Dental Implants are Not the Same

This is a complicated subject that even most Dentists don’t understand. In summary, because there is no “best” implant for all situations, it is important to use an implant that has a scientific documented high success rate (not just an advertising claim),  be from a reputable company that will probably still be here many years from now, for spare parts if needed, and the use of a particular brand design optimized for each particular patient. This is better than trying to use one kind of implant for everyone. Some systems we use are from: Nobel Biocare, Astra, Zimmer, HiOssen, Neoss, Alpha Bio, Dentis, Sweden & Martina, Straumann, Neodent, and Ankalos.

Also, we use manufacturers original restorative parts; no 3rd party parts are used. Unfortunately, the implant manufacturers world has become very complicated. Because many of the manufacturer’s patents have expired, many independent companies are cloning each other’s designs, however, it is unlikely that they are exact copies, as proprietary metallurgic treatments are still secret. Complicating matters further, Laboratories can now copy parts. This may result in poor tolerances and poor quality control, as now even small labs can do as they please. This may result in increased microleakage between parts resulting in bone loss around the implant over time.

To stress the complexity of this subject, for example:

Most implant designs use grade 2, 4, 5, or 23 titanium. Other designs cryo treat the titanium or use other materials, such as tantalum. Implant macro design topology include thread pitch angle, thread depth, thread number, and thread cross sectional designs. Micro design topologies are the microscopic surface roughness of various forms created by acid etching, surface blasting, and chemical treatments. Active chemical treatments involve using calcium, phosphorous, fluoride, and other compounds to create a bioactive surface. The design of the implant-abutment interface, usually categorized as an external, or internal connection, may be proprietary depending upon the implant system. Platform switching designs are the mismatch of a smaller diameter abutment mated to a larger diameter implant body interface and may have beneficial biological effects.

Gregory Louie DDS, DICOI, AAAID 520 La Gonda Way, Suite 101 Danville, CA 94526 925-837-2300

About the Doctor

Dr. Louie first started his dental experience as a dental laboratory technician in 1976. Triple majoring in the Biological Sciences, Psychology, and History, he graduated with an undergraduate Bachelor of Arts Degree in 1983, before attending his dental training at the University of the Pacific in San Francisco, completing his dental degree in 1986. After practicing as a general dentist for several years, he completed an advanced training residency in dental implants at Brookdale Hospital in Brooklyn, NY, and at NYU, before receiving advanced specialty training in Prosthodontics at the University of Illinois at Chicago.

Some of his active associations and organizations include the: American College of Prosthodontics, American Dental Association, California Dental Association, Regional Dental Associations, American Academy of Implant Dentistry (Fellow), International Congress of Oral Implantologists (Diplomat), American Academy of Cosmetic Dentistry, Las Vegas Institute for Continuing Education, Dental Organization for Conscious Sedation, and the American Academy of General Dentistry.

Dr. Louie lectures extensively about dental implants and dental reconstruction techniques and procedures. He was past director of the Hi Ossen Implant Manufacturer’s Dental Implant Training Center in Walnut Creek, and the director of the Tri Valley Dental Implant Training Center, and has lectured extensively domestically and internationally. He has taught many dentists the art and science of dental implants and restorations.

The Future

True to our current philosophy, as we continue on in life’s travels, I see our office keeping up with technology in providing the latest dental techniques for our patients. As far as for my personal interests, I find myself spending time with my family and raising my son. I still find time for my interests in playing music, Guitar and Piano, as well as occasionally ice-skating. Some of my earlier accomplishments included ice-skating in Skate America 1990, and Worlds 1991.

Our Practice

Our practice is team orientated, and it is our policy to give comprehensive, compassionate care with reasonable fees.  Although Dr. Louie has had many years experience as a Dental Lab Technologist, General Dentist, and still enjoys Family Dentistry, as a Prosthodontist Specialist, our office has an emphasis in Dental Implants, complicated restorative reconstruction, advanced bone grafting, advanced tissue grafting, Laser biostimulation, and preventative care.

What Is A Prosthodontist?

A Prosthodontist is a dentist who specializes in prosthetic reconstruction, the specialty of esthetic and reconstructive dentistry. This may include Crowns, Dentures, Fillings, Implants, and Maxillofacial Prosthetics, etc. It is one of one of the lesser known of the nine dental specialties recognized by the American Dental Association. As in the medical field, in the dental field, additional years of full-time specialized training after becoming a dentist is required before being recognized as a specialist in a particular field. Not only does a prosthodontist deal with simple cases, but are specially trained for the more complex cases.  Some examples are patients who need full mouth reconstruction, with real teeth or in combination with dental implants, cancer patients who have lost their jaws, nose, ears, etc. and is not limited to the mouth.

Maintenance and Preventative care

Prevention is probably the most important action regarding teeth and gum problems. Even though our Dental technology is good, it can never be as good as what nature has given us. Proper brushing, flossing, and regular dental visits can prevent most of the common Dental problems we see today. It is common to see serious Dental problems occur when they could have been prevented. The absence of pain does not indicate that everything may be fine. Gum disease, for example, is the most common reason adults loose their teeth, however, it is common not to feel pain until the last stages. There is no cure to re grow back ALL the bone that has been destroyed. This is one example why regular check-ups can be valuable: catch it early.

Cosmetic Dentistry

“Cosmetic Dentistry” used to be a popular “catch word” regarding improving smiles.  Actually, what we do is a combination of form, function, and cosmetics, and they are all interrelated. Having a beautiful smile is very important for self-esteem, and this can have a profound influence in the successfulness of an individual’s social, business, and personal life. With the newer bonding agents, ceramics, and diagnostic technology, cosmetic dental procedures can have great results, but, without the compromises that were common only a few years ago.

Our Services

We offer full dental services. These may include:

  • Exam and Cleanings
  • Cosmetic Dentistry and Teeth Whitening
  • Tooth Colored Fillings, Crowns, and Bridges
  • Gum Treatments
  • Dentures and Partial Dentures
  • Same Day Denture Repair
  • TMJ Problems
  • Complex Restorative Cases
  • Dental Implant Placement and Restorations
  • Bone and tissue reconstruction
  • Laser decontamination and biostimulation
  • Complementary Dental Implant Consultations

Advanced Technology Dentistry

  • Digital 2D radiography
  • Digital 3D radiography, Complimentary implant Consultations
  • Advanced Technology, Ceramic and Metal Crowns and Bridges
  • Dental Implant Placement and Restorations, “Teeth in One Day”
  • Bone and Soft tissue Regeneration Technology
  • Minimally Invasive Surgical Techniques
  • Minimally Invasive Restorative Techniques
  • Periolase Laser: LANAP, LAPIP, BLAST
  • Radiolase Assisted Dentistry
  • Long Wave TENS (Transcutaneous Electrical Nerve Stimulation)
  • Functional and Cosmetic Prosthodontic Therapies
  • Anxiolysis Sedation

Bone Grafts are Not all the Same

People often get confused regarding the many types of bone grafting. Today it is possible to significantly regrow bone that is lost through time, or, it is common occurrence that a bone graft is initially placed when a tooth is extracted, just to find out that there is still not enough bone to place an implant. Thus, there are many other types of bone graft techniques and bone graft materials and technology to address this issue.

Site Preservation Bone Graft: After an extraction, bone graft material is packed into the extraction socket to preserve as much as the existing bone as possible; This type of graft is not designed to regrow a ridge that has shrunk over time, but only to help to preserve as much bone as possible that is already there.

Sinus Lift Bone Graft: Often if an upper tooth is extracted many years ago, the existing bone will shrink, and the sinuses get larger (pneumatization) resulting in a short bone height. If an implant is placed, it will therefore poke into the sinus, however, it is possible to lift the sinus membrane and graft bone so that bone will enclose the whole implant. This will strengthen the support of the implant.

Guided Bone Regeneration Bone Graft: This technique is probably the “gold standard” for regrowing the thin and shorter bone height ridges. Granulated bone is “shaped” and secured with membranes to increase thickness and height of resorbed ridges of bone, enough so, that implants can usually be placed.

Onlay Block Bone Graft: A block of bone is shaped and secured to a resorbed ridge. This technique is usually not as predictable as GBR, and because of the difficulty of the blood vessels to penetrate a block of bone, may result in greater shrinkage when healing.

Bone graft Materials:

As with bone graft types, there are many bone graft materials, each with their advantages/disadvantages. Often we may combine the materials in different ways to get the desired results.

Autograft: Your own harvested bone.

Allograft: This is a Freezed Dried Human Bone product.

Xenograft: This is a Freeze Dried Animal Bone product. The most common animal bone is sourced from cows, pigs, horses, and even camels

Synthetic: The most common synthetic grafting granules are made from tricalcium phosphate (TCP), however other grafting particles such as Hydroxyapatite are not usually used with implant s because their lack of resorption and being “hard as a rock” to drill through; Concrete.

Growth Factors (healing proteins). These are usually grown synthetically, or extracted from your blood and combined with the bone particulates listed above.

It’s Not Only The Bone, It’s the Soft Tissue Too!

For long-term life and stability, there must be adequate soft tissue (gums) around the implant for bacteria seal. As the “Bone sets the Tone, the Soft Tissue is the Issue”. There are basically two kinds of soft tissue, the thin easily movable type, and the thicker non-movable “keratinized” type. The thicker “keratinized” type of gums is more desirable.

Also for long-term stability, there must be adequate thickness above the implant. As with bone, be can grow tissue as we need it in most cases.

All Crowns Are Not Created Equal

Crowns (Caps) are usually done when there is not enough tooth structure to hold a filling. A filling is only as strong as the remaining tooth to hold it in. Because a crown goes over the entire remaining tooth, it can be much stronger, more resistant to breakage than a filling. However, there are many different types of crowns, each with their own advantages and disadvantages. Crowns can be full coverage or partial coverage. They can be fabricated by casting, milling, sintering, pressed into a mold, or a combination of the above. Here are some popular types:

  • All metal crowns

There are different kinds of metal alloys used in dentistry. Each specific alloy composition is usually a trade secret by each manufacture, but the American Dental Association classifies them into 3 basic categories: Non-precious metal, Semi-precious metal, and Precious metal alloys.  

Non-precious alloys are strongest, but are not as biocompatible. There is no gold or other precious metals, but may contain some silver. They may have a large composition of nickel. This can cause problems with allergic reactions, especially with females who wear a lot of nickel containing jewelry. Casting fabrication accuracy can be a challenge, especially with large bridges.

Semi-precious alloys contain precious metals such as Gold, Platinum, Palladium, and Silver. These alloys are more biocompatible with tissues, are easy to fabricate accurately, especially with large bridges, and are stronger than Precious metal crowns.

Precious alloys contain a high amount of Gold, and may be slightly more biocompatible than Semi-precious metals, but are significantly weaker. Because of this, they are not used often with porcelain fused to metal crowns (PFM) or large bridges. They also tend to wear faster. However, plaque and tarter do not adhere to the surfaces well, compared to actual tooth structure, thus it is easier to keep clean.

  • Porcelain fused to metal (PFM)

PFMs consists of an inner metal coping, with tooth-colored porcelain baked on top. The primary reason that these crowns were popular, is that they are tooth-colored, not metal colored, as with all-metal crowns. These crowns have been the “go to” crowns for tooth-colored restorations for many years, however, because the metal coping blocks the light, if there is any future shrinkage of the gums, there will be a “black line shadow” appearance at the gumline. Cosmetically, this may not be acceptable.

  • All ceramic crowns

The technology for fabricating all ceramic crowns have progressed to the point that for tooth-colored crowns, these are the most lifelike and the most popular. Several types of ceramics are used. Old-fashioned porcelain has the potential of having the best beauty, however, Lithium Disilicate crowns come very close in beauty with 4X the strength. Zirconia crowns are the strongest, with up to 10X the strength of porcelain, but are very opaque, and do not look lifelike. These are usually placed on the back teeth, where it is hard to see them.

  • Composite crowns

At one time these crowns were popular, because of the ease of fabrication. They consist of a composite mix of ceramic powder and a plastic binder. Their strengths are below porcelain, and are not as durable. It is important to discuss with your dentist which crown will be right for you. Dental technology is in the midst of a technology boom, and new materials are on the horizon.

Ailing and Failing and Complications of Dental Implants

Dental implants have a very high success rate and should last a very long time with proper maintenance. Some studies have success rates of 100%. But the majority average is between 95-99% for 5 and 10 year success rates of bone integration.

However, in real life, there is no such thing as 100% success, and dental implants are no exception. There are many types of possible complications regarding dental implants and their restorations:

  •             Placement in the wrong location
  •             Over stress of the implant
  •             Bone loss around the implant
  •             Gum inflammation and bleeding around the implant
  •             Excess crown cement that has not been removed
  •             Medical conditions which affect the healing and maintenance
  •             Drug interactions
  •             Improper crown or bridge (prosthetic) design and fit
  •             Improper oral hygiene and maintenance
  •             Nerve and tissue damage
  •             Pain
  •             Broken components
  •             Loose abutment locking screws
  • Etc. etc. etc.

Regarding possible complications, it is important to note that with any procedure, there are risks/benefits. We use the latest technologies such as Laser, Healing Proteins, Ultrasonics,  Air Abrasion, and Chemical-Medication techniques and more for treatment and retreatment for any of these complications. If you have problems with your existing dental implants, we will be happy to discuss the possible options for a predictable outcome