Dental Implant Treatment

Dental Implants, Something to Smile About

Implant treatment is one of the most life changing treatments in dentistry. For people who have lost their teeth, implant therapy provides a second chance to take eating and smiling for granted again. For those who have lost even a single tooth, the ability to replace it without damaging adjacent teeth is a modern day miracle. Studies have shown that when implant patients were asked if they had to do it all over again, over 90% said they would.

Why Choose Dr. Arvanitis for Your Dental Implant Smile

• over 21 years of General Dentistry experience combined with over 16 years of implant experience. Dr. Arvanitis has placed and restored over 1200 dental implants and placed over 25,000 bonded esthetic restorations. His implant work has been accredited and peer reviewed.
• Diplomate of the American Board Of Oral Implantology
• Fellow of the Academy of General Dentistry
• Fellow of the International Congress of Oral Implantologists
• Fellow of the International Academy of Dento-Facial Esthetics
• Associate Fellow of the American Association of Implant Dentists
• Sustaining Member of the American Academy of Cosmetic Dentistry
• Founding Member of the Canadian Academy of Esthetic Dentistry
• Minimally Invasive extraction techniques to conserve bone and soft tissues, as well as bone preservation grafts at the time of tooth loss if implants aren’t being placed immediately
• The ability to extract a tooth and put the tooth right back with an implant and temporary crown on it the same day. This means that you leave the office not even appearing to have lost a tooth. No removable denture temporary tooth and the ultimate in tissue conservation.
• Access to advanced diagnostic planning with hospital based CAT scans and computerized 3-Dimensional treatment planning.
• Platelet Rich Plasma
• Dr. Arvanitis has the ability to handle the whole reconstruction from diagnosis through to surgery and finished with his cosmetic expertise. Not only do you get a wealth of implant experience but also a wealth of cosmetic experience so that your implant smile can look as natural and aesthetic as possible when finished.

What You Need to Know About Tooth Loss

One of the most common misconceptions I encounter in my office is that the easiest solution to any dental problem is removing the offending tooth. Many people feel that once the tooth is lost, their dental problem is over. Most find out too late that loss of teeth leads to much more catastrophic problems down the road.

Bone Loss Results From Tooth Loss

In a recent survey by the Institute for Dental Implant Awareness, only 36% of respondents were aware that bone loss resulted from missing teeth. And, 75% of respondents with bridges, partials or dentures would have changed their minds about these treatment options, had they known about the bone loss/deterioration that would occur.

Why Does Bone Loss Result from Tooth Loss?

Natural tooth roots are embedded in the jawbone, providing a stable foundation that allows the teeth to function properly. When teeth are lost or extracted, the bone that previously supported these teeth is no longer needed and begins to deteriorate or resorb.

How Can this Bone Loss and Facial Structure Collapse be Prevented?

Dental implants serve as substitute tooth roots, providing the same function as natural tooth roots, including stimulating the bone, thereby preserving it and preventing the bone loss that would normally occur with tooth loss. The jawbone actually forms a bond with the dental implants, creating a stable foundation for replacement teeth that look, feel and function like natural teeth.

Posterior Bone Loss

When all of your posterior teeth are missing, the back of your mouth actually collapses as the bone deteriorates. The teeth in the front begin to flare out as the corners of your mouth begin to droop. Your appearance begins to change as the height of the jaw decreases. If your posterior teeth are replaced with a partial denture, the resorptive process is accelerated as the partial presses down on the gums and underlying bone as you eat. Replacing the posterior teeth with implant supported teeth preserves the bone, preventing this deterioration and collapse.

Facial Structure Collapse

When all of your teeth are missing, the jaws deteriorate rapidly. In addition, as the bone melts away your muscles migrate, or pull back from their natural position. Your lips cave in as they lose support and wrinkles increase dramatically as your facial structure collapses. This can also result in significant overall health problems related to improper digestion and malnutrition. Dentures accelerate the bone resorption process as they put pressure on and compact the gums and underlying bone. As facial structures continue to collapse, the dentures must be relined (made thicker) to compensate for additional bone loss. As the years go by and bone continues to be lost, less and less tissues are left to support the denture. The dentures become harder and harder to keep in. Foods like corn on the cob, apples, and salad become impossible to eat. Fear of the denture falling out in public erodes self confidence and people become afraid to smile or eat in public.

Replacing your missing teeth with implant supported overdentures or bridges will preserve the bone and prevent the further deterioration of facial structures and the related health and functional problems that would normally be associated with complete tooth loss.

All Extraction Techniques are Not Created Equal

What Happens When a Tooth is Lost?

The loss of a tooth is an eventuality that many of us may have to face in our lifetime. However, removing the tooth is not the end of the end of your problem, but the beginning of many more.

Traditional techniques for removing a tooth frequently involve destroying anywhere from 20% to 30% of the bone that holds it in place. Additionally, once the tooth is lost the remaining bone will naturally atrophy or shrink if it isn’t being used. Up to 50% of the surrounding bone will be lost during the initial healing period and even more over time. If the lost tooth is in the front then the loss of bone will leave a defect which will be noticeable.

In addition to the loss of bone, the surrounding teeth will begin to shift, opening up spaces eventually causing the loss of more teeth.

How Can This be Prevented?

Dr. Arvanitis uses new techniques for tooth removal that have been designed to preserve the bone by not removing it during the surgery. The best techniques available today also involve placing the implant right into the socket of the extracted tooth at the time of extraction. Additionally a grafting material is then placed into the socket around the implant which will support and feed the surrounding bone during the healing period preventing the initial atrophy. If the patient is not ready to proceed with the implant then a bone graft alone will be used to preserve the bone. Over time however, the natural atrophy will still occur if the implant is not placed. Thus it is imperative that the critical areas of the jawbone needed to support implants are preserved. If you have lost one or two teeth, then the area should have dental implants placed within the first year to prevent the long term bone loss. If you already have dentures then implants can be used to hold them in place and the areas where these implants would be placed need to be protected. Only by placing dental implants can the bone be preserved.

If you are about to lose a tooth please ask your dentist about your options or call us to schedule an appointment.

Over Engineering for Success

Let us imagine for a moment that you are a civil planner and you were building a long bridge. You are presented with 2 different plans from 2 different companies. One bridge costs 75 million dollars and the other 100 million dollars. Upon closer inspection you find that the less expensive bridge is being built on 6 pillars while the more costly one has quoted for 8 pillars. You call in the civil engineers so that you can find out which to choose. After all you don’t want to waste money over engineering this bridge. Money is tight. Both engineers tell you that 6 pillars is the minimum number required to hold this bridge, but the one who planned for 8 tells you that by building to the minimum you have no margin for error. What if the metal fatigues over time? What if the bridge ends up supporting more traffic in the future than you are planning for? What if? He tells you that with 6 pillars you could end up overloading it and risk collapse some day. But with 8 you will stress the bridge less every day and it should last longer. Additionally with 8 pillars you have a little more room to overcome stresses that may occur in the future that are unforeseen today. If you build to the minimum then you risk the 75 million dollars. Additionally, if anything happens it will cost more to fix it in the future than it would to build it right in the first place.

Which bridge do you want to drive on when it is 20 years old? The one built to minimum standards or the one overbuilt?

When we treatment plan a person for implants we have to look at many of the same factors as our civil planners and engineers. First and foremost we need to survey the area where the implants will be placed. How strong is the bone? How much chewing force will be applied? Man or woman? Young or old? Frail or built like a bull? Will the implant teeth be biting against natural teeth, dentures or more implants? What type of teeth will be placed on these implants? The more fixed the teeth are, the more support they require. Removable dentures can be held in place by fewer implants than fixed porcelain teeth. A minimum of 8 implants is required on the upper jaw to support fixed non-removable porcelain teeth, provided that the bone density is good. If the bone density is poor then 10-12 implants may be required. This will vary from person to person depending on the factors listed above. It is always best when engineering anything to over engineer it. If you build to the lowest, cheapest standard then it may work for a while but eventually it will fail. Also when you consider that we hope that the implants will last a lifetime, we have to build in a little bit of a cushion. So let’s say we could support all the teeth on 6 implants at the barest minimum and we place 6. Then we make the porcelain teeth (which by the way cost between $7,000- $14,000 just for the laboratory to make them- not including the dentist’s fees, which are more) and we then lose an implant. Now we are supporting the teeth on just 5 implants which is below the minimum. Soon the other implants will become overloaded and begin to fail. Eventually all the work will be lost. If an engineering cushion had been built in from the beginning by placing 8 or more implants then if one is lost it is no problem. When you consider that everybody heals differently and that on average implants have a survival rate of 96%-97% then it stands to reason that 3-4 out of a hundred will fail to initially integrate. (This usually happens before the porcelain teeth are made but not always) A cushion is therefore not only good engineering from a stress point of view but also from a practical point of view. If I need 8 implants, place 10 and one fails to heal, then we can still continue on and make the teeth. If I place 8 and one fails then we have to wait 3-4 months for the site to heal before we can replace the implant. This will then have to heal for a while again before the teeth are made. Do you really want to wait an extra 6-9 months for your teeth because we didn’t place enough implants?

My philosophy is to over-engineer everything. I want my work to last.

Sinus Lift

What is a Sinus Lift?

When an upper back tooth is lost, not only will the outer bone and gum shrink but the maxillary sinus that sits at the root tips will begin to expand as well. Just the simple act of breathing in and out is enough pressure to cause the sinus to expand once the tooth roots no longer hold up the sinus floor. Consequently, if you decide after a few years to replace this missing tooth with an implant you may be told that the sinus floor is now in the way.

The analogy I usually give to my patients is to imagine that you want to hang a very heavy picture on your wall. We all know that despite the wall looking very solid on the outside, that your wall is actually hollow behind the drywall. Thus if we put our anchor into this wall it will punch through into the air space behind the drywall. This isn’t a good idea if that space is in your sinus.

So how do we get around this? Well we need to add some plaster behind the drywall so that the implant anchor will be totally in plaster. This is what a sinus lift entails. Lining the bony floor of the sinus is a lining we call the sinus membrane. Imagine the skin on the inside of your nose that lines your nasal passages extending through all your sinuses. It is this lining that we lift up. Between the lifted sinus lining and the bony sinus floor we place our bone graft. This is then left to harden and turn into new bone and eight to nine months later the new bone will be ready to have the implant anchor placed. This, is a Sinus Lift and it has become a very common procedure with a high success rate.

PRP – Platelet Rich Plasma

What is PRP?

PRP is a secret ingredient now being used by many Plastic Surgeons and Dentists that helps patients to heal faster post surgery. It is short for Platelet Rich Plasma. A small amount of your own blood is drawn at the time of surgery, and treated to remove all the red blood cells leaving behind the white immune system cells and the platelets. These platelets and white blood cells contain many of your body’s own natural growth and healing factors which are then replaced into the surgical site. Why all the excitement about PRP? PRP permits the body to take advantage of the normal healing pathways at a greatly accelerated rate.

During the healing process, the body rushes many cells and cell-types to the wound in order to initiate the healing process. One of those cell types is platelets. Platelets perform many functions, including formation of a blood clot and release of growth factors (GF) into the wound. These GF (platelet derived growth factors PDGF, transforming growth factor beta TGF, and insulin-like growth factor ILGF) function to assist the body in repairing itself by stimulating stem cells to regenerate new tissue. The more growth factors released into the wound, the more stem cells stimulated to produce new host tissue. Thus, PRP permits the body to heal faster and more efficiently.

A subfamily of TGF, is bone morphogenic protein (BMP). BMP has been shown to induce the formation of new bone in research studies in animals and humans. This is of great significance to the surgeon who places dental implants. By adding PRP, and thus BMP, to the implant site with bone substitute particles, the implant surgeon can now grow bone more predictably and faster than ever before.

PRP has Many Clinical Applications:

• Bone grafting for dental implants. This includes onlay and inlay grafts, sinus lift procedures, ridge augmentation procedures, and closure of cleft, lip and palate defects.
• Repair of bone defects creating by removal of teeth or small cysts
• Repair of fistulas between the sinus cavity and mouth

PRP also has Many Advantages:

• Safety: PRP is a by-product of the patient’s own blood, therefore, disease transmission is not an issue.
• Convenience: PRP can be generated in the doctor’s office while the patient is undergoing an outpatient surgical procedure, such as placement of dental implants.
• Faster healing: The supersaturation of the wound with PRP, and thus growth factors, produces an increase of tissue synthesis and thus
• Faster tissue regeneration.
• Cost effectiveness: Since PRP harvesting is done with only 30-60 cc of blood in the doctor’s office; the patient need not incur the expense of the harvesting procedure in hospital or at the blood bank.
• Ease of use: PRP is easy to handle and actually improves the ease of application of bone substitute materials and bone grafting products by making them more gel-like.

Frequently Asked Questions About PRP

1. Is PRP safe?

Yes. During the outpatient surgical procedure a small amount of your own blood is drawn out via the IV. This blood is then placed in the PRP centrifuge machine and spun down. In less than fifteen minutes, the PRP is formed and ready to use.

2. Should PRP be used in all bone-grafting cases?

Not always. In some cases, there is no need for PRP. However, in the majority of cases application of PRP to the graft will increase the final amount of bone present in addition to making the wound heal faster and more efficiently.

3. Will my insurance cover the costs?

Unfortunately not. The cost of the PRP application is paid by the patient.

4. Can PRP be used alone to stimulate bone formation?

No. PRP must be mixed with either the patient’s own bone, a bone substitute material such as demineralized freeze-dried bone, or a synthetic bone product.

5. Are there any contraindications to PRP?

Very few; Obviously, patients with bleeding disorders or hematologic diseases do not qualify for this in-office procedure.