the overdenture or fixed dental implant bridge such as the Prettau.

Having significant thickness of your bridge will prevent problems that you may not think about such as breaking your bridge or breaking your implant overdenture. This happens so commonly when the depth of the implant is too shallow and a full arch zirconia, hybrid all on 4 bridge or overdenture case is made and the material was so thin that it just breaks in half or the teeth chip or fracture off.

Bone leveling reduction alveoloplasty can be very important for replacing all upper teeth also especially if you are missing gum tissue. Sometimes we have to use pink tissue ceramic colored porcelain to mimic lost gums. You never want this transition between the prosthetic pink gum and your natural gum to show when you smile. Although the pink gum tissue looks very natural, it does not look natural if you see the line between the two in full smile. So sometimes a bone leveling reduction alveoloplasty is done in order to hide the transition. I have been doing this procedure for at least 15 years as of 2015.

Other Benefits

Another other benefit is the bone shavings can be used to graft another area of the mouth that may need bone! This can be combined with L PRF/PRP (made from your own blood)  and other bone grafting materials to as your own bone and make a composite bone graft that is extremely successful.

Bone leveling is also important to make sure that the heads of all the implants are all relatively on the same plane. It is extremely common for the lower jaw to be missing more bone in the back and the bone to be sticking up in the front. This bone that is sticking up in the front is usually reduced for thickness purposes and to make sure the implants are at a good level with the rest of the bone and the other implants. Typically I do this procedure when I am placing anywhere between 3-10 implants in the jaw. It also allows for the gum to be closed very well and stitch in such a way that the gums almost always touch each other. This is called primary closure and leads to fast healing from surgery.

What is the disadvantage of this procedure?

If bone leveling reduction alveoloplasty is used in the wrong location, such as a single missing tooth, you will end up with a huge, open black triangles between your teeth. It is not meant to be used in cosmetic areas of the mouth such as upper front teeth. These areas are better served with bone grafting than bone reduction leveling. It is meant to treat long span missing teeth or when you are missing all teeth. Bone reduction alveoloplasty needs to be carefully planned from a full set of photographs and a 3-D scan. The point is to take away just enough bone but not too much.

Please feel free to comment and ask questions.  Please use the proper area of the blog to do so

Lifting, Moving Over-Denture…Leading Burbank Dental Implant Dentist Reviews Reasons Why. (3 min Video)

dental implant denture burbank Dentures lift and move and dental implant overdentures can too!  In this video shot in my Burbank office, I review some of the common problems that can lead to a denture supported with dental implants to lift up when you chew.  Your anatomy can also contribute to a denture that moves.

Careful planning and an understanding of your unique situation can help reduce or eliminate your denture or overdenture from lifting.

Dental implants are the best denture adhesive!


 

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
Voted Best Dentist in Burbank -2006, 2008, 2010, 2011
www.burbankdentalimplants.com

Snap In Dentures on Dental Implants – Burbank Dental Implant Specialist

Snap in dentures is a term some patients use when they come to see me for dental implant dentures in Burbank.  There is a product called the "snap on smile" that is not related to implant dentistry. 

Snap in dentures are dental implant overdentures.  That means they go over dental implants.  The more implants you have the more stable the dentures.  Just as important to the number of implants is the spacing between the implants.  The more space between the implants, the better. Overdentures are not fixed bridges.

Snap in denture burbankSnap in/on implants are dentures!  It is important to remember that.  They are dentures that snap in, they are not porcelain or "real" teeth.  You must remove them and clean under them. 

I performed the surgery and made the teeth for the examples below.

125_2565   Implant attachment mechanisms

Snap in dentures are wonderful!!!  They are best for the patient that has been wearing dentures for many years. Someone who is already used to dentures is the best candidate. 

They are NOT wonderful for someone who is just about to lose all their teeth.  If you are about to lose all of your teeth or all the teeth on one arch, you are more used to SMALL natural teeth, not an acrylic denture that has the pink plastic covering the roof of your mouth and check areas. A fixed bridge is a better option for this situation, but sometimes a snap in denture can work well.

IMG_8757 How many implants do you need? Snap in dentures typically use 2 -4 implants on the bottom and 4-8 implants on the top.   The overdenture can be made to look extremely life like if a very high end dental lab is used…very similar to natural teeth. The denture will feel stable and secure.

IMG_5971

Lower dentures are more challenging than upper dentures because there is no suction to hold them in. This lack of suction, along with jaw and tongue movement during chewing and speaking can cause a lower denture to be very uncomfortable and sometimes painful. The lower denture simply floats on the ridge where the teeth used to be and does not stay in by using suction like the upper. Because lower dentures slip and slide, and as a result cause continuous gum pain when eating, the snap on denture option is a must for lower dentures. For many patients, it is the minimum standard of care for a satisfactory quality of life.

Most of the time I see new overdentures that are made very cheaply using "economy" teeth.

If your current dentures fit well and look good, I can usually reline them to convert them to snap in over dentures.

Keep in mind that the surgery is much more advanced than replacing a single tooth.  This is because you will have bone loss if your teeth have been missing more than 3 months.  Placing implants in areas of thin and deficient bone requires substantial skill and experience.

Ramsey Amin DDS dental implants

Mini implants used for snap on dentures are often only a temporary solution but are often marketed as a "permanent" solution.

I have treated patients as old as 91 with dental implants. A healthy 91 year old can have implants while an unhealthy 50 year old may not be able to.

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

Can I Replace My Dentures With Dental Implants? Burbank’s Ramsey Amin DDS explains

"When should a denture be replaced?" “Can I replace my dentures with dental implants or an implant overdenture?” These are two questions that patients in my Burbank, California office ask on a routine basis.

There are instances where your dentures may have been replaced after 1 year or less, and on the opposite side of the spectrum, there are people who have worn the same dentures for 25 or more years. These ranges obviously are extremes.

Between four to eight years is the ideal. This would seem to imply that the average denture fabricated from contemporary materials will wear out and deteriorate within that time and/or the average denture patient's jaws have changed so much that a new denture must be redone. Each individual's denture needs are different. There are many factors that I take into consideration when evaluating the need to replace dentures.

Denture Longevity Considerations
Lost vertical dimension: The proper linear distance relationship between the upper and lower jaws is called vertical dimension. This is unique for each individual.

IMG_5612 
As one's jaw changes and the ridges upon which dentures rest shrink, a denture becomes loose and vertical dimension begins to change. Additional plastic (acrylic resin) is added to the inside of a loosening denture (called relining a denture) to stabilize it by reducing looseness caused from jaw shrinkage.

The current position held by most dentists is that when vertical dimension has been lost by three millimeters or more, a new denture should be fabricated in order to restore vertical dimension and maintain functional health.

You may have worn the same denture for extended periods with considerable loss of vertical dimension over time. Since vertical dimension loss is a slow, but nevertheless progressive, process, you may have gradually adapted to a continually increasing closed bite position. These individuals often have a sunken facial

Continue reading

Permanent Dentures and Teeth – Is it Possible With Dental Implants?

You may hear a radio ad that talks about "permanent" teeth or "permanent" dentures.

Permanent is a very strong word and may not be completely true. It may be a marketing tactic only.

A major implant manufacturer even says it!

Dental implants are fantastic, and they are the closest thing to being "permanent."  Dental implants are the best tooth replacement option available. The implant is the part that goes in the bone, but either porcelain teeth or dentures have to be attached to them.

Permanent dentures do not exist.  The overdenture that is made on top of the implants will wear out just like any other denture will.  The teeth on dentures are plastic, so they do wear out every few years and need to be replaced. Porcelain teeth whether they are made as a crown on your natural tooth or on an implant can chip or break necessitating its replacement.

Don't get me wrong…dental implants are the best, but don't let someone tell you that the teeth are the last ones you will ever have.  I would be very leary of a dentist in Burbank, Glendale or South Africa for that fact who said dentures or implant teeth are "permanent."

You should be aware of the real and honest facts that implant teeth may need to be replaced…especially dentures.

Bottom line: The implants in the bone are not replaced often, but the teeth on top of the implants can require maintenance, repair and even replacement. 

Here are some related articles that I wrote:

Dental Implant Maintenance…OVER-DENTURE VS FIXED BRIDGE

Fixed Dental Implant Bridge vs. Implant Denture – What is the REAL Difference?

How Many Dental Implants Do I Need Under My Denture?

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

Zinc Poisoning from Denture Adhesive? Burbank Dental Implant Dentist Review

This is very new information that is yet another reason to have dental implants rather than using messy pastes and liners to hold in loose dentures.

Zinc is a component used to make denture adhesive.  When you use excessive denture adhesive paste, you ingest zinc.

Excessive zinc intake may cause problems in the blood and nerves of your body.

There is no need for denture adhesive if you have an implant overdenture or have fixed dental implant bridges.

Below is the actual letter sent out to all dentists. If you wear loose dentures and use these products, I suggest you read this carefully. I have highlighted the important parts.

Please ask any questions in the comments section below.

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

******************************************************************************************************************

GlaxoSmithKline

February 18, 2010

Dear Doctor,

This communication is to alert you of the potential health risk from long-term excessive use of GSK's zinc-containing denture adhesives Super Poligrip 'Original', Super Poligrip 'Ultra Fresh', and Super Poligrip 'Extra Care.' As patient safety is our foremost concern, as a precautionary measure GSK has voluntarily stopped the manufacture, distribution and advertising of these products. GSK has discussed this situation with the FDA and no further action is required.

GSK continuously monitors published scientific literature and the adverse events we receive in relation to all our products. There is a variety of sources of zinc and it is an essential part of a healthy diet. However, in 2009 we received an increased number of adverse event reports. Together with the published literature", these suggest that excessive use of these products, typically for several years, may lead to the development of excessive levels of zinc in the blood (associated with copper deficiency). The reports describe the development of myeloneuropathy and blood dyscrasias. Neurological symptoms may include sensory disturbance, limb weakness and difficulty walking. These reports are very rare, given that several million people are users of the products.

It is important to note that zinc is not absorbed through the mouth, remaining bound to the adhesive and is only absorbed when swallowed. A small amount of adhesive is swallowed during normal use. This is not considered to be harmful.

Patients who have used Super Poligrip 'Original', Super Poligrip 'Ultra Fresh', and Super Poligrip 'Extra Care' in accordance with the instructions may continue to do so safely. While the majority of patients do use these products safely, some patients apply more adhesive than directed and use it more than once per day, usually due to ill-fitting dentures. These patients have been advised to consult their dentist for advice.

We have instructed denture wearers who have used GSK zinc-containing denture adhesives Super Poligrip 'Original', Super Poligrip 'Ultra Fresh', and Super Poligrip 'Extra Care' in excess of the product directions for several years or are concerned about their health to discontinue use, consult with their Doctor and use a zinc free alternative (e.g., Super Poligrip 'Free', Super Poligrip 'Comfort Seal Strips', Super Poligrip 'Powder'). A typical 2.4oz (68g) tube should last 8-10 weeks.

If you have any patients who describe neurological symptoms associated with long-term excessive denture adhesive use, you should refer your patient to their Doctor for assessment. We also ask that you report the case to us toll free (866)640-1017.

Regards,

Dr. Howard Marsh

Chief Medical Officer

GlaxoSmithKline Consumer Healthcare

# Hedera P, et al. (2009) Myelopolyneuropathy, and pancytopenia due to copper deficiency and high zinc levels of unknown origin II. The denture cream is a primary source of excessive zinc. Neurotoxicology 30: 996-999.

Nations SP, et al. (2008) Denture Cream: an unusual source of excess zinc, leading to hypocupremia and neurologic disease. Neurology 71:639-643.

Why Even Have Missing Teeth Replaced? – Dental Implants, Etc…

Most adults can expect to have 32 teeth. The four third molars, or “wisdom” teeth, are often extracted because they do not grow into the mouth well or there is not enough room for them to remain in proper alignment. It is very unusual to have wisdom teeth replaced. But the other 28 teeth are needed.

Your mouth, jaw, and body developed together over millions of years. They are designed to operate together at peak efficiency. When you lose a tooth, the efficiency decreases and function suffers. When you lose a tooth, you lose some ability to chew food properly. This may mean that you either place more stress on the other teeth in order to chew all the food you eat, or you do not chew well enough and what is swallowed is not quite ready to be digested. This can lead to digestive difficulty. You might have to eliminate certain favorite foods because you cannot chew them thoroughly.

For each missing tooth, you lose approximately 10% of your remaining ability to chew food.

Other problems also occur. The teeth adjacent to the space left by the missing tooth will eventually shift.  If for example, a lower tooth is extracted, the opposing tooth in the upper jaw will grow slowly (or sometimes quickly) longer in a downward direction into the missing tooth space. This is called extrusion or supereruption. Here is an example:

Collapsed bite- need for dental implantsThe teeth on either side of the missing tooth space will move and tilt off their proper vertical axis and drift into the missing tooth’s space. This can make these teeth more prone to decay and gum disease because it is much harder to keep the teeth clean when they are not aligned properly.

Root structure that is normally covered by gum and bone may become exposed. All this can happen if one tooth is lost. Other major problems can occur if multiple teeth are lost. There is a loss of the arch length, the distance from the back of the last tooth on one side of your mouth to the back of the last tooth on the other side of your mouth.

With collapsed bite and loss of vertical dimension, the distance from your chin to the tip of your nose decreases, making your face shorter.

Extrusion and movement of your maxillary (upper) alveolar bone until the gum tissue from the upper jaw can touch the teeth or gum tissue of the other jaw causes loss of facial tone and shape. The facial muscles of the cheeks and mouth sink into the edentulous (extraction) site. There can also be severe cosmetic problems when the extracted tooth’s space is visible when you talk or smile. This is not a pretty sight to anyone.

There is loss of self-image and self-esteem and a feeling that you are getting old. Once you bone loss- need for dental implantsstart losing teeth, you can actually start to look old. Losing a tooth is pretty serious. The longer you wait after a tooth is extracted, the more difficult and expensive it can become to make the replacement you need. With very few exceptions, it is better to replace missing teeth as soon as possible. Evolution designed you to chew your food with 28 teeth.

I will discuss with you the best type of dental implant replacement that will restore your mouth to health. My office is located in Burbank, California.

You can choose to do nothing at all and leave the space or spaces…this is not usually recommended. You can have a fixed replacement made that could be an implant, a conventional bridge (crowns/caps), a dental implant overdenture or a combination of implants and bridges. The advantages of the fixed replacements are that they are not designed to come out of your mouth at any time, they are the easiest to live with, feel more like the original teeth, and are more cosmetic than removable dentures.

A removable partial denture is held in place by metal clasps that may be visible. It is bulkier and may interfere with your speech for a period of time. However, generally, dentures cost less than a fixed replacement.

Your jawbone and teeth were meant to function in a particular fashion. The interaction is complex and marvelous. Loss of teeth degrades this function. Preserve your health. Replace missing teeth as soon as possible!

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

Dental Implant Overdenture Locator Attachments…Patient Information

If you already have dentures, dental implants can be used to "lock" your denture to the bone. This is called an overdenture.

Please see this post for some overdenture basic information.

There are many choices for securing your implants to the denture. You should know that are bars or individual anchors. I will focus on the locator attachment.

Abutment%20open%20assy-white

This video will help you understand the basics: (if you cant see the video use this link http://www.youtube.com/watch?v=i8hb6_9Es6A )


Here is a picture of what they look like in the mouth:

IMG_1255

This is a picture of the actual attachment that gets embedded into the denture.

IMG_1252

Does this help you? Please comment below!