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Medical Forum / General / Dentistry / May 20074 new implants... Questions/comments
Well, after a year and a half of untold exams, tests, models, surgeries, etc., I finally have 4 new teeth, that is, crowns on top of my titanium implants. The thing is, I got very accustomed to not having hardly any teeth on the lower left, especially. Just a big gap there for 36 years. Then a bigger gap after #18 got pulled a year and a half ago. (I posted Background info on this at the end of my post if you want or need that info.) So.... I finally got 4 crowns placed on implants this week. A 3-cap "bridge" of crowns over implants for #18, #19 and #20 (3 implants, 3 crowns), and then one crown on the implant at #29. Well, after all this work - a year and a half of appointments, painful surgeries, l o n g dental sittings, etc.... I am not really thrilled with the way these things feel nor "act" in my mouth! I realize that having a 3-tooth bridge where I had NOTHING for 36 years is bound to feel a little "different". Maybe that's all it is, and maybe it will take months to get used to them being there...? But they just feel very weird, like they don't belong, and worse - here's the rub: they seem to trap food around them, especially next to the gum, on both sides, at the bottoms. The bridge of 3 especially have this problem, but the one at #29 also seems to attract food at the bottom near the gum. The "bite" seems fine, I feel the (grad student) dentist did a good job of adjusting the bite (at least, that doesn't seem to be an issue) and my ability to chew seems just fine. But I heard the prof say "I wish they hadn't made them so wide", and I am thinking THAT might be the problem. Since they seem wider than my other teeth (wide towards the inner mouth, towards the inside), that seems to create an "indentation" kind of a concave area underneath them, between the crowns and my gums. Get the picture? And in that concave area food seems to gather and I have to then use my finger sometimes to move it out of the way, my tongue seems unable to do this. It seems to "trap food" in that concave area, kind of like there is a small "ledge" between the bottom of the crowns and my gums. Am I making sense? Could it be that the crowns need to be re-made, to stick out less towards the inside of my mouth? What are the chances of getting the prof to admit this and re-do them if this is the case? (I assume this would be some expense, and that they would prefer not to do this!) If this IS the case, how would I go about "proving" they are too wide? I mean, I am just guessing (in part based on a comment I heard the prof say), but all I know is, food seems to get stuck there. Not exactly "stuck" as in "caught" but it seems to be attracted there and difficult to move out of there. It seems fairly obvious to me that the extra width is causing this concave area and thus food getting trapped there. So, after all the year and a half of work leading up to this point, it is very anti-climactic, disappointing, and almost depressing. Yes, I can finally chew and that is great! But the discomfort of food getting stuck around the crowns seems a big price to pay... I have the exact same problem on #29 even though it is only one tooth, not a 3-crown "bridge". I am just thinking the student(s)(?) who made the crowns made them all too wide...? Questions: Have any of you seen this problem before? How difficult is it to fix it? How long should I expect to "get used" to this, if they cannot or will not adjust it? (since I have had nothing there where that bridge of 3 crowns is, for 37 years) I have an appointment there on Monday to have my 4 lower front teeth filled, so I will definitely be asking about this. But as usual, any feedbck I get here might help me in talking to them about it, as knowledge is power. Thanks for your help! If any patients are here who have had a similar problem I'd also love to hear from you! [I still have 2 more implants on the upper right to get crowns, after they integrate, maybe in September.] ______________________ BACKGROUND INFO if you want or need it, as to why I got the implants: I had 8 or so teeth extracted when I was a teenager. No one seems to remember WHY, as it was 37 years ago. But for whateever reason (I suspect quackery) I had the teeth removed, and due to my parents' ignorance and perhaps not being properly advised by the dentist/surgeon, I never got those teeth replaced in any way: no bridge, no partial plate, nothing, just space there. Most were on my lower left, where I was left with only #30 in the back. The rest were taken out of the lower right and upper right. Due to my own ignorance (also ignore-ance) and lack of funds, I also never did anything to replace those missing teeth. Part of it too is that I just "got used to" not having them, and felt it was not so important to replace them. Hindsight is 20/20... In any case, I eventually lost my ONE lower molar on the left, and then I was left with nothing to chew with at all on my left side, and only a few on the right. At that point (a year and a half ago) I began looking into implants. Jim, It's unfortunate to have invested so much time and expense into replacing your teeth, only to be dis-satisfied with the result. I am familiar with the problem you are describing and can be a common occurrence. Implants are not shaped like teeth and are often much smaller in diameter than the roots they replace. The final crown need to transition from a circular implant to a larger rhomboidal tooth form. Sometimes the technician that fabricates the crown does so in a manner will traps food. I gathered from your post that the treatment was completed in a school environment. This is a bonus in your case, because the primary motive in an educational institution is training...not profit. And it is clear that there is something to be learned and improved upon. First of all, be honest and to begin... assume everyone has your best interest in mind. It is in the student's best interest to learn to please patients, as this will result in a more successful practice. I think you should let the student know what complication you are experiencing...and be specific. Tell the student you are generally comfortable; the bite feels good; none of your other teeth hurt. This limits the options they need to consider. But then tell clearly what problem you are experiencing; food impaction that cannot easily be removed with your tongue; mention any roughness or ledges you feel. Convey how frustrating and uncomfortable it is to have food stuck in your teeth. We all are familiar with getting a popcorn kernel in between our teeth. Then ask, how it may be fixed. It may be easy...such as unscrewing the bridge and modifying the emergence. But...it may also be more complex. Realize this...you purchased a customized tooth to be placed on the implant. For it to be successful, it should harmoniously integrate with the oral environment...including functions such as self-cleansing or easy maintenance. If the final crown doesn't do this...it has failed. I think, an integral step was missed and this is where the student can learn... The best method of ensuring success is through clear communication between all parties involved patient, dentist and technician. How do we communicate the final crown shape and function? With a simple, plastic, temporary crown. This is easily modifiable and allows the patient to test how well it functions. Once the dentist and patient have come to an agreement on the comfort, shape, function and appearance. This temporary can be duplicated by the technician. If, as I may assume from your title JimSocal, you reside in southern California and there are 3 dental schools in close proximity for you to choose for a second opinion. Regardless of where you reside, you should seek a second opinion. Ideally this second opinion will be an objective observer to provide you with their opinion of your condition and experience. This will help put your observations in perspective...for instance were you biased against these new crowns by over hearing the instructor? Does this new dentist find any fault? Do he see where any change could be made? Most patients are very pleased with their implant crowns. This is why implant treatment is the most rapidly growing business in dentistry. I wish you the best...Good luck. Sincerely, Don > Jim, > It's unfortunate to have invested so much time and expense into [quoted text clipped - 64 lines] > Sincerely, > Don Thanks very much for your informative and encouraging reply! I do think the crowns need to be adjusted, the more I eat and feel what is happening with them, and I can only hope that the dentists and profs want to do what is right, not what is easier or cheaper. Of course I am willing to accept that I just need to get used to them, if they insist that is what I need to do, but my feeling is that they need to be re-made or altered to make food not get stuck under them. >How do we communicate the final crown shape and function? With a >simple, plastic, temporary crown. This is easily modifiable and >allows the patient to test how well it functions. Once the dentist >and patient have come to an agreement on the comfort, shape, function >and appearance. This temporary can be duplicated by the technician. I am very surprised they did not take this step. They seemed to go to no expense of time and money and effort on building stints and models and having me get a cat scan and etc... but then failed to do this step, which it seems to me would have avoided the problem I am having. I go in today for another procedure and I'll tell them of the problem with food impaction. I'll report back here what they say. For implant retained restorations, if the implant is going to be partially loaded right away, some temporaries will be made, but these are **NOT** normal contour and cannot be copied. Personally, I always do a mock up on a model and have the lab copy that, but I am OCD. Most dentists simply order the restorations from the lab with no guidelines to shape and contour, and the lab technicians almost always get it very, very good.  Signature/ Amatus / > >>How do we communicate the final crown shape and function? With a [quoted text clipped - 11 lines] > I go in today for another procedure and I'll tell them of the problem > with food impaction. I'll report back here what they say. I am a dental technician who has made thousands of these crowns and this seems to be a major problem with implant crowns. Triclinic explained one problem with "The final crown need to transition from a circular implant to a larger rhomboidal tooth form." Also some implant are placed to close to the tongue (to far lingual) or too close to the cheek (Buccal) or too close the the adjacent teeth, (in other words, not in the center of where the tooth should be). This is another factor that could cause the contours of the crowns to trap food or cause the technician to make the crowns too wide. I haven't make a bridge that screws on for around 10 years, and yours is probably cemented on. If they were put on with temporary cement, they can be easily removed and recontoured. If the practitioner used permanent cement, they may need to be cut off and redone. If the crowns have been in the mouth for more than a couple months, there could also be some problems with glazing them but there are ways around that. BTW I also have 4 implants, and love them, and food does get trapped in them occasionally, I just live with it, mainly because it is about 10% of the problem that partial dentures are. Good Luck > Well, after a year and a half of untold exams, tests, models, > surgeries, etc., I finally have 4 new teeth, that is, crowns on top of [quoted text clipped - 104 lines] > only a few on the right. At that point (a year and a half ago) I began > looking into implants. >I am a dental technician who has made thousands of these crowns and this >seems to be a major problem with implant crowns. Triclinic explained one [quoted text clipped - 18 lines] > >Good Luck Thanks for the reply. It's sounding like this is a fairly common problem and so I hope they will be willing to work with me on it, to at least TRY to adjust the crowns not to trap so much food. After a week of noticing what is going on, it is clear to me that they are too wide towards the tongue side. Maybe they can be shaved down, maybe not. Maybe they need to be re-made, I'm not sure, but they should be able to answer that. I can only hope they will be honest with me and not try to weasel out of more work or more expense on their part. It's not a small problem, nor an occassional problem, mind you. As I have had them now for a week, the problem has gotten no better, and almost EVERY time I eat it is a problem. It's like these things are food magnets and it's very uncomfortable to always get food trapped next to and under them. Thanks again for the info! I go into today for work on my front teeth, so I will inform them of the problem with the crowns, and see what they have to say about it. If they blow me off with a "well, that's just the way it is, there's nothing we can do about that", then I'll seek an outside 2nd opinion. >I am a dental technician who has made thousands of these crowns and this >seems to be a major problem with implant crowns. Triclinic explained one [quoted text clipped - 5 lines] >the contours of the crowns to trap food or cause the technician to make >the crowns too wide. Well, I went to the dental school today to get resin composites on my front teeth, and I told them about the food impacting problem. The prof looked at it and said "This is a common problem. But they are made very well and this is just the way implant crowns are sometimes. There's nothing that can be done about it, you just have to get used to it." I told the dental student that I was going to get another opinion, which I am. Question: How much would an implant crown specialist charge me just to come in and have him look at them and tell me if they were made right or not? And would one even do it, since in the past I have found that one dentist does not want to say anything bad about another dentist? How do I go about getting a 2nd opinion? I don't want to go to another dental school because that is a big bureaucratic hassle and anyway they would be even less likely, I think, to say to the other school, "You didn't do this right and it needs to be re-done." What I am looking for is an honest opinion from someone who has done enough implant crowns to be able to tell me if these are indeed within the standards of good dental work. Call and ask what the consultation fee is. Fees for this vary tremendously. If your implants are tipped toward the cheek to take advantage of available bone without further grafting, you are going to have undercuts next to your tongue, no matter what (unless the teeth are designed so that they do NOT touch when you close. Signature/ Amatus / > >>I am a dental technician who has made thousands of these crowns and this [quoted text clipped - 33 lines] > enough implant crowns to be able to tell me if these are indeed within > the standards of good dental work. >Call and ask what the consultation fee is. Fees for this vary tremendously. > >If your implants are tipped toward the cheek to take advantage of available >bone without further grafting, you are going to have undercuts next to your >tongue, no matter what (unless the teeth are designed so that they do NOT >touch when you close. Do you mean if the implanted posts are angled outward towards the cheek, as opposed to be straight up or being angled towards the tongue? I wish I could remember how they looked in the x-rays. I remember they were angled, but I don't remember which direction. Yes, the teeth touch when they close. The bite seems to be VERY good. They made a model of my teeth before the crowns were made. They put posts, sticking out like teeth, so to speak, into my implants and then made a model from that and sent that to the lab. It seems like they did a very good job of doing the implants and getting the bite right (of course I really don't know, I'm just basing this on how it feels and looks). But like I say, food keeps getting caught in and around the bridge of 3, especially, and also around the one implant crown on the other side. I will call and ask what the consultation fee is at a dentist I respect. Will the consulting dentist have to take xrays to see how the implants are angled? If so, maybe I can get a copy of my xrays from the school, instead...? Jim, The best method for a referral is from acquaintances. If you know any dentists, ask them for a referral. Another method is to call a related specialty and request a referral. For instance, Oral Surgeons and Periodontists place implant and Prosthodontists restore implants. You might call a local Periodontist and ask for a referral to a recommended Prosthodontist. You can find a local Periodontist from: http://www.perio.org or a Prosthodontist from: http://www.prosthodontics.org/patients/find.asp Both are websites for the Specialty Boards. General Dentists also restore implants and may provide a helpful consult. But if you are going to attempt to influence the school to modify your treatment, they will use experts to determine if treatment could be improved and it will add weight to your discourse if you have consulted an expert as well. As for the Xray...it will only be able to tell if the implant is angled in the direction towards or away from the adjacent teeth. It cannot tell if the implant is angled towards your tongue or cheek. Besides, if the implant is angled...there is not any good solution to change that. Once integrated with the bone, it is very difficult to remove. The question now...is whether the emergence can be modified or improved. As for how to go about the consult...be specific in your questions. Make a list if it helps and ask the dentist is each of your concerns can be improved...or how probable it is that they could be improved. It may not be an obvious answer. Just a follow-up in regards to temporaries...the shape can be duplicated and should be of normal contour. There is no reason a temporary shouldn't be a natural shape, as there are many functions related to shape; and an impression of the temporary is a good mode of communication with the laboratory responsible for fabricating the crown. Good luck. Sincerely, Don Thanks for the info and advice! The prof said that there was nothing to be done, that this is "just the way these things are sometimes". Yet, this is the same prof who told me he knew nothing about NTI, but when I pushed him on it by expressing some stuff I learned here, all he could say was "But I'm pretty sure those are just used for migraines and things like that". In other words, this is a guy who may be a very good dentist and maybe a good prof, but he isn't necessarily up on the latest of everything nor have all the answers. The bottom line is, the implant crowns get food trapped around them every time I eat, it's very uncomfortable to deal with it, and I'll pay more money to get it right if I can find someone who can and will make it better. (Of course, I'll first try to force the school into doing it, but if they refuse, then I have to do whatever is necessary to get this right.) If another expert or two says "No, there is nothing that can be done about it", THEN I'll give up and say "sh.t! Why did I spend all this time and money (and pain) on implants??!" >Jim, > [quoted text clipped - 38 lines] >Sincerely, >Don You describe a normal and thorough technique. It is possible that the contours you now have are the best that can be expected with your particular anatomy. I don't know from here. Signature/ Amatus / > >>Call and ask what the consultation fee is. Fees for this vary [quoted text clipped - 29 lines] > are angled? If so, maybe I can get a copy of my xrays from the school, > instead...? >You describe a normal and thorough technique. > >It is possible that the contours you now have are the best that can be >expected with your particular anatomy. I don't know from here. Yes, that could be the case. A shame none of the dentists or surgeons I dealt with along the way ever mentioned "Well, you know, it could be that the implants you get might cause food to get trapped around them and be very uncomfortable and annoying in that way". What bothers me is that everyone always made it sound like the implants were pretty much exactly like natural teeth and there would be no such problems. I thought the only real problem with them was that sometimes they fail. Other than that I expected them to be like natural teeth. No one ever told me any different, nor did I ever read anything like that on the various web sites about implants. Oh well, live and learn. I suppose I'd have gotten them anyway, considering that I really did not have much of a viable alternative. It would have just been nice to know that they don't always turn out so "natural", so I would not have been so disappointed. So I'm going to get a 2nd opinion from an experienced implant crown guy if I can, and see what he has to say about it. If he says it's the best it can be, then so be it. But if he says it can be better, then I want to try to make it better. Thanks for your input. A lot of natural teeth trap food. Signature/ Amatus / > >>You describe a normal and thorough technique. [quoted text clipped - 29 lines] > > Thanks for your input. True. I wonder if a proxa-brush would help? D > A lot of natural teeth trap food. I love those things. I, also, give out a lot of "end-tuft" brushes. Signature/ Amatus / > True. > [quoted text clipped - 3 lines] > >> A lot of natural teeth trap food. >I love those things. > >I, also, give out a lot of "end-tuft" brushes. This is what the dentists I'm dealing with don't seem to understand: the problem isn't _so much_ that my implants trap food that is difficult to remove with brushing. They probably do, but I'm just not as bothered by that, if they do. The problem I am complaining about is that the implants trap food around them when I eat that cannot be removed with my tongue. That is, the food just gathers there in this indentation below my bridge and it stays there making my mouth feel very dirty and uncomfortable until I brush them. Yes, I do brush after every meal. But it's just an uncomfortable feeling to have food stuck in my mouth when I eat. Before - with my natural teeth - I would eat and I felt fine, no problem. My teeth would feel "normally dirty" - that is, a normal level of food remnants would remain. But now larage amounts of food get trapped around the implants. It's a totally different amount of food - much more - than what you get with normal teeth. They're saying that is normal. And I'm saying that if it is, one should be warned about it before contracting to get implants, that's all. Personally, I'm still operating on the theory that this is NOT normal, that the implant crowns were made too wide and need to be re-made. But I will have to get an expert's opinion on that. I could be wrong. |
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