Do I Need Custom Dental Implant Abutments?

There is a lot of confusion with patients that have come to me for 2nd opinions. The question is whether or not their dental implants need custom abutments or not.

 

I will try to make this as non-technical as possible. If you are confused, comment below and I will reply.

Most implants have three pieces. The implant that goes in your bone, the abutment the holds the tooth, and the crown tooth that attaches to the abutment.

   Implant_anatomy basic pic

 

In my practice the additional expense of a custom abutment is only necessary about 10% of the time. It can increase the cost of the dental implant by about 10%.

 

The best way to avoid making a custom abutment is for your implant to be placed correctly. Many implants are placed incorrectly at a incorrect angle and require a custom abutment to make it straight again.

 

Nothing beats a well-placed implant!

 

A well-placed implant allows me to use a pre-fabricated abutment and reduce cost to the patient. This type of abutment also has a better fit than a custom one since the titanium mating surfaces was manufactured to fit very tightly. Well made dental implants have a very tight connection between the implant and the abutment. This is very important for the long-term maintenance of your bone around the implant.

 

Here is case of the back molars replaced with dental implants and prefabricated abutments:

IMG_8576 IMG_8580

 

I use custom abutments for the following scenarios:

  • An implant for an upper front tooth where the gum may be thin and the titanium would show through. (White zirconia abutment)
  • The space between your upper and lower teeth is really small and the implant need to be held by a screw instead of by cement.
  • Multiple or full mouth bridged dental implants.
  • Overdentures that have a bar to hold them in.
  • Excessively thick or thin gums.
  • Excessively "scalloped" gums.

Here is a picture of a custom white zirconia abutment and the final crown that I made:

IMG_3696 IMG_3699 

IMG_8813

Sometimes the way the gum heals from the surgery may change an original plan for a prefabricated abutment to a custom one.

 

I teach classes to other dentists about dental implants. Most dentists are not aware when you should use a custom or prefabricated abutment.

 

As a Diplomate of the American Board of Oral Implantology (the highest certification acheivable), dentists and patients seek me out for education and opinions on what is the best treatment.

 

My goals are to simplify and streamline the procedure for patients. I do see an overuse of customized abutments when the prefabricated one would have been just as good or better.

This entry was posted in Cost of Implants, Dental Implants, Example Dental Implant Cases and tagged , , , . Bookmark the permalink.

136 Responses to Do I Need Custom Dental Implant Abutments?

  1. Dr. Andrew says:

    Beautiful coverage here…the pics are so descriptive…thanks a ton for this nice update it can almost be a study material.

  2. Morgan says:

    Dr. Amin,
    I have a situation that I would appreciate in getting your professional opinion on.
    Tooth number #19 I had an Implant that was placed incorrectly at an angel. Very uncomfortable because there is a big gap by the gum line between 19 & 20, food gets trapped all the time and there is a major gum recession on #20 which has become extremely sensitive to cold & Air . After I expressed my concern to the performing Perio, he suggested custom made Abutment in supporting the new crown that would fill the gap between 19 & 20…
    In your professional opinion, would you say it would be better for me to go with custom abutment and new crown or have the implant removed and bone graphed again and redo the whole implant in its correct position????
    After reading the information about custom abutment and the draw backs I am concerned that this may be a temporary fix rather than a permanent one. Btw, he also suggested in having gum Graf on facial of #20 to reduce the sensitivity..
    Look forward hearing from you.
    Morgan

  3. Hi Morgan,
    The angle of placement of a dental implant is very important.
    Unfortunately, without examining you, I can not tell you if it is a good plan.
    Anyway to post some pictures or x-rays for me to look at?
    Sorry,
    Dr. Amin

  4. Morgan says:

    Dr. Amin,
    I greatly appreciate your response to my email. Per your request I have a clear photo of the x-ray for your review but i would like to know how to send it to you.
    Look forward hearing from you.
    Regards,
    Morgan

  5. MICHAEL says:

    DR. AMIN,
    I HAD AN IMPLANT PUT IN ABOUT 6 MONTHS AGO AND I AM GETTING READY TO HAVE THE ABUTMENT AND CROWN PUT IN. MY DENTIST IS CHARGING ME 1250 FOR THE ABUTMENT ALONE. I ASKED WHY MY PERIO CHARGED ME 477 FOR THE SAME PIECE 6 MONTHS AGO (WHICH HE SENT TO HER OFFICE). SHE TOLD ME IT WAS BECAUSE SHE USES BETTER MATERIAL AND THERE WAS A PIECE THAT WENT IN BETWEEN THE ABUTMENT AND THE CROWN. THIS IS ALL NEW TO ME AND I AM JUST WONDERING IF SHE IS OVER CHARGING OR IF THIS IS CORRECT. MY PERIO SAID HE WOULD CREDIT ME THE 477. I AM JUST TRYING TO FIGURE OUT WHAT THE DIFFERENCE IS BETWEEN HIS (477) AND HER (1250) ABUTMENT. ANY INFO WOULD BE HELPFUL. THANKS, MIKE

    • barbara says:

      an excellent oral surg. did 2 adjacent sinus lift + bone and implants. my reg. dentist said i needed a custom abutment (2,000 each) plus crown. he charge $2,000 each for custom abut. (i didn’t know this beforehand and did not have choice). the implants are excellent. but the crowns and custom abutments are on order. why would i need “custom” abuts.? I’ve had other implants w/o any custom abutments. thanks for you imput. barbara

      • Ramsey Amin DDS says:

        Hello Barbara,

        $2000 for an abutment alone in the year 2014 seems \costly. Are you sure it is not the abutment and the crown combined together? It is not uncommon for the abutment and crown together to reach into the mid $2000 range.

        Sometimes custom abutments are absolutely necessary. This could be due to gum depth, gum thickness, whether the implant is connected to other implants, degree of scallop, angulation, aesthetics and about 50 more other things.

        Very respectfully,

        Ramsey Amin DDS
        Diplomate of the American Board of Oral Implantology/Implant Dentistry
        Fellow of the American Academy of Implant Dentistry
        Burbank, California

  6. Hi Mike,
    What is the charge for the crown if the abutment is $1250?
    This will help me answer your question!

    • Mary Corbett says:

      Hello,
      I am having an implant on my front tooth starting with surgery to remove old front tooth # 8 ,it has a post and crown now. The tooth fell out suddenly ,dentist re-cemented tooth till I start this procedure. I will have bone grafting done during first surgery and a interim partial made to get me through all of this. How soon after first surgery do they begin a custom abutment procedure.When does the implant procedure begin,after four months of healing if I heard all this info correct?

      Thank you,
      Mary Corbett

      • Ramsey Amin DDS says:

        Hi Mary,

        The timing of your upper front tooth dental implant is variable. If the bone is in better condition, an immediate, same-day dental implant with same day bone graft can be done and in fact may yield the best result.

        If there is any compromise whatsoever in your existing tooth and surrounding bone, the procedure should be done in stages. From what it sounds like, you’re tooth will be extracted, bone will be added on that same day and the area allowed to heal for approximately 4 months. 4 months later the dental implant will be placed and allowed to heal for approximately another 4 months. So about 8 months have gone by. That is about the time that the crown and/or custom dental implant abutment can be fabricated along with a temporary crown in order to “groom” the gum tissue back to its original shape.

        So all in all Mary, it is really going to depend on your unique situation. The upper front teeth tend to be the most expensive of all the dental implants if you want to turn out well. They are extremely complex and require extreme attention to detail.

        Good luck,

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

  7. Epiphany79 says:

    Dr. Amin,
    I too am about to have abutments and crowns fitted on teeth #10 and #11 when I can find a dentist to do this.
    Firstly – does a periodontist need to fit the abutments I currently have healing abutments and a flipper) and crowns or can any dentist do this?
    Secondly – can you give me a rough price scale for a custom zirconium abutment? (I am assuming that i would need custom as these are 2 front teeth).
    Many, many thanks if you can help me with this, Emma (CA)

  8. Hi Emma,
    A periodontist does NOT need to do this. Who ever is making the crowns should make the abutments for the best results. The #10 and 11 area is a very tricky area of the mouth when two implants are right next to each other.
    See this post: http://www.dentalimplantdentistryblog.com/2009/04/the-triangle-of-gums-between-teeth-and-implants.html
    Don’t just find “any” dentist to do this. Look for someone who is a Diplomate of the American Board of Oral Implantology /Implant Dentistry and a
    Fellow of the American Academy of Implant Dentistry. You will be in good hands with them.
    From the cost perspective they may be around $750.00 each.
    Does this help?

  9. annie jackson says:

    My dentist did not give me the price for the crown and abutment until after the implant was placed. He is charging me 4,200k for 3 teeth is this too much?

  10. sms says:

    You own a amazing flair .Best of luck and keep going.And yes i have tweeted your site

  11. Phuong Le says:

    Dr. Admin
    My mom had a implant on her lower right canine n her doc says she needs an custom abutment Bc her gum line is the same level as her implant . He used a 5mm He recommended her to get a gum reduction but says she must pay 650. I was informed that he probably inserted the implant wrong n he shouldn’t even charge us for it. What can I do if He says she has to pay?

  12. Hi Phoung,
    The need for a custom abutment does NOT mean the implant was placed wrong!
    Sometimes you have to use them to make a tooth just right.

  13. MH says:

    Dr. Amin,
    I just had an immediate implant put in the place of tooth #21. That tooth few years ago had a root canal done and crown put on top and just few months ago it broke at the gum level. So the specialist recommended immediate implant and it was placed at the same time when he extracted the rest of the tooth. It has been 3 weeks from the surgery and I am little nervous because the tooth next to it is still tender ( the tooth that is on the right side of #21 when you facing me) As I looked at the ex-ray it looks like the implant is pretty large and its right up to the tooth that is tender. Should I be worried? Is that normal for the implant to be so close? I do not have very big teeth or bite so I am also some what worried that the healing cap seems to be taking the whole space between the two teeth. When the doctor placed the abutment just to try it out right after the surgery I could not even close my mouth because it felt larger than a tooth. He mentioned something about getting a smaller abutment. Is the immediate implant usually larger than the two stage implant? I know that the general dentist will have to put on a crown in about 3 months. how much room is it necessary around the abutment for the crown to fit? Please let me know if you have any recommendation or should I just let the professionals worry about what they have to do.
    Sincerely
    MH
    M.

  14. Hi MH,
    The x-ray you are looking at is a two-dimensional image of a 3D object. Sometimes implants on x-rays can look like they are on top of one another or touching things that they really arent.
    Please make sure your dentist, knows about the tender tooth.
    Some immediate implants are bigger or smaller than the original tooth.
    Please keep me posted with your progress.
    Dr. Amin

    • MH says:

      Hello Dr. Admin,
      Since the last email the tooth next to the implant stopped hurting and I am finally after a year and a half in the process of restoring the tooth. I do have a question for you. The surgeon that put the implant in, had to take out the healing cap off because it was moving around to much. So he let the gum close over the implant. He told me that I would need custom abutment and that the dentist that would do the crown would make that for me. Before restoration I had to go back to the surgeon so he could recover the implant and put in a healing cap on. Instead, he put in the abutment that initially came with the implant (that was too big) and said that he was using it as a healing cap. I went to the restoration dentist today, and he told me that all he is going to do is adjust this abutment by making it smaller. He said he has to shave it down from the top as well as around because it is too thick. Does this sound right to you? I thought that custom abutment meant that it was going to be made to fit the implant and much smaller. The restoration dentist is also restoring #20 tooth at the same time by putting on a crown on that one as well. This tooth is not the one that was hurting (that was the tooth #22 I think) the tooth #20 and #21 are little on top of each other. #20 came in late so it looks like a smaller tooth and it is so close to the implant that the restoration dentist wants to do both at the same time. I am only concern in how much would he have to shave down the abutment to be able to place a nice crown on it. When the abutment is in place, it looks like its about 2mm away from #22 and maybe 1mm away from #20 and of course way too tall. The abutment almost feels like a tooth. What do you think doctor? Am I missing something here? Is it normal to shave down the abutment like this? I just don’t want to compromise the strenght of it. Any advice?

      • Sometimes you have to drill on the implant abutment in the mouth. Often times the results turn out even better than a traditional coping tpe of impression. Are you local enough for me to see you?
        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry

  15. Linn says:

    I just finished the process of having the surgical portion of the implant done (which involved a bit of bone grafting, so it’s taken 7 or 8 months to get to this point). I phoned my dentist to schedule having the tooth portion (sorry don’t know terminolgy) made. I found out that just this portion is going to cost $3000. The dentist’s office told me that it is “$1500 per abutment.” I only have one tooth missing, and only one implant, but apparently my dentist “always” uses two abutments. Does this make sense to you? Is this normal? I’m suffering from sticker shock. (This is, of course, completely separate costs from the surgical part.) Is there a cheaper acceptable option? It will take me at least a few months to save this much. Is there a time limit?

  16. Hi Linn,
    The “two” abutment part sounds odd if it is only one implant. It may be a “two-piece” implant or abutment.
    Keep in mind the the crown and abutment usually cost MORE than the surgery.
    Respectfully,
    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

  17. Pete H. says:

    I have been told my wife needs a molar replaced with an implant. We dont have alot of money to pay for this. Groupon has a deal going on that reads as follows…$999 for Titanium Dental Implant and Prefabricated Abutment (Up to $2,100 Value) this is from a company called Dental Masters. 24hr cancellation notice required. Services are non-transferable. Not valid for bone grafting, bone augmentation, or any further diagnostic aids or treatments. Consultation required.
    Does this offer seem valuable?

    • Hi Pete,

      This ads are like teaser rates on credit cards. Based on the ad, there is no “tooth” crown on the implant so it is misleading.

      Many of these facilities are “mills” where patients are just churned out. Remember you are replacing a body part…time, skill and planning need to happen in order to have a lasting, great result. I have personally had to redo many implants done in these “super-center” type of offices. You will probably see many different dentists.

      I would not do it.

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Fellow – International Congress of Oral Implantologists
      UCLA and Western U. Dental School Faculty

  18. galina says:

    I am going to put zirconium crown on tooth #12. My dentist want to use titanium abutment with zirconium crown. But I think, that abutment should be zirconium too.
    He told me that zirconium is fragile.

    • Hi Galina,

      If your gum is thick, the zirconia will block the metal from showing through. Yes, having a titanium abutment is stronger but zirconia abutments are not fragile at all.

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      UCLA and Western U. Dental School Faculty

  19. shay sams says:

    when is it necessary to have a prefabricated abutment in conjunction with a custom abutment?
    thanks

    • Hi Shay,
      You either have a prefabricated OR a custom abutment on a single implant, not both.

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

      • shay sams says:

        i thought so from your readings but im being charged with both on each tooth
        now im being told i will receive abutments on the teeth and just the prefabricated abutments

        is this correct?
        thank you for taking the time to address these concerns

        • Hi Shay,

          Just speak to your dental implant dentist. I am sure there is just a misunderstanding and your dentist is not trying to fool you. If you are having a bridge, some dentists call the anchor an abutment, but the real word is a retainer. That is my best guess. Keep me posted!

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

  20. PAT DRURY says:

    I HAVE A QUESTION ON IMPLANTS , IM HAVING IMPLANTS PUT IN SOON AND I KNOW THEY TAKE A FEW MONTHS TO HEAL #29 #30 , THEN SOON I WILL HAVE THE CUSTUM ABUNDMENTS DONE , CAN THEY PUT A TEMPORARY CROWN IN FOR A FEW MONTHS UNTIL MY INSURANCE KICKS IN A GAIN THE NEXT YEAR ? TO PAY FOR THE CROWNS? OR DOES THIS PROCEDURE HAVE TO BE DONE ALL AT ONCE CROWNS AND ABUNDTMENTS ? IS THERE SUCH A THING AS TEMPORARY CROWNS ON ABUNDMENTS ? TRYING TO SAVE SOME MORE MONEY AND USE MY INSURANCE AS WELL.. THANKS

    • Hi Pat,

      This is a wonderful idea that I use very often! Not only will it help you save some money, but it also allows the gum tissue to mature and form around the implants. In addition, it allows the bone to be “loaded” slowly if it was an area that was bone grafted for the dental implants.

      :) Dr. Amin

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

  21. shay sams says:

    hi dr amin
    this isnt coming from the implant doctor, but from the primary dentist
    i dont understand a charge of $7000+ for crowns and impressions of three teeth
    thank you

    • Hi Shay,

      Keep in mind that often times, making the teeth and abutments is more costly than the implants themselves. This is normal.

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

  22. betty says:

    So after paying $2,500 for dental work & another $2,500 for braces.. also paid paid $1700 for a front tooth implant & it covered the bone graph, the screw looking thingy & the actual “tooth” to be implanted now I’m being charged almost $1,000 for something called the abutment which I’m just finding out was left out from pricing by error, do I really need it? Am I being over charged? Or should I consider myself lucky?

    • Hi Betty,

      It sounds like it was an honest mistake. You need the abutment. There is no way around it unless it is a one-piece implant. The fees are reasonable.

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

      • Bob says:

        Dr. Amin,

        Your website is great…very informative. I am currently contemplating implants on my two upper front teeth. Both have had root canals and crowns. I recently broke one tooth off at the gum line. My dentist removed the adjacent front crown in order to support a temporary crown for the tooth I broke. My questions are the following: 1. can two adjacent implants be placed at the same time; 2. is a bone graft and tissue regeneration required if there are no apparent bone problems; 3. my dentist is suggesting using the #7 & #10 teeth to support a temporay crown during healing; and 4. the total cost is $13K which seems high based on my research.

        Thank you.

        • Hi Bob,

          Thank you for your kind words.

          Yes, two adjacent implants can be placed at the same time and the right way to proceed. A bone graft is often necessary even when you don’t see a problem. There are often voids between the socket walls and your newly placed dental implants that should be filled in. If 7 and 10 are untouched teeth, I would not make crowns out of them for temps. Temporary bonding or other conservative options are best.

          As for the cost, the front and center upper teeth are the most complex teeth in the mouth for implants and can run from 8 -15K to replace. Make sure your dentist is highly experienced in this area of the mouth. Ask to see similar cases results that they have done.

          Respectfully,

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

  23. shay sams says:

    thanku for your input it has been very helpful

    i found he has me fixed with abutment crowns and abutments
    if this clarifies things a little better.

  24. Sarah R says:

    Hi Dr Amin. I have 3 implants. #7, #10 and #11. I have been wearing temporary abutments and crowns for the past year because my dentist cannot find a custom abutment for # 7 and #10. My periodontist used biohorizons 3.0 implants in these areas and he said that no one is currently making zirconium implant abutments and I need to wait. I don’t want to wait any longer but I also don’t want a metal abutment! I hate my temporaries, my teeth look gray. Please help. Are you aware of any labs that will make custom abutments for 3.0 implant size??

    • Hi Sarah,

      Is it the gums or the teeth that look grey? Look VERY closely. If it is just the tooth, a titanium abutment should work easily. If not, a company called ATLANTIS abutments should be able to make them if it is a two-piece implant. The problem is the small diameter which is good for the front teeth. Also, if the implant is one-piece, then there are no options for zirconia. Do you live near me? Let me know what happens.

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

  25. Liz Whitlock says:

    Dr. Amin,
    I had two root canals/crowns on #29 &#30 less than a year ago. #30 had to be repeatedly reattached and still loose with pins inserted, # 29 has broken off at gum. Dr. says I need implants & still paying for original work. Can the broken tooth be removed and left for a while or dones it need to be replaced immediately? I do not have any molars on my left side. Should I consider implants there first?

    • Hi Liz,

      That is a story I hear all too often. It sounds like the teeth were very “borderline” when you had the crowns. Crowns are great as long as there is substantial tooth under them.

      It is important to replace both teeth asap to avoid big problems and expense in the future.

      Respectfully,

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

  26. Sarah R says:

    Hi Dr Amin! Thank you so much for responding to my post! The gums don’t look gray. I think my tissue are thick enough around the implant. The tooth does look gray though. Its a temp crown with a metal abutment. But my implants are 2 pieces. So I can get a new abutment. Sadly I don’t live near you. I’m in Indiana. I wish I did! I need help! I’m still in the same boat I have been in. I want my permanent crowns but my dentist can’t find ceramic abutments for my type of implant. He says I won’t like the gold abutments. But I’m just tired of waiting. I don’t know what to do. I want it to look good but I don’t want to wait anymore time for the ceramic. Its been 2 years! He just keeps telling me that I wont like the gold ones. He says that the crowns he would have to make me will have to be a special with metal in them and it sounds ugly. Should I go somewhere else?

    • Did you or the dentist talk to ATLANTIS abutments? They should be able to make them if it is a two-piece implant from a major company.

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

  27. Rekha Pawar says:

    I had two implants placed 3 months ago. My oral surgeon told me one month back that I needed to see him in one month and give me abutments. Well I saw him today..I said I might be going to a different dentist to place the crowns..I have bee shopping around. Anyway he didnt give be the abutments and said to let me know the name and he’ll have to talk to him. He said the dentist will be making abutments. I’m confused.
    These are for my canines..I never had permanent teeth and at age 50 I had two dentists tell me they were getting lose so I had the implants.

    • Hi Rekha,

      Every dentist has a different technique than the other so it is a good idea that the surgeon speaks to the new dentist. Shop around based on experience and expertise rather than price. You want this done very well to avoid long term issues.

      Let me know what happens.

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

  28. Joy Yang says:

    Hi, Dr Amin
    I had #14 extracted and am going to have a dental implant. I had consultation with 2 different doctors. One told me that I need a sinus augmentation and the other said it’s not necessary. Will it be okay with the implant screw-end stick out in my sinus? Will it damage the sinus membrane if I don’t have the sinus lift?

    • Hi Joy,

      Generally speaking it is not a good idea for an implant to be sticking into the sinus without bone around it. The sinus bone graft needs to be done for a dental implant to hold well for the long term

      Attached is a link for you to learn more.

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

  29. Jennifer says:

    Is there a way to tell a zirconium abutement crown from an all porcelain abutement crown?

    Also I noticed you refer to the zirconia abutement as white zirconia abutement. I thought zriconia abutement mean a white color abutement. I also thought that zirconia is made from a very strong type of material(procelain/ceramic).
    I am really worry cuz the dentist I went to for these items did not put the correct description or a valid dental code. The young lady told me that she had to do that cuz I didn’t know the dental code to give her. I thought that didn’t make any sense cuz I am not in the dental business and why would I be supplying her with the right dental code for insurance purpose. I am very worry cuz inital consultant they did give me a piece of paper stating exactly what I want, but after they made me pay the lump sum and when I got the receipt it says totally different items.
    I paid a few hunderd 10 days ago with a debit card, but the remaining balance on tuesday with a charge card. Am I glad I did that cuz credit card and debit card is a total different. With the few hundred dollar I paid I cannot even get it back even thought if the dentist is attempting to give me something different than What I asked and thought I paid for. Anyway, I was told by another denist on youtube that they should know the code. He also think it sound fishy that they don’t know the dental codes for the items that I paid for. Please advice. I am so frustrated and depress over trusting dentists. Last year I paid for a lava crown and the dentist put in a procelin over metal despite the fact I paid the different amount of the total implant restoration package. This dentist website disappear , but her business is still there.

    • Hi Jennifer,

      Zirconia is white. Not all custom abutments are zirconia though. Some are still titanium metal for good reason.
      Unfortunately, not all procedures have a dental code that is ideal. It is not uncommon to change a code, but the fee should not change without you being aware of it. Often after a procedure is completed, some things change and you have to use a code that is the closest match if it does not fit the mold of insurance codes.

      Some dentists and dental offices only dabble in dental implant treatment, while others specialize in it.

      I’m sure your dentist is ethical and not trying to pull on over on you.

      Respectfully,

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

  30. Jennifer says:

    Hi Dr. Amin,
    What would you charge to do an implant on the top front upper jaw. It is one of the two front teeth in the center of the mouth???

    I sent more than 20 mintues reading through all your comment and decided I would like to ask another question. Can u think of a reason why a dental practice that is in-network with my dental insurance ask me to pay up front for my abutement crown??? They have all my insurance information and have over 1 week to verify that I am who I am. Obvious they can get the information that I have enough money to cover the 60% of the crown. And this denist is not my regular dentist I go to. My regular dentist can do abutements ,but when I told him the implant that was placed in my front lower jaw tooth is a Legacy , then he said he never heard of it and didn’t go any futher. It sound like he is familiar only with the popular brand implant and worked only with those implant types or could it be that he just don’t feel comfortable with working with brands that he never heard of or maybe he doesn’t do custom zirconia abutement. I am tryng to figure is there a big different between a legacy 3.0 implant than other brand implants of the same size. I don’t know if I am confusing with this question.
    I am hoping you can help to answer some of my questions. I am getting really stress from the issues of dental work. I like honest dentists and those that is up front with me. I only found out about zirconia abutement through my own internet research and the same goes fro the zirconium abutement crown. Never in the past had any dentist told me there is different types of crowns. The ones I used before I had internet access (13 or more years ago) kept putting procelain over metal on me. They never even told me there are different types of crowns. I wish more dentists would tell their clients of the different choices available, but most just don’t.

    Again Thank you so much for spending your precious time in reading emails from people and god bless. I believe honestly is what will get dentists free referals to their services and the bad ones get ding on yelp and other review sites.

    • Hi again Jennifer!

      It is customary in today’s dental practice to collect your portion up front. Keep in mind that your crown and abutment is being custom made and hand crafted by a dental lab technician. Your dentist had to do a lot to get an impression of the implant. As an analogy, if you order a custom upholstery for a piece of furniture it is customary to pay a portion in advance too.

      Insurance companies play games and your 60% is only an ESTIMATE. They may not pay at all even though you are in-network.

      Legacy is an excellent dental implant. You have one of the best implants made in your mouth. It sounds like your dentist did the right thing to refer you out if he is not comfortable doing the work. That is a sign of a good dentist!

      Good luck!

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

  31. Christina says:

    Hi Dr. Amin, It’s been almost a year since I had a 3mm implant for tooth #7. For six months now, I have been working with the dentist and lab to get a good shade and shape for the crown. I am told that I have to have the metal abutment because of the 3mm implant. This abutment shows blue/grey through the crown. I have taken several trips to the lab and dentist office and am now on my third trial crown. They just can’t seem to get it right. If it’s not the color then it’s the shape that keeps changing. I am so fed up!!! Now the lab says I will have to pay for another crown if I want them to do it over. Why should I have to pay twice for them to actually make a wearable crown? My dentist says that I am focusing to much on #7. Well, for paying over $4k out of pocket for the whole procedure, I think I am entitled to getting a good looking crown so that I can smile confidently again. With all the technology today I feel that the lab should be able to make a crown as far as shape and color. It seems as though the dentist blames the lab and the lab won’t work with the dentist and I am stuck in the middle. Please Help!!

    • Hi Christina,

      Can you get a custom zirconia abutment from Atlantis? If anyone can make it, they would be the ones. The problem is the narrow 3.0 platform.
      You can always make a PFM custom abutment to get some white color under the gum.

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

  32. Joy Yang says:

    Hi Dr. Amin,

    I had a post several weeks ago and thank you so much for the response. That helps a lot!

    I still have several more questions would like to get your opinions:

    -is that fine to just have local anesthesia? the doctor I went to told me that they do offer oral conscious sedation (which is a mix of different pills that leaves you conscious but you have no memory of the procedure). It is a bit more expensive for that and there is more paperwork that needs to be filled out prior to the appointment.

    -the doctor also told me that for an implant #14 a Sinus augmentation would be ideal but you can get away if you use a shorter implant. Most likely the sinus membrane will be broken. Post-Op Anti-biotics will ensure against any sinus infections. Do you think that makes sense? I’m a bit intimidated by what he said. will i get infection or chronicle nasal problem in the future?

    Joy

    • Hi Joy,

      Some type of sedation is the way to go. Depending on the method of placement, the surgery can be tough for you. I would suggest sedation for dental implant placement. Some upper implants are placed with compression which is a feeling that can not be numbed.

      If a sinus lift bone graft is needed, that is the right way to do it. The upper jaw is best served with longer implants. The membrane is not usually broken. If the sinus lining is broken, it will most likely repair itself.

      Ask how many sinus procedures he has done.

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

  33. jodi says:

    Hi Dr. Implant of molar was successful. No pain at all. 6 months later when abutment andhealing cap werqere put in…….major pain! Feels like healing vapid on too tight. Oral surgeon and dentist are stumped. He has removed cap 3 tq

    • Hi Jodi,

      You question was cut off. Can you resend it?

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

  34. Glenn says:

    Dear Dr. Amin,

    I just had #19 pulled (It had had a root canal and became abscessed). My periodontist charged $345 for the extraction and $510 for the bone graft. In four months, he will place the implant. He quoted $160 for the stent and $2200 for the placement.

    Four months after that, I will return to my regular dentist. I was quoted $795 for the custom abutment (code 06057) and $1850 for the crown (06058). So altogether, this is over $5000. I am experiencing “sticker shock.” I see much lower prices quoted here and elsewhere. I live in Laguna Niguel. Is this a more expensive area for such work? Or is #19 a more expensive tooth? Both doctors are very good. I don’t have insurance but I do have an Aetna dental plan, whose prices for the abutment and crown are only $400 lower, but I was told my dentist would not honor those prices for this work. A friend had similar work in this area for similar prices. I don’t understand why the prices I read online are so much lower. I don’t want shoddy work that will cause more problems later, but do I have to pay this much?

    • Hi Glenn,

      I think your last line says it all. Choose your dental implant dentist based on their skill, training, experience and judgment. These are body parts you are replacing. The fees are within a normal range as of 2012 for a very skilled implant dentist.

      There are several areas in my own practice that I am able to save my patients a significant amount of money since I do the surgery AND make the tooth.

      Sorry for the sticker shock!

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

  35. Robert says:

    Is there a company that handles hard to find abutments?

    • Hi Robert,

      What brand of implant do you have? You can always custom make one! Atlantis is a popular company.

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

    • RamseyAminDDS says:

      Atlantis abutments can usually be custom made for you.
      What is the brand of implant you have?

  36. Josh says:

    Dr. Amin,
    what a nice and informative site you got here!
    To help you answer Robert`s question (if you do not mind)
    Atlantis is a great system, however ,some brands may not be covered by it.There are some dental labs or milling centers that will make custom abutments for most of brands. At HiCeram dental lab we make these custom abutments in any size and for any brand using our own facility. Depending on the brand name some custom made abutments may be even less expensive than prefabricated ones.

  37. robert says:

    sustain internal bevel implant

  38. Mary says:

    Dr. Amin,
    I just had a broken bridge removed from my lower right teeth. #31 is missing. I discussed getting an implant with my dentist. He agrees this is a great option for me as I have very strong bone to work with. However, he says he will need to place two implants in order to correct the one missing tooth. I do not understand this and have found nothing to support this method online. Do you have any input for this treatment?

    • RamseyAminDDS says:

      Hi Mary,

      You probably had a three tooth bridge from 31 to 29. You were already missing the middle tooth 30 and now you lost 31. You will be missing the very back two teeth.

      It is strongly recommended not to attach implants to natural teeth. That being said, two implants are necessary to replace teeth in that area.

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

  39. John says:

    Greetings:

    After having two root canals and two crowns on #30 we opted for extraction and implant. It was about one year between extraction and setting the implant. It has been 5-months since the implant was set in the bone. We are getting reading to start working on the restoration. It appears that I have a very large gap between #29 and #31, #31 is possibly migrating backwards. My regular dentist in the USA recommended a custom abutment. I live out of country in Colombia and the doctor performing the work is trusted and professional. The implant appears to have been set correctly and straight. What are the options I have for abuments materials, what is recommended and what is most successful? Will a custom abutment do anything to help with a possibly over sized gap? And make material would you recommend over it for the crown? I am not sure if a custom abutment can even be fabricated here. I have a Biomet 3i implant…does they do the abutment and crown or does some private lab do that part. Should the abument and crown come from the same place? Thanks for all you help…

    Regards,
    John

    • RamseyAminDDS says:

      Hi John,

      The custom abutment might help. The lab can fabricate an Atlantis custom titanium abutment for you. Over this you can make a monolithic zirconia crown. These are both modern methods to achieve your goals. Gold is another strong option if you don’t mind metal in the mouth.

      The large space will put some extra force on the bone and the crown. This is called a cantilever force.

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

  40. cathy says:

    Dr. Amin,
    I had an implant (biomet3i) on tooth number #19 last July and went back to my general dentist to get abutment and crown. The general dentist ordered a custom abutment but the shape of abutment is square. The surgeon that put the implant in, had a cylinder healing cap. When the general dentist tried put the square shape abutment into cylinder shape implant, it was so painful. I refused let him to put it on because I’m wondering if it’s custom abutment, how come it will be square shape. I want to get an second optional. Is sounds right to you that come with different shapes on abutment. I look forward hear from you. Thank you very much!

    • Ramsey Amin DDS says:

      Hi Cathy,

      A square abutment is not a bad thing! The top of the abutment is made square to prevent rotation of the crown. If it was circular, the crown would spin and likely come off easily.

      The gum part is often bigger than the healing abutment in order to provide a better emergence of the crown. You may have to get numb to insert it.

      It is best to let your dentist proceed.

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

  41. Carina Aitken says:

    Hi Dr.Amin,

    I will be getting a titanium implant for tooth #10 in a few weeks. (My front left one, I hope I said the correct number). My perio is charging $3800 for the surgery as he said there is a little bone grafting he will need to do at the same time. My dentist who is wonderful referred me to him as she had performed a root canal and crown on that very tooth 3 years ago. It was extracted along with tooth #11 (right beside it) because I developed a draining cyst on the gum between these two teeth, which was not at all painful but wouldn’n’t heal.
    The maxillofacial surgeon and perio referred me back to my dentist to determine whether 2 implants for #10 and #11 were preferable. Perio said for longevity 2 implants were better, however 1 implant with a bridge attached to my canine tooth was better aesthetically. My dentist agreed with the bridge option and said because my tooth #11 was very small before, 1 implant and a bridge on the canine would be better for me. She doesn’t usually like to damage good teeth but said she felt it was better for me. I would very much value your professional opinion and think that is wonderful of you to take your own time and answer queries from patients who you’ve never met. What a great man you are!
    Regards,
    Carina

    • Ramsey Amin DDS says:

      Hi Carina,

      Having two implants side by side in the front of the mouth is challenging aesthetically. This is because the triangle of gum between them often recedes leaving a hole or square teeth.

      A cantilever is not a bad idea at all. I do this also. Keep in mind you can also cantilever off of an implant or use some really awesome gum colored porcelain. How low or high your smile is a major part of that decision.

      Good luck and thank you for your kind words. ;)

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

  42. Carina Aitken says:

    Dr Amin,

    My apologies, I just looked on my dental record and I gave you the wrong teeth numbers. It’s my upper front left central tooth and the one beside it that were extracted. My records say these are #21,22. It is #21 getting the implant.
    Regards,

    Carina

  43. Julia says:

    Dr.Amin,

    I have an implant on tooth #19 seven months ago. Now it is time to put on the crown. I had consultation with 2 different doctors. One told me that I need a custom abutment and the other said it’s not necessary. Can you please have a look at my X-ray and give me your opinion?

    Thanks,

    Julia

    • Ramsey Amin DDS says:

      Hi Julia,

      From X-ray alone it will be impossible to tell if you need a custom abutment. There are so many factors that are important.

      Here are just a few factors:
      Shape of the gum, thickness of gum, space from top to bottom, angulation, implant depth, multiple splinted implants.

      In most simple situations, if the dental implant is placed by an experienced dentist, a custom abutment an be avoided.

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

  44. Kate says:

    Dr. Amin,

    I have 7 dental implants 3 in each upper sides (left & right) molars next to the K9’s. My dentist just finished putting the crowns in the right side. She claimed she put custom abutment that is why my bill was very high. However, I see metal in the top of my teeth and in your illustration seems white abutment for custom? Can a custom still be all metal?

    • Ramsey Amin DDS says:

      Hi Kate,

      Yes, custom abutments are often made of titanium and look like metal. Not all dental implant custom abutments are white. The white ones are typically zirconia.

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

  45. Nancy says:

    My husband is in the process of getting implants. He has already had work done by the oral surgeon and now he is going to our regular dentist to fix the rest. The oral surgeon was not one of the dentists in our dental plan so we had to pay out of pocket. Now our regular dentist is putting in 2 implant supported porcelain fused to metal crown and 2 custom fabricated abutment. Since he is a participating dentist in our plan and to which we have been going for over many many years, my husband thought that these would be covered but we have found out recently that they are not. The fee charged for each was $2,000 which is a total of $8,000 which we cannot afford at all! As I have been researching prices, I have seen that these can be less than $2,000. We are at our wits end. I saw in your blog that you mentioned that the standard prosthetic abutment can support a crown in the posterior molar region and is less money than the custom. My husband’s implants are in the back of his teeth. Is there anything else than can be done – like just get regular crowns now. We are just not able to pay this large fee.

    • Ramsey Amin DDS says:

      Hi Nancy,

      Something seems a little off here. I would speak to the office. There may be a miscalculation. The dental implant custom abutment alone should not cost $2000.

      Respectfully,

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

  46. Ines says:

    Dr. Amin –your work is great. I am a dental lab technician in Germany finishing my implant training. Thanks for the inspiration.

  47. marguerite says:

    Please advise. I had one implant with a standard abutment on the upper side last year. I had to have ridge augmentation and bone transplant on the lower two on same side. The implant specialist was instructed by the regular dentist to position the two implants for custom abutments. The bone transplant was only 5o% successful(not sure what that means!) Additionally, one of the supporting teeth will be crowned but will have to be removed eventually because it is too small and will fracture. What should I do?

    • Ramsey Amin DDS says:

      Hi Marguerite,

      Can you explain your implant and abutment situation more clearly? I don’t really understand what you are trying to say buy I want to help!

      Sorry,

      Dr. Amin.

      • marguerite says:

        My general dentist instructed the implant specialist to put install the implant at a particular angle so that she could do custom abutment. She told me that it was necessary for a perfect fit. “Custom abutments are smaller” and will give a better fit, she says. That seems logical but expensive-740. per abutment . Shouldn’t the implant specialist be installing the custom abutment? Do the healing caps need to be custom also? Implant specialist is putting on healing caps prior to the custom abutments. I am waiting on an answer from him regards this question. Can see how a custom abutment would fit over a standard implant.

  48. Brooks says:

    Your article lists 5 major reasons when custom abutments are required but also implies in the beginning of the article that implants placed at an incorrect angle require a custom abutment. Is this correct. What about a situation where the implant has to be placed at an angle because the teeth on either side are at an
    angle? FYI implant was performed on #31. Thanks in advance.

    • Ramsey Amin DDS says:

      Hi Brooks,

      Yes, angulation is another reason to use a custom abutment. I place many implants purposely at alternate angles to maximize your available bone. #31 usually leans toward your tongue naturally.

      Your teeth and bone are not straight but implants are. Sometimes you need to accommodate this difference with an angulated custom or prefabricated abutment.

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

  49. Loretta says:

    I have learned much from your website and would like to ask you a question or two on implants…I have had a lower back molar ectracted (by a periodonist) (375.00) and he also did a bone placement graft weeks later for 1,250.00 …I will be ready for the placement of the implant in November with a cost of 2400.
    Then my new dentist ( I consulted with him for some cosmetic work) is going to finsh the implant with a custom abutment ($500.- $1,000 ) charge, and lastly an implant crown for $2300.
    All in all, a total charge of $6825.- 7325.00 for one implant….this seems a little high to me….what are your thoughts? …(2300.00 for a crown seems a little high to pay)
    Thanks so much for all of your time and effort!
    Loretta

    • Ramsey Amin DDS says:

      Hi Loretta,

      It sounds like you don’t have a straightforward implant!!! Those fees are not out of line for a *VERY* experienced implant dentist in 2013 doing a very difficult case.

      I am often able to save my patients a lot of money by doing both the surgery and the teeth process myself. Most people are surprised!

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

  50. burd cleary says:

    Please help me – I had an implant put in 5 months age. First part healed beautifully (also had bone graph) with no pain or problem. When abutment was put in 6 weeks ago, I have had grade 4/5 pain off and off. Surgeon has cleaned out gum in that area twice and put in new abutment. I still have pain and hesitate to go to my dentist and have final tooth put in. I am very concerned about this as the pain will not go away. There is not swelling, redness and surgeon said there is no infection. As soon as the cap is put on the abutment, pain starts in a day.
    Thank you so much for help

    • Ramsey Amin DDS says:

      Hi Burd,

      The implant may have rotated when the abutment was placed. Your implant may be failing. Have you taken x-rays or a 3D scan yet?

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

  51. marguerite says:

    My general dentist instructed the implant specialist to put install the implant at a particular angle so that she could do custom abutment. She told me that it was necessary for a perfect fit. “Custom abutments are smaller” and will give a better fit, she says. That seems logical but expensive-740. per abutment . Shouldn’t the implant specialist be installing the custom abutment? Do the healing caps need to be custom also? Implant specialist is putting on healing caps prior to the custom abutments. I am waiting on an answer from him regards this question. Can’t see how a custom abutment would fit over a standard implant.

    Reply
    – See more at: http://www.burbankdentalimplants.com/do-i-need-custom-dental-implant-abutments/#comment-2756

    • Ramsey Amin DDS says:

      Hi Marguerite,

      When a custom abutment will improve the final outcome of your tooth it is definitely worth it. You can make a custom abutment for almost any standard implant.

      I would suggest a CAD milled custom abutment rather than a custom cast abutment.

      Sometimes an implant tooth can ONLY be made with a custom abutment. If a prefabricated abutment would work well, I’m sure your dental implant dentist would be done.

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

  52. Bev says:

    If the abutment fits perfectly in the implant in the impression tray, but does not fit the implant in your mouth, why would that be?

    • Ramsey Amin DDS says:

      Hi Bev,

      From the impression to the final tooth there are about 500 things that can go wrong. Examples would be, rotated analog in stone, warped cast, void in impression material, adjacent tooth movement, platform damage and many more.

      I’m sure your dentist will correct it. These things happen and sometimes the exact reason can not be determined.

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

  53. Ismy says:

    Hello doc,

    I recently had an implant (straumen) of my front tooth (1:1 as the doctor says). The surgery went fine and i was also given a denture to wear and it was relieved from the area of the implant. I was told by my doctor to do the mouthwash regularly and just today while i was doing mouth wash the cap ( white thing on top of implant) it broke. Although it didnt cause any pain i need to know if i should have a new cap on the implant as i still have to wait for around 4 months for crown etc? Secondly if my implant is exposed will it cause infection and shall i wear denture in this instance?

    Many Thanks
    Ismy

    • Ramsey Amin DDS says:

      Hi Ismy,

      I am guessing the white part is just a cover cap and shouldn’t be an issue for you. I would see your call your dentist and discuss this so they are aware. The implant may need to be re-exposed at the time of your crown placement.
      ;)

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

  54. joanne brown says:

    Hi, thank you for this informative forum.

    I need to get implants in tooths #7 and #10, I already have quite a few in my mouth, but they’re all in the back, and i wasn’t nervous, nor did I question any of the placements, implants abutments or crowns.
    #8 and #9 still have some life to them, although the gums have receded significantly over all of them including the cuspids. I had tooth #10 pulled and bone added already, and will hopefully do the same to #7 this week.
    I have a big smile and so much of this recession has been making me keep my mouth closed for a long time. It’s been periodontal issues.
    My mouth is on the larger side, but never wore braces (or needed) and all my teeth are relatively a nice shape and fit well in my mouth. I’ve had the stuff fillings are made of filled in on a lot of the area where gums recede (another mess), I don’t know if this should be removed from 8 and 9, before I begin all this, or if that will make the final 7 and 10 to small, or leave it, and get 7 and 10 made with pink porcelain on the tops of the crowns-any advice on that?

    My other question is since i have a good size mouth and what will be ample bone, do you think a standard implant, abutment will do? What are your favorite implants (size, and make) for #7 and #10.

    Thank you again

    • Ramsey Amin DDS says:

      Hi JoAnne,

      Thank you for your very kind words. It sounds like you have fillings up at the gumline to cover over abrasions of your roots. Those are done with white fillings.
      Unless you have a very low smile line and don’t show any gums I would not suggest using pink porcelain for the single teeth numbers 7 and 10. He really don’t want to see the pink transition zone in the smile as it is really difficult to hide. I use pink tissue porcelain on dental implants a lot, but she have to be very careful how it is placed, where it shows and a host of other factors. It looks really awesome when used correctly and really horrible when used incorrectly

      You may be able to have gum grafts over the roots on teeth 8 and 9 therefore lowering the gumline and evening out implant 7 and 10. This all has to be considered before ever placing the implants on 7 and 10 so that they can be placed at the right tissue depth.

      A standard abutment rarely works well in the front of the mouth. A custom dental implant abutment will shape to your unique gums. The scalloping of the tissue and emergence profile of the custom abutment can’t be matched in the front of the mouth. In the back of the mouth prefabricated abutment or screw retained abutments will work just fine in many situations where the implant is well placed.

      Good luck!

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

  55. joanne says:

    Thank you, I’m glad I asked about the pink porcelain, I thought it was something that would be preferred for people with high lip lines where it is obvious the gum shrinkage.

    Today I met with the dentist, everyone is of different opinions. She thinks it would be best to remove 8, 9, and 10. But, she would add implants at the time of extractions. Her suggestion is a bridge on the four teeth, but implant on teeth 7, 9 and 10, I had thought it was too many implants in the four tooth spot. She doesn’t think the two on the outside will support the four teeth. I agree with her, that why should i buy 2 teeth now, and then a four tooth bridge in a few years, my only concern is that it will look funny if there are too many implants. what do you think?

    Thank you very much,

    • Ramsey Amin DDS says:

      Hello JoAnne,
      If you are going to extract #8 and 9 it is probably better to only place two implants on the ends 7 through 10. The main thing you’re trying to avoid his having implants that are too close to one another. Ovate pontics work great here!

      It works great if you have very large wide teeth, to have one implant per tooth. So without seeing you I couldn’t tell you what is best.

      Respectfully,

      Dr. Ramsey Amin

  56. Teresa M Halperin says:

    I will apreciate if you could answer this question:
    After almos 1 year my implant on the upper front start having an odor,I do keep good oral cleaning, but still that odor ,,my dentist tell me I should have done a Custom Abutman,as he told me in that time ,but I did not,because I was told by others it was not need and it will only be more money. Now he think I should remove it and place a custom abutman and a new crown if I continue having this problem after I finish the antibiotic he told me to take….Could you please advice me ? I really apreciate so much if you could do it…….And pardon my spelling, thank you very much

    • Ramsey Amin DDS says:

      Hello Teresa,

      Your dentist is probably right. A custom abutment likely should’ve been done the first time to prevent the margin from being so deep which can create an odor. Without seeing you it would be impossible to know this for sure, but I have seen this many times before.

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

  57. Rebecca says:

    What is a healing cap?? When showing your basic 3 part implant
    1. implant
    2. abutment
    3. crown
    When is a healing cap necessary.

    • Ramsey Amin DDS says:

      Hello Rebecca

      A healing abutment is an intermediary piece used during the dental implant treatment. If the implant is placed in a single stage, meaning through the gum, the healing abutment prevents the gum from closing over the top of the implant.

      It is typically a titanium domelike structure that is screwed into the top of the implant. It will be replaced when the final crown is seated.

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

  58. Steph C says:

    I recently had the all on 4 procedure(about a month ago). The way the prosthodontist placed the abutment causes me to look like I have awful buck teeth & dramatically changes my appearance- for the worse!
    I hate it! When asked, the dentist replied he can’t “push it back” for 6 months. I’m VERY upset. Can you please advise? I don’t even look like me anymore.

    • Ramsey Amin DDS says:

      Hi Steph,

      This video link should help answer some of your questions. It is a review on all the on four procedure

      Your comment about not even looking like yourself is a really common after having the all on four dental procedure. It is all about planning and a really good surgical abilities to avoid this.

      The reason for this is that oftentimes the final teeth are attached on the same day of the surgery. It is my opinion after doing this procedure for 15 years, that the final teeth should not be attached on the same day of the surgery. It is okay to attach temporary teeth, but just don’t do the final ones.

      The all on four dental procedure is very under engineered. The reason your dentist cannot correct things is it is too risky to unscrew the bridge while the implants are so new. The implants themselves could unscrew because they haven’t been given time to integrate to the jawbone.

      Typically we try to do a try-in procedure prior to extraction and same-day dental implant replacement. I routinely do this with my patients so they can see their teeth in their mouth before the actual procedure takes place. It is best to pre plan all surgical and prosthetic stages of complex implant dentistry.

      I have found over the years that the all on 4 procedure in **some** clinics is a really quick and dirty procedure that is poorly planned out.

      Be sure to find out if you’re final teeth will be plastic denture teeth or porcelain/zirconia teeth.

      Good luck and hang in there!

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

  59. Jay Laflamme says:

    Dear Dr. Amin
    I’ve read your website and it is very informative and you are very kind to take so many questions. I too would like your opinion. I had a Standard Titanium Implant (#19,30) placed on molar number 30. It healed with no problems and after four months my dentist said he would check and see if we could proceed to the next stage of abutment and crown. He opened the gum; removed the healing cap and said the implant looked very good and he then placed the abutment. He then took an imprint for the crown and I came back later in the week to have it placed. While I waited for the crown I had no pain with just the abutment. When he placed the crown he packed some bone grafting around the abutment and added some self disolving stitches before he cemented the crown. The crown fits very nicely and looks beautiful. Today is day five and though there is not really pain the gum feels very sensitive all around the crown and I’m not sure if I’m imagining it but it may be slightly receding on the outside side of the crown?? The tooth is very solid and does not hurt if I put pressure/chew on it at all. Is it normal for the gum to be very sore after the crown is placed ? Is it normal to put bovine bone graft under the crown when placing it? Is it normal to open the gum and put in the abutment and then the crown 4 days later? Is it normal for it to hurt more at night? My dentist office has a message that my dentist is on holiday for three weeks and I am asked to go to another dentist if I have concerns. I am not sure if this is all just normal healing and will settle soon.
    Thank you very much in advance
    Jay Laflamme
    British Columbia Canada

    • Ramsey Amin DDS says:

      hello Jay, I will try to answer your questions!!
      I’ve read your website and it is very informative and you are very kind to take so many questions. I too would like your opinion. I had a Standard Titanium Implant (#19,30) placed on molar number 30. It healed with no problems and after four months my dentist said he would check and see if we could proceed to the next stage of abutment and crown. He opened the gum; removed the healing cap and said the implant looked very good and he then placed the abutment. He then took an imprint for the crown and I came back later in the week to have it placed. While I waited for the crown I had no pain with just the abutment. When he placed the crown he packed some bone grafting around the abutment
      and added some self disolving stitches before he cemented the crown.

      this is definitely a bit strange–Sometimes the gum will be opened slightly just to allow the crown to sit on the margin and remove residual cement.

      The crown fits very nicely and looks beautiful. Today is day five and though there is not really pain the gum feels very sensitive all around the crown and I’m not sure if I’m imagining it but it may be slightly receding on the outside side of the crown??
      I would not be surprised about this because he basically had surgery on the same day the new tooth was put in

      The tooth is very solid and does not hurt if I put pressure/chew on it at all. Is it normal for the gum to be very sore after the crown is placed ?
      not normally

      Is it normal to put bovine bone graft under the crown when placing it?
      no
      Is it normal to open the gum and put in the abutment and then the crown 4 days later?
      no not really
      Is it normal for it to hurt more at night?
      all of this is just a bit abnormal. The fact that bone was put in at the same day the crown was cemented is definitely odd

      My dentist office has a message that my dentist is on holiday for three weeks and I am asked to go to another dentist if I have concerns. I am not sure if this is all just normal healing and will settle soon.
      Thank you very much in advance
      Jay Laflamme
      British Columbia Canada
      I wish you weren’t so far away. Make sure you see your dentist soon as possible. My guess is most of that bone is going to get rinsed away.

      sorry for all the bad news… Keep me posted please

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

  60. Jay Laflamme says:

    Dear Dr. Amin,
    I also meant to ask when I should start flossing under my crown? As I just had stitches under it five days ago I do not want to interfere with them
    thank you
    Jay Laflamme

  61. Mike S says:

    Hi,

    Hi Dr. Amin,

    I have five implants. My question is regarding the implants for teeth 28 & 29, especially tooth 28. It sometimes feels like the crown comes out too far and can rub against my lower cheek and touch my upper cheek just inside the lip. I’m wondering if an angled abutment could could help to move the tooth in and away from my cheek and lip.

    Thanks,
    Mike

    • Ramsey Amin DDS says:

      Hi Mike,

      It sounds like your crown is just too bulky. You can likely Just change the crown and leave the abutment intact.

      The dental implant crowns made in my office are scanned into a computer, designed on a computer and milled through multiple robotic arms. They are then hand glazed and tinted for color and character.

      This attention to detail will provide a tooth which is designed for proper contours, function and esthetics.

      The dentist must guide the lab on how each tooth is to be designed. There is A LOT that goes into this.

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

      • Mike S says:

        Thanks for the response. I think you might be right that it is a little bulky, but I also think part of the problem is where the implant is placed. The placement might have been necessary due to what bone was available. I have crowns that are retained with a screw at the top, so I can see there isn’t much room for the crown to be brought in and away from my cheek. That is why I’m wondering if an angled abutment with a crown cemented to it could possibly be a better way to go in this situation. What are your thoughts? I will probably make an appointment to discuss this with someone in my area (Chicago), but would appreciate any insight you have.

        Thanks again,

        Mike

        • Ramsey Amin DDS says:

          Hello Mike,

          A custom titanium abutment and cement retained crown may be the answer. I would suggest that the abutment be fabricated by milling it from a solid block of titanium rather than a custom cast abutment. a screw retained crowns and would only be needed in this area if you’re teeth are really short.

          http://www.burbankdentalimplants.com/abutments-burbank-dental-implants-expert-dr-ramsey-amin-case-follow-up/

          The abutments in this link above are not custom. You can see that the abutments are in line with the teeth and don’t stick out at all. It sounds like your implant was put in had a funny angle.

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

  62. Allison O. says:

    I had several upper front teeth get implants and we are in the process of getting the crowns and bridges made. Earlier in the week we did what we thought was going to be placement of the permemat crowns but they were way way off and the two front teeth were angled incredibly froward.. my dentist was really surprised that the lab would do that.. but in the process I asked why they would even look like that at all. And she stated that the surgeon had to place the feont ones at an angle somewhat because basically they would have gone through the top of my jaw I guess she was implying. Itru my dentist and the aurgeon has always been very thourough and has great respect here..t couldthat true?
    and i do have asmall face and even with bone grafting my dentist said theres no way to make hem the same exactly because of the original bone loss

    • Ramsey Amin DDS says:

      Hello Allison,

      I’m sure your dentist in dental implants surgeon know what they are doing. Upper front dental implants are by far the most difficult situation to replace so that it blends perfectly with your other teeth.

      What is created by god in nature is always different than what can be created artificially by man. I am not saying that a near perfect result cannot be done, I’m just saying that there are realistic expectations and limitations to all dental implant reconstructions.

      In my private practice and Burbank, the planning of an upper front tooth takes 2-3 visits prior to ever doing anything whatsoever. There are photographs, 3-D scans and 2 meetings with the patient prior to doing any treatment at all. Virtual renderings are made of the teeth so that every possible compromise or complication can be addressed prior to them ever happening. I know, it is a lot to do for just one tooth, but it is such an important tooth being in the very front of your mouth to be done as good as possible.

      It is essential that the implant is placed in the most ideal position possible as that will have the greatest affect on the final aesthetic outcome. Most upper front teeth require bone and/or gum grafts in order to make them look perfect with dental implants.

      I hope I helped answer some of your questions. Please visit my smile Gallery webpage to get some examples:

      http://www.burbankdentalimplants.com/smile-gallery/

      Very respectfully,

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

  63. joy says:

    I had tooth #14 missing and planned to have an implant. I was told by an implant dr that she would open my gum to do a bone graft to lift my membrane, which I totally understand. But I recently just finished my invisalign treatment and will have to wear a retainer for the rest of my life. I am wondering if I still need to have the implant done since the retainer basically will secure the teeth in places and as long as I keep my teeth healthy, maybe I don’t need an implant? What is your opinion? Thank you so much.

    • Ramsey Amin DDS says:

      Hello Joy!

      It is not realistic to wear a retainer your entire life. Tooth number 14 is the upper left first molar and is one of the most important teeth in the entire mouth. The longer you wait, the bone will shrink even more. This will make lifting of the sinus membrane more complex, risky and costly. The sooner you have it done the more straightforward this procedure will be.
      An orthodontic retainer can not support your bite as a dental implant or natural tooth can. Even people that have partial removable denture still have tooth movement. God gave you all these natural teeth for reason.

      ;)
      Very respectfully,
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

  64. Ann says:

    I had the first part of my implant completed. It healed well. When I went to my dentist for the final crown measurement he told me the post was at a 30 degree angle. He said, I will need an abutment. Will this weaken the tooth or will it be as strong as if there wasn’t an abutment?

    • Ramsey Amin DDS says:

      Hello Ann,

      Some dental implants are purposely placed at 15-40° angles. I often do this when placing implants for a full mouth dental implant bridge such as a Prettau.

      http://www.burbankdentalimplants.com/prettau-dental-implant-full-mouth-bridge/

      Custom abutments as of 2014 are wonderfully strong as most of them can and should be made by CAD/CAM milling technology. This allows a computer to design the abutment in for it to be cut out of a solid block of titanium by essentially robot that has 4-9 arms. A CAD cam milled abutments made of titanium is better than a custom cast abutment if it can be made this way.

      Very respectfully,

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

  65. Heather says:

    I have a successful #5 implant of many years. 8 months ago I had extraction of #14. Complications ensued, with fistula. Revision surgery 4 months ago. Successful, currently with bone regrowth 2mm thickness at narrowest point. Now getting around to #15 which started having intermittent pain about 2 moths ago. On exam yesterday discovered it is cracked in 3 places, perhaps to root. Maxillary sinus is low-hanging. If extraction of #15 becomes necessary can bone grafting be successful and strong enough to tolerate 2 implants despite originally thin bone and further compromise by piece of bone coming out during extraction of #14? If so, how soon could bone grafting commence? I am 68 and generally in good health. If I can keep #15, do you have an opinion of benefit of bone graft and implant for #14 versus no bone graft and partial?

    • Ramsey Amin DDS says:

      Hello Heather,

      The health of your dental implants is largely predicted by the health of the natural teeth right next door.

      If a dental implant and bone graft are done for #14, and #15 flares up in the process, your likely to have more complications. It sounds like tooth #15 is questionable. At your age of 68 years, you need to have dentistry that is solid, predictable and long term. The last thing you need is a dental abscess while your 80 years old. Without seeing you, I might suggest extraction of #15 and placement of 2 dental implants with a lateral window sinus bone graft.

      This will allow you to place long implants and split the teeth together for long-term function and durability. This also allows transmission of the load of your bite into the bone properly. It will become far more costly uncomplicated to have to replace each of these teeth as separate surgeries rather than to do them together.

      The upper molars are considered the most complex teeth in the mouth to replace with dental implants due to the nature of the soft bone marrow and your bite being very strong in this area. Failure is common if it is under designed.

      And lateral window sinus bone graft in the right hands, is a very predictable procedure with a high degree of safety and effectiveness.

      Respectfully,

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

      • Heather says:

        Hi Dr. Amin
        Thank you for your reply. I called your office today about perhaps going forward with implants for 14 and 15. I understand that the earliest time you might have for a procedure is in November. As I mentioned, 14 is already extracted and healed. I was wondering if I could go ahead with an extraction for 15 locally and then come down in November for a lateral window bone graft for both teeth (and also later on have you do the impIants). In other words, is it okay to have a delay between extraction and this type of bone graft? I would like to have the extraction as soon as possible.
        Thank you for your thoughts.

        • Ramsey Amin DDS says:

          Hello Heather!

          If this is the Heather that I think it is… It was great meeting you in person!!! I look forward to seeing you soon. I’m glad things worked out well. Thank you for traveling the distance to be treated by me… I was very flattered by that.

          Very respectfully,

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

  66. Denise Fournerat says:

    Hello Dr. Amin
    I so appreciate you taking time to answer so many questions. I live in the Southeast which makes it geographically difficult to see you. Here is my situation and question. Thank you in advance for your time and gift of your knowledge
    I am have 19 teeth extracted ( bad crown procedure left my teeth over prepped to hold the crowns and all the crowns are falling off and the teeth are fracturing ) having said that I am having two lower and four upper implants placed for holding dentures, this will be done in stages, First – extractions- bone grafts- aveloplasty and aveloectomy – and implants- temporary dentures. 4 months later – expose the implant and healing abutments placed – 4 months later final abutments and final dentures. My question is why do I need two sets of abutments? Is it really necessary? Why can’t the final abutment be placed at the time the implant is ready? This will save me close to 5,000.00 thank you again.

    • Ramsey Amin DDS says:

      Hi Denise,

      It sounds like you’re having upper and lower over denture suture replace all of your teeth. Healing abutments and final abutment are different and you generally need both of them.

      Healing abutments are used to allow the titanium dental implant to pass through your gums. In allows see her gums to heal around the implant. In your situation, you’re implants will be buried in a traditional two-stage technique. When they are exposed it is generally not a good idea to place the final abutment at this time. This is because he did not know the shape and measurement of the gums and angulation of the implants to place the proper abutments. Oftentimes the fee for the healing abutments is built in to the surgical dental implant placement.

      I would to speak your dentist in clarify the treatment plan before you start so there are no surprises. Occasionally an immediate load denture is attached to abutments to allow you to not have to remove the denture. These are usually done when a fixed dental implant bridge is performed.

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

  67. Rava Graves says:

    Dear Dr. Amin,

    Thank you for taking time to help those who are not your patients. #19 fractured so my dentist removed the crown and I am scheduled (with an oral surgeon) to have it extracted and a bone graft for an implant. The dentist is planning to place the implant at some point after healing. The oral surgeon’s staff indicated that the implant could also be done at their office. I am wondering what your thoughts are about a ‘1 step surgical implant procedure’, thereby eliminating a second surgery which is appealing to me as I am not crazy about being anesthetized twice if it is not necessary. I also read that the post-surgical discomfort and pain are much less than in a 2 stage technique procedure. Your thoughts, please? Thank you so much and God bless you.

    • Ramsey Amin DDS says:

      Hi Rava,

      Thank you for your kind words. I enjoy talking to people around the world. I believe that knowledge should be shared.

      If you’re having a combination socket bone graft and extraction, the pain typically comes from the extraction and not from the socket bone graft. Doing these 2 procedures together is great. Sometimes 3 procedures can be done together which would include the extraction, the socket bone graft and the implant simultaneously.

      The choice should be made based on what is most predictable and safe that will yield the best result rather than making his decision based on money or pain.

      Having IV sedation and intravenous anti-inflammatories will greatly reduce your pain afterwards. Using your own growth factors made from your own blood also decrease pain and swelling quite tremendously.


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

  68. Joe cochran says:

    Too many decisions!

    @ seperate treatment plans, ones charging 4374 per tooth 4 and 5, )bonegraph done, ready to go with implant.) Seems the one that is more expensive is less experienced.

    So im thinking to have the implant done by one(Most experienced, 1200.00 fee each), and abutment crown by the other. (similar fee but more of general dentist) The gen dentist charging 2160 just for implant) So a more experienced implant doc charges less.

    Thanks

    What info do I need to know in order to make sure the implant will match the abutment?

    • Ramsey Amin DDS says:

      Hi Joe,
      Choose your dentist based on training, skill, education and experience in treating your situation. Sometimes the most experienced dentist are able to reduce costs because we do this very routinely.

      Of course you need to have a good relationship and like each other since you will be spending quite a bit of time together!

      You will need to have any information regarding the implant matching the abutment. Your dentist will know how to mesh the 2 parts together.

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

  69. Pingback: Dentist Does Far More Than Just Drilling And Filling-healthy for living tips

    • Ramsey Amin DDS says:

      Hi Teekay,

      It sounds like you need a great orthodontist. When you lose a tooth and your bite shifts, oftentimes your midline will be off center making your smile look crooked. After the orthodontist corrects your shifting teeth, they may or may not create space for the teeth that were lost which can be later replaced with dental implants. You need to be seen in comprehensive manner. If you don’t do anything, things are likely to get worse over time

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

  70. Carmen says:

    Hi Dr Amin,

    Long story short- I’ve had two implants put on lower left side when I was living in Europe a few years ago. Now I live in Usa and I want to finish the job but my dentist can’t find the right abutments for the Alpha Bio implants that i ready have and he is hinting that he needs to remove them and place new ones in. My previous dentist in Europe says that he doesn’t have any info on me anymore (or doesn’t want to be bothered). What other options do I have without paying a small fortune for new implants again?

    Thank you in advance for your time and consideration.

    • Ramsey Amin DDS says:

      Hello Carmen,

      Many dental implants use a universal internal hex. Some implants use a proprietary connection. The dental implant made by Alpha bio may fit into this category. Regardless, a dentist well experienced and restoring dental implants will be able to find components to restore your implants. Do not just remove them without a really good reason. I would strongly suggest you consult with another dentist.

      Here are some links that show some of the differences of screws and connections:

      Very Respectfully,

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

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>