What to Expect with Dental Implant Treatment

By | Treatment Information

Here is a general overview of our dental implant treatment strategy at Triple Crown Dentistry:

Appointment 1 – Diagnostics and Plan Development (time: 30-45 minutes)

A CBCT 3D scan will be taken and a careful examination of the patient’s soft and hard tissue anatomy is performed as well as an evaluation of a patient’s medical health and current prescriptions.  Candidacy for a dental implant as well as determining the most likely implant size and potential additional surgery needs with be evaluated and discussed.  Surgery date can be scheduled and preoperative prescriptions written and surgery details will be discussed.

Appointment 2 – Surgery date (time: 2-3 hours depending)

Dental implant placement surgery or any surgery needed before implants can be placed.  Most likely this surgery will include the placement of the implant and potentially a healing cap and temporary crown or retainer to be placed to provide a temporary tooth in the space while the implant heals and integrates into the bone.  If a surgery is needed prior to implant placement like a ridge augmentation graft or a significant sinus lift, the implant may need to be placed after the grafts heal although this is rare.  In most cases a sinus lift is performed and the implant is placed at the same time as the sinus lift.

Appointment 3 – Post op checkup (2-3 weeks after surgery) (time: 15 minutes)

Two weeks after surgery you will return for a checkup to see how well the implant surgery site is healing.  Any sutures will be removed and the site will be thoroughly evaluated to ensure everything is healing well.  

Appointment 4- Impressions for abutment and crown (3-4 months after surgery date) (time: 30 minutes)

Healing cap will be removed and impression will be taken for and abutment and either a treatment crown or a final crown. Healing cap placed back on implant and impressions sent to dental laboratory for custom crown work.

Appointment 5 – Delivery of abutment and crown (1-2 weeks after impressions) (30-45 minutes)

Healing cap removed and final abutment placed. Crown fitted, adjusted as needed and cemented to abutment.  Bite relationship checked and adjusted as needed.  This is typically the last appointment in the implant process.  In certain cases a 6th appointment might be needed although it is rare.

Appointment 6 – Bite relationship check-up (Rarely Needed)

In certain cases like full arch cases of cases with several implants, a follow up appointment may be needed to ensure that the bite relationship is correct and ensure that any bite interferences are corrected.

Which Dental Implant is Right for You?

By | Treatment Information

At Triple Crown Dentistry we offer a fully array of options for dental implants.  Implants can either be placed in an area that has been missing a tooth for some time, or placed immediately after a tooth is extracted.  We have an implant dedicated for each of these situations, including the only FDA cleared implant solution for immediate molar replacement.  Our ability to perform your implant placement at time of extraction can eliminate the need for a 4 month healing process and expensive socket preservation grafting.  This advantage means less money out of pocket for our patients and a reduced amount of time needed to get you your implant crown placed and chewing with the tooth again.

Types of Implants

We have partnered with Keystone Dental Implants to provide our dental implants.  We use the Genesis and Tri-Max systems from Keystone, very high quality implant systems that give us the peace of mind that we are providing our patients with the best implants available on the market.  For more information on Keystone’s Implants please click here.

The Keystone Genesis implant is made of medical graded titanium that =is the coated in a nano-spark surface which provides superior integration into the jaw bone.  That and the thread pattern of the implant allow for superior initial stability at placement and allows for immediate placement in non-molar teeth and often allows for a temporary crown to be placed at time of surgery.   The Genesis system also has a pink anodized collar.  This feature prevents the gray shadowing that can show through the gums with implants.  This grayness is a common problem that is eliminated with the Genesis system.  At Triple Crown Dentistry we feel that the Genesis system is the superior dental implant on the market.  Our patients deserve the best in our surgical skills as well as the best in dental implant products and Keystone allows us to provide the best implant treatment available in modern dentistry.  For more info on the Genesis system click here.

Keystone has the only FDA cleared implant for use in molar extraction sites which is one of the most common situations for dental implant needs.  This system gives us the ability to extract a molar and replace it with a large diameter implant that closely mimics the size of the natural molar root and preserves the natural width of the ridge.  Without this system the molar would need to be extracted and grafted, then placing the implant 4 months afterwards.  Our molar replacement dental implant is the best on the market and prevents that delay of 4 months and reduces the treatment plan to only one surgery date rather than two.  

Your Implant Treatment Options

  • Single/Multiple Tooth Replacement.  
    • If you are missing one or several teeth, there is no more natural replacement option than a dental implant.  
  • Full arch fixed prosthesis
    • For those who have no natural teeth and want a fixed option to replace their teeth and do not wat t removable denture
  • Implants to retain loose fitting denture or partial denture
    • If a patient has a denture but it doesn’t fit and/or function well, dental implants can be used to provide retention for an existing denture
  • Implants with bar for a removable denture
    • If a patient wants a denture that fits and functions at the top level possible but still wants the denture to be removable, an implant bar is a great option.

 

The Benefits of Dental Implants

By | Treatment Information

Dental implants are the superior treatment option for missing teeth as well as retention of loose fitting dentures.  Implants replace a missing tooth with as close to a replacement as possible in modern dentistry.  Implants were first used in the late 1950’s.  Over the past 60+ years the quality of the implants on the market has dramatically increased and now boast a 96% success rate in 25-30 year studies.  This success rate is much higher than any other option for replacing missing teeth.  At Triple Crown Dentistry we use only high quality dental implants and components, as well as advanced surgical techniques (including sterile field and platelet therapy) and technologies (in house 3D scanner and top quality implants and equipment) to ensure the best of outcomes for our patients.  Dr. Eric Nunnally has 15 years of dental laboratory experience, has received extensive training and certifications in dental implantology and is highly skilled in the surgical placement as well as the restoration of dental implants. He is a surgical graduate of the Midwest Implant Institute and is completing his fellowships with the American Academy of Implant Dentistry and the Midwest Implant institute.  He has been invited to lecture and train other dentists in dental implants internationally. At Triple Crown Dentistry you can receive all of your implant treatment in one location at the highest level available in dentistry.

There is no better option for missing teeth than dental implants.  Conventional dental bridges can replace missing teeth, but this requires the surrounding teeth to be crowned which might not need crowns.  Bridges also require an increase in home care and can be troublesome and difficult to properly clean because the patient cannot floss between the teeth because they are connected.  Bridges often need to be redone within 5-10 years of placing them, which can lead to a much more expensive treatment option over a patient’s lifetime.  However, bridges are still a good option for patients who might not be candidates for dental implants due to bone anatomy.

For a denture patient, chewing forces have been reduced to 10% of the function of a natural set of teeth. Natural teeth have a function of 560 pounds per square inch, while a denture without implants can only provide 50 pounds per square inch!!!  There are so many reasons that this becomes and issue and reduces the patient’s ability to chew food and get a proper nutrition.

Dental implants also prevent bone loss, which is very important in denture patients as well as patients replacing only one or several teeth.  Jaw bone will recede steadily after a tooth is missing.  A denture patient will experience resorption of their jaw bone over the years, which leads to loose fitting dentures and the need for relines.  After a significant amount of bone has resorbed the denture might not be able to have an adequate retention and lead to a lot of patient frustration and dissatisfaction.  This bone loss can also cause a closure of the patients jaw opening and lead to a significant amount of esthetic issues.

When a dental implant is placed in the bone, it can halt the resorption process and maintain the height of the bone into the future.  Like a tooth root, the bone wants to remain attached to the dental implant and will maintain as much bone height as possible.

Patient s must be evaluated for candidacy.  While most patients are candidates, sometimes additional surgery requirements like grafting and sinus lifts must be determined with a detailed comprehensive exam.  This usually includes radiographs and a clinical exam as well as thorough review of a patient’s medical conditions and potential complications.  At Triple Crown Dentistry we pride ourselves on proper planning for dental implants with the best of diagnostic equipment and patient evaluation procedures.  Dental implants are a long term solution to dental needs and each patient must be properly evaluated to ensure the best result possible.

Dental implants are not without risks and must be maintained with good oral hygiene, regular dental cleanings and flossing just like natural teeth. With proper care a dental implant should last a very long time (30+ years) and provide a superior benefit to cost when compared to other dental options.  

Post Operative Instructions

By | Treatment Information

Proper Care After Dental Extractions

1- Pressure should be placed on the gauze pad that has been put over the extraction site for one hour. If the bleeding continues new gauze should be placed and pressure applied for another 45 minutes.

2- If you are supervising children who have had an extraction done, make sure they don’t bite on their numb lips or tongue (it can cause serious injury to their soft tissue).

3- Avoid eating or drinking anything hot on the day of your extraction. Also, do not rinse your mouth and do not use a straw for drinking. Do not spit and do not drink carbonated beverages. Do not brush on the day of the surgery; you can gently resume your brushing and flossing the day after.

4-You may experience some pain, bruising around your lips, and/or some swelling, especially after extraction of impacted wisdom teeth. Ice bag application and medication prescribed for you will help to minimize your discomfort.

5- Please take all the medication you have received based on the provided instructions.

6- During the first 2-3 days after surgery a diet of soft food and liquids is recommended (soup, yogurt, milkshakes and juice).

7- For more complex surgical procedures, including Impacted Wisdom Tooth Extraction, Implant Surgical Procedures, etc: You will receive an ice wrap which should be worn for the rest of the day until you go to bed on the day of surgery (10 minutes on and 5 minutes off). Instructions for various surgical treatments will have some unique directions, which will be supplied to you at the time of your treatment.

8- Call our office if you experience excessive bleeding, severe pain or swelling, or if you have any questions or concerns. In case of serious emergencies call 911.

Proper Care After Dental Fillings

1- Do not eat on your new filling for one hour and until your numbness is gone.

2- If you are supervising children who had fillings done, make sure they don’t bite on their numb lips or tongue (it can cause serious injury to their soft tissue).

3- Do not bite hard or chew on silver amalgam fillings for 24 hours.

4- You may experience cold and heat sensitivity and some gum soreness; this usually subsides within a few days.

5- Call our office if you experience pain or discomfort for more than a few days after the fillings, or if you have any questions.

Proper Care After Dental Crowns/Bridges

1- Crowns and bridges usually take 2 or 3 appointments to complete. On the first appointment, the tooth/teeth are prepared, impressions are taken, and a temporary crown is placed on your tooth/teeth.

2- You may experience sensitivity, gum soreness, and slight discomfort on the tooth/teeth; it should subside after the placement of the permanent crown(s).

3- Whenever anesthesia is used, avoid chewing on your teeth until the numbness has worn off.

4- A temporary crown is usually made of plastic-based material or soft metal. It can break if too much pressure is placed on it. The crown may also come off; if it does, save the crown and call our office. The temporary crown is placed to protect the tooth and prevent other teeth from moving. If it comes off it should be replaced as soon as possible. To avoid losing your temporary, do not chew on sticky or hard food (chewing gum, ice). Try to chew on the opposite side of the temporary as much as possible.

5- Continue your normal brushing but be careful while flossing around the temporaries (remove the floss gently from the side). If it is difficult to get the floss between the temporary and surrounding teeth, refrain from flossing until you receive your permanent crown.

6- After the permanent restoration is placed you may feel slight pressure for a few days. Also, the bite may feel different for a day or two. But if after 2-3 days the bite still feels uneven or if you feel discomfort when chewing on the tooth, call our office. Delaying the necessary adjustments may damage the tooth permanently.

7- Call our office if you are in pain or if you have any questions.

Proper Care After Root Canal Treatments

1- You may experience moderate pain and sensitivity to pressure on your tooth. Also, you may feel gum soreness for few days after your treatment. The healing process may take several days but the pain and discomfort should subside gradually.

2- Take any medication that was prescribed for you according to instructions.

3- Usually a temporary filling has been placed on your tooth; do not bite on the tooth for one hour and while you are numb. Also, until the permanent restoration is placed, be very gentle with the tooth. Try to chew with the opposite side.

4- Continue your brushing and flossing.

5- Follow up with the placement of your permanent restoration as you have been advised. Any unnecessary delay in placement of final restoration may damage the tooth permanently.

6- Call our office if you are in severe pain or experience swelling, or if you have any questions.

Proper Care After Dental Deep Cleaning

1- You may experience some cold and heat sensitivity (especially after deep cleaning).2- If you have received anesthesia do not eat anything until the numbness has worn off.

3- Continue your regular brushing and flossing.

4- Some bleeding for a day or two after cleaning is normal, but if you experience any excessive bleeding call our office.

5- Call our office if you are in pain or if you have any questions.

Proper Care After Braces Placement

1- You may experience some pressure and discomfort on your teeth.

2- Be gentle with braces and avoid chewing hard and/or sticky food.

3- Brushing and flossing around braces is sometimes challenging and time consuming, but very important.

4- Call our office if you have any questions.

Proper Care After Gum Surgery

1- You may experience some pain, swelling, and bleeding after the surgery.

2- Take all medication that was prescribed for you according to instructions.

3- Apply an ice bag on your face over the surgical site on the day of surgery for 10 minutes on and 5 minutes off.

4- Keep your next appointment on time for removal of sutures and follow up checks.

5- DO NOT raise your lips with your fingers to inspect the treated area.

6- DO NOT brush teeth near the surgical site. Brush teeth in the rest of your mouth.

7- There is often a temporary loss of feeling in the operated area and the tooth may feel loose.

8- Do not smoke, spit, or use a straw on the day of the surgery (avoid smoking for a few days after the surgery).

9- Should any difficulties occur, do not hesitate to call our office anytime. In case of serious emergencies call 911.

Proper Care After Dental Implant Surgery

1- You may experience some discomfort and bleeding the day of the surgery.

2- Take all medication that was prescribed for you according to instructions.

3- Apply an ice bag on your face over the surgical site on the day of surgery for 10 minutes on and 5 minutes off.

4- Keep your next appointment on time for removal of sutures and follow up checks.

5- DO NOT raise your lips with your fingers to inspect the treated area.

6- DO NOT brush teeth near the surgical site. Brush teeth in the rest of your mouth.

7- There is often a temporary loss of feeling in the operated area and the tooth may feel loose.

8- Do not smoke, spit, or use a straw on the day of the surgery (avoid smoking for a few days after the surgery).

9- Should any difficulties occur, do not hesitate to call our office anytime. In case of serious emergencies call 911.

Proper Care of Dentures After Delivery

1- You will experience some discomfort with any new denture for a few days. All new dentures need several adjustments to completely and comfortably fit your mouth.

2- You should take the dentures out every night and keep them in a clean container filled with water or denture cleaning solution. Your gums need to rest and be without the dentures every day for a period of time.

3- Clean dentures thoroughly with a brush and water before putting them back in your mouth.

4- It may be difficult to talk normally with the new dentures for a few days. One way to practice is to read a book or newspaper out loud for a period of time everyday. Your tongue and muscles will get used to the new dentures and you will talk normally very soon.

5- Call our office if you are experiencing pain, discomfort, or if you have any questions.

Proper Care After Apicoectomy

1- Swelling, minor pain and/or skin discoloration may be experienced following the surgical procedure. This will be temporary.

2- In order to keep the swelling to a minimum, use an ice pack for the first few hours after surgery (on for 10 minutes and off for 5 minutes).

3- The day after the surgery, use lukewarm water rinses for the treated area following each meal. This should continue for the first 3 days following the surgical procedure.

4- Eat only soft foods. Avoid hard and chewy foods.

5- Get plenty of rest and insure normal intake of food, especially liquids such as fruit juices, soup, and milk. Use a vitamin supplement if desired. Try not to sleep on the operated area for 2-3 days.

6- DO NOT raise your lips with your fingers to inspect the treated area.

7- DO NOT brush teeth near the surgical site. Brush teeth in the rest of your mouth.

8- There is often a temporary loss of feeling in the operated area and the tooth may feel loose.

9- Take all medication that was prescribed for you according to instructions.

10- Should any difficulties occur, do not hesitate to call our office anytime. In case of serious emergencies call 911.

Proper Care After Bone Graft Surgery

You have just had surgery completed for the reduction of periodontal pocketing and/or for replacement of bone in an area where pathology existed, or in conjunction with endosseous dental implant surgical placement with or without platelet addition to the bone graft. You will be advised of the particular procedure and pertinent directions relative to your treatment modality. Whether you were put to sleep for this procedure or were only given local anesthesia, the post-operative instructions remain the same.

You will have several sutures (stitches) placed at the surgical site. These sutures may or may not be resorbable. If you have been told that you received external silk sutures, they have to be removed by us. The sutures will cause a pulling of your tissue over the bone grafting site. Since the bone graft site will have approximately 15 % more bone fill than what was naturally there, it is imperative that you do not pull up your lips or cheeks to show or examine the area. The undue pressure will cause the sutures to widen away from the surgical site, expose bone, create more pain, and delay healing dramatically. This delay can lead to the need for the area to be sutured again when you are seen for your 1 week post-surgical evaluation. The sutures will remain in place for 2 to 3 weeks depending on the size of the graft, the severity of the pathology, and the condition of the tissue being sutured.

Your doctor will tell you what time period to expect, but keep in mind that this is not etched in stone and the doctor may extend the time before your sutures are removed to assure adequate healing and to avoid surgical regression.

You also may have a periodontal pack placed over the surgical site. The pack is pink in color and impregnated with antibiotic, which will protect the surgical site from infection and any washout of the particulate bone utilized to restore your jaw. The pack should be left in place for as long as possible. If a pack is placed the doctor will remove the packing at your 1 week follow up and decide if the packing should be replaced or kept off. Usually the packing is kept on for 7 to 10 days at a minimum. You must return to the office if your pack falls off before you are seen for your 1 week follow up.

Your maintenance during healing has to be completed carefully. You can brush in every area except where the periodontal pack is placed. It is imperative that you use NO ASTRINGENTS such as mouth wash or antiseptic solutions during the healing period of your bone graft. Listerine, Viadent, or any other potentially caustic agent can RUIN your bone grafting procedure if contaminated, and require a replacement bone graft. The doctor and our staff will reiterate this to you at, during, and after your bone graft surgical procedure. After the first stages of healing are satisfactory, we will provide you with normal saline and instruct you on how to use it (with or without the addition of salt), as well as irrigation syringes for cleaning the surgical site.

Since bone grows and heals slowly, it requires conditions conducive to a proper environment and blood supply. Thus, it is imperative that immediately after your bone graft you alter your diet, as you would for any oral surgical procedure. This means that you should not eat anything that is too large, too hot, or too sticky. Your food should be tepid or on the cool side. Any food that is too hot will have a deleterious effect on your surgical procedure. Common sense must be used in determining what should be done or avoided. If for some reason you have questions about anything post-surgically, please call the office and we will inform you of the proper action to take.

Smoking after any oral surgical procedure will ALWAYS delay or disrupt normal healing due to a decrease in oxygenation of the tissue that is healing. Smoking should therefore be stopped for the first 7 to 10 days to allow for adequate initial tissue closure. Complete epithilization (closure) and wound healing normally takes a minimum of 21 days from the day the surgery was completed under ideal healing conditions, and with no other underlying systemic causes such as Diabetes Melitus, etc.

Bone grafting is a very predictable surgical procedure when done correctly and when patient cooperation is adhered to. Please try to be reasonable in understanding that this procedure has inherent risks associated with it, as stated in your informed consents. Some of these risks are also pertinent to your post-operative care.

We want nothing more than a perfect outcome with the surgical procedures that you are having done to rehabilitate your bone. This can only be attained with your cooperation. Please feel free to communicate with us at any time to make sure that the procedures you are having are properly maintained. No question is ever perceived by our office as being silly or unreasonable. We would rather have questions answered immediately than risk the chance that the procedure will not go as planned, especially from omissions that are preventable.

As stated above and outlined in your informed consents, please remember that there are some instances when no matter what is done, the outcome is not perfect. There are even infrequent occasions when a surgery may have to be redone; these situations are neither the doctor’s nor the patient’s fault.