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Dental Implants: THE FIVE QUESTIONS You Must Ask Your Dental Professional By Dr. Helaine Smith and Dr. John L. Favaloro

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Page 1: Dental Implants:

Dental Implants:THE FIVE QUESTIONSYou Must Ask Your Dental Professional

By Dr. Helaine Smith and Dr. John L. Favaloro

Page 2: Dental Implants:

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Table of ContentsCreative Commons License 2

Introduction 3

Why You May Need a Dental Implant 4

The Dental Implant Procedure Explained 6

Why General Dentists aren’t Dental Implant Experts 8

The Five Questions You Must Ask Before Getting a Dental Implant 11

Question #1: Am I a dental implant candidate? 12

Question #2:What is your training? 13

Question #3: How many dental implant procedures have you performed? 14

Question #4:Where will the CT scan be performed? 15

Question #5: Do you have pictures of previous cases? 16

Save $200 on Your Dental Implant Procedure 17

About Dr. Helaine Smith and Dr. John L. Favaloro 18

Subscribe to Dr. Smith’s E-Newsletter 19

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Creative Commons License

Official disclosure: Although this e-book discusses medical and oral health conditions, in no way does it take the place of

advice and care from your dental or medical professional.

This work is licensed under the Creative Commons Attribution-No Derivative Works 3.0 United States License. To view a copy

of this license, visit http://creativecommons.org/licenses/by-nd/3.0/us/ or send a letter to Creative Commons, 171 Second

Street, Suite 300, San Francisco, California, 94105, USA.

You may post this e-book on your blog or email it to whomever you believe would benefit from reading it. Thank you!

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Introduction

As the “new” thing in dentistry, dental implants have received considerable press of late. And it’s no wonder. With implants,

dentists can replace patients’ missing teeth with strong, stable devices that look and feel just like real teeth.

As with any medical procedure, however, consumers really need to do their homework before agreeing to have a dentist

perform a dental implant – otherwise, complications can result that can jeopardize your health.

In an effort to educate you, we’ve developed this e-book about dental implants and what you need to know before you let

anyone work on your mouth. We hope you find it helpful.

Helaine Smith, DMD

John Favaloro, DDS Board Certified Periodontist

April 2010

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Why You May Need a Dental Implant

In simple terms, a dental implant is simply a hollow titanium pin that is surgically placed into your jaw. An “abutment” or

piece of metal is screwed into the pin once healing is complete. Your dentist then places the “tooth” or crown on this

abutment — giving you a very natural looking tooth.

Dentists often use implants instead of bridges because implants last longer and are much stronger – in fact, they look and feel

just like a real tooth. According to the Consumer Dentistry Website, studies have shown a five-year success rate of 95% for

lower jaw implants and 90% for upper jaw implants. (The lower success rate is because the upper jaw, especially the posterior

section, is less dense than the lower jaw, making successful implantation potentially more difficult to achieve.) Typically, your

dentist will suggest the implant procedure if you’re missing a tooth or teeth (yes, you can have multiple implants placed into

your mouth). Dentists can also use standard-sized implants or mini-dental implants to support dentures – often referred to as

“implant-supported dentures.”

Basic implants cost anywhere from $1,250 to $3,000 each, according

to DentalResources.com, but the total cost can escalate to $15,000

to $30,000 depending on location, complexity and the need for bone

or gum restoration work. Many dentists provide financing because

most insurance providers don’t cover implants (although they

should, as a missing tooth or teeth can adversely affect your health,

but that’s another topic).

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

Nobel Biocare Implants and Abutment © Nobel Biocare

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If you smoke or have gum disease, your dentist may advise you to either stop smoking or undergo treatment for periodontal

disease before performing the implant procedure. Although dental implants aren’t susceptible to tooth decay, the gum tissue

around the implant can become infected due to poor oral hygiene. Hence, it’s very important that you brush and floss your

implant or implants – just as you would your natural teeth. It’s also important that you have regular cleanings to protect your

investment.

Reasons Dental Implants Fail

• Lack of osseointegration – the process where the bone grows around the implant.

• The implant was poorly placed or should not have been placed at all.

• Infection due to smoking or poor oral hygiene.

• The abutment comes loose, causing the tooth to break or fall out.

• Undiagnosed or underlying medical problems.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

5© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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The Dental Implant Procedure Explained

The first step in getting your implant is to determine that you are in fact a candidate for the procedure. If, for example, you’ve

been missing a tooth or teeth for years, the bone beneath the gum tissue may have receded too much, making it difficult to

properly place an implant. To rectify this, advanced procedures may be required, including bone grafting. Most general

dentists can perform basic bone grafting procedures, but as with anything, you’ll want to ask how often your dentist performs

this type of procedure, how often his/her skills are updated through continuing education, etc. Bone grafting will also add

considerably to the cost.

Next, your dentist will do a CT (Computerized Tomography) scan of the head and jaw in order to determine proper placement

of the implant. Because CT scanning instruments are quite expensive, many solo practitioners don’t do scans in office.

Instead, you’ll be referred out. (At our Boston office, for example we use XPresscan, a company located right in our

neighborhood.) From this scan, the dentist can locate nerves and arteries; determine the shape and size of the jaw and

position of existing teeth; note any potential issues or challenges; and plan for the exact placement of your implants.

What is a General Dentist?

• Holds degree from accredited dental school.

• Must pass written examinations to receive license.

• Trained to advise and treat issues relating to the mouth and teeth.

• Licensed to write prescriptions.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

Placing the implant itself is fairly straight-forward once specific pre-planning is complete. The dentist places a hollow titanium

post into the jaw bone. After the post is placed, a healing cap is placed into the top of the post to protect the inner threads

while the gum tissue heals and the bone begins to adhere to the implant. This healing process can take 2 to 6 months.

Once the healing process is complete, the dentist then removes the protective cover

and places the abutment (an extension) into the implant and tightens it using a

special torque wrench. This process actually requires real skill to know how much

torque to apply to ensure the abutment is screwed into the implant so that it doesn’t

come loose.

The first time Dr. Smith saw Dr. Favaloro place an abutment, she was surprised to

learn that placing an abutment is technique sensitive in order to keep the abutment

tight and in place for years. This is where a periodontist’s specialized training really

comes into play (more on this in the few pages).

Once your abutment is placed, your dentist then makes the new crown which covers

the abutment. The beauty of a dental implant is that it doesn’t shift over time (the way

a crown and bridge will) because it’s placed directly into your bone. (The crown that

covers the abutment may need to replaced in about 10 - 20 years, depending on wear.)

For implant-supported dentures, the dentist places either standard-sized implants or “mini” implants into the bone and the

dentures are then “snapped” onto them. Implant-supported dentures give you the support and confidence you’ve always

wanted as they don’t move around like ordinary dentures. Even better, implant-supported dentures eliminate the need for

goopy dental creams and adhesives.

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WhyGeneral Dentists aren’t Dental Implant Experts

Although the implant procedure itself sounds relatively straightforward, here is the scary secret most consumers do not know:

General dentists do not receive much training in dental school on how to perform the implant procedure – nor do they

receive surgical training!

Although Dr. Smith has advanced cosmetic training, she does not perform dental implant surgery nor would she even

consider having another general dentist place an implant in her mouth. Because general dentists lack surgical training, having

one perform your dental implant surgery is akin to having your family doctor replace your knee! Ouch!

Because placing a dental implant does require oral surgery, anything can go wrong, including:

• Hitting (or severing) cranial-facial nerves.

• Drilling into the sinus cavity.

• Severing the mandibular artery, which can cause death.

• Life-threatening infection.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Periodontists are now the recognized dental implant experts

Periodontists receive an additional three years of training – which includes one full year of dental implant training – on top

of their general dentistry training.

Peridontists are trained to conserve gum tissue and bone and can also perform all types of reconstructive surgeries such as

sinus lifts and bone grafting. They know the facial and cranial bone structure inside and out and know how to consider the

entire structure of the cranium and jaw when placing an implant. These considerations include: surrounding teeth and roots,

nerves, the sinus, shape of the jaw, and blood vessels.

In short, placing a dental implant is a very complex procedure— which is one reason Dr. Smith relies on Dr. Favaloro, her

board-certified in-house periodontist.

A “board certified” periodonist is one who passed a rigorous examination. Not all periodontists are board-certified.

What is a Periodontist?

• Three extra years of specialized training.

• One full year of dental implant training.

• Trained to conserve gum tissue and bone.

• Performs all types of reconstructive surgeries.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Any dentist can take a continuing education course but . . .

General dentists, oral surgeons, and endodontists can all

take continuing education courses in order to learn how to do

implants. The quality of these courses varies, however. You

can take months of coursework from the Las Vegas Institute

of Advanced Cosmetic Training, which is the gold standard

as far as advanced dental training goes.

Or, dentists can take what we refer to as “mill” courses —

those two-day weekend courses that allow a dentist to then

hang a “certificate” on the wall announcing he/she is now a

“dental implant expert.”

So, how do you tell the qualified implant specialist from the bad and the ugly? If you’re considering a dental implant, you

really need to do your homework and ask the questions we’ve outlined in this book. If your dentist refuses to answer or gives

you vague answers, leave the office – fast!

What is an Oral Surgeon?

• Performs oral and facial surgery, including biopsies and implants.

• Extracts teeth, including wisdom teeth.

• Has four years of hospital-based training versus “chair-side” training.

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DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

Implant-supported dentures "snap" into place

and are much more secure than traditional dentures.

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The Five Questions You Must Ask Before Getting a Dental Implant

It can seem somewhat intimidating to ask any medial or health professional questions about his/her qualifications and

training. You don’t want to insult the person by asking questions, and you do want to trust the person who will be performing a

procedure on you – whether it’s teeth whitening or complex surgery!

So it can be easy to forego your due diligence – it removes any discomfort you feel.

Unfortunately, unethical health professionals do exist, as seen by the stories you see in the media about people dying from

“simple” procedures such as liposuction. To paraphrase Bill O’Reilly, no one is looking out for you – so it’s very important

that you ask your dentist the following questions before agreeing to a dental implant procedure.

Any dentist worth his or her salt will be glad you asked these questions – and will take all the time you need to answer them.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

11© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Question #1: Am I a dental implant candidate?

If your dentist recommends that you receive an implant (versus a bridge and crown), ask him or her to explain how he or she

arrived at the diagnosis. Your dentist should be able to explain in plain English why an implant is being recommended as well

as how the procedure will take place. Don’t be afraid to ask to see your X-rays and other supporting pictures / information.

If you’re seeing a periodontist, he or she will look at your entire facial structure, the health of your teeth and gums, and the

surrounding gum tissue and bone in order to discern if you’re a candidate for dental implants.

WARNING

Not everyone is a candidate for dental implants,

especially if the jaw bone has receded or if you have other medical issues.

If you’re scheduled for open heart surgery, for example, Dr. Favaloro or Dr. Helaine Smith would advise you to hold off on your

implant surgery until after you receive the “okay” from your physician as the medications you take pre-heart surgery can

cause serious complications during your implant surgery. It’s also wise to tell your periodontist or dentist if you’re planning to

have open-heart surgery (or any surgery!) or about any pre-existing medical condition, such as diabetes.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

For this patient, implants were placed in order to secure dentures.

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Question #2:What is your training?

Now that you know general dentists don’t receive implant training in dental school, it’s imperative that you ask your dentist

point blank where he or she learned how to do dental implants.

Other questions to ask include:

• When did you receive your training? How often to you update it?

• How many course hours do you have with regard to dental implants?

• May I see your course certificate?

• Are you certified with the Academy of General Dentistry or the American Academy of Cosmetic Dentistry?

If the dentist took a weekend continuing education course, you can research this course online to see whether it’s accredited.

For example, the Misch International Implant Institute, which is an independent teaching institute similar to the Las Vegas

Institute for Advanced Dental Training, offers exceptional ongoing training for dentists.

WARNING

Be very wary of the dentist who brushes off your training question. Surgery is serious stuff.

You don’t want someone who doesn’t know what he/she is doing drilling around in your jaw bone — trust us.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Question #3: How many dental implant procedures have youperformed?

A dentist can tell you he or she is “certified” to perform implant procedures but what if he or she took a weekend course 18

months ago and hasn’t performed one implant since then? Scary!

WARNING

You simply *cannot* assume that a framed diploma or certificate

hanging on the wall equals a competent health professional.

Hence, it pays to ask *any* dental professional (periodontists included) the following questions:

• How many dental implant procedures have you performed?

• When was the last time you did an implant case?

• What were the outcomes for the last three implant cases you did?

• Are you taking additional coursework in implantology? Where are you taking it and why?

• If a patient has an adverse reaction or complication, what is your procedure for dealing with this?

• Are you available after-hours if I have questions or concerns?

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Question #4:Where will the CT scan be performed?

Comprehensive dental imaging, including CT scans and X-rays, is a key part of preparing for implant procedures. As a dental

implant candidate, your dentist will either schedule your CT scan at a local hospital or other imaging facility or will perform it

in-house.

WARNING

If your dentist tells you he/she doesn’t need a CT scan in order to perform the surgery,

be sure to ask why, then call another dentist for a second opinion!

CT scans portray highly accurate images of your jaw alignment and facial structure – including the sinuses and nerves –

enabling the dental professional to create precision dental implants tailored to each individual.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Question #5:Do you have pictures of previous cases?

In addition to asking your dentist about the dental implant cases he or she has performed, ask to see photographs – and not

just photos of a person’s mouth, but the photos of the actual person. (In Dr. Smith’s lobby, for example, she has a photo album

which displays the “before and after” photos of her cases, and in addition to the close-up photos of the mouth and teeth, she

also has photographs of patients – often with them standing next to her. Dr. Smith’s patients comment that it’s this photo

album that often “sells” them on having

their treatment done at her office.)

You can also do a bit of detective work on

your own: do a search for the dentist online

and see if he/she has any negative reviews

as well as calling the Better Business

Bureau.

WARNING

Don’t rely solely on the information you find on review sites. Review sites such as Yelp can give you

lots of great information about a dentist, but it’s also pretty easy to pay people to write positive reviews.

Likewise, one disgruntled patient can wreck havoc with a dentist who is otherwise exceptional.

The bottom line with choosing the right dental professional to perform your implant procedure is this: if you feel

uncomfortable in any way, get a second opinion. Ensuring that you feel safe and confident with any medical professional is

your right . . . and your responsibility.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

Before: Photo of patient with dental implant.Look carefully -- you'll see the implant cover.

After: The crown, which looks just like anatural tooth, has been placed over the

implant abutment.

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Save $200 on Your Dental Implant Procedure

Take the first step toward a beautiful new you – call Dr. Smith’s office today at 617-327-1350 to schedule your free consultation.

If you’re a candidate for dental implants and decide to have Dr. Smith and Dr. Favaloro perform your procedure, we’ll reduce

the cost of your procedure by $200.

The Dr. Smith / Dr. Favaloro advantage:

• Board-certified periodontist in-house – You won’t have to travel to another specialist for your surgery then back to

your dentist for the crown.

• Immediate answers – If either Dr. Smith or Dr. Favaloro has a question for the other, it’s answered immediately, saving

you time by eliminating the need for referring out.

• Impeccable cosmetic work – In addition to ensuring the crown for your implant is indistinguishable from your natural

teeth, Dr. Smith can also help restore surrounding teeth that may have gaps or be discolored, broken, or chipped.

You’ll walk away with a gorgeous new smile and increased confidence.

• Pain-free dentistry – Both Dr. Smith and Dr. Favaloro are trained and certified in advanced sedation dentistry

procedures, ensuring you feel no pain during your dental implant procedure.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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About Dr. Helaine Smith

Since graduating from dental school in 1991, Dr. Helaine Smith has been driven to provide the

very best in dental care and advanced cosmetic dentistry procedures. Not satisfied with

providing general dentistry, Dr. Smith sought advanced dental training at the Las Vegas Institute

for Advanced Dental Studies. She is now one of two percent of dentists in the United States

who provides full mouth reconstruction. In addition, Dr. Smith is a Fellow in the Academy of

General Dentistry – an award granted to dentists who have more than 500 practice hours and

have passed a comprehensive 400-question examination.

To book Dr. Smith to speak about dental marketing or cosmetic dentistry, please contact her at www.helainesmithdmd.com.

You can also check out her blog at www.helainesmithdmd.com/blog.

About Dr. John L. Favaloro

A Board Certified Diplomate of the American Academy of Periodontology and a Fellow of

the Academy of General Dentistry, Dr. Favaloro combines expertise in periodontics, implants

and oral medicine. Dr. Favaloro holds certifications in implantology from Noble Biocare, 3i

Implant Innovations, CoreVent (Dentsply,) INI, and Interpore IMZ and is licensed to practice in

Massachusetts, Florida, and California. After obtaining his DDS from Georgetown University,

Dr. Favaloro continued his training in the U.S. Navy and at Boston University’s School of

Dentistry where he specialized in periodontics and dental implants.

DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350

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Subscribe to Dr. Smith’s E-Newsletter

If you enjoyed this e-book, then you’ll enjoy Dr. Smith’s bi-monthly e-newsletter, “Successful Smiles.”

Based on her real-life experience drawn from working with hundreds of Boston cosmetic dentistry patients over the last twelve

years, "Successful Smiles" is a cosmetic dentistry newsletter featuring lively articles about the transforming power of cosmetic

dentistry and great dental care.

Subscribe today at: www.helainesmithdmd.com/e-newsletter/

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DENTAL IMPLANTS: The Five Questions YouMust Ask Your Dental Proffesional

© Dr. Helaine Smith All Rights Reserved.

www.helainesmithdmd.com | 617.327.1350