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FAQ – Overview

What is a crown?
A crown is a cap that covers most or all of a tooth. Crowns can be made from a variety of materials.

  • Gold Crown—lasts the longest, never chips or cracks, wears at about the same rate as natural teeth, but some people do not want to show gold, particularly in the front of the mouth.example
  • Porcelain fused to metal Crown—tooth colored, long lasting, has the strength of metal on the inside with porcelain fused to the outside, but porcelain can wear the opposing tooth since porcelain is harder than tooth enamel. Since porcelain is glass it can chip or crack, while this doesn’t happen very often it is hard to repair when it does.
  • All porcelain crown—the most esthetic, not as strong or long lasting as gold or porcelain fused to metal but technology has improved the success of this type of crown over the past few years. Most suited for the front of the mouth.Example 1: Severe wear to natural teeth – Smile and function restored with all ceramic crowns.

    Example 2: Unsightly old porcelain fused to metal crowns restored with new all ceramic crowns.

What is a bridge?
A bridge is way to replace missing teeth by crowning the teeth on either side of the missing tooth and connecting the missing tooth (teeth) to the crowns. It is glued into the mouth and thus is not removable. It functions and looks like real teeth. Bridges can be made from the same materials as crowns are made, however, all porcelain bridges have not proven to be as successful as gold or porcelain fused to metal.example1 example2

What is a partial denture?
Partial dentures are removable appliances that replace missing teeth. They are held in the mouth with clasps—small wire like clips—that grab the existing teeth. Partial dentures are less costly than other alternatives—ie. bridges or implants. The biggest disadvantage to partial dentures is that there is something foreign in the mouth, with metal going under the tongue or across the palate. Food often gets caught around all this hardware and the clasps often show when you smile or talk.

What is a partial denture held in by implants?
One disadvantage of the partial denture is display of retentive clasps. When implants are used to retain a partial denture we eliminate the un-esthetic clasp.

What is a complete denture?
When someone looses all their teeth the missing teeth are replaced with a denture or “plate.” Upper dentures generally work better than lower dentures because of the tongue which tends to dislodge the lower denture. Chewing efficiency compared to natural teeth is reduced by about 75%. Taste is reduced due to the need to cover the top of the mouth for upper dentures.

What is an overdenture?
An overdenture is a denture that rests of a few remaining teeth that have been cut off at the
gum line. The advantage over a complete denture is that the overdenture rests on the retained teeth rather than the gums and since some teeth are present there is less bone resorption which occurs once the teeth are removed. Implants can also be used to hold the overdenture in place and implants also reduce or stop bone resorption.

Overdenture

What is a dental implant?
A dental implant is a titanium metal screw that is placed into the jaw bone and used to support crowns, bridges, partial dentures, or overdentures.

Can anyone have dental implants?
Generally speaking the answer is YES. General health should be good since implant placement involves out patient surgery. Studies have shown that the success rate is greater with non-smokers and non-diabetics although we have successfully placed implants for diabetic smokers. The amount of jaw bone available to place the implants can limit the options but recent surgical techniques and implant design improvements have reduced the importance of bone volume so that we are able to place implants in sites we would not have considered 8-10 years ago. Age is also not a factor. We have place implants in patients as young as 14 and as old as 92.

What is the success rate of dental implants?
The answer depends on where the implants are placed and how many teeth are supported by the implants and the brand of implant used. Some implant systems are more successful than others. On average, in the upper jaw the success over 15 years is 92-93 %; in the lower jaw, 95-96% over 15 years.

What is the best dental implant system?
There are lots of good implant systems available. World wide there are about 1300 dental implant companies and in the U.S. about 70 dental implant companies. Not all of these implant companies will make it financially. The last thing a patient wants is an “Edsel” in their mouth. The most advanced implants tend to have roughened surfaces and other technological design advancements that promote healing and ease in restoration. Dr. Becker chooses to limit the use of implant to 3 or 4 implant systems that are assured of being “around” for a long time and employ the latest technological advances. Currently, 97% of the implants restored by Dr. Becker are made by Straumann Co ITI Dental Implant System and Nobel Biocare.

How long will dental implants last?
The generation of implants now commonly used (called Root Form Implants) were introduced in North America in about 1982. Many of these early dental implants are still in place serving these patients well. So, we don’t know what the upper limit is. The implant systems we have today are superior to those introduced in 1983, thus, we expect long years of use from today’s dental implants.

Is it painful to have dental implants placed?
In most cases removal of a tooth is move discomforting than the placement of implants. The surgical procedure is done under the influence of a local anesthetic. Intravenous sedation is available upon request. Minor discomfort can be experienced immediately after the anesthetic wears off. This is counteracted with the use of prescription medication. Typically, by the second day only Tylenol is needed. Resorbable sutures are used so within 7-10 days the patient looks and feels as if nothing had been done.

Are dental implants ever rejected by the jaw bone?
The process of the bone growing to the titanium implant is called Osseointegration. With the early implant systems about 10% of the implants placed did not osseointegrate. These had to be removed. With the advent of roughened surfaces and improved implant design the occurrence of non-osseointegration has been reduced to less than 0.1%. If an implant does not osseointegrate, it is removed, the site is allowed to heal about 2 months and a new implant can be placed in the same site. Oddly, the statistical success rate for this second implant is greater than the first—no one knows why this phenomenon occurs.

How long after dental implants are placed do I have to wait until they can be used for supporting my new teeth?
When root form implants were first introduced in North America in 1982 the protocol was for submerging the implants under the gum and jawbone for 6 months or longer. A second surgery was then needed to uncover the implant so it could be used to anchor the dental work. Today, most of the time, only one surgery is needed to place the implant in the jaw and it can be used in 6-8 weeks. In some situations the implant can even be loaded the same day as the surgery. Regardless of the needed healing time Dr. Becker will usually provide for some type of temporary appliance so that the patient can function and meet the public with confidence.

Can a tooth be removed and a dental implant placed at the same surgical appointment?
YES. Most single-rooted teeth can be removed and an implant place at the same appointment. The technology for removing molars (multi-rooted) and placement of an immediate implant is evolving. At this time Dr. Becker usually has the molar removed, it is allowed to heal for 2 months and then placement of the implant.

Why are dental implants so popular?
The biggest reason for the popularity of dental implants is their success. There is nothing that a dentist can offer to replace missing teeth that has the potential to last as long as dental implants. As life expectancy increases (86 for women and 78 for men) the need for a reliable permanent dental replacement system for missing teeth has become more evident in the overall health of the patient. Implants provide people with dental replacement that are both functional and esthetic. The demand has always been there, dentists just needed the tools to fulfill that demand.

Why are dental implants so expensive?
Technology in the biologic world is wonderful but expensive. The quality control assuring each implant meets exacting standards of precision and is totally sterile is costly. The care, knowledge, experience and precision to place and restore each implant case takes years to develop and is also costly. Even so, the cost of placement and restoration of dental implants has come down over the last few years. In some cases, placement of implants can be cheaper than conventional alternatives, such as bridges.

Why won’t my dental insurance cover dental implants?
Prior to the generation of implants introduced in 1982, the success for implant systems was less than 50% over 5 years for the lower jaw and worse in the upper jaw. Dental insurance companies saw this as a futile and experimental procedure that they were unwilling to support, so they all placed a clause in the insurance contract that disallowed coverage for implants. Since insurance companies are more interested in the “bottom line” than in your health, they have been slow to acknowledge the proven benefits of dental implants. This trend may be easing since we are seeing some coverage allowed for the restoration of the implant but not for the surgical phase.

Who should I see to find out if I can have dental implants?
Most oral surgeons and periodontists do the surgical placement of dental implants. These specialists usually do not restore the implants with teeth. Nearly all prosthodontists (Dr. Becker is a Prosthodontist) and many general dentists feel comfortable restoring dental implants. If you want to explore the possibility of placing implants then you should contact the people that do lots of them. Dr. Becker restores over 200 implants per year and he works closely with several oral surgeons and periodontists in the metropolitan Denver area.

What is TMJ?
TMJ stands for TemporoMandibular Joint. This is the jaw joint, up near your ear. Many people refer to TMJ Syndorm, or simply TMJ, as a series of symptoms that manifest in discomfort to this jaw joint area. Sometimes the discomfort can be severe and sometimes just annoying. It is often more severe in the evening, at night or immediately upon waking.

The cause of TMJ varies but 80+% of the time it is muscle related, which can be aggravated by stress from daily living (family, friends, job, etc.) and imbalance in the way your teeth function against each other (occlusion). If you are experiencing something abnormal to your jaw joint it would be wise to call it to the attention of your dentist to evaluate the symptoms. Physicians are not comfortable treating TMJ and usually refer you to your dentist.

Why won’t my dental insurance cover treatment for TMJ?
Traditionally, our knowledge of the jaw joint, beyond basic anatomy, has been limited. Although, this understanding is increasing rapidly with new research, there is still a lot of unanswered questions. Pet theories and treatments come and go and the cost can be expensive, sometimes with limited results. In addition, there has been a blurring of who is responsible for joint care—is TMJ the domain of your general physician, an ENT specialist, an oral surgeon, the orthodontist, a prosthodontist, your dentist? While all of these therapists have had some success with TMJ care, it is usually expensive. Thus, insurance companies generally have clauses written into their contracts that excludes therapy for TMJ syndrom. They will however, cover diagnostic procedures such as x-rays. Sequential diagnosis is critical to eliminate pathologic causes, such as tumors and arthritic destruction.