Q: Could my dental implants be causing my low grade fever and migratory body aches? They were put in in 2008. One of the crowns recently failed twice, so the oral surgeon replaced it and laser etched my gums.

A: Do you have peri-implantitis? Are the implants failing? How do your x-rays look? What is the bite like? You really need to be seen for another opinion from a qualified laser trained periodontist who knows how to do the LAPIP therapy.

Q: After gum disease and a denture, can you have two teeth replaced as implants?

A: If you want an overdenture, then it might be possible to put in two implants to support the denture. We often prefer four implants for greater stability.

Q: I am in the process of having an implant put in. The titanium screw was placed (minus abutment) with bone and gum grafting done at the same time. How long will it be before I can put my suck down (temporary denture) back in? The gum area is still swollen and I’m afraid it will interfere with the healing process and graft (the gum line has been built up and is now over the denture. Is that because of the swelling and it should fit again once swelling subsides?).

A: It could take a week or so until it really heals and shrinks. You should have a soft tissue reline and check in with your dentist to verify the healing is going well. You do not want to put pressure on the surgical area.

Q: I have full upper dentures and just had my four front teeth pulled and replaced with a partial plate. I have two natural teeth on one side and one on the other, plus an implant. I complained to the dentist who did the work about pain in the large tooth next to the implant. He ignored me and tried to sell me on having my upper denture fastened by four mini implants. The gum around the large tooth in question is red, puffy, receding and painful. I have an excellent young primary physician who I like and trust and wonder if he is ethically allowed to diagnose my gum problem. I am going on 86. I paid the dentist about $2,500.00 for the four extractions (easy) and the partial and am terribly disgusted that he ignored my painful problem.

A: I recommend you see a Periodontist or an Oral Surgeon to treat this problem.

Q: I’m missing my two superior lateral teeth. Should I get a dental bridge or something else? What do you suggest?

A: You really need to be seen for x-rays and a full evaluation to really give you a fair diagnosis. However, the options usually are implants, bridges, or removable partial dentures.

Q: I had periodontal surgery a few weeks ago because of receding and bleeding gums (that I had complained about for the last year and a half and eventually self-referred to the gum specialist). They stitched me back up after surgery and even after healing I have some major concerns and am wondering what is typical and/or expected? When I went back for my follow-up, he said “I don’t like what I see” and has now indicated that I am going to need to either get a bridge for my bottom four front teeth or four implants (of course my insurance won’t cover the implants). I was shocked. Had no idea I would eventually (somewhere down the road) lose these teeth. They, particularly one tooth, are also MUCH looser now after the surgery. They were not loose beforehand. Is this typical? Recommendations?

A: I would suggest you speak to the Periodontist and see if the teeth can be splinted. You might want to discuss a night guard appliance also if you do choose to save the teeth. See if you can get the prognosis of the teeth from the periodontist as well. If these teeth are determined to be very poor, then the options of a bridge or implants might have to be considered.

Q: Periodontal disease has loosened three of my lower front teeth. My dentist wants to do gum surgery in an effort to save them. I had laser surgery two years ago. My concern is that the surgery may fail and I will still have to do implants. I am afraid that there may not be enough bone left for the implants to be successful. My dentist had said there is a 50% chance the gum surgery will fail but is anxious to save my natural teeth if possible.

A: My specialty area as a Periodontist is in Laser Gum Surgery, so I can tell you we have many cases where we have splinted the lower front teeth, done LANAP, adjusted the occlusion, and placed the patient in a night guard appliance. However, there are a number of factors in the decision. Sometimes, it might be better to extract the lower front teeth. You would have to be seen clinically to determine the best course of treatment for your situation.

Q: I have had upper dentures for years. Would I still be able to get implants even though my gums have receded?

A: Most people can have dental implants after wearing a denture. However, you would need special x-rays and scans to determine in which areas the implants can safely be placed. In addition, a thorough oral examination and review of your medical history would need to be done prior to treatment.

Many patients are able to discard their dentures after all the dental work is complete. The esthetic and patient comfort results are amazing.

Q: I’m having a tooth pulled and my dentist wants to do a bone graft. Is this needed? Can it be done at a later date?

A: We routinely graft bone at the time of our extractions. In addition, we use a special protocol with an ND/YAG laser called “Laser Site Preservation”. The healing is rapid and we don’t get dry sockets and post-operative infections. We prefer not to do a secondary procedure (who would?) to graft the socket. The area should be ready for an implant, bridge, or removable appliance within 3 months.

Q: What gum is best to chew if you have dental implants?

A: If the implants are finished and restored with properly fitted permanent crowns, then chewing gum of any kind should be fine. We usually recommend sugarless gum.

Q: I recently had a tooth removed. I have gum recession where the tooth was removed. Can a periodontist build that back up so I can get an implant?

A: Typically, when we extract teeth we do an immediate bone graft and laser procedure (socket preservation) around the extraction socket. If a patient has not had a socket preservation done, then an evaluation for a secondary procedure or possibly more would be necessary to build up the area for a future implant.

Q: My husband is going through the lengthy process of getting two implants which as you know is quite costly. We are getting lots of denials from the insurance company, but pursuing.  Do you know what the rationale would be for our dentist to have done four gum treatments on the same day for two teeth?  Does that make any sense? Thank you.

A: It is very difficult to know what type of gum treatment was done on the two teeth you are referring to. Was it soft tissue grafting?  Did he have a bone graft?  Ridge augmentation? In our practice, it is not uncommon to perform multiple procedures on the same day depending on the needs of the patient.

Q: I had a bone graft performed on tooth #18 back in April 2011.  An implant was performed in January of this year.  Within 3 weeks, the implant loosened and came out.  It was replaced in March with a larger diameter implant (same length).  Is this common?  What would cause this?  This was done by a well-known Periodontist here in the Boston area.

A: Implants can fail for no reason at all even though the success rate is over 90%. There are many factors that can possibly cause the loss of an implant. Risk factors include smoking, diabetes, poor bone quality, poor occlusion (bite), a compromised medical condition, trauma and a number of other more rare events.

The placement of the wider diameter implant is the correct approach and hopefully will lead to an improved outcome.

Q: I am missing two teeth lower teeth and am considering replacing a bridge with implants. I have been told that I will need to have bone harvested from the back of my mouth and inserted into my jaw to prepare it for implants. I will be under general anesthesia but am very nervous about this whole procedure. How painful will it be when I wake up?  How difficult is recovery from this procedure?

A: There are many different treatment options to consider when treating this area of the mouth. The anterior region of the lower (mandibular) jaw tends to have thinner bone. In many cases the ridge of bone is deficient for the placement of implants. In our office, we use local anesthesia and use either freeze dried bone (cadaver bone that is safe) or synthetic bone. We graft the sites as needed before implant placement. We would usually wait at least 3 months before the placement of the implants. We do not use general anesthesia. We do not have to harvest the bone from the back of your mouth. We try to keep the procedure as simple and conservative as possible. However, in very extreme and rare circumstances such as automobile accident cases or severe trauma, it might be necessary to refer you to a hospital trauma team. Many of those cases do require general anesthesia.

Q: What can you eat with temporary implant teeth?

A: It depends on the case and the individual situation. You can eat most things. You just want to be careful with very sticky foods such as gum, or hard things, so as not to break them.

Q: I would like to know what the warranty on dental implants is and what has been the success rate on them. I would also like to know what has been the success and side effects of having the laser treatment done.

A: Laser Periodontal Surgery is a safe therapeutic modality and very successful in gum disease treatment. It has essentially replaced over 75% of our conventional surgeries. We are currently preparing our cases for publication. There are no side effects of the laser. Implants are over 90% successful. If an implant fails before the one year anniversary, we replace it at no charge to the patient. This rarely occurs.

Q: Does the quality of crowns and implants vary?

A: Yes. A few Periodontists and general dentists have tried to save a few hundred dollars by using implants from China and other questionable sources that were contaminated with lead and other impurities that are not biologically acceptable and safe. But most use high-quality FDA-approved products. Always ask your specialist what manufacturer the implants and crowns are procured from.