Implants Keep Bone Loss from Occurring and Altering How You Look

We stress implants for a very good reason:  it's the only way to prevent bone loss in your jaw when teeth are missing.  Over time, bone loss distorts your appearance, which is obviously something you don't want and we don't want.  Implants are the best way to keep bone loss from occurring and altering how you look. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Immediate Single Tooth Implant

When one of your upper front teeth has to come out, immediate replacement and maintaining your same appearance is of utmost importance.  This patient's root fractured underneath an existing crown.  The crown was taken off and preserved, and the root fragment removed.  Fortunately, a dental implant was able to be placed immediately in the existing socket and residual bone.  The implant, measured with the Osstell device showed an adequate initial implant stability quotient to have a tooth placed on it immediately.  An abutment was fashioned for the implant the the existing crown used as a temporary to maintain the patient's preoperative appearance.  The immediate single tooth implant procedure is highly successful and if you need this type of treatment, this is a service we provide on a regular basis.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Implants Treat the Disease of Bone Loss

The bone around tooth roots is a special kind of bone:  alveolar bone.  It receives stimulation from the roots of the teeth it encloses.  Alveolar bone is healthy unless subject to inflammation from periodontal (gum) disease, which cause it to recede, or if the forces of chewing are greater than the capacity of the bone to withstand.  The full-mouth series of radiographs above clearly shows some teeth, and some segments of teeth, to have significantly reduced levels of bone.  The one universal truth about alveolar bone is that it resorbs (shrinks) when teeth are removed, because the bone loses its stimulation.  The best thing about dental implants is that they preserve bone.  Placed as soon as possible after tooth loss, the implants stimulate bone in the same way that natural tooth roots used to.  This means that possible dental implants  should ideally be included in treatment planning before teeth are removed.  A CT Scan can be used with dental imaging software to determine the exact location, size and number of implants.  By preserving bone, dental implants counteract the results of tooth loss and aging, and help control facial changes.  They give you the security of knowing things will stay in place when you eat, talk and smile.  They contribute to your comfort, quality of life, and self esteem.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

What is Peri-implantitis?

Risk Factors in Implants Failure

Peri-implantitis is a more serious disease distinguishable from the condition of peri-implant mucositis.  It is characterized by an inflammatory process around an implant, which includes both soft tissue inflammation and progressive loss of supporting bone beyond biological bone remodeling.  It is present when there is bleeding on probing and/or suppuration and detectable bone loss.  Since after all dental implants are placed, the bone undergoes a process of remodeling that results in the loss of an average of 1mm of bone height, the only way to document further bone loss is by comparison to a baseline radiograph obtained at the time of suprastructure placement, or by (if no baseline radiograph is present) using a threshold vertical distance of 2mm from the expected marginal bone level following remodeling post implant placement.  Risk factors include:

• previous periodontal disease--does not affect implant survival rate, but is a more frequent finding in patients with a history of periodontitis
• poor plaque control or difficulty cleaning due to prosthesis design dictated by esthetics, phonetics and function
• residual cement that provides a positive environment for bacterial attachment
• smoking--a 3.6 to 4.6 times greater risk of inflammation
• genetic factors that contribute to patient susceptibility
• diabetes--which affects tissue repair ability and defense against inflammation
• possible bite overload

Diagnosis of Peri-implantitis

The presence of bone loss and probing depth alone is not enough to make the diagnosis.  Only in the presence of bacterial inflammation, is bone loss, seen over time, definitive for peri-implantitis.  Non-surgical therapy has not been shown to be effective in the treatment of peri-implantitis, therefore surgical intervention is necessary, and there are several ways to do it.  An understanding of peri-implant mucositis and peri-implantitis underscores the importance of regular monitoring and professional care for dental implants as well as natural teeth.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Minimum Age For Dental Implant?

What is the minimum age for a dental implant?  This is especially important for boys and girls who have congenitally missing teeth.  

Dental implants should not be placed until after skeletal growth is complete.   Once placed, an implant and the bone which surrounds it do not change, so we don't want the jaws and teeth around the implants to continue to develop.  

In general, boys mature skeletally between the ages of 17 and 19, girls between 16 and 18.  

How do you really tell?  A "carpal index", or wrist film (X-ray), can be taken and evaluated by a radiologist.  The film will tell if the bones of the wrist (especially the adductor sesamoid) are completely formed (ossified), the growth (epiphyseal diaphyseal) centers of the fingers (proximal, middle and distal phalanges) are fused and the growth (epiphyseal diaphyseal) center of the radius is fused. These factors suggest completion of skeletal growth.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

All-on-4: Implant-Retained Fiixed Bridge Succes for Denture Patients

Dr. Robert Tupac participated in an All-on-4 presentation at the NobelBiocare headquarters in Yorba Linda, California given by Dr. Ken Parrish.  This technique has been developed to maximize the use of available bone and to allow for immediate function.  Tilted posterior implants are placed to optimize anterior-posterior spread to provide a fixed prosthesis that has enough posterior teeth for bite support and effective chewing.  Dr. Tupac has personally performed this treatment, with great success, on more patients, over the last several years, than any other prosthodontist in the Central Valley.  This technique also allows the patient to go from wearing a removable complete denture to having implants and a temporary fixed bridge in a single appointment.  For more information, visit Dr. Tupac's website www.drtupac.com or call the office at 661-325-1275.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Restore Your Smile And Confidence With Dental Implants

Robert Tupac assisted Martha Sanger, periodontist, in the placement of implants and an immediate fixed provisional bridge, at he same time the patient's lower teeth were removed.  This collaboration gives patients in the Central Valley the option of going from an arch of failing natural teeth to an implant supported screw retained provisional bridge in a single appointment.  Both Dr. Sanger and Dr. Tupac are Nobel Biocare partners.

If you or a loved one experience the embarrassment of slipping dentures, an uncomfortable denture fit, lack confidence in speaking and/or laughing Dr. Tupac can provide a solution in a single day.  Call Dr. Tupac and find out how you can enjoy eating and speaking again with confidence.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Osstell ISQ

We uncovered a Nobel Replace Select implant, submerged for four months in grafted (Bio-Oss) bone, and its Osstell ISQ was 74, making it eligible for permanent restoration.  Having used the Osstell device for over eight years, we find it a consistent, reliable and objective device to measure implant stability.  Learn more at www.drtupac.com and www.nobelbiocare.com.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Replacing Missing Teeth Critical for Daily Function

The muscles of the head and neck work together to determine how we eat, breathe, speak and how we look.  Chewing muscles are supported by the jaws and teeth, and are responsible for the stability of the head and neck.  For this reason, the replacement of missing teeth is important in maintaining our social and biological capability in many different areas:

• lower jaw position, in relation to the skull--allows neck muscles to hold the head in its proper posture--a loss of teeth can cause the head to drop, eyes to be downcast and breathing space of the throat to be decreased
• the height of the lower third of the face--upper and lower tooth contact maintains the length of chewing muscles, keeps the lips and cheeks supported, and contributes to facial attractiveness
• speaking--both the space in the mouth and the airflow through the mouth determined by the shape of the palate, tongue and position of the teeth creates proper speech sounds
• eating--mastication of the right kinds of foods to have a balanced and nutritious diet

Tooth replacement enhances quality of life.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Dental Implant Placement for Patients Taking Anticoagulants

If you are taking anticoagulants, and want or need a dental implant, is it possible?

Physicians usually prefer that their patients who are on anticoagulant therapy (eg.: Warfarin) not interrupt that therapy, since the dose has been carefully calibrated to the individual patient's condition.  For patients taking Warfarin, the risk of thromboembolism is reduced.  A report in the Journal of Oral Implantology suggests that a less invasive, "flapless" procedure is indicated in these cases, because it reduces the amount of bleeding during and after surgery.

We have been using the Nobel Guide procedures for many dental implant placements for several years.  It is a method in which, using a 3-D scan of the patient's mouth, the surgery is performed "virtually" on a computer first, and a rigid guide is fabricated to fit in the patient's mouth and be used at surgery.  With the guide fixed in place, the implants are placed through the guide without having to reflect the tissues.
As always, we discuss the patient's planned surgery and get approval from the patient's cardiologist prior to the procedure.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

All-on-4 (or 6) at the Time of Extraction--Success Rates

The Journal of the American Dental Association reports a two-year retrospective analysis of upper four or six implants placed immediately after tooth extraction and immediately used to support a fixed bridge.  Between 2001 and 2009, in 65 patients (32 women, 33 men), aged 43-83 years (average 60.5), 334 dental implants were placed in postextraction sockets and supported teeth immediately. The follow-up period was two years.  97.9% of the implants survived after two years and 100% of the prostheses were stable. These survival rates were comparable with that reported for traditional delayed implants in the upper jaw.  JADA 2/2012

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Bisphosphonate-Related Osteonecrosis in Cancer Patients

As reported in the American Dental Association Journal, the prevalence of bisphosphonate-related osteonecrosis in patients with cancer could be as high as 13.3%, which is more common than previously thought.  Bisphosphonates are the group of medications commonly used to treat bone weakening in older patients.  An important side effect is the risk, though small, of bone necrosis in sites that are surgically exposed, as in dental extractions or dental implant placement.  The authors examined studies in this area and separated out those with documented follow-up (those in which dental experts participated) and found the rate, in cancer patients, to be 13.3% instead of the previous reported average of 6.1%.  For patients without cancer, the prevalence of BON (bisphosphonate-related osteonecrosis) for patients receiving oral bisphosphonates is 0.10%.  The implications of this new information for the dental practice are: the possibility of deferring oral surgery and considering non-surgical approaches such as root canal therapy, fixed bridgework or removable partial dentures for patients who are receiving antiresorptive therapy.  JADA 2/2012

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Implants Keep Bone Loss from Occurring and Altering How You Look

We stress implants for a very good reason:  it's the only way to prevent bone loss in your jaw when teeth are missing.  Over time, bone loss distorts your appearance, which is obviously something you don't want and we don't want.  Implants are the best way to keep bone loss from occurring and altering how you look. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

All-on-4 Success in Bakersfield

Parel and Phillips, in the Journal of Prosthetic Dentistry report on a study of implant survival rates for 558 jaws treated with 4 implants per jaw in a patient population between 2008 and 2010.  A total of 2,132 implants were placed, with only 48 failures, giving a 97.8% success rate.  Of the few failures, they were 5 times more likely in the upper jaw and more often associated with male patients, poor bone density, opposing natural teeth and the location of the most posterior implant.  Smoking, bone volume, systemic factors, addictive drug use and pathology, including the existence of periapical infections did not appear to be related to failure in this population.  When patients with greater risk had additional implants placed, there were no failures.  Dr. Tupac, Bakersfield's only full time Board Certified Prosthodontist,  specializes in taking patients from failing teeth to implant supported fixed bridges and has been successfully treating patients in this manner for many years.  All treatment, from diagnosis and treatment planning, to extractions and implant insertion, to fabrication and placement of the fixed bridges is accomplished in his office.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Implant Maintenance With A Water Flosser

Dental implant (single or multiple) restorations present a hygiene challenge due to their infinite locations and shapes.  No single toothbrush, manual or powered, and no particular type of dental floss has been shown to be superior for cleaning purposes.  Given the substantial investment in dental implant restorations, this is a problem.

Water Pik, Inc. makes an oral irrigation device called a water flosser.  It is an easy to use device with ten pressure settings and five different tips.  It can clean both above and below the gumline, in between teeth, and under and around implants and different prosthetic designs.  It can remove plaque biofilm.  It has been show to be more effective than string floss.  It can be used in conjunction with antibacterial solutions, such as chlorhexidine, and salt water.

For more information, see: www.waterpik.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Can An Implant Replace An Infected Tooth?

A report in the the Journal of Implant and Advanced Clinical Dentistry of a total of 95 patients (42 female, 53 male) age 19-75 (mean 50.5) with 97 screw type implants immediately placed in molar sites at the time of extraction shows 100% success at three years.  The key to the technique is careful extraction techniques to preserve bone and adequate implant stability upon placement due to obtaining maximum bone to implant contact.  The presence of infection in the extracted teeth was not a contraindication.  On average, the implants were restored with abutments and crowns 12-16 weeks after placement.

Source: JIACD, sept/oct2011,vol3,#6,pp37-44  More at www.drtupac.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Measuring Implant Stability

Dr. Tupac published an article in the California Dental Association Journal, December, 2003, titled "When Is An Implant Ready For A Tooth?" which described the manner in which implants are tested for their readiness to support teeth.

We uncovered a Nobel Replace Select implant, submerged for four months in grafted (Bio-Oss) bone, and its OsstellISQ was 74, making it eligible for permanent restoration.  Having used the Osstell device for over eight years, we find it a consistent, reliable and objective device to measure implant stability.  

Learn more at www.drtupac.com and www.nobelbiocare.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Front Tooth Extraction, Implant, and Crown

Dental Implant 

This patient's front tooth had an existing crown that was hanging down because the root was fractured.  It was not restorable.  The panoramic and individual radiographs confirmed the fracture.  The intent was to extract the tooth, place an immediate implant if possible, and if the stability of the implant was sufficient then immediately place a tooth on the implant.

Implant Procedure

We removed the crown, and then extracted the root with periotomes in order to not injure the boney socket.  After confirming the socket was intact, it was curetted, and sequential drills were used to extend and shape the site according to the anatomy as seen on the CAT Scan. The appropriate sized implant was then chosen and placed.  The Implant Stability Quotient (ISQ) was measured with the Osstell Resonance Frequency Device and it was determined that the implant was stable enough to have a tooth placed on it immediately.  An abutment was screwed onto the implant and the patient's own crown was relined to fit the abutment and placed with temporary cement.

After osseointegration of the implant is complete, a custom abutment will be placed and a new permanent crown fabricated.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Tooth Loss Ramifications

A Rise In Periodontal Disease 

Today there are 25 million people in this country who have no teeth, and that number will increase to 38 million in  2020. As age increases, so does the prevalence of edentulism (no teeth):  22% at age 45, 36% at age 55, 42% at age 65, and 56% at age 75.  In addition, another 80 million people are missing at least one or some of their teeth. The greatest risk factors are untreated periodontal disease, asthma, diabetes, dementia, cancer and heart disease.  An individual with heart disease is 4 times more likely to be edentulous than with no heart disease. Dr. Tupac, a Board Certified Prosthodontist, has solutions for missing teeth.  Dental implants are disease resistant, preserve bone and conserve remaining teeth. Find more at www.drtupac.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Nobel Active Implants

Just yesterday we placed a Nobel Active dental implant in a missing tooth site that had been gone for ten years. It only required local anesthesia, and in four months the partial denture will be history. The Active implant has bone condensing properties that allow minimally invasive bone preparation. A single suture covered the area.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309