Periodontal Specialists

SINUS LIFT AND DENTAL IMPLANTS

Sometimes after teeth are extracted, people lose bone in the posterior upper jaw below the sinus. This results in limited available bone for placement of dental implants as a means of tooth replacement.

In order to now place dental implants in the back of the upper jaw, a bone graft procedure called a “sinus lift” or “sinus elevation” is necessary. These procedures can be performed concurrently with the placement of dental implants or, in some cases, may need to be performed a few months in advance of placing dental implants. This all depends on the amount whatever little bone is still available under the sinus.

There is a procedure called a 3D cone beam CAT scan which can determine how much bone exists in the area of the sinus. Then, dental implant placement can be planned in conjunction with the placement of dental implants or in advance.

The type of bone that is used in such grafts is cow bone. This bone is 100% safe as it is harvested from cows that are raised specifically for the purposes of these bone grafts and are fed and treated appropriately. There is no evidence in the scientific literature of any risks of disease transmission to humans from such treatment.

The sinus lift/elevation procedure has benefited millions of people world wide in the past 40 years since it was developed. This allows people to enjoy the function and comfort of dental implant supported fixed non-removal prosthetics for life.

BROKEN TEETH AND IMPLANTS

When you break a tooth, you may notice a gum boil (looks like a pimple on the gum). This is an indication that something is wrong with the bone and roots of the tooth. Most likely, the tooth has a root canal and even a post inside which could have led to a tooth crack over time. This most likely means that the tooth has to be pulled out and replaced with a dental implant either right away or over a 4-6 months period of time.

If the tooth to be pulled out is a single rooted tooth (incisor, cuspid, premolar) then an implant can be placed right away into the socket. If on the other hand the tooth is an upper or lower molar, then the tooth is extracted and bone grafted immediately. An implant may not be possible right away because the configuration of the socket left behind most likely cannot accommodate the shape of a dental implant. Therefore, often times, the tooth is extracted, bone grafted, allowed to heal for 4-6 months and then a dental implant is placed. Following three months of healing, the crown or bridge can be placed.

For any questions, please call our office 416-225-9910.

Tooth Extraction, Bone Regeneration, and Dental Implants

One of the most common treatments we perform in the office is tooth extraction, bone regeneration and dental implants. The reason this procedure needs to be performed has to do with the fact that when teeth break beyond the point of repair, they must be removed. In order to replace teeth, patients have the following options:

1. No tooth replacement

2. Dental bridge

3. Partial or full denture

4. Dental implant(s)

 

The first option is a poor one because if you do not replace missing teeth, you risk tooth shifting and over-eruption by other teeth in the opposite jaw. This can lead to alterations and changes in your bite which can lead to life-long pain and discomfort (e.g.. headaches, jaw pain, and more broken teeth).

The second option is old technology and results in destroying adjacent teeth. When you lose a tooth, if you have teeth on either side of the space, a dentist can cut down these teeth (permanently destroying these teeth) and placed a bridge in the space to replace the missing tooth or teeth. However, these bridges are relatively short term and no dentist can assure you use of such a bridge for more then 7 to 10 years. Often times, the teeth that hold these bridges undergo the tooth decay process which lead to more treatment like root canals and more root fillings. So crown and bridge treatment can actually lead to more tooth compromise and more tooth destruction in the long-term. Even though dental insurance companies are happy to cover such treatment, these are your teeth being destroyed. So proceeding with this treatment JUST BECAUSE dental insurance may cover it is extremely short sighted and can lead to more tooth loss in the upcoming few years.

The third option, a partial or full denture, can be cheap but extremely uncomfortable. Dentures can loosen and fall out of you mouth when you laugh, you can get food stuck between the denture and your gums leading to extreme pain and they can smell really awful when food is stuck under them and not cleaned out multiple times per day.

So the best option in today’s modern world where people want to look, feel, and smell their best, is the dental implant. A dental implant is a titanium alloy post which is gently inserted into the jaw bone, hence, replacing the ROOT of the tooth. A couple months later, once the implant has integrated with your own bone, a dental crown or CAP is screwed into the implant. It’s that simple. It doesn’t hurt. It’s a little more expensive then a bridge, but in the long term, it will likely last for the rest of your life whereas a bridge you will replace multiple times throughout your life and potentially lose the bridge teeth as well.

Dental Implants are long lasting, easily cleanable, and relatively inexpensive dental treatment options that should last a lifetime. They replace teeth to the extent that they look almost identical to the teeth being replaced (assuming you treat the problem in time and don’t allow your bone to degenerate too long).

I always tell my patients that if a tooth is cracked and you are experiencing an early abscess (gum boil), then you should have the tooth extracted as soon as possible because otherwise you risk losing more bone and requiring bone grafting PRIOR to dental implant placement. When you have an abscess, you lose bone. When you lose bone, it becomes more challenging to place an implant. Therefore, if you wait a long time before dealing with an infection (abscess), the tooth will be extracted and then, instead of placing the dental implant right away into the tooth socket, you will need to spend thousands of dollars on a bone graft PRIOR to placing the dental implant a few months later (usually four months later). People who wait too long end up spending A LOT more money then those who address the problem right away.

An extraction and dental implant with a final crown three months later should cost around $4500-5000. However, if wait too long with an infection and you end up requiring bone grafting BEFORE the dental implant, this could increase the cost of your treatment by $1800 to $5000 per tooth. Why wait? If you have a tooth infection or pain or gum boil, give us a call for a consultation and let us tell you what is the best course of action. You can call Dr Veisman at 416-225-9910 for a consultation.

DENTAL IMPLANT OPTIONS

So you lost your teeth and you are stuck wearing a denture. Now what are your options?

Well, if you are missing, say, all your upper or lower teeth, you basically have THREE options:

Option 1- An REMOVABLE acrylic denture that clicks into three to four dental implants

Option 2- A FIXED acrylic denture that is screwed permanently into four to six dental implants

Option 3- A FIXED Porcelain bridge that is screwed permanently into six to eight dental implants

Which option is best? That depends on:

A. Your budget (financial capability or limitations)

B. Your anatomical and physical constitution (how much bone you have left in your jaw)

C. How much time you are ready to spend in the dental chair

D. How ready and prepared you are emotionally and psychologically to move forward with one of the treatment options noted above

 

Let’s discuss each of the options above one by one.

 

Option 1-Removalbe acrylic denture

Advantages: Relatively inexpensive , needs 2 to 4 dental implants,quick to complete treatment, requires minimal bone, can eat most things like steak, corn on the cob, apples and bite into bagels

Disadvantages: Must be taken out daily to clean, needs a couple connection parts to be replaced every year (associated with some minimal cost), does have a little movement

Cost: $10,000 to $15,000

Time to completion: 3-4 months

Pain/Recovery: Minimal

Option 2- Fixed Acrylic denture

Advantages: Fixed so you never take it out; comfortable (never moves around in your mouth), very esthetic, requires 5-6 dental implants

Disadvantages: More expensive then the removable version, may take longer to complete treatment

Cost: $25,000 to $40,000 depending on whether you are treated by a General Dentist or Prosthodontist

Time to Completion: 5-6 months

Pain/Recovery: Minimal

Option 3-Fixed Porcelain Bridge

Advantages: VERY cosmetic, very strong, generally has the best long term prognosis and longevity of the three options-REMEMBER! YOU GET WHAT YOU PAY FOR!

Disadvantages: Most expensive of the three options, takes longer to complete treatment

Cost: $50,000 per jaw (so full mouth rehab with 8 dental implants in top jaw and 8 dental implant in lower jaw can cost over $100,000)

Time to completion: 5-6 months

Pain/Recovery: Minimal

So, these are your options. Remember NOT to shop around for best price. Meet as many surgeons as you need until you find the one you are MOST comfortable with and the one that has the best credentials. You can also ask to speak to previous patients who have had the treatment you are interested in and ask the patients any questions you may have until you are 100% comfortable to proceed. If you can’t afford to go ahead with any treatment right away, you are better off waiting and saving up rather then proceeding with an unqualified surgeon where you don’t feel right. Just wait, save and do it right the first time. There is an old saying “People who pay for quality only cry ONCE!. “

 

Treating Gum Disease

Treating gum disease is important because there are various complications which can arise throughout the body if this disease is left untreated. There is a strong relationship between gum disease and:

1. Low-weight pre-term babies

2. Diabetes

3. Heart disease and stroke

4. Alzheimer’s

5. Arthritis

6. Lung disease

By seeing a specialist in gum disease called a PERIODONTIST and getting treatment, you lower your risk of developing any of the above mentioned diseases in addition to helping keep your teeth for life. As well, by seeing a periodontist, you will be tested for other diseases which can manifest in the gums such as LEUKEMIA. Periodontists can check for oral cancer, such s MELANOMA, which can also show up on the gum tissues.

If you have bad breath, bleeding gums, loose or migrating teeth, call us today at 416-225-9910. Let us help you keep or improve your oral and overall health.

WHY GUM GRAFTS ARE IMPORTANT

Many people know they have receding gum lines, exposed and sensitive roots and even loose teeth. However, these same individuals don’t realize that they are at risk of tooth loss if they don’t proceed with gum grafts that will accomplish two goals:

1. Cover the exposed roots

2. Increase the amount of healthy and strong gum tissue to help maintain tooth health and longevity

If gums are allowed to continue to recede and not treated with gum graft procedures, then the same affected teeth with gum recession will be placed at risk of:

1. Further recession and sensitivity to hot and cold temperatures

2. Root decay which is difficult to treat and could result in root canal treatment

3. Further bone loss which results in tooth loss and a cyclical bone loss

Note some examples of treatment of recession and improvement in:

1. Comfort

2. Esthetics

3. Tooth longevity

 

CONNECTIVE TISSUE GRAFT (GUM GRAFT)

Covering exposed root and receding gum lines

Covering exposed root and receding gum lines

 

ALLODERM GUM GRAFT

Donor skin graft

Donor skin graft

 

 

 

Tooth Replacement with dental implants

Some people lose all their teeth at an early age. In this case, Margaret is a 60 year old female who who lives in Newfoundland, Canada. She lost all of her upper teeth when she was 16 years old. Since then, she has been embarrassed to smile, covered her mouth whenever she did smile, and was limited in what she could eat. Three years ago, her daughter ( a nuclear physics student at the University of Toronto) found Dr Herbert Veisman on-line along with other specialists and practitioners. Since we were the only office to address her questions on-line and offered to see her for a consultation at her convenience, she decided to take a flight to Toronto and meet with us. No one offers our services within a 1000 km of where she lives.

When she arrived, she was very emotional about the fact that she had a difficult few years (having lost a number of family members). She wanted a new lease on life and she felt that if she could get her smile back, life would be much better. When she initially presented, she was overwhelmed by the amount of work that was needed and the associated costs of treatment. Margaret was told that she would need major bone grafting (due to years of atrophy and bone loss after losing her teeth  almost 45 years prior), would also need 8 dental implants along with a sophisticated dental bridge which these implants would then support. The cost would be around $80,000.

After thinking about her options for a couple of weeks, she returned for a second consultation and decided to proceed with the treatment. She was a little apprehensive but mostly excited to turn her life around. We started with the bone grafting procedures. During the healing and interim period, she sore a full upper denture (same one she had been wearing for several years) so there was little change to her life. After 6 months of bone healing, we proceeded to the 8 dental implants. After another 3 months of healing, work commenced on her final dental bridge which would be supported by the 8 dental implants.

Now, she returns to Toronto every 3 months to ensure that she protects her investment in her new smile. She can talk, smile, eat and kiss with confidence. She is happier then she has ever been. Her story was featured in Elevate Magazine (see www.torontoimplant.com PATIENT section first page) and several people have since come in for the same identical treatment because they were inspired by her. They all had identical experiences and have, in turn, referred many of their friends and family from all over Canada.

We are pleased to illustrated Margaret’s case here with BEFORE and AFTER photos.

Patient: Margaret

Age: 60

Home: Newfoundland, Canada

History: lost all her upper teeth almost 45 years ago

Treatment Goals: Replace all her upper teeth with a FIXED dental bridge on dental implants

Limitations: Patient lost most of her bone that would support dental implants, therefore, requiring BONE GRAFTS first

Innovative Technology Used: Donor Bone block technique; 3D CAT scan imaging; IV sedation anaesthesia

Time of treatment: 9-12 months

Cost: $80,000 (payment plan available)

Prognosis: Excellent (should last for the rest of her life with proper maintenance)

Margaret

 

Always consult a specialist for your surgical needs

If you are considering having any kind of surgery, my best advise to you is to ALWAYS CONSULT A SPECIALIST.

Only specialists have the 3-5  years of training above and beyond dental school. Specialists receive intensive specialized training under strict supervision of an accredited university. General dentists and physicians do not have such training and may not be in a comparable position to handle any complications which could arise after surgery. Specialists receive hundreds of hours of clinical training, must read thousands of scientific articles and journals, and take many Board/ Regional/National examinations to ensure quality control and qualify to perform surgery. General physicians and dentists do not go through such rigours and do not have the years of experience dealing with various complications in university-based environments. Anyone can perform a surgery. Few can handle the complications that can arise.

Remember that when you are seeking various medical and dental opinions, you should NEVER allow cost to skew your judgement. Remember the old saying: YOU GET WHAT YOU PAY FOR. There is nothing in this world that you can’t find for lower price or inferior quality. Benjamin Franklin once said that “The bitterness of poor quality remains long after the sweetness of low price is forgotten”.

As well, an old friend of mine used to have a saying: People who pay for quality only cry once! 

My advice to my patients is that if you cannot afford to do your treatment right now with someone who is a specialist, you are better off waiting until you can afford to do it right. Otherwise, you risk not only losing all your money, but you also risk your safety and well-being by having specialized, high-risk services performed by an unqualified or under-qualified operator. Most of the time, complications arising from operator error are not reversible and you could be disabled for life. In some cases, you could even die from such complications.

ALWAYS ASK YOUR PHYSICIAN OR DENTIST IF THEY ARE A SPECIALIST AND ASK TO SEE THEIR SPECIALIZED CERTIFICATE. YOU CAN ALSO CHECK ONLINE  OR SPEAK WITH THE COLLEGE OF PHYSICIANS AND SURGEONS OR COLLEGE OF DENTAL SURGEONS OF ONTARIO TO CHECK AS TO WHETHER OR NOT THE PROFESSIONAL IN QUESTION IS ACTUALLY A SPECIALIST. 

NEVER TRUST ANYONE! ALWAYS VERIFY FIRST!

As in anything else in life, when it comes to shopping around for the best surgeon, the old adage “buyer beware” applies.

Intravenous Sedation and Anesthesia

Our patients appreciate having the option to sleep right through all bone grafting, extractions, dental implants and gum surgical procedures in our office. The advantages of having treatment with anesthesia include:

1. Having more treatment completed in one sitting so you don’t have keep coming back for more and more treatment

2. Able to monitor people who are medically compromised

3. Having a portal IV in the vein for delivery of life saving medications in case of an emergency

4. Delivery of antibiotics directly into your system to drastically reduce chance of post operative infection

5. Delivery of anti-inflammatory medications to reduce chance of any swelling and pain post operatively

6. Can’t hear, feel or see any of the treatment and you awaken happy and refreshed after completion of surgery.

 

Many patients equate having sedation during surgery to “flying FIRST CLASS” on an airline. It’s a great feeling to go for surgery and not feel anything or be nervous throughout the entire treatment.

Bone grafts in periodontics

There are various types of bone grafts that can be performed in the periodontal office.

1. Guided Tissue Regeneration- bone grafting around an already existing tooth which has lost bone due various problematic issues. The bone grafting procedure consists of opening the gum around the tooth, cleaning out the defect, adding bone and a resorbable membrane and closing the gums tightly around the tooth with suture. The bone takes about 6 months to grow back around the tooth. This technique has been around for 30 years and is effective in saving certain teeth.

2. Guided Bone Regeneration- bone grafting of a tooth socket AFTER extraction of the tooth in question. The socket bone is regenerated because an implant may be planned as tooth replacement in the empty tooth site. After FOUR months, the extraction site is x-rayed and assessed for a dental implant and crown placement.

3. Bone Block Graft- when there is enough vertical hight of bone to place a dental implant but not enough HORIZONTAL bone, then a bone block graft is placed on the ridge and stabilized with at least two stainless steel screws. The screws are left in position for four months. Once an x-ray is taken after four months, the site is assessed for a dental implant. Once it is decided to place a dental implant, the gum is opened and the stainless steel screws are removed. Finally, a titanium implant is placed in position. Three months later, a crown can be placed.

4. Sinus Lift Procedure- when someone loses an upper molar, there may be extensive bone loss such that implants may not be possible UNLESS a bone graft is performed. Such a bone graft procedure is called a SINUS ELEVATION (LIFT). The gum is opened, a window is created on the lateral aspect of the upper jawbone and bone grafting material is used to fill the sinus site. If there is at least 3-4 mm of bone, an implant may be stabilized at the same time as the bone grafting procedure. Dental implant crowns may be placed at 4-6 months. Otherwise, if there is less then 3-4 mm of bone, the bone graft is performed and then 6 months later, the implants may be placed. Three months later, the crowns may be placed.