Dental Questions: Why do I have to wait for my implant crown?

If you have had an implant placed at our office or one of our specialists' offices, chances are you had to wait three to four months for the implant to heal before having a crown placed on it. Conversely, you may know someone who had an implant placed and left the same day with a (temporary) Crown. Why did you have to wait all that time for your crown? The reality is that there are hundreds of approaches to implant placement, and our office uses the most predictable and conservative method possible. 

Dental implants gain their rigidity in the mouth from two primary sources: the physical retention of the implant screw in bone and the growth of new bone around the implant. The screw force that develops immediately as the implant is placed is formally known as primary stability. This type of retention locks the implant and allows the new bone to form around the it, creating a phenomenon known as osseointegration or secondary stability. Osseointegration creates the definitive force that stabilizes the implant crown for daily use. 

Some techniques will rely on primary stability to support a crown on the implant immediately. In these methods, the screw force of the implant is absorbing all the forces of biting or chewing. Any movement or looseness would prevent new bone growth and could lead to implant failure. At Thousand Oaks Family Dentistry, we know a dental implant is a big investment into your future comfort and quality of life. We prefer to use the most predictable implant techniques and wait for secondary stability to develop. Waiting three to four months for your implant to fully heal is a small price to pay for better chances at success!

We know that choosing a treatment to replace a missing tooth can be overwhelming. At our office, we pride ourselves in offering patients all their treatment options, along with a thorough evaluation to help you pick the right choice. If you have any questions about dental implants, bridges or other tooth replacement methods, please give us a call!

Dental Implant vs Bridge: Single Tooth Replacement

For most patients missing a single tooth, a fixed (non removable) and natural looking replacement is the number one priority. Historically, dental bridges offered these results by crowning the teeth adjacent to the missing space and "bridging" it with a false tooth. However, the rise of dental implants has created new opportunities to restore missing teeth without needing to modify the neighboring dentition. The best choice for your mouth depends on a number of biological and cosmetic factors. Take a look!

Dental bridges are an excellent way to restore missing teeth without requiring surgery or implant placement. The most obvious drawback is that the adjacent teeth need to be modified to receive crowns to support the bridging tooth. However, if both teeth already have crowns or large fillings, a bridge can seem like a more attractive option. The biggest hesitation towards placing a bridge is when one of the neighboring teeth is completely healthy and free of any previous dental work. From a oral hygiene standpoint, bridging two teeth creates a potential food trap and an area that is difficult to floss. You will probably need to use floss threaders to clean under and around this area. Cosmetics are difficult to judge on bridges. The height of remaining soft tissue, space to be covered by the false tooth and angulation of adjacent teeth will all influence the final outcome. 

Likewise, implants allow dentists to restore missing teeth independently of neighboring teeth. In fact, an implant does not even need a tooth on both sides of it to be placed. This is why implants are the first choice for replacement when the last teeth in the dental arch are lost. Since an implant is placed surgically, cosmetics can be managed via bone remodeling and gum grafting. A well placed implant is indistinguishable from natural teeth. However, implants have a long healing time, typically requiring 6+ months from insertion to final crown placement. In the meantime, patients are provided with a temporary denture called a flipper if cosmetics are a concern. Another consideration with implants is bone height and health. There needs to be ample space and width for the implant to be placed without damaging nerves, blood vessels or sinuses. Not every patient will qualify for implant surgery. 

Deciding between an implant or a bridge is ultimately your choice. However, an exam and conversation with your dentist can alleviate concerns and help guide you towards the option that suits your needs best. If you would like to schedule an exam or consultation, please give our office a call today!

Dental Implants: Our Office Policies

Without a doubt, implants are the newest and biggest trend in the dental profession. Never before have dentists been able to replace teeth so easily without dentures or bridges. Thousand Oaks Family Dentistry is at the forefront of implant treatment, offering tried and true techniques and procedures. As such, we would like to take a moment to inform our patients of how our office handles implant treatments.

A dental implant essentially consists of three parts: the titanium screw that sits in your bone. the "abutment" that extends above the gum line and the crown that is cemented or screwed to the abutment. At out office, we typically have one of our specialists place the implant screw. They bring years of knowledge and expertise to the procedure, along with advanced technology like Cone Beam CT scanners. All of this allows them to get better results in more difficult areas. Our specialists use Swiss made Straumann implants, which utilize the highest quality components and materials available. We don't want to take any chances with a procedure as sensitive as implant therapy.

After the implant screw is placed, it generally takes three to four months for the bones and gums to heal. In the meantime, we can offer you a temporary denture called a "stay plate" or "flipper" to fill in the missing space. Once the implant is fully integrated, it generally takes two appointments three week apart for us to take an impression and for our lab to create the final crown. While the process is long, implants are the ideal treatment for replacing lost teeth. We avoid having to alter adjacent teeth (as with a bridge) and there is no need for a removable appliance (as with dentures). It truly functions like the tooth that was there before. 

Does our office ever place our own implants in-house? We do, but only in specific cases. Firstly, we do not accept new patients solely to place implants (you must be a patient of record). You must also be healthy, have adequate height/width of bone and only need a single implant. For these patients, we can place implants replacing posterior teeth (molars and premolars). Any case that violates these parameters deserves the expertise and attention of a dental specialist. 

At Thousand Oaks Family Dentistry, we are ready and excited to handle your implant treatment. The first step is an evaluation to check your teeth and discuss options. If you would like to schedule this exam or learn more about implant dentistry, please give our office a call! 

Case Presentation: Premolar Implant

Every day, our office sees patients with a wide variety of restorative needs, each of which we try to match on an individual basis. Today's patient came to us with decay in their second premolar that structurally compromised the tooth. Radiographs revealed that there was not enough healthy enamel/dentin left to do a traditional filling or crown, so we had to consider other treatment possibilities. After reviewing options with the patient, it was decided that the tooth should be extracted and replaced with an implant by one of our specialists. 

Take a look at how the decayed (darker appearing) tooth was removed and replaced with a titanium implant. 

After the implant was placed and healed, we took impressions to make a custom mounting for the final crown (called an abutment). Since the second premolar is far back in the mouth, we had our lab create a gold abutment matched to a porcelain and metal crown. This combination of materials allowed us to create a crown that was both durable and beautiful without risking damage to the opposing teeth. The patient gets all the structural benefits of a metal crown, but with no metal showing. Careful planning provided us with great results; both our office and the patient were ecstatic with the outcome!

The final product! Notice how natural the implant crown looks in the patient's mouth. 

Overall, dental implant cases typically take about 8 months from start to finish. The vast majority of this time is spent making sure the implant is healed correctly and properly integrated into bone. In the meantime, there are numerous other considerations and adjustments needed: the appearance of the surrounding gum tissue, the color/shade of the crown and even the shape/material of the underlying abutment. If you are interested in an having a dental implant placed or are just curious about what goes into making an implant, please feel free to call our office! We are always happy to walk you through any of our procedures!

What's In an Implant?

If you are considering getting a dental implant placed, you have probably done some research and found out there are many options and variables associated with the treatment. You may have even seen the informational video our office produced on the topic. Because of their rise in popularity, we wanted to take a moment to address some of the common questions associated with implants and how they might play into your dental treatment. Take a look!

1. What is a dental implant?

An implant is a bioengineered screw that serves as an "anchor" for replacing one or more teeth. It typically sits below the gum level and creates a mounting point for a crown, bridge or dentures. Implants come in a variety of shapes and sizes to meet a number of demands and spaces to fill. 

An illustration of an implant vs natural teeth.

2. What is it made of?

Most commercially available implants are made of Titanium or a Titanium alloy. Titanium is an incredible material in that it resists corrosion while promoting bone growth. This factor allows your body to heal around the implant and create a strong bond. Some companies now make implants made from milled ziconia as well. These offerings are marketed as beneficial since they are metal free, but long-term research still needs to be done to confirm if they are as safe and predictable as titanium implants. 

3. Who is eligible to receive a dental implant? 

Implant recipients need to be generally healthy and have one or more teeth that need to be replaced. There are also certain restrictions on bone level height, bone health and extraction healing that need to be evaluated by a dental professional prior to implant placement. 

4. Who places the implant?

At our office, Dr. Kari Ann Hong places many implants in-house. However, depending on mouth location, health complications and patient needs, the expertise of a dental specialist may be utilized. Periodontists and Oral Surgeons are both extremely qualified and knowledgeable in the placement of dental implants. 

5. How is it used to replace a lost tooth?

After the implant is placed and heals, a small metal/zirconia flange (called an abutment) is screwed into the implant. Once the position of the abutment and the esthetics of the surrounding gums are approved, an impression is taken and sent to a dental lab. They will then make a crown that both fits on the implant and looks natural in your mouth. 

How the implant, abutment and crown work together. 

6. Does your office use a specific brand/type of implant?

Our office uses Straumann brand implants. These implants are made to meet very rigorous standards with the highest quality materials available. They manufacture a number of different sized implants that allow for many unique treatment options. Straumann is a very common and respected brand in implant dentistry, assuring that your implant will be serviceable for as long as possible. 

7. How is implant pricing structured?

Implant pricing is usually broken into three fees for the implant, abutment and final crown. Each fee will be for the procedure and the delivered "part." Naturally, this system will vary slightly office to office. 

8. Do I have to wait between having the implant placed and putting a crown on it?

In almost every circumstance, you will need to wait for your bone to heal around the implant before attaching a crown. This is to assure complete osseointegration before introducing stresses from biting and chewing. Some procedures/techniques allow for "immediate loading" of implants, but overall success rates are typically higher if you wait for the bone to heal first. The time you will have to wait varies person to person and needs to be evaluated by a dental professional. 

9. Will I be "awake" for the procedure?

At our office, we offer mild forms of sedations for implant patients with who have dental phobias. However, most people find the procedure both quick and very tolerable. If you do wish to be "asleep" for the procedure, there are a number of dental specialists who can arrange that treatment option. 

10. Will it look like a natural tooth?

Yes! Implants can be some of the most natural looking dental restorations available. Unlike a bridge, you can floss between the implant and the adjacent teeth, and unlike dentures, you will not need to remove it at night or before eating. Overall it is a great cosmetic and functional choice for tooth replacement. 

We hope we answered any questions you may have on dental implants. There are a number of options available in tooth replacement, and implants represent only one of them. If you would like to know more about implants, how they are placed and if they are appropriate for you, please call our office. We are always happy to answer any of your questions!

Crowns and Bridges

Hands down, dental crowns and bridges are the most versatile restorative tools at our office. Whether going on previously decayed teeth, root-canaled teeth or a dental implant, they offer convenience, beauty and excellent flexibility. Please take a moment and read why we love crowns and bridges at Thousand Oaks Family Dentistry!

In it’s simplest form, a dental crown is a hard, solid object that replaces the natural “crown” of the tooth. It can add structural rigidity, biting function or esthetic value to any damaged or decayed teeth. Similarly, bridges are three (or more) crowns made in tandem, were the outermost two units are attached to your natural teeth (or implants). The goal is to “bridge” the gap created by a tooth that was previously removed. Both crowns and bridges are prepared using the same techniques.

Crowns and Bridges are placed for a number of reasons. Crowns can be used to fix teeth that have too much decay to be rebuilt with a dental filling. They can also restore structure after a tooth becomes cracked (depending on the nature of the crack). Bridges are used to replace once-missing teeth in almost any area of the mouth. All that is required is that the gap is “surrounded” by viable teeth for the bridge to be mounted to. Likewise, implant crowns are the final restorative step in implant surgery and give the implant its beauty and functional ability.

The basics of how a tooth is prepared for a crown. (Read top left to lower right)

To prepare a tooth for a crown or bridge, we essentially remove a ~1.5mm gap from around all surfaces of the tooth, in addition to any defects or decay. The walls of the teeth are slightly tapered, so that the crown can be placed easily and has ample tooth structure to hold on to. At the gumline, a distinct ridge (called the “margin”) is created to give an explicit surface for the crown to be cemented against. In the case of bridges, this step is done on two separate teeth, with special care given to making both teeth completely parallel. For implant crowns, these steps and designs are built into the shape of the abutment, which is essentially a manufactured “undertooth” made at an off site dental lab.

1) A natural tooth is broken/decayed and cannot be repaired with a filling 2) The tooth is prepared for a crown, giving it clearance for the new unit and proper structure. 3) The final crown is cemented and delivered. 

Preparing and delivering bridges is done with much the same technique. However, a missing tooth is replaced in the process. 

After your tooth is prepared, we have a number of material options for making your crown or bridge. In nearly every case, we will use tooth colored materials and restorations. We can match almost any esthetic concerns, from color to matching staining patterns and the shape of adjacent teeth. For front teeth, we often use eMAX lithium disilicate crowns for their excellent esthetic properties and strength. In molars and back teeth, we typically place a material called Bruxzir. Bruxzir is an engineered zirconia that surpasses all other crown materials in terms of hardness and durability. We also have a number of more traditional crown materials at our disposal, ranging from gold to zirconia and porcelain fused to metal (PFM). Picking a crown material is a discussion between you and Dr. Kari that considers your whole-mouth condition and your specific wants and needs.

An example of an eMAX bridge/crown. 

At a crown preparation appointment, we start by getting you numb and taking an initial impression for our temporary crown. We then prepare the teeth, taking care to provide ample clearance for the new unit. Once the tooth is fully prepared, we take a final impression and make notes for the lab. Finally, we use our first impression to make an acrylic temporary. While this will not be as strong as your final crown, it will allow you to leave with a fully shaped tooth. This is important for esthetics, chewing function and for maintaining the space between the prepared tooth and the opposing tooth. After two weeks, the lab will deliver your crown, which will be adjusted, seated and cemented in a quick follow up appointment. The process for implant crowns is slightly different, but still requires appointments for initial impressions followed by the actual crown delivery.

If you have any further questions concerning dental crowns, please give our office a call. We place and deliver crowns almost every day and can walk you through your unique needs. There should be no confusion, fear or apprehension surrounding your crown or bridge treatment!