This is a list of frequently asked periodontal questions we’ve compiled from our patients. Please take a look below to learn more!

Dental Implants

I had tooth #18 extracted 20-25 years ago. Can I now have it replaced with an implant or is it too late? It was replaced with a bridge when it was extracted (false tooth for #18 attached to a crown for #19) and now the crown on #19 has broken. I am in the process of having implants for #29 and 30. General dentist says to wait until 29 and 30 are done but did not tell me what my options were going to be.

One of the reasons your dentist is telling you to hold off is because they probably want to give you at least one functional chewing side on the right, before addressing the left side.  Even though you lost your tooth a long time ago, it doesn’t necessarily mean you don’t have enough bone for implant placement.  This greatly varies between individuals.  In order to establish whether you have sufficient bone or not, I would recommend taking a CT Scan (3D x-ray) and have it clinically evaluated by a Board Certified Periodontist.

How long after a patient quits smoking can implant treatment begin?

Smoking can adversely affect the success of dental implants. It is protocol to quit smoking at least 2 weeks prior to implant placement, though longer periods of time can certainly be beneficial. Please be aware, that formed smoking habits may have permanent damages to your tissues even after quitting.  That said, patient’s who smoke still get dental implants.  However, your Board Certified Periodontist may choose longer healing periods and/or a conservative surgical approach.

I have severe bone loss in my upper jaw and I’ve been told to extract my teeth and get dentures. I want dental implants but with the amount of bone loss that may not be possible. Do I have options? Has anyone tried Emdogain or other bone regeneration techniques or would bone grafting give me the bone I need? I really don’t want dentures.

Even when bone loss is severe, it is possible to augment bone and place dental implants in most cases.  Usually major bone augmentation is done with a patient’s own bone. Emdogain, in particular, is an enamel matrix protein that will not be significant for this procedure.  In order to evaluate the outcome, your periodontist must look at the amount of horizontal and vertical bone loss, the anatomy of the defect, and then treat/eradicate any periodontal disease prior to implant placement.

If you don’t have enough bone to replace all your teeth with implants, you have several options.  You may choose to go with a hybrid prosthesis (5-6 implants supporting a fixed denture without the flange) or an overdenture (2-6 implants supporting a removable denture).  These options may provide enough stability and comfort for you and may minimize the amount of procedures you need to have for implant placement.  Please discuss your concerns with your Board Certified Periodontist so he/she can present the best options for you.

I lost 6 upper teeth – all the ones that show and I think this is a chance to be proactive about how I age. Where should I ask my dentist to bulk them to give me the best bone structure over time? For example, should I get them thicker at the base near the lip and the sides near the cheek and how bulky? If they are already curved to accommodate my face is that good enough?

It is very difficult to answer this question without proper diagnostic information.  Definitely, if you have crows feet or drooping around the upper and lower lip, then adding a flange (base) around dental implants may serve as support, evening out lines and creating a younger appearance.  Implant brand will not be a deciding factor here.  I suggest searching for a Board Certified Prosthodontist and Periodontist for proper evaluation and mock up of the treatment outcome.

My research of mini dental implants leads me to believe that they’re preferable and cost less than regular dental implants if you have a single tooth gap/problem. I’d like an expert opinion about mini implants.  Do you recommend them for your patients?  When?

Mini implants were designed for temporary use.  In some cases, during the healing phase of regular dental implants, some patients prefer to have temporary prosthesis which is where mini dental implants are great.  They frequently fail within 1 year. If you are looking for a permanent option, my recommendation is to go with a well-researched and guaranteed brand of dental implants such as Nobel Biocare, 3i, Straumann, or AstraTech.  I know you may find contradicting information online, but I encourage you to look into the research studies (i.e. Pubmed) rather than company-driven advertisements.

For someone with chronic periodontal disease and bone loss, would it be best to use veneers to improve the look of the teeth or go directly for implants? Obviously, having the teeth removed is permanent (so is the progression of periodontal disease) and I can’t imagine being ready to run and do that now, but I also think it’s important to be practical and realistic. Veneers would cost tens of thousands. Would it be about the same as implants? How long do implants last vs. veneers and what is the best option?

Most importantly, you must be sure that you eradicate all active periodontal disease.  Once all the infection is gone, and disease is arrested (where it doesn’t get worse) you will need to have your Board Certified Periodontist evaluate how stable your periodontal status is. Lumineers can be bulky and may be more difficult for you to perform proper oral hygiene, which is the opposite of the goals of periodontal disease treatment. Implants are definitely a great option.  However, patients with periodontal disease have higher failure rates and may require bone augmentation prior to implants placement which may increase the length and cost of treatment.  Longevity of both Lumineers and dental implants is directly proportional to patient’s compliance and oral hygiene, as well as good overall health.  Bottom line, make sure your disease activity is arrested prior to any option you choose.

Contemplating dental implants. Dentist say it can be all done in one day? A car accident took most of my front teeth out and pregnancy with four children took the back molars. My dentist states pulling the rest, placing the implants needed, and then settling whatever set I decide on (permanent or removable) will be done in one day. The only difference is that any removable will be temporary because the fit will be measured the day of and then placed a week later. Is this safe? Normal? Can it be done properly this way? No grafting needed. He measured gums and bones.

If you have a sufficient bone amount for dental implant placement, it is absolutely okay to have all implants placed on the same day.  However, loading these implants on the same day with a prosthesis attached to them may increase chances of failure.  Waiting 4-6 months for healing in the upper jaw is a safe protocol.  If you are getting a temporary removable prosthesis that will not be attached to the implants, then this is a very safe route to go.  You are very fortunate that after trauma, you don’t need any grafting.

I already have upper dentures. Can I have implants to keep the dentures in place?

If you have an existing denture, you can definitely have 4-6 implants placed to support the denture and make it less bulky.  You will need to have a new denture fabricated after dental implants are placed.  Upper dentures usually have good stability and most patients don’t feel the need for dental implants.  However, if this is your concern, you should contact a Board-Certified Periodontist for proper evaluation and treatment options that best address your concerns.

My teeth and gums are in very good condition but are unattractive in several ways: color, bad orthodontic decisions (a tooth was extracted because it was out of line and rotated resulting in a small arch with already small teeth–giving my mouth a sunken appearance), and “fan-shaped” teeth. What options are available to improve my smile. This would be about 98% cosmetic. I have a tooth missing in my upper jaw for which the recommended treatment is a bridge and a sensitive lower jaw tooth.

There are a few very important diagnostic steps that need to be completed prior to determining treatment.  Each patient’s treatment varies depending on those factors.  From the information you have given us, it is very difficult to assess exactly what is necessary to address your concerns.  However, it seems that you may be able to address your concerns with cosmetic dentistry, such as veneers or crowns.  For the missing tooth, you may consider an implant instead of the bridge, if you have enough space for implant placement.  Implants generally help preserve adjacent teeth and give you the ability to floss between teeth, where bridges require cutting down adjacent teeth and result in difficulty in flossing.  Also, sensitivity can be caused by several different conditions and treatment may vary.  If sensitivity is due to gum recession, then you may want to see a board-certified periodontist for a possible gum graft.

I am considering quite a lot of dental implants. However, I was very put off by the idea of a “fake gum” to support the implants. The dentist said it was because the real gum would shrink back, etc, once the real teeth were out. I am still interested in implants but hate the fake gum. My question is, if I had my teeth replaced with implants one (or two) at a time, would the gum still shrink back and make the whole thing unstable? Or would it then work OK without the fake gum?

When there is a lot of bone loss prior to extraction of teeth, it is common to get gum shrinkage and extra space. Once implants are placed, extra space requires longer implant crowns which may look unnatural.  In this case, there are 2 ways to correct the problem: either with pink porcelain around crowns or pink acrylic around crowns, depending on what restorative treatment is chosen.  To know whether you require this or not, there are several diagnostic steps that need to be completed. If you feel that you need a second opinion, visit a periodontist for a consultation.

I’m afraid about dental implants, are they painful?

Dental implants are not painful at all during the surgery act.  Usually, local anesthetic is used to numb the surgical area.  Some doctors, including us, offer IV sedation (twilight sleep) to their patients, which also makes the procedure very comfortable.  After surgery, some discomfort may occur, which is alleviated with basic pain medications.  Usually, a single dental implant results in less discomfort than extraction.

Gum Lift

Is someone who has had a gum lift more prone to gum recession later? I know receding gums can cause some real problems. After a gum lift is the tissue more vulnerable or will it heal up to be just as strong as before?

A gum lift may imply gum graft (shortening the tooth, helping to cover an exposed tooth root) or crown lengthening (lengthening the tooth, exposing the hidden crown from underneath the gumline). Gum grafting (adding your own tissue or artificial tissue together with the gum lift) can help thicken your gums, which will also help to prevent recession from reoccurring and will definitely make your gums stronger.

However, the single most important thing you can do to prevent the recession from reoccurring is to eliminate the original cause, which is usually plaque or trauma. If you are referring to crown lengthening, then if the surgery is done properly, you should not be predisposed to gum recession. A surgeon will usually make sure to leave a sufficient amount of keratinized/attached (good) tissue to protect the tooth.

I dip and my gums seem to be receding on my lower left K9 tooth. Will it fall out? Also, is there any way that if I quit, my gums will heal themselves and push back up?

Dipping can definitely contribute to gum recession as it traumatizes gums continuously.  If recession progresses enough, you may eventually loose the tooth.  FYI, companies add polyester shards to tobacco to irritate and create wounds in gums for higher uptake of nicotine.  Besides gums recession, dipping can significantly increase chance of oral cancer.  I would definitely recommend quitting your habit ASAP and seeing a board-certified periodontist to diagnose and treat your gum recession.

Do I have to go to a cosmetic dentist for a gum lift?

A board-certified periodontist should be your first choice for a gum lift.  Cosmetic dentistry is not a specialty.  Cosmetic dentists are general dentists that have a preference for treating patients with cosmetic concerns. A periodontist is a specialist that is trained in treating lost gum tissue in Los Angeles.

I have receding gums and have lost a few teeth because of this. Can a dentist stop gums receding?

Receding gums can be caused either by trauma or periodontal disease.  Only removal of these etiologic factors can arrest lost gum tissue in Los Angeles. Gum recession follows bone loss and, if enough bone loss occurs, you will end up losing the teeth.  Since you’ve lost some teeth already, you may want to see a board-certified periodontist for diagnosis and proper treatment to prevent future tooth loss.

I just finished my 2nd visit for periodontal disease and had the bacteria scraped away. I’m wondering if there is anything I can do to help grow the bone back and promote my gums to form again? My two lower front teeth now have huge gaps between them.

It is great that you got your deep cleaning, which will help you arrest the disease process.  Unfortunately, bone and gums don’t grow back.  Occasionally, in some instances, you may be able to get a bone graft or a gum graft.  However, black triangles between teeth cannot be grafted, but in some instances can be filled in with the help of restorative dentistry (crowns, veneers, fillings). A board-certified periodontist will be the best reference for whether or not you are a candidate.

I would like to get a gum graft for the gum recession I have had recently. My concern is my gums are rather inflamed and I don’t know if the procedure can be done while they are in their current state. How is inflammation addressed prior to and after a gum graft?

The inflammation of the gums can be taken care of with a professional cleaning and great oral hygiene home routine.  This step is essential prior to addressing gum recession, as a surgical outcome greatly depends on it.  You should see a board-certified periodontist to assess and treat your lost gum tissue in Los Angeles.

Tooth repair

When I was in middle school (now 21) I fell and injured my front tooth. I have had three root canals and a surgery to remove the root. After a couple of years, the tooth is now becoming a huge pain again. My Endodontist has said she could do the same root removing surgery again or the tooth should be extracted. What do you think would be the best option? It is the front left tooth on top. If I get it extracted, should I get a bridge or an implant, seeing as I’m 21-years-old?

Usually, after so many endodontic retreatments, the prognosis of additional endodontic treatment is significantly lower.  The chance that you will have another problem with it again is very high.  Because of your young age, I would definitely choose to go with a dental implant rather than a bridge.  A bridge requires cutting down 2 adjacent healthy teeth, compromising their longevity and making it difficult to clean/floss in between them. On the other hand, a dental implant will preserve your adjacent teeth and will address only the problem area (missing tooth).

I think your best treatment option is to extract the tooth, use a bone graft to reconstruct/preserve bone, and then place a single implant.  Occasionally, a gum graft will also be necessary to preserve good gum tissue, protect the area from trauma, and create a symmetrical, even look.

Contact Expert Los Angeles Peridontists

If you have any questions, please give us a call at  (310) 299-8329. The husband and wife team of Dr. Aalam and Dr. Krivitsky run the CENTER for Advanced Periodontal & Implant Therapy in Brentwood and pride themselves on being a reliable source of information. We encourage you to contact a Los Angeles periodontist or book an appointment.

Next, read our periodontist blog.

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