Frequently Asked Questions

 

General Dental Implants

What are Dental implants?

Dental Implants are designed to be a permanent replacement for natural teeth. At present, they are the best treatment alternative to natural teeth. Made of titanium (the same material utilized in hip replacements) and shaped like a screw, human bone bonds to the implants to create a stable anchor on which natural appearing teeth or restorations can then be attached.

 

Who performs Implant Dentistry?

Implants involve two phases of treatment, surgical and restorative. Oral and Maxillofacial Surgeons perform the surgical placement of the implant(s). Your restorative/family dentist then places the crown(s) or restoration(s).

 

Am I a candidate for Dental Implants?

Good News! With the exception of growing children, dental implants can benefit people of all ages. Though a few medical conditions and smoking may slightly decrease the success rates of dental implants, these health concerns do not eliminate the possibility of receiving them. During your initial implant consultation, our doctors will evaluate your health history to determine if you are a candidate.

 

What are my options to replace all my teeth if they are beyond repair?

Thankfully in this modern age you have many options! Depending if you prefer to remove your new prosthesis nightly or would prefer it be “fixed” and only removed by your dentist, you have options. In most cases, all your teeth can be replaced on the same day with dental implants.

 

Can I get dental implants if I smoke?

Yes, you can. While smokers are at an increased risk for complications, implants are not contraindicated if you smoke. There are however procedures such as certain bone augmentations and sinus augmentations that are not perform if you smoke due to the greater risk of severe complications.

 

Does age and osteoporosis affect dental implants?

Implants are just as successful in patients of advancing age with osteoporosis as it is in younger patients.

 

What if I don’t have enough bone for dental implants?

Bone grafting is the process of increasing the quantity of bone you have so that you CAN have dental implants.  Today, bone grafting techniques and tissue engineering are highly successful and predictable. Often bone grafting can be performed at that same time as dental implant placement to avoid lengthy healing times to regain your teeth.

 

Are dental implants expensive?

While the initial cost of dental implants is slightly more than the alternatives, their longevity, functionality, and durability make them a secure investment. Through performing your normal oral care at home and seeing your restorative dentist at recommended intervals, dental implants can last a lifetime. In the long run, they are better investments in your overall health with much less time spent in the dental chair.

 

Are dental implants covered by insurance?

Yes, many insurance companies do provide a benefit towards the surgical phase of dental implants. While your dental plan often has a maximum per year, our dental implant insurance coordinators will coordinate your benefits between your dental insurance company and you. Your family dentist will work with you to navigate your coverage for your implant crowns/prosthesis.

 

Will dental implants be painful?

“Having my tooth pulled was more painful!” The high success rates that we achieve with dental implants are in large part due to the gentle surgical techniques used to place them. As you probably know from having your wisdom teeth removed, Oral and Maxillofacial Surgeons are trained in hospital and outpatient general anesthesia. Therefore, Drs. Salin, Weiner, and Semanoff are able to offer a wide range of anesthetic options. You may choose to be awake only utilizing local anesthesia (such as Novacaine®) or you may feel more comfortable asleep with intravenous sedation. Any method that you chose, it is our primary concern that you feel as comfortable as possible throughout the entire procedure, from initial consultation to final restoration.

 

How long is the healing process for a dental implant?

It only takes 4-6 months for bone to heal to implants. Following the healing period, a permanent crown can be placed on the implant(s) within the next 2 months. That’s it! On occasion bone and/or gum tissue augmentation is required to produce the most natural appearing tooth as it emerges from your gums. These additional functional and cosmetic procedures may extend the implant process.

 

Will I be missing teeth after the implant is placed?

Our doctors will work closely with your restorative dentist to ensure that you have a natural appearing temporary restoration on the day of surgery, either attached to the implant itself or a removable prosthesis. We realize losing a tooth can make men and women of all ages self-conscious; therefore, it is important to us that you continue your normal activities following the implant procedure.

 

When can the dental implant process begin?

If you have had an initial consultation, our doctors will now be planning your implant case with your restorative dentist to get you ready for the implant placement procedure. If you have not yet had your consultation, you can expect to have a panoramic x-ray taken of your face and mouth in addition to speaking with the doctors about your individual case.

 

What type of anesthesia will be used for a dental implant?

We perform the majority of dental implants and bone grafts in the office under local anesthesia, with or without general anesthesia.

 

Do dental implants need special care?

Your implants will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.

 

Why would I select dental implants over more traditional types of restorations?

There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a “partial” at night may be inconvenient, and dentures that slip can be uncomfortable and rather embarrassing.

 

What types of prostheses are available?

A single prosthesis (crown) replaces one missing tooth and each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants you need depends on the type of complete prosthesis (removable or fixed) you receive. A removable prosthesis (overdenture) attaches to a bar or ball in socket attachments, whereas a fixed prosthesis is permanent and removable only by a dentist.

 

All-On-4® Dental Implants

What is All-On-4 and why is it so popular now?

Many patients need an affordable option to replace their entire upper and/or lower teeth. 15 years ago, this was very expensive, took 6-12 months, and had unpredictable outcomes. Today that has all changed. Innovative Implant and Oral Surgery was the first practice in our region to provide this procedure over 10 years ago. All-On -FourÒ allows our patients to have new teeth within 24 hours with very little downtime all while sleeping in our office under intravenous anesthesia.

 

How do All-On-4 implants work?

By tilting two of your dental implants at a significant angle, we create a tripod effect across a total of four implants, providing the best possible stability. In fact, recent studies demonstrate that the bone surrounding the tilted implants is as strong or stronger than the bone surrounding conventionally placed implants. On these four implants, we place a permanent complete prosthesis to replace all the teeth on either your upper or lower jaw.

 

How do I know if I am a candidate for All-On-4?

Most patients are candidates! Our surgeons must perform a thorough dental and medical evaluation to determine if this procedure is right for you.

 

Can implants be placed at the same time as tooth extraction?

Absolutely. In fact, this is how we perform most All-On-4 procedures. We understand that patients want to transition from their old teeth to their new teeth in as little time as possible. After we remove your old teeth and place your dental implants, your dentist can attach your new teeth that day or within 48 hours. This first set of teeth is temporary. After the dental implants heal, your dentist will secure a final prosthesis that looks and feels natural, and is made of the highest quality materials.

 

What if I don’t like the temporary prosthesis?

Think of your temporary prosthesis as a trial run. While your dentist will do everything to make you happy and comfortable in your temporary prosthesis, there are qualities that you may feel need improvement. Therefore, while your implants are healing, we want you to be picky and notify your dentist of anything you don’t like, including the shapes of the teeth, the color, etc. Your dentist will then fabricate your final teeth to suit your preferences. This is the advantage of a temporary prosthesis!

 

How will my final teeth be made?

After your implants have healed, your dentist will take molds of them. He or she will then send these molds to the Nobel Biocare® dental laboratory. They will design your All-On-4 prosthesis using a computer program, and then craft your new smile with their patented computer-aided milling system.

 

Can I be asleep for my All-On-4 procedure?

Yes! We encourage it. Within our office, we’ll perform your procedure in one of our six state-of-the-art operating rooms. Together with your family dentist, we will perform the entire procedure while you sleep. We can’t think of a better way to receive dental care than while you sleep. However, if you prefer to be awake, that’s fine too. We will use local anesthesia (novacaine) to perform your procedure. During your initial consultation, our surgeons will review your medical history and determine if you are a candidate for outpatient, office-based, general anesthesia.

 

Is the All-On-4 procedure painful?

Rarely. Most patients have a hard time believing that removing all of their teeth, placing implants, then placing teeth onto the implants isn’t painful… but it usually isn’t. Your temporary teeth act as a bandage, reducing your pain and swelling.

 

How long should I allow for recovery after my All-On-4 procedure?

We recommend allowing 4 to 5 days for recovery. Although most people will have minimal swelling, everybody responds differently.

 

What can I eat after my All-On-4 procedure?

For the duration of your implant healing phase — typically 4 months — your diet will consist of soft food, such as oatmeal, scrambled eggs, and tuna salad. There’s an adjustment period, but all of our patients quickly adapt. Once your implants have integrated (fused with your jawbone), your diet may return to normal.

 

How will my home care differ with my All-On-4 prosthesis?

As you will see during your consultation, the prosthesis fits intimately onto your gum tissue. Food rarely sneaks under your prosthesis. However, if it does, we recommend a floss known as “super floss” to clean under the prosthesis. It’s hygenic and easy to use. Also, your dentist and dental hygienist will provide a quick and easy home-care regimen to keep your prosthesis sanitary.

 

Dental Implant Surgery

Is it normal to be swollen after my dental implant procedure?

Yes, swelling peaks 48 to 72 hours after surgery, and ice has a minimal effect after 36 hours (besides easing pain). Maintaining an upright position and sleeping with three to four pillows may help to decrease the amount and duration of swelling.

 

I can see a silver cap in my gums where the implant was placed. Is that normal?

Not to worry. Some silver caps are placed above the gums intentionally and some become uncovered during implant healing. If you see a silver cap, make sure you keep the area clean by rinsing with mouthwash for 1 minute, twice a day. These silver caps can collect plaque, so please use a cotton swab to clean them. Avoid damaging the implant site during cleaning.

 

I have a “bubble” or abnormal swelling and pain in the site of my implant(s), is that normal?

No! Successful implants heal without complications. After the initial surgical swelling and discomfort have subsided, call the doctors if you notice a “bubble”, drainage, or anything out of the ordinary. Do not wait.

 

When can I eat on the side of my mouth where the implant was placed?

For the first 6 weeks, please eat a soft diet on the opposite side of implant placement. If we placed implants on both sides, then you must restrict your diet to pureed soft foods (such as eggs, tuna salad, egg salad, cottage cheese, soft pasta, flaky fish, etc.).

 

The silver cap that my surgeon placed is loose, what should I do?

Call for an appointment immediately. If left loose, gum tissue may grow between the implant and silver cap, necessitating an additional minor procedure under local anesthesia.

 

Bone Grafting Surgery

When can I eat on the side of my mouth that the bone graft was placed?

For 6 weeks, limit your diet to soft foods and avoid chewing on the side of the bone graft.

 

I wear a denture or partial denture. Can I use them after the bone graft?

Each bone graft is different. Please ask your surgeon before placing a denture onto a site that contains a bone graft.

 

I had a tooth removed and bone placed in the tooth socket, and now I see a hole with white material. What is that?

When we place bone in a tooth socket after extraction (socket preservation), we also place a white sheet of material over it to provide protection. This initially protects the bone and then dissolves and is replaced by your native gum tissue. This event occurs 3 to 5 days after the extraction, leaving a crater-like appearance in the tooth socket. This is normal. Be sure to eat on the opposite side, and do not hesitate to call if you have any questions.

 

Distraction Osteogenesis

What does the term distraction osteogenesis mean?     

Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments to allow new bone to grow in the gap.

 

Is the surgery for distraction osteogenesis more involved than traditional surgery for a similar procedure?

No. Distraction osteogenesis surgery is usually done on an outpatient basis with most people going home the same day of surgery. The surgical procedure itself is less invasive than similar, more traditional surgeries, so there is usually less pain and swelling.

 

Will my insurance company cover the cost of an osteogenesis surgical procedure?

Most insurance companies will cover the cost of the osteogenesis surgical procedure provided that there is adequate and accurate documentation of your condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.

 

Is distraction osteogenesis painful?

Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort.

 

What are the benefits of distraction osteogenesis versus traditional surgery for a similar condition?

Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for bone grafts, and therefore, another surgical site. Lastly, distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments is involved.

 

What are the disadvantages of distraction osteogenesis?

Distraction osteogenesis requires you to return to the surgeon’s office frequently during the initial two weeks after surgery. This is necessary because in this timeframe your surgeon will need to closely monitor you for any infection, and teach you how to activate the appliance. In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.

 

Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?

Yes. Recent advances in technology have provided us with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.

 

Does distraction osteogenesis leave scars on the face?

No. The entire surgery is performed within the mouth and the distraction devices we use remain inside the mouth. There are no facial surgical incisions, meaning no unsightly facial scars.

 

Are there any age limitations for people who can receive osteogenesis?

No. Distraction osteogenesis works well on people of all ages. In general, the younger the person, the shorter the distraction time and the faster the consolidation phase. Adults require a slightly longer period of distraction and consolidation because their bone regenerative capabilities are slightly slower than those of adolescents or children.

 

Wisdom Teeth

What are wisdom teeth?

Wisdom teeth are the third and last set of molars, which typically erupt between the ages of 15 and 20.

 

Why do we have wisdom teeth?

The current consensus is that our ancestors required an extra set of molars for chewing large amounts of plant matter. However, most people don’t have room for them and must have them removed.

 

Why should I remove my wisdom teeth?

Wisdom teeth require extraction when they cannot erupt properly within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted wisdom teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

 

Tooth Extraction Surgery

Is it normal to be more swollen a few days after my tooth extractions?

Yes. After surgery, swelling peaks in 48 to 72 hours, after which it starts to go down. Ice has minimal effects after 36 hours, except to ease the pain. Maintaining an upright position and sleeping with three to four pillows during the night may help to decrease the amount and duration of swelling.

 

How long should I expect the bleeding to continue?

Bleeding will generally subside in 24 hours, although oozing may continue off and on for a few days. If bleeding continues, bite on a cold, moistened piece of gauze in 45-minute increments (without removing) for 1 to 2 hours. If it still continues, biting on a moistened teabag may help. Do not hesitate to call your surgeon if you feel your bleeding is abnormal.

 

Pain medication is not relieving my pain, what can I do?

If you’re able to take ibuprofen (Motrin® or Advil®), you may begin alternating your narcotic medication (Tylenol® with codeine, Vicodin®, Percocet®, Darvocet®) and ibuprofen every 4 hours. These medications help to decrease inflammation and thereby pain. If you are unsure if you can take ibuprofen, please call the doctors before initiating this alternative pain regimen.

 

The teeth near the extraction socket are sensitive. Is that normal?

After a tooth is removed, the surrounding bone, soft tissue and nerve become inflamed. Therefore, other teeth in the area or distant from the area may become sensitive due to the phenomenon known as “referred pain”. This will resolve by itself. If you are concerned, or if symptoms continue, please call your surgeon.

 

It has been 3 to 4 days after my extraction and the pain is getting worse, what should I do?

Make an appointment to see your surgeon. A very painful condition known as “dry socket” may develop 3 to 4 days after tooth removal. Common symptoms include a steady increase in pain, throbbing at the extraction site, ear pain on the side the tooth was removed, and a bad taste or odor in your mouth. Treatment involves placing medication into the socket that will ease your pain until the body heals itself. Other causes of pain may be infection, a problem with a neighboring tooth, sharp edges of the tooth socket, and bone exposure through your gums.

 

Is it normal to have a fever after my extraction?

After any surgery, patients may experience a low-grade fever. Do not take your temperature in your mouth after oral surgery, as it will naturally be higher. Preferably, take your temperature in your underarm. If fever continues or is elevated (>101.0°F), please call the doctors.

 

The stitches have fallen out and it has only been a few days after my extraction, should I be concerned?

Not to worry. Stitches often fall out at various time intervals for various reasons, which is why we often place multiple stitches. Other oral surgical procedures, besides dental extractions, require stitches to have a successful surgical result. If your stitches fall out early after a non-extraction procedure, please call our office.

Surgery

I am pregnant, is it safe to have oral surgery?

If you are pregnant, we’ll only perform emergency oral surgery (not elective surgery) and use local anesthesia. You will be required to bring clearance from your OB-GYN doctor or have it faxed to our office (215-322-7832).

 

I take Coumadin (Warfarin), do I need to stop?

If you take Coumadin, you may not need to stop. You must call our office to determine the proper treatment. Bloodwork (INR) is often required. If you have had bloodwork performed in the previous month, please obtain the result from the prescribing doctor before calling our office.

 

I take Plavix (Clopidogrel) and/or Aspirin do I need to stop?

Not necessarily. Often it is based on the procedure you will be having, so please call our office to determine if stopping these medications is necessary. If you must stop, please do so 7 days prior to your procedure, as this is the time required for the medication’s effects to be inactive.

 

I have a joint replacement, should I take antibiotics prior to my surgery?

This decision is to be left to your orthopedic surgeon. Please contact your orthopedic surgeon to determine if antibiotics are necessary.

 

I breastfeed, is it safe for my baby if I undergo general anesthesia?

The anesthetic agents used for general anesthesia are quickly metabolized and excreted from your body. Therefore, we recommend that you pump and store enough breast milk to be used for 24 hours after your anesthetic.

 

General Anesthesia

How long prior to my general anesthesia must I not eat or drink?

You may not eat or drink anything for 6 hours prior to your general anesthesia. If you must take medication, do so with a tiny sip of water 2 hours or more prior to your procedure. If you require antibiotic prophylaxis, you may take the medication with a tiny sip of water 1 hour prior to your procedure.

 

What medications may I take the day of my general anesthesia?

Most of the medications you take daily can be continued the day of your general anesthetic. Any medications you normally take in the morning should be taken prior you procedure, especially blood pressure medications, GI reflux medications, seizure medications, thyroid medications, etc. If you have any questions, please call our office the day before your planned procedure.

 

How soon after the general anesthesia can I drive?

You should not drive a motor vehicle or operate dangerous machinery for 24 hours after your procedure. This time is necessary to allow your body to metabolize the anesthetic agents.

 

I’m nauseous and vomiting, is that from the general anesthetic?

It may be, but most of the general anesthetic medications used today do not cause nausea and vomiting. Rather, narcotic pain relievers, swallowed blood, pain, etc., may all be culprits. Please call our office if nausea and vomiting continue, as we can prescribe medication to help.