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Sinus Perforation from a Dental Implant

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I have a couple of questions about a sinus perforation that happened during my dental implant placement. First, should it have happened? My dentist said this is fairly common. It went a few millimeters into the sinus cavity.  Second, did my dentist handle this correctly once it happened? About six months into my procedure, the dentist realized that the area was not filling in correctly and he suspected bone loss. He removed the implant. He said there was no infection because there was no bone there. Because of that he said I would not need an antibiotic. He told me he did not repair it but cleaned and stitched the area and told me it should heal on its own. Then in a year we can start again. He also told me to take Flonase and not blow my nose. The week or two following, I had a problem with crackling and some mild pain. I felt like it was getting infected. He reluctantly agreed to give me an antibiotic. Thank you for any guidance you can give.

Morgan

Dear Morgan,

illustration of dental implant

There are a few issues here. I think following the perforation was handled okay. However, the perforation itself and the fact that there was no bone integration are serious issues. While there are some occassions that a sinus would be perforated, it is certainly not common and definitely not by several millimeters. In dental terms, that is a HUGE amount. This should not have happened. I’m curious as to what type of diagnostics he did before your dental implants procedure. A CT scan would have shown him the complete layout of the area and prevented the perforation. It also would have told him if there was enough bone structure to support the dental implant.

Before you allow your dentist to start over, I think you should find out exactly why the first one failed. Be aware that you will also need some bone grafting done before you procede with the procedure a second time. Aside from the missing bone you already had, the area where the dental implant was will need bone to be filled in to the area.

Make sure, if you stick with this dentist, that he does adequate diagnostics to prevent these problems a second time.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

 

A Case of Dental Implant Incompetence

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I had a dental implant placed. A week or so ago, everything felt a bit loose. I called the dentist and he had me come in and he did an x-ray. He said the dental implant itself was fine and the problem was likely just that the dental crown was loose and needed to be recemented. I was relieved, to say the least. The real problem I ran into was when the dentist tried to rebond the crown. He tried to take it off, but the crown wasn’t budging. He got a special tool to help him, which did eventually get the dental crown off, but when it came off the dental implant came with it. I don’t know why this happened. Is is still possible to get a dental implant or is this a done deal and I need to look for something else?

Kaylie

Dear Kaylie,

illustration of dental implant next to natural teeth

I am sorry this has happened to you. I am having trouble understanding this level of gross incompetence. It should have been more than obvious it wasn’t your crown when he couldn’t get it off easily. A loose dental crown will come right off. His not recognizing that caused him to yank out your dental implant.

He should not have been able to yank that out easily if it were a secure dental implant. This tells me that the implant had failed. This does not mean that you cannot have another dental implant placed. I just would not recommend you do it with this dentist. There are several reasons for dental implant failure.

One could be that the dentist placed the crown well before the bone had time to properly integrate with the implant. Another possibility is that there was never enough bone there to support the implant to begin with. There is also the possibility of infection, but that is usually accompanied by a fever and some pain.

In your place, I would ask for a full refund. Then, if you still want a dental implant as your replacement, I would go to a dentist that had a significant amount of post-doctoral training in dental implants. This way you can be assured they know what they’re doing. One thing to note is that before you can have the dental implant procedure redone, you will need to have some bone grafting done in order to build back up the bone that is certainly gone now that you’ve lost the implant. Once that is healed up, you can start the implant procedure.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Antiobiotic for Infected Dental Implant?

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I have had a dental implant for quite some time, about 22 years. In recent, months it became loose. I went back to see my dentist and he told me the implant is infected. He wants to remove it and said he could replace it with a dental bridge. The teeth next to the dental implant are healthy, so I am not too keen on grinding them down. Is there an antibiotic I can take to deal with this infection and keep my dental implant?

Peg

Dear Peg,

illustration of dental implant

I am sorry your dental implant is giving you trouble but glad that it lasted as many years as it did. Once your dental implant is loose it means that it will fail, so taking an antibiotic will not solve the problem. The damage has already been done, usually in the form of bone loss. That bone is essential to retain your dental implant.

While a dental bridge is an option, it does not sound like one that you are excited about. If you want to, you can get a new dental implant put in its place but it will take some work. First, you will want to deal with any residual infection that is left after you have the dental implant removed. Then, you will need to replace the bone structure that was lost from both the infection and the extraction. You can do that with a bone grafting procedure. Once that is healed, you can then have a new implant placed. That is a lot of procedures, but it will give you back a dental implant.

Other than that, a dental bridge is the next best option, but yes, it would mean grinding down the two healthy adjacent teeth. A third option is a removable partial denture but it will not be nearly as secure as your dental implant was as it is not permanently placed.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

“Best Implant Dentist” Said No to My Daughter

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My daughter has Down Syndrome. She is an adult now and mostly independent. Though she still lives with us, she holds down a job. She’s recently had a spate of cavities and one of her teeth recently had to be extracted. We did some research and it appears that dental implants are the best tooth replacement. We also received a bunch of recommendations and everyone said this dentist was the best implant dentist. We went to see him for our consultation. After he examined my daughter’s mouth he told us she does not take good enough care of her teeth and he will not give her a dental implant. My daughter burst into tears so I wasn’t able to stay and talk to him about this. We never got to find out our options. Should I try to reason with him to do them or do we need to look for other options or even another dentist who will do her implant?

Margie

Dear Margie,

An illustration of a dental implant

Dental Implant with Crown

 

While I am certain you could find a dentist willing to place your daughter’s dental implant, I do not think you should. It sounds like your daughter is struggling with her dental hygiene. If that is the case, it was wise for this dentist to say no. If a dental implant is placed, it will likely fail. That is not just a matter of needing to do it again. Even to get the first implant, she would need surgery, then a healing time, then time for the bone to integrate to the implant. During all of this time, dental hygiene is paramount in order to prevent an infection from setting in. Implant infections can be serious.

Then, if you wanted to replace it, the implant would have to be removed. Then, she’d need a bone grafting procedure to build back up the lost bone in that area. Only after that would you get to start over on the whole procedure.

She does have options. I would consider getting a dental bridge for her tooth replacement. It is possible her adjacent teeth have decay and will need dental crowns anyway. In that case, a dental bridge will make more sense anyway.

I hope this helps.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Disastrous Dental Implant Procedure

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Almost three and a half years ago I had a full mouth reconstruction done with a mixture of dental crowns and dental implants. It cost me close to $40,000. Now the crowns are falling off and some of the implants themselves are loose. Every time I called their office it went straight to voicemail. My mouth has become unliveable. I can’t eat anything and have stumps for some teeth and nothing for others. I finally just showed up at the office and there was no one there. No one. I asked the business next to them and they told me that they just didn’t show up one day and then a week or so later the police came around asking for them. I have no idea what to do from here.

Katie

Dear Katie,

illustration of dental implant next to natural teeth

I am sorry this happened to you. Let’s start with legal recourse. Obviously, without a dentist to hold accountable there is no way to get a refund, but I would get a dentist to document everything so if he does show back up you can take him to court.

Now, we’ve got to get this situation with your mouth dealt with. You didn’t say how many crowns versus dental implants you had. I think you need to see a dentist with significant dental implant training and have them look everything over. The loose dental implant could be a loose crown if that is still on it. Hopefully, that is the case. Dental crowns being re-bonded will cost you a lot less money than if you have to completely replace the dental implants.

If you have failed implants, you will need a bone grafting procedure before you can even replace the implants. This will build up the bone that is lost from the implant failure. Once that has healed, you will be able to restart the dental implant process.

Be careful who you go to in order to document this case and repair it. Dental implants are such an advanced procedure that can have serious consequences if done incorrectly. Look for someone who has post-doctoral training in implants specifically. Without that, you are at risk again.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Bone Grafting Failed

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My dentist has done hundreds of dental implants. Because of that, I felt fairly confident that he could do mine without any problems. That has not turned out to be the case. When he went in for the surgery, he discovered there was less bone than he thought. He did not place the implants and told me I’d need some bone grafting. I agreed to that procedure and had a second surgery. Then, it was time for my dental implants again. When he went in, again he felt there wasn’t enough bone and decided I would need to have a dental bridge. I’m very frustrated because I have had three surgeries and no dental implant. I don’t understand why the bone grafting didn’t work. Will I be stuck with a dental bridge?

Eugene

Dear Eugene,

illustration of dental implant next to natural teeth

You do have one good thing going for you here. As frustrating as your situation has been, your dentist had integrity. I can’t tell you the number of patients who have come into our office with failing dental implants and after looking at them, it was obvious their dentist placed them poorly or that they didn’t have adequate bone. The dentist had to know this but rather than admit a mistake they just let the patient have a surgery and procedure that was bound to fail. Leaving the patient to wonder why their implants failed. Your dentist would rather you know his procedure did not work than leave you with a failed procedure.

A second good thing about your dentist is he is trying to improve his skills. Some dentists are content just to do the procedures they are comfortable with, but your dentist is trying to learn new technologies and procedures that will help his patients as he improves. We all start somewhere.

That being said, he is still developing his bone grafting skills. It is likely if you go to a different dentist, who is more experienced in bone grafting, that you will be able to get your dental implants. I do not think your dentist will be offended by you going elsewhere for this procedure. Just be sure to check with them how many successful bone grafting procedures they’ve done.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dentist Placed Implants Knowing They Would Fail

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I went to my dentist about getting some dental implants. He has placed quite a few of them so I felt comfortable with the procedure. After some initial diagnostics, he said everything was good to go. Then, I had the procedure, after which he told me that after he was in there he realized there really isn’t enough bone for them to last. Yet, he put them in any way. Now he is suggesting that we remove them and I get a dental bridge instead. Can he do this? Part of me feels like I should get a refund.

Luke

Dear Luke,

illustration of dental implant

No, he can’t do this, nor will you have to get a dental bridge. When a dentist places a dental implant, there is an implied warranty that he believes it will stay in. He has already admitted that he knew it would not hold together but placed it anyway. He can’t do that. Essentially he did a surgical procedure on you knowing it would fail. If he had told you that, I sincerely doubt you would have gone through with the procedure. Not to mention that any type of medical procedure always carry risks with them.

Additionally, this was completely preventable. You said he did some initial diagnostics. That is what they were for; to see if you had enough bone support and were a good candidate for dental implants. Either he didn’t do adequate diagnostics or he has no idea how to interpret them. Either way, it is essentially malpractice.

In your place, I would tell him that you want him to pay for the bone grafting that is necessary for you to have a successful dental implant procedure and the dental implants and procedure as well, with the dentist of YOUR choice. Then, I want you to find a dentist with post-doctoral implant training and a high success rate.

If he agrees to that there is no need to take this any further. If he doesn’t, then tell him you will speak to an attorney and you will likely get all of that plus more for your time as well as the risk and trauma he put you through. What your dentist did is inexcusable.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dental Implants Fell Out in Two Days

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I need some advice. I had six dental implants placed for some implant overdentures. It’s only been two days and I’ve already had half of them fall out. Is there any chance the other three will stay? Does this rule out me being able to have viable implant overdentures? If not, how do I go about getting them? Also, I feel I am entitled to a refund. Is that unreasonable?

Kevin

Dear Kevin,

implant supported dentures

No, it is not unreasonable to expect a refund. In fact, I would not just ask for a refund on the implants that have fallen out thus far. It’s very likely you will lose the remainder of them as well. Most decent dental implants have a 95% success rate. Your dentist fell significantly lower than that. What I really would like you to do is see someone who has an expertise in dental implants to see what was the problem that caused the failures to begin with. There are quite a few reasons dental implants can fail. I’m going to list some of the more common here:

  • Infection. This is often the result of poorly fitting implant fixtures
  • Diagnostic shortcuts. This is the result of your dentist to not properly assess whether or not there is adequate bone support for the implant. Implants need enough bone in your jawbone to secure the implants. He should have done lots of scans, hopefully including a CT scan.
  • Incorrect placement of the implant. This is another problem with diagnostic shortcuts. Dental implants are a 3-Dimensional procedure and without a CT scan your dentist only has 2-Dimensional images to go by. As a result, some dentists have punctured sinus cavities or damaged nerves, leaving people with jaws they can no longer feel.
  • The use of substandard implant fixtures. Getting fixtures in the United States is more expensive than overseas. The reason for that is we have laws dictating the safety and quality of our dental implants. Some dentists purchase them overseas where they can get them much less expensively in order to increase their profits. Unfortunately, that puts you at a higher risk of failure.
  • Premature loading. I would love to know if the implant failure happened before or immediately after the placement of dentures. If it happened as a result of the denture being placed, that means your dentist did not wait long enough for your bone to integrate with the implants. Placing premature stress on the implants will cause them to fail.

Once you know why your implants fail, it will help you have a way forward. So, what should you look for in an implant dentist to evaluate these? You want someone who has post-doctoral training in implant dentistry. It’s not taught adequately in dental school, so the post-doctoral training is a must.

This blog is brought to you by Hilton Head Cosmetic dentist Dr. Bonnie Rothwell.

Titanium Versus Zirconia Dental Implants

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I’ve recently been looking at alternative health sites to try to get a better grasp of my health. In one article I recently read it indicated that recent studies have shown that metal in the body can cause neurological ill-effects. I have two titanium implants. Should I switch them out for the newer zirconia implants?

Kelly

Dear Kelly,

Zirconia dental implants

I’d be very interested in seeing that article. My guess is they didn’t actually document which “studies” showed these results. I sincerely doubt they had any scientific integrity. Let’s start with the idea that metal in the body can cause neurological ill-effects. Our bodies naturally have metal in them. In many cases, those metals are necessary to sustain our lives. Just one example would be iron. There is iron (a metal) in our blood. Without enough of it, we become anemic which can be life-threatening. Metals on their own are not dangerous in our bodies, depending on the type of metal.

With that in mind, let’s look at the specific metal you are referring to in regard to your dental implants. Titanium is highly biocompatible and have been used as biological replacements for decades, including such things as hip replacements. There have been no studies, as far as I am aware, that show any neurological problems as a result.

Zirconia is becoming more readily available for dental work and is a great advancement. It is especially helpful to give patients a metal-free option for dental crowns on their back teeth because it is so strong. If you were ever to need any additional dental work, getting it done with zirconia would be a fine option.

Should You Replace Your Dental Implants?

That being said, I don’t feel like I can recommend you replace your current dental implants unless there was a problem with them. To do so, would mean you are removing healthy implants. When you remove them, it will also take bone structure with it. That bone structure is necessary to integrate and retain the new implants. This will require you to need some bone grafting done in order to have enough bone again. Now you have added an additional procedure.

Let’s say all that goes fine. None of that guarantees the new implants will succeed. So now you’ve taken out viable implants, added an additional procedure, and have to hope the second set will fare as well as the first. To me, it seems like totally unnecessary expense and risk. Though I’m sure you would be able to find a dentist willing to make money off of it, I am going to recommend you save your time and money and just keep the implants you have.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Key Factors in Dental Implant Failure

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I am getting some dental implants done. I’ve had tons of x-rays done, but now my dentist wants to do a CT scan. Is this really necessary or is he just padding on the cost of tests? I have one other question while I’m asking things anyway. I have another dentist I can use that doesn’t require CT scans, but he uses a brand of implant called Venturi. I can’t find out much information on that brand. Does that matter?

Casey

Dear Casey,

An illustration of a dental implant

Dental implant with crown

You’ve asked some important questions. I’ll start with the CT scan. This is actually an important part of the dental implant process. It’s a good sign your dentist is asking for one. Placing dental implants is a 3-Dimensional procedure. While, as you already know, you can find a dentist willing to place them without the scan, it is not for your benefit.

Your upper teeth are quite close to your sinus cavities. It is very easy for you implants to be placed too far and perforate your sinuses. To avoid that, some dentists will use shorter implants so they don’t risk hitting the sinus cavity. Unfortunately, these don’t always hold up as well. If it fails a year later, you won’t know why.

I recommend doing the CT scan. Not only can it prevent the perforation, but it also helps the dentist to know if you have enough bone density in your jaw to sustain the implants. If there’s not, you’ll need some bone grafting to ensure you’re a good candidate.

Do Dental Implant Brands Matter?

Your second question is also important. The quality of the dental implant has a huge impact on the success of your procedure.
I don’t know much about that particular manufacturer, which does have me concerned. Most of the top implant dentists will use one of the following brands because they have good quality control.

  • Straumann
  • Nobel Biocare
  • 3i
  • BioHorizons
  • Zimmer
  • Astrotech

The fact that the second dentist you are considering is not using one of these brands, on top of the fact he doesn’t require a CT scan makes me quite leary of his work.

This blog is brought to you by Hilton Head Dentist Dr. Bonnie Rothwell.

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