Dentist

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.

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.

 

Cost isn’t the only thing you should be asking when it comes to something as important as dental implants! Especially if you’re opting for the All-on-4 Dental Implant procedure. It can mean the difference between a happy, exciting dream come true, or a costly, time consuming battle. So how do you choose the right dentist? In this video, we share with you the top 5 questions that you should ask during your consultation before committing to any surgery. Want to ask us these questions, and more? Come on in for a free consultation!

 

5 Most Important Questions Video Script

Hi, I’m Dr. Hendriks. I am so grateful to be able to share with you the five most important questions that you should ask before you choose a provider for your dental implant surgery.

Number one, you need to make sure that you do all your homework on the doctor and how much experience he has. You want to go through the website, you want to go through Google reviews, you want to go through even Better Business Bureau, you want to find out if they’d been sued for anything. I’m not saying that people had been sued or guilty, but if you have multiple lawsuits out that might say that there’s been some miscommunications and possibly some negligence. When you’re looking at for a doctor to do your implant surgery, you’re looking for someone that can show you by examples that they’re really good at what they do.

Number two, unlike buying a car, a truck implant procedures are so different, and going to one office or another office, it can be a completely different product and service. You should ask the doctor where do you send the lab work? Is it here in the United States? Is it here locally? They should have some type of website. I recommend you go to the website and look and see what the expertise of this lab is. No matter where the lab work is sent, this question should always be answered. I think you should also ask the question are there any warranties in place in case something happens in the future?

Once you know exactly where you’re going to have the lab work sent, this is an important question you should ask your doctor, and that is what type of materials are you going to use? There are lots of different materials and all on for procedure is just a surgical procedure. What you put on top of it, the bridge that we place on top, can be a number of different things. You could have an all acrylic bridge, you can have a tenia bridge you can have a trilor, a pectin, you can have a titanium, or you can have zirconia. Six different types of bridges and I’m just naming a few of them, and depending on what material is being used, it can come with certain complications. If you asked the question, “Hey doc, what type of materials are using?” and they act funny about it all, this might be an indication that there may be corners being cut.

Number three, I call them contingency plans. When things go right, it’s awesome, but no matter what you do, in what profession, there’s always speed bumps, and sometimes you might have things come up that you’re not planning on. This is why I have to ask the doctor, what contingency plans do you have in place for failed implants, for devices that break prematurely? What if you get infection a few months out? If something doesn’t work out? Is there a plan in place now that’s going to help us save us time, money, or future emotional pain so that we don’t have to experience a worst case scenario?

It’s really important also to remember that there always will be the cost of cleanings in the future and there’ll be some maintenance associated with any device that you have put in your mouth. It’s important to find out what those costs are upfront, because sometimes our some really big costs that can come behind that if you’re not prepared for it, you can be very upset with. I know offices here locally that actually will put their price super high so they don’t have to worry about cleaning their patient’s teeth. You should ask these questions upfront.

Number four, timeline. This is something that can really frustrate patient. Some doctors say they’re going to be in treatment for six months, but end up taking a full year, and so if you talk to them and say, “Doc, can I see a timeline of when the surgery starts and every appointment that you plan to have so I can guesstimate when we’re going to be finished?” It’s not a perfect science, but a doctor that doesn’t have a game plan for you is a doctor that might be confused as to what the treatment should be or could be.

In really great offices, they’re going to give you a sheet that says we have five different appointments or 10 appointments, and this is how long the appointments going to last. This is what you should expect, and this is how much you should pay. I have experienced times where treatment has gone much longer than I expected also. But here’s the thing, doctors offices that have done it over and over again get better and better, and that’s why you want to find a doctor who has tons of experience, has been through the rodeo, has worked with lots of labs, and seen the worst of the worst. The cool thing is that today in certain offices, you can actually condense that time into as little as a week. That’s the cool thing. Instead of being in treatment for six to 12 months, you literally could have the treatment done in less than a week.

And lastly, number five, what is the focus of the practice? Is this a practice that does lots of general dentistry and a little bit of all on four or is it a practice that does mainly all end for, and just a little bit of general dentistry? Would you rather have someone that does that procedure every day or once a month? When an office focuses squarely on all on four, that means that there’s going to be a team of well-qualified people that are going to help support you. The doctor is just one person. It’s so important to do the research on the doctor, but here’s the thing, the doctors one of probably 10 or 15 individuals. And so as you look at the practice, look at the people when you walk in, how do they treat you?

The doctor could have amazing experience and you may like them a ton, but the reality is he’s probably just going to do the surgical portion of the procedure. The majority of the work is done by the staff, the assistants, and the team. Even though you want to develop that relationship with the doctor, if you don’t have a good feeling about the people that work around him, that’s a pretty good indication that you probably should find somewhere else.

All right, let’s go ahead and recap. These are the top five questions you ask before picking an all on for dental implant provider. Number one, doctor experience. Number two, what materials are being used and where are they coming from? Number three, contingency plans the doctor has in place in worst case scenarios. Four, the timeline. How long is it going to take? And five, the team. Are they going to fit with your personality, with what needs you have?

 

Thank you so much for watching. If you have any other questions, please reach out to us and we’ll answer those questions. If you’d like to interview me and ask me these five top questions, I would be happy to. If you look at other videos, you’ll see that we have answers to all these questions. We love what we do at Dream Dental. We’d love to be able to help you. Please call us, let us know how we can serve you. What we say here every single day is we don’t just change smiles, we change lives.