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

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

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

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

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

Fellow-American Academy of Implant Dentistry

An abutment for the dental implant process is needed regardless, unless the implant is a solid one-piece design. An abutment allows for the teeth or tooth to be connected to the implants. It is the part that sticks out of the gum.

That being said, most of the dental implants I use are a three-piece design, incorporating a removable dental implant abutment. Having this design makes for versatility in how the tooth, bridge, or overdenture is made. A disadvantage is that it is another piece in the system where failure can occur.

Some abutments are made of gold, titanium, or zirconia as three broad categories.  There are also categories for the types of uses of the implants, such as:

• Engaging abutments
• Non-engaging abutments
• Overdenture stud abutments
• Waxable abutments (UCLA-type)
• Healing abutments
• Screw retained abutments
• Cement retained abutments
• Angled abutments
• Custom CAD/CAM abutments

I know this all sounds confusing, but the selection, manual preparation, placement or designs of your dental implant abutments are critical to success.

In my Burbank, California office, I break down the abutments into two simple categories. These are abutments that allow the crown to be cemented, or abutments that allow the dental implant crown to be held in by a screw. The screw itself sometimes can be a disadvantage because it is the smallest piece in the system. Although not often, the screw can break or loosen.

Most dental implant abutments are screwed into the implant and “torque” into place.  Others are a type of press fit called a morse taper, or a combo of screws and press fits. The tightness of the connection of your abutment to the implant is one determinant whether you will lose bone around your dental implant.

Your implant dentist should have a strong understanding of when to use which abutment, and where to use each type. It should NEVER be one recipe for all patients and situations. Many dentists rely on the lab to choose the abutments; this is never a good idea, and often results in a much higher cost for you.

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

When she first arrived, she said that she “struck gold” with her dentist. She felt relaxed and comfortable. In fact, my dental assistants had a warm blanket ready for her in the dental chair.

During her procedure, she had all of her bottom teeth pulled (10 in all), and she was given a set of dental implants. These implants are designed to serve as an anchor for her dentures. Her procedure was extremely successful, and she was in and out of the office in about an hour. She left my office with an immediate fixed cemented temporary for her entire lower jaw.

She couldn’t believe how much these implants improved her appearance, and her friends and family couldn’t believe how amazing she looked after major oral surgery. Take a look at the video below to learn more:

They used to break when cheap dental implants were used that had an “external hex” as opposed to an “internal connection.”  A dental implant is a screw within a screw.  The implant itself looks like a screw and then the implant abutment usually connects to the implant by a screw.  These screws are about 1.25mm with an allen hex on the end, and they are made of medical-grade titanium. It is the silver one in the picture. The green piece is not relevant.

Internal connection implants like I use take the force off the screw and place it on the connection or deeper in the implant.  The main reason for a screw to loosen or break on a well- placed implant is excessive bite force on the implant.  Keep in mind that your bite changes over time on your implant and that it can become excessive over time.

Other reasons a screw can loosen or break are:  poor quality implant, rounding out the connection by excessive force of placement, poorly casted screw seat in a screw-retained crown, or an abutment that didn’t get torqued properly.

The x-ray shows the broken screw still inside this implant.  That tiny piece is not easy to get out as it needs to be backed out about seven revolutions.  It is like trying to take out an eyeglass screw and the Phillips head is broken off.

Careful technique, patience, and a slow drill in reverse can grab the screw out.  Most dentists that are involved in implants have never done this.

In the video, you will learn about two major classifications of abutments: pre-fabricated and custom abutments. Dr. Amin, our Los Angeles implant dentist will inform you about specific benefits and drawbacks of each type, as well as explaining the different uses that pre-fabricated and custom abutments have in dental implants cases.

Restoring your dental implants is critical to your long-term dental health, which includes minimizing your risk for bone loss in the future. Rest assured, Dr. Amin is well-experienced and skilled to create your dental implants for a breathtaking, healthy smile.

When you choose Dr. Amin, you will receive top-notch, award-winning dentistry. When you come in for your consultation, Dr. Ramsey Amin will patiently listen to your concerns, and help you decide if dental implants are right for you.

(from L to R: This is how the patient came to me with her existing temp in place, a picture of the abutment after I reshaped it, and the final porcelain crown and corrected gum line appearance).

A baby tooth may become fused to the jaw bone and look submerged compared to the other teeth.  Those baby teeth may be difficult to extract if they are fused (ankylosis).

 
The most common tooth to be missing is the upper front tooth called the lateral incisor. Those teeth are just next to the two big upper front teeth.  Dental implants are used very commonly to replace those teeth.  Many times, I replace these front baby teeth before the age of 18 because of cosmetic concerns of not having one or both front teeth.

The other common tooth is the lower second bicuspid or “premolar.”  This very common missing tooth replaced with dental implants is located in the middle of your bottom teeth.  The bicuspid tooth is usually sitting atop of a nerve in your jaw.  Extreme care must be used to avoid this nerve during placement of a lower second bicuspid implant.  A shorter implant is usually used in this area.  A special curve of the nerve referred to as the “mental loop” should also be assessed.

Also, the size of the implant and the size of baby teeth are different.  The real bicuspid tooth that should have been there, is smaller than the baby tooth.  This makes the dental implant look more like a molar. In the front of the mouth, it is the opposite, so more space is needed to prevent the tooth from looking too small.

Often times, I will extract a baby tooth and replace it with a dental implant, abutment and crown on the same day.  Bone grafting may be needed to fill the voids between the two.

If you are missing just one permanent tooth, often times your smile midline will shift to one side or the other making your smile appear crooked.  I have my orthodontist work closely with me so that we can get the spacing just right so that the dental implant looks great.  Planning is the most important when it comes to replacing baby teeth with dental implants.

In summary, your baby tooth or teeth can be replaced with dental implants.  Just make sure that all the details about the treatment plan and diagnosis are made well in advance of starting treatment.  This will make for a very smooth process for you.

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

The Cost of Dental Implants

The cost of the procedure(s) is probably the most common disadvantage cited by patients.  How much do dental implants cost?  How much is a sinus lift bone graft?  How much is an implant crown? These are questions I hear all the time.  Dental implants and grafting in my office are reasonable and affordable. 

Keep in mind that implants are body parts that you really want to make sure you have a very experienced surgeon as opposed to a novice that may do few implants per year.  The cost varies depending on the difficulty or ease of your unique mouth.

Dental Implants Normally Will Not Cover the Implants Procedure

Dental Insurance is another disadvantage.  Most dental insurance plans don’t cover dental implants, bone grafts, sinus lifts, etc.  Sometimes they will cover part of your procedure.  They may only cover the crown, abutment OR the implant itself. 

Keep in mind that dental insurance does not go very far at all.  Unlike medical insurance, it has a very low yearly limit that has not changed in 30 years!  So what ends up happening is the whole implant process costs more than the average $1000 or $1500 yearly limit set 30 years ago! 

Don’t get me wrong, dental insurance helps, but it only helps with part of ONE implant if they even cover any of it.  Many plans just exclude them altogether.

Dental Implants Require Surgery

Another disadvantage of dental implants is that it requires a surgery.  The implant has to be placed into your bone.  Surgery is not without risks.  In my own hands, the dental implant complication rate is about 1%, but the average is somewhere between 5-10%. 

Risks include, infection, prolonged bleeding, damage to other teeth, nerve damage, delayed bone healing, jaw fracture and many others.  Knowing how to recognize and quickly treat complications is the key

Restoration replacement

 
Another con of dental implants are that the teeth or tooth will probably have to be replaced some day. 

If you have an overdenture or a full arch fixed implant bridge with plastic teeth, those teeth WILL wear out and need to be replaced.  A porcelain crown or bridge on an implant can chip or break, too.  The teeth that go on top of implants are no different than the teeth without implants.  It is normal to replace crowns, fillings, bridges and dentures…they don’t last forever.  Good design, a great lab and the diagnosis is the key to minimizing having to replace your dental work.  Making implant teeth is often more complex and costly than the surgery and bone grafting…experience counts.

Over time you can lose bone around your dental implants

Some slight bone loss over many years is normal.  If you lose too much bone, you may have to replace the whole implant.  The original surgery and original fabrication design of the teeth are a huge factor in the long-term health of your dental implants.  Choose a very skilled implant dentist.

Implants Take Time

A common disadvantage for dental implants is that they take time.  Although I replace many teeth, with same day implants and bone grafting, the majority take three to four months to complete.  This is because bone just heals slowly.  If you need bone grafting, treatment time can extend from 3 months to 18 months or more depending on your unique situation.  A regular bridge can be made in days or weeks.

The bottom line is that there are disadvantages to the dental implant process.  The reality is the pros outweigh the cons.  Overall, the process is a long-term benefit for a short term sacrifice. Dental implants are by far the best option in the majority of situations when teeth are lost.