I need a dental implant…what should I know and ask? Your input is much appreciated.

[lambskin]

I have to get a dental implant in a front tooth and never had one before. I know it will be very costly, but there seems to be different materials( from porcelain to titanium) and techniques vary. The post and crown are 33 years old and due to bone absorption the post is failing. No infection or abscess. Any recommendations as to type, technique, pre op and post op issues? Any advice is really helpful as I have never had one before. Thank you.

 

[kenny]

Not an expert here, but can offer this info.
Nobody "needs" an implant.
A partial denture is an option and WAAAAAAAY cheaper.
They will look the same, but the implant (if it works and is paid for) is less hassle than a denture.

All the steps of the implant may take a year, and it's possible there will be complications and rejection, and the money you pay is not a money-back guarantee that it will work out or last forever.

After they extract the bad tooth the teeth next to it and above or below it will likely move which can be bad news and additional expense to fix or prevent movement.

 

[TooPatient]

DH is going through an implant right now. We didn't really ask details because we were both exhausted and didn't have the extra energy. The dentist is quite good so we just went with that. He had to have his tooth extracted. When they did the extraction, they put in a bone graft (not real bone, but some sort of material) to make it most likely to have an implant be successful. From there, it was a minimum of three to four months of healing. He is just there in the last couple of months. Now getting scheduled for some full mouth scan that will give the dentist a good look at what is in there and if an implant can be done along with specifics. I guess there are a couple of options based on how it looks. It is also possible DH will end up at a specialist office or being told an implant just won't work. So for now I just schedule the scan plus follow up and see where we go from there.

 

[Lookinagain]

I'm in the process of getting one now for a molar which had to be removed. I'm at the last steps, but it is a long process. They extract the tooth (and put in the bone graft material if needed), you wait a couple of months for that to heal, then they open the spot up again and put in the metal screw and stitch over that again. Then you wait about 4 more months. Then you go in and they open it up a little bit again (I think---this is my next step) and put something on the screw and do what they do to actually make the tooth that will fit on top. I think then it's another couple of weeks while the tooth is made and you go back and have the tooth put on. So you would be without a tooth for many months (unless, since yours is a front tooth they have some kind of temporary tooth). Since mine is a molar I couldn't get a bridge because apparently a bridge needs a real tooth on either side. If I could have gotten some kind of permanent bridge, I would have, just because implants are a long process with many steps. Yes, implants are expensive. Prices probably vary based on where you are located but I think mine will cost around $8,000 all in. I'm in New England. I also think that what you choose to do may be influenced by your age. I'm older and it's a rear tooth, so again, I would have been satisfied with a bridge, but it wasn't an option for me. If I were you, I'd investigate both. Neither the extraction or the insertion of the screw were painful. So that was a relief. It's really just the time and for you, what they will put in the space while you are going through the long process of an implant. If a bridge is an option I would think it would be faster which may be important since again, yours is a front tooth.

 

[tyty333]

I've had one done. Dont know what its made up...are you talking about the crown or the part that goes down into your gum? Anywho,
I had a broken root that caused an infection down in my gum/bone. It took 3 tries to get the graft to take. It took about a year of going
back and forth before it was complete. It was in a side tooth on the bottom. They didn't really want to do a bridge because they would have had to file down my natural teeth (that were perfectly fine and pretty) on either side of the bad tooth. I had an oral
surgeon do mine until it came to having the tooth put on the post at the end (the Dentist took care of that).

So, the bad was...
- it's a long-term process...you might want to google see if you can find the failure rate at initial installation (if interested or not)
- it was quite painful for me when they did the initial extract and implant (that failed) but I think that was because I had an infection
- it's expensive (but what you gonna do???)

The good...
- I've had it for a couple of years now and it looks perfect and is easy to take care of.
- My Doc gave me Valium for the night before and the morning of the extraction/implants. That made it easier but you need a driver.

I'm not sure what you are saying that you have never had one before but you said what's there (post and crown) is 33 years old and
is failing. What has a post that isn't an implant? I'm not very familiar with dental terms/apparatus. Is what you have, that is failing,
just a crown?

My advice... it's a marathon...not a sprint. That should help put you in the right state of mind. I was never told the extent of what
it could/might take so was not prepared.

Good luck!

 

[kenny]

... When they did the extraction, they put in a bone graft (not real bone, but some sort of material) to make it most likely to have an implant be successful. ...

It is ground up real human bone material from a cadaver.
In the days following this bone installation, some of the bone particles from this dead person may come out of the wound and you will feel them, like sand or gravel, in your mouth and be told to spit them out instead of chewing and swallowing them.

This donor bone material hopefully will fuse with your jawbone (for a lower) or skull bone (for an upper).
They do this bone transplant to build up a more-substantial foundation for the metal plug that will later be screwed into your jaw bone.
Often there is bone loss associated with a tooth that had to be extracted.

Months later if that heals okay the oral surgeon can install the metal post.
Months later if that heals okay, your dentist can make the false tooth that (I think) gets cemented onto this metal plug.

It's quite a procedure.
I think I'd opt for a partial denture because it's way quicker and simple, less invasive, and involves less medical risk and thousands of dollars cheaper.

But please do lots of homework about the procedure itself and the doctors and dentist you will select.

 

[canuk-gal]

HI:

My DH has at least 4 dental implants--and yes, as above, it is a long process. He suffered very little and healed well. My DH had several bridges prior, that broke.

His Dentist is excellent and worked very hard on my husbands teeth. Yes, it is very costly, but most people don't want dentures and do want as natural teeth as possible. As I said to DH, No teeth = no eating.

Success to you.

cheers--Sharon

 

[rocks]

HI:

My DH has at least 4 dental implants--and yes, as above, it is a long process. He suffered very little and healed well. My DH had several bridges prior, that broke.

His Dentist is excellent and worked very hard on my husbands teeth. Yes, it is very costly, but most people don't want dentures and do want as natural teeth as possible. As I said to DH, No teeth = no eating.

Success to you.

cheers--Sharon

I was hesitant to say anything since my experience is anecdotal. My husband places and restores implants regularly. He isn’t a fan of bridges or partials. You have to damage healthy teeth to anchor a partial or bridge. Often as time goes by the patient will experience gum recession and bone loss.

With all the technological advances of late, implants have become predictable, much more common, and less expensive if you don’t have any other conditions that would complicate the surgery. He doesn’t even prescribe narcotics after the surgery; just alternating Tylenol and advil.

 

[Lookinagain]

He doesn’t even prescribe narcotics after the surgery; just alternating Tylenol and advil.

Yes, I was told to take Advil and Tylenol. I didn't even really need it but took it the first day. I did have an infection prior to extraction, but they cleared that up with antibiotics before the extraction and I didn't have any pain when it came time for the tooth to be removed.

 

[rocks]

Yes, I was told to take Advil and Tylenol. I didn't even really need it but took it the first day. I did have an infection prior to extraction, but they cleared that up with antibiotics before the extraction and I didn't have any pain when it came time for the tooth to be removed.

Fantastic to hear. Hubby says patients are shocked when no narcotics are prescribed. Then, they discover that the drugs aren’t needed.

 

[TooPatient]

It is ground up real human bone material from a cadaver.
In the days following this bone installation, some of the bone particles from this dead person may come out of the wound and you will feel them, like sand or gravel, in your mouth and be told to spit them out instead of chewing and swallowing them.

This donor bone material hopefully will fuse with your jawbone (for a lower) or skull bone (for an upper).
They do this bone transplant to build up a more-substantial foundation for the metal plug that will later be screwed into your jaw bone.
Often there is bone loss associated with a tooth that had to be extracted.

Months later if that heals okay the oral surgeon can install the metal post.
Months later if that heals okay, your dentist can make the false tooth that (I think) gets cemented onto this metal plug.

It's quite a procedure.
I think I'd opt for a partial denture because it's way quicker and simple, less invasive, and involves less medical risk and thousands of dollars cheaper.

But please do lots of homework about the procedure itself and the doctors and dentist you will select.

I know they used a synthetic material for the bone graft. That was definitely one question I wanted to know an answer as we considered partial bridge or implant. There are a couple of synthetic options available that are as good or better than natural bone, thankfully.

I'm not sure what the specifics were for the partial bridge. It lost my support when they mentioned it would require work on the teeth next to the one that was extracted. I remember thinking that it seemed undesirable to do damage to otherwise healthy teeth. The price difference was around $1,000-1,500 total assuming no insurance. Comparable price factoring in what insurance covers of each.

Definitely invasive and takes a long time! We are driving nearly two hours each way to get to a very good dentist rather than using anyone closer to home. Worth the hours of driving to get it done right!

 

[eapj]

I don’t remember many details but had an implant placed about 15 years ago. It was a long process and I was missing a tooth for months. The worst part for me was the extraction. That hurt after the fact if I recall but the rest was no worse than getting a filling. I have had significant gum loss around the implant which doesn’t bother me since it’s a molar (the dentist says I’m taking care of it well so I’m not sure if that’s just what happens or if I have an issue) but I wouldn’t be happy if that happened to a front tooth (especially because I have a gummy smile already). Anyway, I’d do it all again as it was totally worth it.

 

[Lookinagain]

It is ground up real human bone material from a cadaver.

my graft was not from a cadaver. They were very clear to me that it was a synthetic material. And it didn't "leak" out of the incision nor was I warned that it might. So maybe something different than what you are aware of? Not sure.

 

[seaurchin]

My two coppers: I have several bridges, which I had for over thirty years with no problems before they needed to be replaced. Now I've had the new ones for about ten years with no problems.

I had a hard time finding someone to do the new bridges. They only wanted to do the far more expensive implants. I was told (aggressively, I thought) all the reasons the implants were better until I replied, "What part of 'The bridges have lasted for thirty years with no problems' did you not understand?"

I am not a dentist so I wouldn't even try to advise anyone about their specific situation but I would definitely also consider the other two options as well (bridge or partial dentures). A lot of dentists and related specialists seemed to me use high pressure sales tactics to try to grab the maximum profit possible from each patient these days. Very disheartening, when you were expecting professional, patient-centered help.

 

[kenny]

It's good to hear there are synthetic options.
Lots of people would be creeped out about getting a donation of "bank bone", especially when told bits of the bone 'gravel' might leak out of the fresh wound and into their mouth.
Apparently they can also do transplants of your own bone.

Now I'm curious about the cost-benefit the choices.
Of course then there is the insurance companie$$$$ influencing the choice if they are paying.
It's unfortunate we all don't get what's medically best, rather than what's cheapest.

SNIP
"Commonly used bone graft materials include autogenous bone (your own bone), cadaver bone (bank bone), bovine bone, and synthetic bone. The selection of graft material and surgical technique is based on the location and severity of the bone loss. In most cases, specially prepared cadaver bone and/or autogenous bone are utilized. Autogenous bone is usually taken from other areas of the upper or lower jaw."

Source:

https://www.massoralsurgery.com/dental-implants/bone-grafting/

 

[kenny]

More info about bone grafting choices ...

How much does dental bone grafting cost

How much does dental bone grafting cost? The cost of dental bone grafts varies widely, depending on the condition of the individual jawbone and the specific nee

www.precisioninperio.com

 

[Lookinagain]

More info about bone grafting choices ...

How much does dental bone grafting cost

How much does dental bone grafting cost? The cost of dental bone grafts varies widely, depending on the condition of the individual jawbone and the specific nee

www.precisioninperio.com

thank you. honestly, I think I'd rather have cow bone than human cadaver bone. I was told i got synthetic. I hope they were honest with me!

 

[tyty333]

I was hesitant to say anything since my experience is anecdotal. My husband places and restores implants regularly. He isn’t a fan of bridges or partials. You have to damage healthy teeth to anchor a partial or bridge. Often as time goes by the patient will experience gum recession and bone loss.

With all the technological advances of late, implants have become predictable, much more common, and less expensive if you don’t have any other conditions that would complicate the surgery. He doesn’t even prescribe narcotics after the surgery; just alternating Tylenol and advil.

I had painkillers for after the extraction and it hardly seemed to help. I was in so much pain I called the doctor after hours (which I hate
to do). He told me I could take another pain killer (basically 2 at a time) which finally allowed me to sleep. I think it may have been the infection though. Maybe the painkillers weren't that strong. I don't remember what they were.

 

[AprilBaby]

I am a dental hygienist. I have seen dozens of implants. No one regrets them and if you can afford it, it’s the best option. Most patients say the pain is not bad. We use ground synthetic bone if needed. They need to sit in the jaw for 4-6 months before having the tooth attached. Don’t do an immediate tooth. Good luck! I would do it if I needed one.

 

[lambskin]

Thank you everyone for responding to my post. I wonder what they will suggest regarding the gap in my smile for 4 + months. I have a job that requires people to look and listen to me all day….ugh! Will my vanity make me plug the gap cost me $?! I was worried about the pain but you all have made me feel a bit better about it. I know it will hurt in my pocketbook as I really don’t have dental insurance. My consultation with the oral surgeon is on Tuesday… I will keep you posted. Again thank you for your help.

 

[missy]

Thank you everyone for responding to my post. I wonder what they will suggest regarding the gap in my smile for 4 + months. I have a job that requires people to look and listen to me all day….ugh! Will my vanity make me plug the gap cost me $?! I was worried about the pain but you all have made me feel a bit better about it. I know it will hurt in my pocketbook as I really don’t have dental insurance. My consultation with the oral surgeon is on Tuesday… I will keep you posted. Again thank you for your help.

Good luck @lambskin! Keeping good thoughts for your consultation Tuesday.

 

[rungirl]

I have a very recent dental implant - the crown was just placed about a month ago. For me, there was very little pain involved in any part of the process. I didn't need a graft, the oral surgeon said I had enough jawbone.

I had the tooth extracted and the implant placed in one visit. It was surprisingly quick, maybe 30 minutes. The evening after that procedure I started to feel some pain so I took a painkiller and that took care of it. The next morning I took one more painkiller (preventatively) and that was the last one I needed.

I waited 4+ months to get the crown placed. It was somewhat of a nuisance having that gap, because I wanted to be very careful with the implant and pretty much chewed everything on the other side of my mouth during that time. Now with the crown, things seem to be back to normal.

One last thing - I don't have dental insurance either. I would recommend that you look into purchasing a dental discount plan if you don't have insurance. My plan costs around $100/year and saves me at least that much even in a normal year. I saved quite a bit on this procedure with that plan.

 

[Lookinagain]

I'm not sure how much dental insurance would cover anyway. A lot of them have a fairly low yearly cap. I think mine, which I get through work, caps out at $2,000 a year in-network, and $1000 a year outside of network. It helps, but doesn't begin to cover the cost. I think if they can put the screw in at the same time they remove the tooth (meaning you don't need a graft) then the cost is less overall.

 

[kenny]

I think if they can put the screw in at the same time they remove the tooth (meaning you don't need a graft) then the cost is less overall.

I think it depends on how much bone loss the individual has.
Often when tooth is so far gone to require extraction, there will also been bone loss in the supporting jaw.

Also I think there needs to be weeks to months of healing time after each traumatic tissue assault, like the extraction.

 

[tyty333]

Thank you everyone for responding to my post. I wonder what they will suggest regarding the gap in my smile for 4 + months. I have a job that requires people to look and listen to me all day….ugh! Will my vanity make me plug the gap cost me $?! I was worried about the pain but you all have made me feel a bit better about it. I know it will hurt in my pocketbook as I really don’t have dental insurance. My consultation with the oral surgeon is on Tuesday… I will keep you posted. Again thank you for your help.

My SIL had to have a crown put on a front tooth and they gave her a "flipper" (I think that's what its called). Basically fake teeth
that just snap over your real teeth so it doesn't look like you are missing a tooth. YMMV...not sure of the cost...hope it's relatively
cheap.

 

[kenny]

Thank you everyone for responding to my post. I wonder what they will suggest regarding the gap in my smile for 4 + months. I have a job that requires people to look and listen to me all day….ugh! Will my vanity make me plug the gap cost me $?! ...

Besides appearance, there are important mechanical reasons to not leave a gap there for months.
A gap allows the two adjacent teeth, and the opposing tooth, to move into the gap.
Teeth that touch prevent each other from moving.

If the gap is left for months you'd have to spend more $$$ to move the teeth back to make room for the new implant tooth.

If you happen to wear a night guard, aka splint, for bruxism (grinding teeth while sleeping, or awake) you can just leave the gap.
The teeth won't move because wearing the night guard every night keeps all 3 teeth where they belong.
This is one of the $1300 night acrylic guards with stainless steel positioning posts that your dentist custom makes to your mouth, not the $25 rubber ones at the drug store.
Of course that's usually for a molar which is not visible in the smile.
But then you might be one of those tough macho guys or gals proud to have a hole in their smile.
When people ask you can tell em it was a barroom brawl, and "you should see the other guy."

 

[vintageinjune]

Thank you everyone for responding to my post. I wonder what they will suggest regarding the gap in my smile for 4 + months. I have a job that requires people to look and listen to me all day….ugh! Will my vanity make me plug the gap cost me $?! I was worried about the pain but you all have made me feel a bit better about it. I know it will hurt in my pocketbook as I really don’t have dental insurance. My consultation with the oral surgeon is on Tuesday… I will keep you posted. Again thank you for your help.

I'm so sorry to hear that your front tooth has suffered from resorption and has to come out, that is always disheartening.

Like AprilBaby, I'm a dental hygienist and have worked in offices that place dental implants. First, I'm glad you are going to an oral surgeon. For a back tooth, a general dentist who has placed implants for years would be fine, for a front tooth, you want the best, and oral surgeons/periodontists do this better than anyone.

Quick summary : Implants themselves consist of three parts: The implant, or the titanium screw that acts like the root support of the part you see, which is the crown. Between the implant and the crown is an abutment that connects those two pieces together. As for the procedure: the front tooth will need to be extracted. A bone graft may be recommended, because the final aesthetic result with depend heavily on having enough bone support for an implant (the titanium screw) to be postioned properly. If a bone graft is needed, it will take 3-4 months to heal/integrate. During that time, to replace the missing tooth your dentist may make you an Essix retainer (looks like a clear invisalign tray) where they fill in the space that is missing with material that makes it look like you have a tooth. While you cannot eat with it in, it allows you to look like you have all your teeth until the implant can be restored. After the bone graft has healed, the implant can be placed. This will again take another 3-4 months of healing time. Once integration has been succesful, an abutment and crown will be ordered. This will be done by the general denist. While I cannot advise on best material for your crown to be made from, it is usually worth the extra money to pay for custom shading if your natural teeth on either side are not a perfectly standard shade/color. I have little white spots on the edges of my front teeth, so when I had two crowns done I paid extra to have my crowns painted to match my natural teeth, imperfections and all. It cost an extra $300 for the two.

Break down of what you will likely be charged for:
-CT scan/3D scan of the area
-Extraction of the tooth
-Bone graft if deemed necessary (this will be done at the same time)
-Retainer to replace missing tooth
-Another CT/3D scan to verify exact width/depth and density of the bone so they can select the size of the implant to place
-Placement of implant
-Abutment
-Implant crown
-Possibly custom shading

Some specialists will charge a fee for the use of a custom guide made from a 3D model of the area to verify they put the implant *exactly* where it needs to go at the correct angle and position (we are dealing with three dimensional space after all) , some may use what is called the X guide which allows the specalist to know where they are in real time as they place it (takes about 10-15 minutes to set up per person). Others may not use any special guide.

Phew! So, a few great things about implants is that they prevent bone from resorbing. Some people opt for bridges and years later get a gap between the floating tooth and their gums because if there is nothing there, the body will resorb the bone in the area (how much depends on genetics). Implants cannot get cavities! They can however get peri-implantitis, so you need to take a little extra care and make sure it is cleaned very thoroughly daily. Once an implant is placed, it will not move as long as it is healthy. Downside for some people is if they were planning on braces to realign their teeth, they need to do it before any implants can be placed. However, in some rare cases, the teeth adjacent to the implant will shift. This happened to my mother's best friend last year (same situation as you). The end result at first was perfect, but over the next 6 months her front teeth shifted so much around the implant that she is now having to get braces in her 60s to fix it. To be clear, this is a very rare case, and none of her dentists did anything wrong aside from not telling her this was a possibility (likely due to it being so rare it just didn't cross their minds). Implants at this point have very good success rates, you can eat/drink like normal and never have to worry about forgetting to put it back in (the number of people I've seen over the years who accidentally lost their partial because they left it at a restaurant is mind blowing). Most likely, once it's done, it is done and you take it with you when you go.

Downside to implants: expensive, time consuming, can be painful if an infection sets in, and like everything there is a potential for rejection from the body.

If anyone offers you a same day implant, run away! (This is where they extract the tooth, place any bone graft material, and the implant the same day). Same day implants in some cases have comperable long term success rates, and sound good because if they are successful you can get your crown 3-4 months sooner, but we are dealing with a front tooth and I would not risk inadequate bone support that could compromise the interdental papilla for the final result (aka, a gumline that looks natural around the implant).

As for insurance, I would ask the receptionist/insurance specialist at your general dental office if they could recommend an individual plan in your state with no waiting periods that covers major restorative and implants that they and the specalist accepts.

 

[AprilBaby]

Thank you everyone for responding to my post. I wonder what they will suggest regarding the gap in my smile for 4 + months. I have a job that requires people to look and listen to me all day….ugh! Will my vanity make me plug the gap cost me $?! I was worried about the pain but you all have made me feel a bit better about it. I know it will hurt in my pocketbook as I really don’t have dental insurance. My consultation with the oral surgeon is on Tuesday… I will keep you posted. Again thank you for your help.

Usually you get a temporary flipper, it’s like a retainer with teeth on it. It’s usually included in the price.

 

[canuk-gal]

My SIL had to have a crown put on a front tooth and they gave her a "flipper" (I think that's what its called). Basically fake teeth
that just snap over your real teeth so it doesn't look like you are missing a tooth. YMMV...not sure of the cost...hope it's relatively
cheap.

This. One of the implants my DH had was an eye tooth. The "Flipper" the Dentist made, looked completely natural.

Sorry about no insurance, but as others have said, the bulk of it isn't covered by many plans anyway.

 

[Lookinagain]

I think it depends on how much bone loss the individual has.
Often when tooth is so far gone to require extraction, there will also been bone loss in the supporting jaw.

Also I think there needs to be weeks to months of healing time after each traumatic tissue assault, like the extraction.

two of my employees who had no bone loss were able to have the screw put in when they extracted the tooth. They both said doing it that way saved a couple of thousand dollars. That's all I know about putting the screw in at the same time. I had to wait because I needed a graft. They both had cracked a molar if that makes any difference.