The dental implant expert may include a prosthodontist, periodontist, oral and maxillofacial surgeon, or general dentist.

When visiting a dental implant expert, be sure to accurately report your health history. It is very important that he or she fully understands the background of your health.

This encompasses systems in the body such as:

• Head
• Brain
• Shoulders
• Neck
• Back
• Heart
• Lungs
• Stomach
• Intestines
• Pancreas
• Liver
• Kidneys
• Hips
• Legs
• Knees
• Feet
• Eyes
• Ears
• Nose
• Skin
• Muscles
• Bones

There are correlations between diseases of the mouth and other systemic diseases such as heart disease, lung disease, nerve diseases, diabetes, Alzheimer’s and cancer.

Your health is very important to your dental implant expert. It is recommended to make every effort to complete this form carefully. The more thorough you are, the better oral health care you will receive and will increase the likelihood of dental implant success.

All the best-

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker
Maryland, Washington DC, Virginia

1. Brushing your entire mouth.

Brushing your teeth only accounts for 5% of the surface area of the mouth. 95% of your mouth is everything but your teeth. Brush the front of the teeth, and back of the teeth.

Also brush the top, sides and bottom of the tongue. Brush the insides of the cheeks, roof of the mouth (palate), floor of the mouth and lips.

2. Brushing softly.

Many people think that brushing harder gets their teeth cleaner. In fact, brushing hard has the opposite effect. It causes trauma to the teeth, whereby the tooth wears away and forms a notch that looks like it was hit with an ax (called an abfraction). Ouch!! Also, the gum tissues shrink and pull away (or recede) from the tooth. The shrinkage opens pores, and that attracts more germs. The cycle continues until you lose your teeth. Brush softly in small circles to remove the harmful germs.

3. Brush after every snack, drink and meal.

Germs grow at the rate of 20 billion per hour in your mouth. Yuk!!! Ever get that “bad taste” between brushings? You may want to consider brushing 5-7 times a day to reduce the bacterial counts in your mouth. This will result in fewer problems.

4. Floss. Floss. Floss.

Avoiding the “tooth lasso” or floss may result in periodontal disease and cavities. Bacterial colonies called plaque can build up between your teeth. Food collects there too. Acids are secreted that begin destruction of your teeth, gums and bone. This damage is permanent.

5. Flossing every tooth.

There is a natural space between teeth. When you floss, make sure you hold the floss against one tooth and then the other tooth. Many people just stick the floss through the teeth, but avoid both sides. Flossing one side, results in not effectively cleaning the areas and disease can grow. The disease from the mouth can also spread through the body causing serious diseases.

6. Rinsing with mouthwash.

When you rinse with mouthwash, many people think this is a substitute for brushing. The rinse delivers chemicals that kill germs, but it does not remove the harmful germs from the teeth. There is no substitute for brushing.

7. Drinking fluids other than water.

Now, I’m not saying don’t ever drink fluids other than water; however, you may want to consider this thought. Beverages such as juices, flavored waters, tonic water, tea, coffee, soda, and sports drinks — all may contain acids that can destroy your teeth, gums and bones within 7 minutes. I suggest that you limit swallowing these beverages with meals. Brushing your mouth immediately after consumption stops the damage from acids. Alternatively, you can rinse with water for 7 seconds to neutralize the acids.

8. Your mouth as a beacon of health.

When your mouth hurts, something is wrong! And many people avoid the signals, waiting too long to seek dental health care. Many people avoid letting their dentist know that something is different with their mouth, even during treatment with dental implants. If your gum tissues change colors on your lips, cheeks, tongue, around the teeth — call your dentist to evaluate the reason for changes. It may be caused by medications, dietary changes, dental infections, or systemic infections such as heart disease, diabetes or cancer.

The mouth has many nerve fibers that let us know when something is wrong. Listen to it, and suffering may be reduced in the mouth and the wallet!

9. Medical problems.

None of us likes to hear that we have developed a medical condition. Is there something “wrong” with me? Am I broken? You may be weak, damaged or hopeless. Heart disease, stroke, lung disease, diabetes, cancer, Alzheimer’s — all may affect our psyche. You may feel depressed about the bad news. The last thing you want to do is go to the dentist! However, I suggest that you do so immediately. Over the last 6 months, I have seen many patients that had heart attacks, pneumonia, diabetes, vision problems, acid reflux disease, H. pylori infections, and cancer. I looked inside of their mouths and was shocked. All of them had periodontal disease (gum disease). Periodontal disease is caused by bacteria that reside beneath the gums. These germs are nasty. They secrete a chemical called endotoxin that causes the body to attack itself – that’s bad! Therefore, I recommend that you visit with your dentist as soon as practical to ensure that gum disease and cavities are not present. Your quality of life may improve by visiting with the dentist.

All the best to your success-

Dr. Joe Kravitz
Prosthodontist, Author and Speaker
Maryland, Washington DC, Virginia

The root word- prostho means false, artificial or replacement; and dontist means dentist or tooth. Many of my friends now know what a prosthodontist is through education about the dental profession.

A prosthodontist invests in extensive education, education, study and practice (at an accredited dental school or hospital) involving:

• Restoring optimum appearance and function of your smile
• Replacement of missing teeth with dentures, partials, plates, complete dentures, removable partial dentures, fixed bridges and dental implants
• Fixing broken, defective and dark teeth with inlays, onlays, ceramic veneers, porcelain veneers, caps, crowns, fillings, bonding and composites.
• Understanding how to fix the bite, occlusion, smile lines, smile, TMJ and temporomandibular joint
• Making bite guards and snore guard appliances
• Training includes reviews of scientific literature, lectures, teaching other dentists and students, treatment of patients, research, and laboratory experience in fabricating restorations
• A skilled architect who can restore the function and appearance of the mouth – teeth, gums, bone and smile
• Prosthodontics is one of the nine dental specialties recognized by the American Dental Association
• Graduate programs include classroom lectures, presentations, intense study and practice is aesthetics/cosmetics, prevention, inlays, onlays, crowns, veneers, bridges, dentures, TMJ, snoring, dental implants, tooth grinding and clenching, injuries to the mouth, birth defects, oral cancer, and partial or complete oral rehabilitation, and pathology of the mouth.
• Mastery of the scientific basics of how the mouth functions and heals properly

Most prosthodontists devote years of additional training after dental school in a program accredited by the American Dental Association based either at a hospital or a university. The training includes reviews of the literature, lectures, treatment of patients and laboratory experience in fabricating restorations. There are approximately 3,200 prosthodontists in the United States of America today.

A prosthodontist is not a cosmetic dentist, though cosmetics and aesthetics are paramount in the mind of a prosthodontist. The American Dental Association does not recognize Cosmetic Dentistry as a specialty. Cosmetics and aesthetics fall under the specialty of prosthodontics.

Please realize that dentistry is not perfect. If it were, we would not need prosthodontists and other dentists. However, the prosthodontist engages in a perpetual process to improve understanding, techniques and success rates for patients.

All the best to your success-

Dr. Joe Kravitz
Prosthodontist, Author and Speaker
Maryland, Washington DC, Virginia

When you miss or delay dental treatment, existing problems may progressively worsen. Infections get bigger. Cavities get deeper.

Gum disease spreads from tooth to tooth throughout the mouth. Bone loss can occur. Teeth and dental implants can get bone loss. Dental implants can move due to bone loss. The good news is that all of the aforementioned problems can be avoided.

Make it a top priority, in 2012 and beyond, to invest in strengthening your health.

It will benefit you to follow your dentist’s recommendations. If your bone, gums or teeth feel different than usual, then it makes really good sense to make an appointment to see your dentist. Over the long haul, it’ll save you significant time and money.

All the best to your success!

Dr. Joe Kravitz
Prosthodontist, Author and Speaker
Maryland, Washington DC, Virginia

A loose retaining screw for a dental implant abutment may yield a mechanical clicking sound. Your fingers can detect the metallic screw clicking inside the dental implant.

This is easily remedied. Visit with your dentist and request that he or she tighten the abutment screw. It’s really that easy :)

Don’t wait three months. Call the dentist immediately to fix the loose screw. Any delay in treatment may cause the thread of the dental implant abutment screw or the dental implants to distort and cause failure.

Remember that early detection helps to minimize more complicated dental treatments. Visit the dentist soon to keep your smile healthier!

All the best to your success,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

The dental implant abutment is required to fasten your new tooth or teeth to the submerged dental implant.

The dental implant abutment comes either pre-made from the dental implant manufacturer or can also be custom made in a dental laboratory to fit your individual requirements.

Dental implant abutments are available in various materials:

1. Titanium metal (silver color)
2. Gold / palladium alloy metal (gold color)
3. Zirconium oxide ceramic (tooth or pink colored)
4. Aluminum oxide ceramic (tooth or pink colored)
5. Hybrid combination or metal and ceramics
6. Tooth colored ceramics (tooth colored)
7. Pink colored ceramics (gum tissues colored)

High quality dental implant abutments are custom shaped to mimic nature. The parabolic or curved shape follows your gum line. The shape of the dental implant abutment can also guide your existing gums that are flat due to a missing tooth, to regenerate to a curved shape. This can be accomplished without surgery. Because I document dental implant procedures with a digital camera, I have learned how to guide the gum tissues (gingiva) to re-grow where there was recession (gum shrinkage) present.

Be wary of lower fee dental implants and abutments, for inferior materials may be utilized to save money. Using incompatible materials such as non-precious metals may cause damage to your bone and dental implants.

Make the investment in higher quality materials for dental implant abutments to increase the probability of success. A successful smile can improve the quality of your life. Remember that if there ever is a clinical issue, immediately call the dentist to be seen. This dental visit can treat the minor issue before if becomes a bigger issue.

Here’s to your oral health and beautiful smile…

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

An ugly gap appears. You start to make whistling sounds. Your teeth may shift causing your bite to become unstable.

Teeth may become temperature sensitive. Bone loss occurs. Gums shrink too. Food gets stuck between your teeth. It can be annoying.

When considering options to replace a missing tooth, I find that it’s best to think about it logically. Either way, it is an investment in time and money.

Fixed Bridge:

The fixed bridge is made by drilling down the tooth on either side of the missing tooth. It requires local anesthesia. It takes 2-4 appointments to complete the process depending on the aesthetic requirements and fit of the prosthesis (fixed bridge). The cost for the bridge may be in the range of $6,000 – $9,000. The complications of a fixed bridge may include the need for a root canal, repeated cavities due to leakage under the bridge.

Dental Implant:

The dental implant and new tooth can be installed in one appointment. You also leave with a custom-crafted resin tooth. You can smile again too! There is a follow-up post op exam to check the healing progress. There is a third visit to install the final ceramic tooth. The cost for the dental implant, abutment and crown may be in the range of $5,100 to $8,000 depending on the need for bone grafting and aesthetic requirements of the case.

The dental implant leaves the teeth adjacent to the missing tooth preserved. There is no need to drill on other teeth to have the one dental implant. If there is more than two teeth missing it is not necessary to have a dental implant for every single missing tooth. Dental implants can be placed spread out to support your new teeth (prosthesis).

The greater investment for the long term is the dental implant. The reason I say that is because the dental implant cannot get cavities.

The dental implant is very resistant to damage from acids as well. The fixed bridge option may yield cavities – that requires the fixed bridge to be replaced in 5-10 years…sometimes sooner! It is very important to understand how fixed bridges fail, so that you can have good strategies for success. Dirty Mouth may improve your understanding of this process.

Logically, the dental implant option may be more logical to replace one missing tooth.

The dental implant is most often the better choice, but not always. It’s best to consult with a dentist to examine:

• Your nutrition regimen
• Your home care regimen
• Your dental knowledge of prevention habits
• Your ability to follow directions
• Your ability to follow up
• Your medical history
• Your dental history and especially cavities (caries)

Please consider the logical process of fixed bridge versus a dental implant – when needing to replace one missing tooth.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

There are several different types of bone grafts available to increase support for dental implants. Let’s review them now…

1. Autograft

An autograft is graft material harvested from your own body. Areas of harvesting (also called the donor site) may include:
a. the upper or lower jaws (maxilla, mandible)
b. in your mouth
c. ribs
d. hips
e. leg bones like tibia and fibula
f. skull

Autografts require an additional surgical site. Sometimes you may have to use crutches to walk for the first two weeks. Ouch! A scalpel is used to cut open the gums and stitches are used to hold the gums closed. There is usually significant swelling, bruising and pain associated with this technique.

Many surgeons will use this technique; however, there is a high failure rate and bone loss because the transplanted bone may not survive leaving worse off that before the surgery. This has nothing to do with the worthiness of the dentist. It has more to do with the way bone heals, how blood vessels grow and the timing of separate cells healing. However, if I can avoid the extra surgery, I look for other alternatives to achieve bone regeneration success.

2. Allograft

An allograft is bone graft material taken from another human. This graft does not require an additional surgical site. The bone graft material comes from a tissue bank. Other people donate their bone. There are stringent standards for excellence; however, the bone tissue bank cannot insure that there is no risk of you getting disease such as HIV or AIDS. For this reason, I do not use this graft material, for I would not want the risk of disease transmission from a fellow human.

While I understand that this avoids the extra surgical area as with the autograft, the risk of disease trumps this for me. There are other alternatives as noted below.

3. Xenograft (pronounces “zeeno” – graft)

An xenograft is a bone graft material made from another species such as cow bone, also called bovine…or pig, also called porcine. There is no chance of disease transmission and it is very safe. The inorganic part of the bone is used as a scaffold. There is no need for an extra surgical site, so the chance of complications is minimized.

The xenograft material is used as a matrix to have your own bone throughout the graft material. Most xenografts are replaced by your own bone over several months to years. The bone regenerated from this material is very dense and strong. Xenografts can increase the support for dental implants.

4. Alloplast

An alloplast is a bone graft material that is man-made. This synthetic bone graft material can be made from surgical grade resins, hydroxyapatite, calcium phosphate, and other minerals that allow your own bone to regenerate into the alloplast material. This material is very safe and encourages your bone to grow throughout. Alloplast bone grafts can increase the support for dental implants and your smile.

5. Membrane

A barrier membrane is used to cover the bone graft for dental implants. The membrane helps to prevent the gum tissues from growing around the dental implant before the bone does. The membrane slows down the growth of the epithelium and connective tissues, so your bone can strengthen the supports for dental implants.

I hope you find this bone graft materials information useful. I wish you joy in your discovery and knowledge, to make a better decision to improve your smile – with dental implants.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

You cannot see the bone graft with your eyes. Bone grafting is accomplished with precision and knowledge of the basic sciences.

It takes a great understanding of how oral epithelium heals, connective tissues heal and bone heals. The dentist devotes many classroom hours towards this understanding so that mastery of the basics can occur.

The bone graft can be accomplished with or without the use of a scalpel and stitches (sutures). More extensive cases may require the gum tissues (epithelium and connective tissues) to be incised (cut open) to reflect the gum tissues to for seeing the area clearly. This process is called reflecting a full thickness periosteal flap.

What are the reasons for needing a bone graft for dental implants?

• Previously extracted teeth (or tooth)
• Missing teeth (or tooth)
• Periodontal disease
• Gum disease
• Extensive caries (cavities)
• Acid damage
• Poor fitting dentures cause bone loss
• Bone infections
• Bone defects
• Weaker bone density
• Cracked teeth (fractured teeth)
• Existing bone is too thin
• Existing bone is too short
• Medical conditions

When bone grafting occurs, researchers have shown that the bone density increases significantly. Some bone grafting materials heal at the expense of fat cells. When there are less fats cells there are more vital (alive) bone cells. When the bone density increases, the bone is of greater strength for the support of dental implants. The greater support for dental implants, the greater the support for your new teeth.

Bone grafting for dental implants is logical.

Bone grafting is for dental implants predictable.

Bone grafting is for dental implants healthy.

Bone grafting for dental implants has materials that come in a loose particle form, gel or putty form, a spongy form, or a block form. A future article will discuss the various types of bone grafts and materials.

If you or someone you know needs bone or was told they could not have dental implants, there is hope. There is frequently more than one way to achieve the primary goal – to have great looking teeth that function well and are durable.

Follow-up after dental implant bone grafting

Also, realize that consistent follow-up with the dentist who performed the surgical and prosthetic work, increases the chance of success. Neglect can lead to premature and unnecessary failure. When a patient misses follow-up visits, and refuses to follow the healthy recommendations for oral health, disease and failure can ensue. Inflammation in the mouth can damage and destroy healthy bone. So, let’s be focused on healthy, reasonable actions towards success so that your bone grafting procedures endure for as long as practical.

Bone grafting for success can lead to better dental implant outcomes. Bone grafting increases your bone density. Bone grafting can be accomplished in as little as one step, within minimal down time. Modern bone grafting techniques have provided us with the ability to help more people suffering with missing teeth, dental pain, poor fitting dentures, and failed fixed bridges. More people are smiling today because of improved procedures such as bone grafting for dental implants.

Be well,

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker

Sub means below and antral means sinus.

This type of bone graft lengthens bone in the upper back jawbone (maxilla). The bone is lengthened below the maxillary sinus and above the bone. At no time does the subantral graft enter your sinus cavity, unless there is a torn sinus membrane that pre-exists.

We are born with a small pea-sized empty space in the upper back jaw – called the maxillary sinus. The maxillary sinus is bilateral, which means it exists on both sides of the upper back jaw. The maxillary sinus increases in size throughout childhood and teen years. Into adulthood, the maxillary sinus expands to the size of a small peach. This expansion destroys the bone of the maxilla around the upper teeth, especially if they are missing. This process of bone destruction is called pneumatization.

Missing teeth equals increased bone loss.

A subantral graft is indicated when the upper back jaw is too short. The subantral graft can provide increased bone length for dental implants and facial support. The subantral graft process is very successful and predictable.

Patient compliance is important with regards to smoking cessation. Smoking during subantral graft healing can make the subantral graft fail due to inadequate blood supply. It is important that you follow your dentist’s recommendations for healing and cleaning your mouth.

You may or may not leave the dental office with teeth. But we have a burning desire to help people leave the office with teeth. The sinus lift is better scientifically known as the subantral graft. The subantral graft can dramatically improve bone support for dental implants and your facial structures.

All the best-

Dr. Joe Kravitz, DDS, MS
Prosthodontist, Author and Speaker
Maryland, DC, Virginia