Why Do Dental Implants Fail?

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Video Transcript:

Why do implants fail? What causes implant failure? People ask, “What’s your success rate?” Well, I would say my success rate is pretty typical to what other doctors are in the country. Somewhere between 95 and 98% is what I would say.

There’s really three parts to any implant. Okay? You have the implant that goes into the bone. It’s like a screw that literally is screwed into the bone. So you have an implant, this would be your bone. Your tissue would be just a little bit higher than that. So tissue would be up here. And inside that implant, you’re going to have a post that comes in here with a screw. And that post comes up like this. So post is screwed into the implant. And then on top of this, there’s the crown. The crown connects to this post.

There’s two types of crowns. You can have a crown that’s retained by a screw or a crown that’s retained by cement. And there’s different indications for each. It’s not necessarily that one is better than the other. I like screw retained crowns better for the most part, but sometimes a cement retained crown is the only thing we can do. But the success of a crown is largely related to the type of material used, the overall fit to the post.

The last thing would be they’re grinding their teeth at night. So even the best crown, if it has so much forces on it, that can cause problems. So if you’re grinding so hard, the screw that connects this into here will become loose and this whole thing gets loose. If his whole thing is getting loose and it breaks, now this implant can be compromised all together.

How well is this implant supported by bone around it? So we look at that through x-rays and CT images and then we look at the health of the tissue. The patient complaining about getting food caught. If it’s red, it’s irritated, it can turn into implantitus, which basically means that once this gets so irritated, now the bone starts to drop. And so at what point does an implant truly fell? As you start to lose bone the patient may not notice anything if losing bone over time and if you catch it early, the success of this implant long term can be saved. But if you wait years and years, the bone level is here, now all of a sudden that bone level drops to here. Can you see? That’s a big problem. Now we have threads and it’s all exposed. It’s hard to clean. But what happens is some patients will come back, it’s here and the implants actually moving. Now we’ve lost the implant.

There’s early failure and there’s late failure. Let’s define early failure as the first six months, okay? This is where the implant is placed and then in the first six months for some reason the implant does not integrate. We put it into the bone and we hope because it’s bio inert, meaning that it doesn’t react or cause an inflammatory process that the body is going to accept it and grow around it. I kind of see it as doctor related problems and then patient related problems. So within early failure with the doctor, this would be where a doctor puts an implant in on someone that’s not healthy. Maybe they have diabetes. Perhaps they are a big smoker. Perhaps they’re going through treatment, cancer treatment or some type of really aggressive treatment where their body’s has a lot of medications inside of it where the body isn’t in great equilibrium.

Basically we look at what the person’s blood sugar is, what’s their blood pressure like, what’s their cholesterol like? We literally ask every patient to go get a blood test. If they haven’t had blood drawn in the past six months, we ask them to go draw blood. But we let the doctor read it and then we’re able to look at that and make a decision if they’re healthy enough.

As far as surgical technique, if there’s not good sterilization or not disinfection meaning the site isn’t super clean, debris that gets down into the site and that can cause an early infection. But sometimes you can have sites that become infected in the first few weeks and then you have to take the implant out and graft and start back over again.

In the first six months it’s really critical that there’s a good prosthetic plan. What that means, most doctors don’t put anything over an implant in the first six months, unless you’re doing it like me. I do temps all the time and if those temps aren’t made properly, you can have implant failure for sure. But if I was to say the number one overall reason why dentists fail in dentistry as a whole is because we just aren’t always great communicators. And so that’s why it’s super important that on the front end, during the process and at the end when you get your actual crown or device, that you have great communication with the doctor, that you ask the right questions and make sure they answer you.

Now it’s about what the patient can do wrong. Early fair the patient comes down to overall health. So you don’t want to lie to the doctor about your overall health. If you have diabetes and you don’t tell them, that’s a really big deal. Diabetes is one of those things that really compromises your ability to heal and that’s why we take more measures to make sure that someone’s healthy enough. And during that six months while you’re healing, making sure you stay healthy too, that you continue to manage any diseases that you currently have.

The biggest thing where patients can mess up and cause failure in implants is that it comes down to compliance. So if a doctor doesn’t communicate super well, the patient may not understand what the importance of compliance is. There’s the what and the why, right? The what is don’t eat hard foods. The why is because it’s going to make you redo the whole surgery again. Making sure you’re on a soft diet in the first week and a half, two weeks. We don’t want you on anything that has nuts, seeds, things that could get inside the suture lines because that can cause an infection. We’re trying to avoid any early infection. Most infections are going to happen in the first couple of weeks. Which couples with that with infection is making sure the patient’s taking antibiotics.

I’ve had patients that they’re very naturalistic and they don’t want to take any more medications. They say they’re going to, but then I find out they don’t, and this is a huge, huge risk. You need to make sure you stay on your antibiotics. We start antibiotics three days before and we do it seven days after. And then with very severe advance surgical cases where we’re doing more with the zygoma or the sinuses, we actually will sometimes do a second round of antibiotics. And sometimes in very severe cases, we’ll actually do a couple of different antibiotics together which is really important.

So we’ve talked about compliance, right? We’re talking about diet, we’re talking about medications, we’ve talked about antibiotics, now we’re looking at the importance of using your anti-inflammatories. So ibuprofen and we’ll prescribe a steroid too. But taking these medications as prescribed to keep the inflammation down. By keeping the inflammation down or the swelling down, it’s going to make it so that you’re going to heal faster. And your risk of having an infection goes down dramatically too. Not to mention you’re going to look a lot better. You’re not going to look like a chipmunk.

When my patients come back and they walk in the room, I can tell immediately if they listened to what I said. If they haven’t been taking their anti-inflammatories or the big thing is sleeping on your side or sleeping flat. If they do that, immediately I’d be like, “You slept on your right side,” or “You’ve slept flat,” because they just look like a chipmunk. All these things make the experience much more enjoyable and less risk of infection.

We also require the patient’s rest. We don’t want them going back to work. We don’t want them getting their heart rate going. We have patients that sometimes are like, “When can I go back and work out?” And I’m like, “Give it a week.”

The last thing I would say that’s most relevant in the early failure stage, it comes down to hygiene. You got to make sure you’re rinsing and cleaning. There’s a certain point where you don’t want to brush around your implant for the first couple of days because it sensitive. But after that we want you to brush your teeth. Hygiene during that first six months is critical. And to me that’s when I’m aggressive. I tell my patients, “I love you but I will call you on your stupidness. I can tell you’re not on a soft diet. I can tell you’re not cleaning it. You’ve got to do better. And if you’re not going to do better, you might as well plan on just putting more money towards because when this implant fails, I’m not going to replace it. It’s going to be your responsibility.”

Okay, so let’s shift gears now a little bit. Let’s go to late failure. Where can a doctor mess up that would cause implants to fail later on? It could be with the original prosthetic plan. Is it possible that the implant wasn’t placed in the right place, which maybe was to build a device or crown that doesn’t line up well? And it comes down to communication again. Communication to your patient about the importance of maintenance.

Cleaning is basically what it sounds like. You’re cleaning around the tissue, you’re cleaning around the device, you’re cleaning around the implant. But when we talk about maintenance, now that’s a totally different thing. Maintenance means that now we’re checking the overall health of the bone around the implant, the health of the tissue around the implant. The color, the shape, the consistency and that’s why it’s important to come and do regular checks because a good doctor will look at the wear patterns and in my case I have night guards on all my patients. A night guard actually protects your teeth so that you can’t do damage during the night. But you can see this and then you can modify it.

And so if the doctor doesn’t communicate the value in this, the patients just disappear. Patients get them put in and they say, “Sayonara.” And if we’re not great at communicating, “Hey listen, you’ve got to come back. Even if you don’t come back to me, you need to go somewhere else and you need to have it done regularly. You need to have it done by doctor that’s looking for these things. He’s looking for the bone health, he’s looking for the tissue health. He’s looking for the overall wear patterns and how you’re biting down and potential grinding.”

Another thing that can go wrong too is that the screw that goes into the implant itself, if you’re grinding, that screw can loosen up and so if you wait till it’s too late and the screw is loose and the crown is moving, patient bites down once and the screws snaps. Now all of a sudden we have a very serious problem where we have to go and try to rescue that screw tip, which is not easy and sometimes we can’t even do it and then we have to actually take the whole implant out.

So late failure. Talk about the doctor’s responsibility. Talk about the patient’s responsibility. We’re talking about maintenance visits, hygiene visits. We’re looking at overall health again and to say that when you place the implant you didn’t have diabetes, but now 10 years later you have really bad diabetes that will affect anything in your body. And if you get any diseases it’s caught early so it doesn’t affect the implants.

Don’t start smoking. Smoking would be the worst thing to do. We used to think that smoking, once an implant was healed, that it would be okay. Now all the studies out there saying that smoking, even after you’re all healed up, it causes implants slowly to lose bone over time.

There’s lots of factors here, but like I said, we started early failure and there’s late failure and the doctor has responsibilities and the patient has responsibilities. You should listen very carefully. Write down, we actually give notebooks to all of our patients. We want them to bring these notebooks back and continue to ask questions over the years so that we make sure that we answer them.

If there’s anyone out there that you know that has an implant and they’re having issues or struggling with it, share this video with them. I would love to help anyone out there that maybe needs a second opinion to see what we can do to help solve a problem for you.

But thank you so much. Appreciate you. Have a good day.

Dentures vs Over-Denture (aka Snap In Denture) vs All-on-4 Dental Implants

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What are the differences? Why do the all-on-4 dental implants have so many options, and how are they different? What’s the best option for me?

If you’ve asked yourself these questions, this video clearly explains the differences and benefits between all of these devices. If you still have questions, then you may need a consultation! These consultations are free and include a free 3D CT Scan. Give us a call at # to book you free consultation today!

Script of video below.

Hi, I’m Dr. Hendriks. Thank you so much for being here with me today. We take an immense amount of time trying to help patients understand why one device might be better for them, why one device might be more expensive, and why some devices just aren’t good options. I’m going to try to go through each one of them and why one device might be better.

Starting off here, if we compare to a bicycle or a denture, a denture is something that is very, very popular in United States. Well, let me tell you why a denture may not be your best solution. A denture completely blocks the inside of the roof of the mouth. The biggest problem with that is that you’re not going to be able to taste the food that you want. It literally is blocking all the taste buds, not all of them, but a majority of them so that most people feel like they just can’t get any enjoyment out of food.

The second thing is that it is really bulky and it has to go into all the corners of your mouth, and so it really can be uncomfortable. For some patients, this makes the whole profile change too. The other reason why I don’t like dentures, to keep the denture fitting well, you have to realign it often, meaning that you have to add material into it. The second that you take your teeth out, you start to lose bone. You never stop losing bone unless you have a healthy tooth or a healthy implant.

When I was doing dentures, they did look beautiful, but the problem is patients would come back and be really frustrated they had to pay for realigns, and the denture was always rocking and moving on them. They couldn’t taste their food. When you go into a denture, you lose two thirds of the menu that you can eat, meaning that you’re only able to generate 30% of the bite that you could generate when you had natural teeth.

The one time I think a denture would be appropriate would be if you don’t have any teeth, all your teeth have been extracted, you don’t have the finances to be able to afford implants at that time. Then if that’s all that you can do, then a denture is better than nothing, but don’t go on a denture just because you want it to look better, because the rest of your life you’re going to struggle with your face falling in. You know, you’ve seen this, right? We’ve all seen it. The person that takes out the denture, and literally their face caves in and they don’t look like the same person. So, don’t let a doctor convince you that a denture is the best option unless you truly have exhausted every resource possible.

Okay, now let’s move on to the next one. An overdenture basically has at least two but oftentimes four implants that are connecting it so that when you put it in, it kind of snaps in like buttons on a shirt, like this. It helps keep it in when you’re talking. As you start to chew and eat, though, oftentimes a denture will dislodge because the reality is that underneath here you see these little black rings. So, when that goes in and out, in and out, what happens is that it’s going to move and it’s going to wear.

So, the biggest reason I don’t like this device is patients typically complain that they’re so frustrated that it costs so much to maintain it. It could be upward of $400 to $500 every time you come in on top of a cleaning fee, on top of a realign fee. This is like a printer, in a sense. You can buy it cheaper than everything else, but it’s the ink that costs you the money. The ink is basically the realigns. It’s these inserts. I would say well over 60% of my patients have upgraded into a different type of device because of these maintenance costs.

So, overdenture is still better than a regular denture, but if you’re going to spend this type of money, then I think it’s best to talk about All-on-4 bridges. The concept is basically putting four implants in the right position and supporting one continuous bridge. So, there’s really two different options. You have a titanium bridge that has acrylic around the titanium bar, and then you have denture teeth that go on top of it. Okay, that’s option one. Here’s an example of just the bar that’s inside there, okay? Option two is what we call a zirconia device. A zirconia device, unlike this one, is built completely all in one piece, okay? So, you don’t have three pieces. You don’t have titanium, acrylic, and then denture teeth. You have one continuous piece, and that piece is super, super strong. So, strength-wise, that’s the biggest difference between the two, okay?

We can customize these into really different colors. You’ll notice that each one of these is different. The gums can be different. The shade, for example. This is super white. I’m not a big fan of really, really white teeth unless the patient wants them, but we can customize. You’ll see there’s no two devices that are made the same. Here’s another example of some teeth.

So, okay, let’s get back. Now that I’ve done an overview of these, let’s get into specifics. Okay, so the titanium device, okay, as you look here, this is kind of cross-section. So, the device would normally look just like this, okay? But to help you understand, I’ve removed acrylic around this so you can see how the bar comes completely around. So, it’s supported 100% by a titanium bar. That titanium is the same titanium grade that the shuttles are made out of, super strong.

But the biggest problem is when you combine those three things, the titanium bar with acrylic and then a denture tooth, what often happens is you have a patient that isn’t doing anything wrong. They’re just living life, and they bite down the wrong way, and a tooth pops off or breaks off. That can be really frustrating for patients. With all the money they paid, that can be super frustrating. So, here’s the thing, if you’re not one of those people who likes to be inconvenienced with a tooth breaking or wearing down over time, then you shouldn’t get a titanium bar, okay? They look beautiful. They’re gorgeous. I mean, I’ve done thousands of these, and I’m very passionate that they are a good option. They’re just not the best option.

Over time, they do wear. These denture teeth, even if they’re the best quality, they’re going to wear much faster than other materials. It’s really important if you have this made by any doctor that it’s made hygienic, meaning that it’s made so it’s super, super smooth and rounded. I see devices that look good, the teeth look good, but here’s the problem is that the what’s underneath, what’s up against the gums and how if … It’s called a ridge lap. If it comes up over, it makes it difficult for you to be able to clean it. It’s not going to last long-term, okay? So, that’s why you have to have a doctor that builds it super hygienic. That’s one drawback to the titanium, is that acrylic does absorb saliva, and so it, consequently, it can be harder to clean because the surface won’t be as smooth, unlike the zirconia, okay?

So, the zirconia, unlike the titanium, is built out of one material. It’s the strongest material known in dentistry. They call it monolithic. It literally can take so much more pressure and strength, and so we don’t have to worry about a tooth breaking off or a tooth wearing down. This is a device, I call it a … It’s a Mercedes tank, in a sense. This is something that when you feel the difference and you come into my office, you feel a difference. This feels about 10 times heavier, okay, because it is much, much stronger than this. Although it’s heavier and it’s stronger, it’s still super gorgeous. This one here takes a lot more time to do, and that’s why it is a little bit more expensive; but at the end of the day, the cost that you would pay in maintenance with the titanium, you will make that difference up in the zirconia.

Like I talked to you about the hygiene being a problem with the acrylic, the zirconia is a ceramic. It’s like a glass, and so underneath where the surface is actually touching the gums, you actually … It’ll be a lot more hygienic. It’s like glass, so food doesn’t get caught in there as well. What I love about it is it’s fully customizable unlike the titanium where we’re using denture teeth that are stock teeth. They’re still gorgeous teeth, don’t get me wrong, but they are teeth that we pick out of a catalog, okay? With the zirconia, literally we build them in our computer, and we design them there, and we mill them. You will only have those teeth. You’re the only person that will have the teeth that you choose, and I think that’s kind of cool.

Fully customizable, meaning not just the size and shape of the teeth. We’re talking about the shade of the teeth, the way that they’re inclined, the way that they kind of pop. If you want teeth that are super bright and white and you want that Hollywood look, we can do that. But if you want to have some textures in it to make it so it looks like people don’t know that you had your teeth taken out, that’s really easy to do with zirconia. We can customize the gums as well, which is a big deal for some people. These shades can go from … I mean, if you look at this alone, if you look at these three, all three different, or all four different devices here have a different shade. So, I’m super passionate about all of this.

So, I’ve covered a lot of information here. The hard thing is that each one of these work for certain people, and I really need to know you to know what’s best for you. Please come into my office, and we’ll sit down and talk personally about what you want in your new smile and what’s most important to you. Then we can find the device that fits your needs and your wants. I promise you this: If you come to Dream Dental, the time that you spend with me or with one of my doctors will be well worth it. We truly change more than smiles. We change lives, and we would love to change your life. So, please don’t hesitate to fill out the form below and give us your information so one of my awesome staff members can reach out to you and start the process of changing your life. Look forward to seeing you.

Top 10 Factors that Influence the Cost of All on 4 Dental Implants

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We just released two new videos discussing these things below. The first video is the summary version, and the second is the extended version

 

 

Patients are often confused and frustrated as to why All on 4 dental implants costs vary so much. From the outside perspective, this frustration is warranted! Cost can vary as much as $15k-$35k per arch depending on these factors:

  1. Geographical location – Depending on where you live, the cost of All-on-4 dental implants can vary up to $20,000 per arch. The lower the cost of living usually leads to a lesser price.
  2. Two Office specialist approach vs One Office that does both Surgical and Restorative – When two offices are involved the fees are almost always more expensive versus an office that handles the surgical phase as well as the restorative phase.
  3. The Surgeon’s Experience (Specifically with All on 4 Dental Implants) – Unfortunately many dentists have a desire to begin doing All-on-4 implant procedures, but they also have so little experience that they will often lower the cost to win a case. This is often done without letting the patient know of the level of experience. This is a big factor in the price, and their inadequacy will usually result in tacking on costly and often times unnecessary warranty fees. Labs that have more experience and provide extra customization charge more to the doctor and therefore the price increases. Some doctors do not disclose that they send their work overseas to other countries with lower cost of labor and no regulation of materials. These devices often look similar to other dental offices but lack the integrity and can fail 3-5 years later.
  4. Number and type of Implants – Although four implants per arch is the perfect and ideal number, at times additional implants must be placed. This can be due to loss of bone, severe infection or the density of inner bone.
    1. Majority of implants are placed in the maxilla or mandible but in certain cases with severe bone loss, longer implants, which are more invasive must be placed in zygoma bone just below the eye.
  5. Sending out Lab Work – offices that can keep most and in some cases all of the lab work in the office are able to lower price as well due to economies of scale. Most offices have the final device made outside of their office.
  6. Cosmetics and Functional Demand varies by Patient – The material used for an all-on-4 dental implant bridge can vary in price significantly .
    1. Titanium Bar is the most commonly fabricated and will usually be cheaper than zirconia because stock denture teeth are used to save money in most cases.
      1. With Denture teeth
      2. With Monolithic polymer
    2. Zirconia is more expensive because it is 100 percent customized to the patients mouth and cosmetic needs, as well as being the most durable bridge
      1. Stained Monolithic
    3. Other Materials not as common – generally these are less expensive than the titanium or zirconia due to the type of mill needed to fabricate titanium or zirconia and are only the substructure attached to implants and need other materials for the teeth and gums.
      1. Trilor substructure
      2. Trinia substructure
      3. Pekkton substructure
    4. The presence of any porcelain for gums and teeth and how it’s veneered or crowned (Porcelain weakens the device but gives it an even more customized appearance)
  7. Level of Anesthesia – This procedure can be done under local anesthetic, I.V Sedation, or General Anesthesia, which increases the price with each level of anesthesia, as well as the location it is rendered in. A hospital setting will be much more expensive than a dental office that brings in an Anesthesiologist.
  8. Additional advanced techniques required to deliver the all on 4 dental implant bridge
    1. Existing implants that are used or removed can increase the price in both scenarios because it creates more work for the doctor and staff to research the implant system or remove the implant/s.
    2. Excessive infection in bone and soft tissue
    3. Excessive bone loss
    4. A maxillary sinus that is positioned more anterior
    5. A mandibular foramen that is more anterior and has branches reaching into anterior chin
    6. Lack of keratinized leather tissue over ridge
  9. Overall level of Difficulty and Risk Factors in healing and long term success with All on 4 Dental Implants
    1. Teeth Grinders – Often break temporaries and have more failures and some doctors will increase the price in anticipation of the higher likelihood of complications
    2. Smokers – Carry an implant complication risk that is 3 times higher than a healthy patient that does not smoke.
    3. Diabetics – As long as the diabetic is controlled with an A1c of 7 or lower, there is no need for higher fees.
    4. Previous drug abuse – Can make the treatment more complicated depending on the likelihood of rebound
    5. High smile pull – One of the most challenging presentations that often carries with it added surgical procedures and restorative appointments in order to satisfy the patient and produce a bridge that is comfortable and easy to clean.
    6. Skeletal deficiencies – Can increase the price because more visits are often needed to systematically create the skeletal appearance that is pleasing, as well as comfortable for the jaw.
  10. Time If you want to have your All-on-4 Dental Implant procedure expedited, this is great for someone who is extremely busy or someone from out of state that doesn’t want to fly back in 4-6 months, you can have your permanent implants in one weeks time! This expedited procedure, if the patient qualifies, can be a little more costly, but it is definitely something we can have done at Dream Dental!

Who would pay the least for All on 4 Dental Implants?

  • Someone living in, or willing to, travel to an area with a lower cost of living and a competitive market (such as Salt Lake City, Utah!)
  • A denture-wearer who hasn’t experienced excessive bone deterioration and still has healthy, leathery tissue
  • Someone who chooses a titanium bar with denture teeth
  • Being awake for the surgery
  • Choosing a single office that does the surgical and restorative work with an in-house lab

The price could be as low as $15,000 per arch!

Who would pay the most for All on 4 Dental Implants?

  • Someone who lives in a city with a high cost of living such as LA, NYC or Miami
  • Someone who needs additional implants or zygoma implants
  • Someone whose teeth are extremely infected
  • Someone who has severe bone loss in the areas where the implants need to be placed
  • Someone with high cosmetic and functional needs
  • Anyone wanting a zirconia bridge with individual porcelain crowns and porcelain gums
  • Choosing to have it done by two offices, an oral surgery and restorative without an in-house lab
  • Choosing to use Full General Anesthesia (generally patients with high anxiety choose this option)
  • Someone requiring removal of existing implants
  • Someone with a high smile pull
  • Anyone who is a smoker, has diabetes, grinds their teeth, or has a history of drug abuse with a deep bite

The price could be as high as $35,000 per arch!

Want to know your cost? Schedule your free consultation today: Book Consultation