The other common type of failure is infection which although rare, can occur with any type of of surgery. Once an implant is infected, its surface becomes contaminated leading to extremely poor prognosis. Antibiotic therapy is ineffective in managing most infected dental implants.

Some dentists elect to ‘watch’ such failing implants in the hope that they will eventually heal and get better. After all, no one likes to experience failure and giving such bad news to a patient is difficult. The fact is, once an implant has undergone non-integration healing or infection, there is nothing that can improve its health. Allowing more time and simply ‘watching them’ only prolongs the problem, promoting further destruction of the bone and more complications.

As soon as a dental implant is diagnosed as non-integrated or infected, it must be removed. The site should be cleaned out and allowed to heal for two to three months before attempting another implant placement. In some circumstances, bone grafting may be necessary to redevelop the implant site.  With proper techniques and tissue management, replacement of failed implants can be quite successful. While it requires additional treatment time and surgeries, it remains the superior treatment option to bridges or dentures.

When rare failures happen with dental implants, it’s best to act quick, remove the failing implants, take a deep breath, and replace it properly.

Immediate replacement with an implant

If the extracted tooth is an incisor, canine, or a narrow-rooted premolar with healthy surrounding bone and no major infection, it may be possible to place an implant immediately at the time of the extraction. This is known as immediate implant and is quite successful as long as it is done in right circumstances. The implant is usually ready for the final crown in three to six months.

Early implant placement

If the extracted tooth is a molar or a multi-rooted premolar with healthy surrounding bone, then it is best to delay the implant placement for two to three months. During this period, the bone heals and the site becomes better suited to accept an implant. While this means a second surgery, the implant success becomes much more predictable. Early implant placement may also be appropriate for incisors or canines if they have very wide roots or when immediate implant placement is simply too risky for a variety of reasons.

Delayed implant placement

If there is bone loss due to gum disease or infection, then it is best to extract the tooth, clean the site, and then graft the extraction site to rebuild its proper form and architecture. After a five to six month healing period, the implant may then be placed.

Depending on the area of the mouth and quality of the bone, dental implants can take from two to six months to heal before they can be ready for restorations. There is no prize for being fast. It’s better to be predictable and successful in the long term. Ask your oral surgeon and restorative dentist for the most appropriate treatment option. The implant should be a lifetime solution, so if necessary, it is better to slow down and stage your treatment.

Not long ago, CT scans were quite cost prohibitive at about $1000 to $1500 per scan. Additionally patients had to go to hospitals or radiology centers to complete their scan. It was both difficult and expensive. But now with progressive technology in cone beam CT scans and their availability in some offices, they are now easier, more convenient, safer, and less costly to obtain.

The cost of dental CT scan in our office is $250. This makes it affordable and easily attainable for many patients. Regardless of the size of the area scanned (we have seven possible fields of view), the cost remains the same. We can then easily share it with other dentists involved in patient’s treatment.

Accurate diagnosis helps us be better doctors and provide more appropriate treatments for our patients. I think this technology is a game changer in dental care and should be affordable by any patient where it makes their ultimate care better.

Several studies have shown increased dental implants failure and complications in smokers vs. nonsmokers. Smoke has over 4000 toxins, including nicotine, carbon monoxide, nitrosamines, benzenes, aldehydes, and hydrogen cyanide. which impair the healing process and contribute to poorer results. Even if dental implants heal initially, the surrounding gum and bone tissue on the surface remains in direct exposure to the smoke and its damaging effects which can lead to mucositis, bone loss, and compromise implant longevity.

Smokers have an increased risk of complications (ie, infection, implant loss, mucositis, and peri-implantitis) compared with nonsmoking patients. Although dental implants can be placed in individuals who smoke, these patients should be encouraged to cease this habit or decrease its intensity, otherwise complications could occur.

So what can you do if you smoke and are getting dental implants?

• Stop smoking at least one month before your implant placement surgery.
• Consider nicotine patches to help you through the transition.
• Frequency and duration of smoking are key factors, therefore cutting down on smoking helps even if you can not stop smoking completely.
• Avoid smoking for at least 6 weeks after surgery as it increases risk of implant failure more during the early healing period.
• If you need an oral fixation,try a fake cigarette. It actually works.

Discuss your smoking habits with your oral surgeon and restorative dentist so they can help you through your treatment. Dental implants can be a lifetime replacement option for missing teeth, but only if you do your part to protect them.

Over the last several years, more dental insurances have begun to cover portions of dental implants but still only about 10-15% of insurances do. Below are some examples of what several of the patients that I have worked with over the past year have received from their insurance:

Example 1: The patient’s plan excluded coverage for implants so instead they paid based on the benefits for a three unit fixed partial denture. Paid: $1300

Example 2: Implants were covered at 50% after a $50 deductible up to a yearly maximum of $1500, which should have come out to about $1100. Unfortunately, this patient had very little of her yearly maximum left. Paid: $695

Example 3: Implants were covered at 50% after a $25 deductible up to a yearly maximum of $1500. Due to deductibles and a difference in the insurance’s usual and customary rates, the patient ended up getting less than 50%. Paid: $1085

Example 4: Even premium insurances don’t pay for the whole thing. This patient’s premium plan covered implants at 80% after a $200 deductible with no yearly maximum. Paid $1600

Other items to consider when using insurance for dental implants:

• There are pieces and parts that go into the cost of an implant that insurances won’t necessarily cover, like x-rays, surgical guides, and anesthesia. Also, they may only pay for one implant every 1 to 3 years, even if you are missing more than 1 tooth. Some will only allow 1 implant per lifetime.
• If you max out your plan on an implant, there may not be coverage for the crown or other yearly dental care.
• Watch out for a missing tooth clause. Just like the denial of pre-existing conditions in medical insurance, some dental insurances will deny coverage for an implant if the tooth was extracted or lost while you were covered under a different insurance.

Since dental implants are mostly an out-of-pocket expense, ask your oral surgeon about different payment plans and options. Remember, dental implants are the standard-of-care for the replacement of missing teeth and are a lifetime solution and investment. No dental insurance can say that.

How about other kinds of implants used in orthopedics? Researchers from the orthopaedic surgery department at Beth Israel Deaconess Medical Center (Harvard Medical School) in Boston have published a report, in the April 2007 issue of the Journal of Bone and Joint Surgery, which lists the implants that are most likely to trigger detectors with new security sensitivities. They found that:

• More than half of all orthopaedic implants may be detected by metal detectors.
• Ninety percent of total knee replacements and all total hip replacements were detected, whether they were unilateral or bilateral.
• Plates, screws, intramedullary nails and wires are rarely detected.
• Cobalt-chromium and titanium implants are much more likely to be detected than stainless-steel implants.
• Lower-extremity implants are detected 10 times more often than upper-extremity and 11 times more than spine implants.
• Upper-extremity prostheses, such as total shoulder replacements, total wrist replacements and radial head replacements, were not detected.

In contrast to orthopedic implants, the titanium in dental implants is pure and not combined with other types of metals such as cobalt-chromium which can increase detection. So go ahead and get your dental implants with no worries of a TSA officer doing an oral pat-down!

Team dentists roles:

• Precise placement of dental implant by the surgeon: Implants must be placed in correct position to create proper function and aesthetics as well as make them easy to clean. Bone grafting may be necessary to support the implants and allow the surgeon to properly align the implants.
• Use premium dental implants: We recommend use of only well researched and recognized dental implants. There are many cheaper ‘copy’ implants that lack evidence and long term studies. Many dentists offering ‘discounted’ implants may be using such copy implants. Patients should always ask which implant brand is being used.
• Use custom abutments: The abutment is the component that is attached to the implant and supports the crown or the prosthesis. Always ask for custom abutments because they provide the proper form for desired aesthetics, function, and cleaning. Many dentists may use stock abutments to save on cost but rarely give good results.
• Precise restoration of implants by the restorative dentist: The crown, bridge, or denture placed on the implants must be precisely fabricated by an experienced restorative dentist and checked for proper fit. The bite should be checked with adjustments as necessary.
• Use of a good lab with quality components and materials: The quality of the work done by a laboratory is an extremely important part of long term success. The precision of fit and aesthetic properties of the finished prosthesis can vary from lab to lab.

Patient’s roles:

• Effective flossing and brushing: Hygiene for maintenance of implants is just as important as natural teeth. Your dentist can show you effective techniques to keep your implants plaque free and avoid gum disease (implantitis)
• Use of a night guard: If you are a bruxer or grind your teeth, your dentist may recommend a night guard. It’s critical that you use your night guard to avoid excessive forces on crowns that can cause chipping or loosening.
• No ‘bottle cap’ usage: Limit your teeth to chewing food, not opening bottle caps, loosening a knot, or contact with any hard material. Both enamel and porcelain can fracture easily.
• Check up and cleaning every three to six months: Professional check up and cleaning is imperative to keeping your teeth and implants healthy. Depending on your specific needs, you need to visit your dentist every three to six months.
• Avoid smoking: Smoking has a direct inhibition on disease fighting immunoglobulins in your saliva. It is best to avoid smoking all together. If it is not for your teeth, certainly for your health.

Because dental implants are not covered by most dental insurances, it makes no difference whether you see a participating or non-participating dental implant specialists. So it is best to choose a skilled surgeon and a great restorative dentist who you trust and feel can provide you with the best service and results.

With lack of insurance benefits, most patients choose affordable payment plans through third party companies. This way they can complete their treatment while making payments over time.

Circumstances where dental insurance may cover dental implants:

• Premium dental insurance plans: There are some premium dental plans that offer up to $5000 annual limit and coverage for dental implants. For example World Bank and IMF offer a premium Aetna plan to their employees with great dental benefits. We have assisted many patients with such insurances for their implant needs.
• Trauma: If you have lost your teeth due to oral trauma, it is possible to get benefits through your medical insurance for bone grafting, dental implants, and crown replacement. A pre-certification may be necessary.
• Pathology: If you have lost your teeth due to jaw cysts or other forms of pathology affecting the jaw bone surrounding teeth, medical insurance may offer benefits for implant replacement of the missing teeth.

Many ask why insurance companies do not cover something as important as dental implants for millions of people who suffer from missing teeth. Their answer is that it is not medically necessary. As far as they are concerned, people can go with partial dentures or simply learn to eat soft foods. And no one has died from not smiling!

Results from grafting or not grafting:

Three simple rules for grafting

Here are three simple rules when bone grafting should be done after a tooth is extracted:

1. Existing bone loss due to periodontal disease or abscess: If bone has already been lost from inflammation or infection, it is best to immediately graft the site following tooth extraction. It is much easier and cheaper to correct the defect at the time of tooth extraction than reconstructing it later which requires more invasive and expensive procedures.
2. Following extraction of teeth in the upper front area (smile zone): The bone is extremely thin in this area and following tooth loss, the bone almost always shrinks and diminishes in dimension. This results is inadequate bone and gum tissue and poor aesthetic results, no matter what the replacement option. Immediate bone grafting will prevent bone and gum tissue shrinkage and the unsightly defects that results. Bone graft will preserve the bone dimension and gum line creating a natural and cosmetic result following implant replacement.
3. Delayed implant placement: If a tooth has been extracted and there is normal healthy bone, but the patient does not desire implant placement right away for whatever reason, then the site should be grafted. This is done to preserve the bone and prevent it from shrinking. An implant can be easily placed later with predictable results. If not grafted, a defect can result, making it much more difficult and more costly to correct later.

Dental bone grafting is a predictable and highly successful procedure when performed properly by a skilled surgeon. It has given us amazing opportunities to rebuild lost bone and gum tissue and provide our patients with the kind of results they want to look great and keep eating well.

Are dental implants abroad or overseas really cheaper?

Many advertisements offering treatment in Costa Rica or other countries certainly make you think so. But I’ve seen many patients who have done exactly that and have came back not only with disappointments but also having to ultimately pay more.

One patient went to India only to come back with a poor fitting prosthesis and loose components. He went back to India to have it corrected only to face the same problems two months after his return to the US. Another patient went to Costa Rica for her implant treatment. Sure they placed the implants and the crowns but failed to provide comprehensive treatment and several months after her return, the adjacent teeth began to crumble. One tooth adjacent to one of the implants had a large abscess which was simply missed and not treated. Furthermore, one of the crowns came loose and getting back to Costa Rica to fix it was not exactly an easy option. She would have to take additional time off work to travel and incur more costs for flights and hotel. Both patients had to seek care from local prosthodontists to correct the problems which ultimately ended up costing them more.

In my experience, there are several problems with going for the cheaper dental implant treatments offered in clinics abroad:

• No comprehensive treatment approach- Proper dental treatment must be comprehensive and often requires a combination of oral surgery, gum treatment, possible root canal treatments, possible orthodontics, along with staged cosmetic dentistry. There is no way to provide such treatments over a weekend or even a week at such clinics. Therefore, they often place the implants without any regard for the overall health of the mouth and the other dentition. This often results in other problems and complications in long term.
• No continuity of care- Following treatment at such clinics, there is no continuity of care. Patients have to follow up with their local dentists who may or may not take responsibility for the work done. In addition, any problems that arise must be taken care of by the local dentist for additional costs.
• Not easily available if problems arise- With questionable quality of care and materials, problems can happen: loose crowns, loose implant screws, chipped porcelain, bite issues, gum inflammation, and others. And when such problems arise, it is very difficult for patients to go back abroad to the dentist who had provided the implant therapy. So patients have to seek care from local restorative dentists and incur additional cost for the treatment. As the result,  patients end up paying much more than if they had just seen their local dentist and specialist for their implants.
• Questionable implants and materials- To account for cheaper treatments, many clinics have to use lower quality implants and restorative materials which in turn can compromise the results and increase complications.
• Questionable quality of work- There is a reason why people from other countries comes to the US for great medical and dental care and that is because of superior quality of care, highly trained specialists with qualifications, technology, and success. The low cost treatments offered to lure patients to clinics abroad are often associated with lower quality of work and poor prognosis.

I often read about people who say: “I am going abroad to get my dental implants for half the price while I take a vacation!” The reality is at the end of it all, most patients end up having to pay more and I don’t have to tell you that going for implant surgery and dental treatment is no vacation!