When you lose a tooth it usually is best for your oral health to have it replaced. Missing teeth compromise your "bite" and ability to chew, and they increase the burden on your remaining teeth. Additionally, when you lose a tooth it can have a serious impact on your appearance. Fortunately replacement of a missing tooth is usually not an emergency. You have time to consider what replacement option is best for you and make an informed decision. This portion of our website discusses your treatment options.

What Are My Replacement Options?

If you are missing one or more teeth and choose to have them replaced, there are several treatment options available:

1.    A "flipper" is a removable plastic tooth replacement. It's fragile and temporary in nature but is inexpensive.

2.    A "cast partial denture" is also a removable replacement. It is precision cast in metal for longer service life. Wire clips hold it in place.

3.    A "fixed bridge" is cemented into place using crowns on teeth adjacent to the open space for support. In select cases a "Maryland" bridge can be made which is cemented to the back of the adjacent teeth.

4.   "Full dentures" or "plates" are the traditional solution for people who have lost all their teeth in one or both jaws. Success with a full denture depends on jaw size, shape, oral habits and patient adaptability. . Some people do very well with dentures, others not well at all.

5.    "Dental Implants" Can be used to support the replacement of one tooth or all teeth. After years of research and clinical trials, we can now provide this option in addition to the traditional treatments listed previously. Teeth supported by implants can be cemented, screw retained, or removable and can be made attracted, stable and comfortable for almost any patient.



Are Dental Implants An Option For Me?

If you are considering dental implants, Dr. Salah will first conduct a thorough examination of your teeth and mouth. Dr. Salah, in consultation with the oral surgeons on our team will then review your medical and dental history to insure that dental implants are appropriate for your dental treatment. Panoramic x-rays of your jaws will be initially taken to evaluate your jaw bone for implant placement. The panoramic will help Dr. Salah and the implant surgeon to determine if additional tests or procedure are necessary to allow proper placement of your implants.


What Is A Dental Implant?

The best way to explain this is to compare a dental implant to a natural tooth. A natural tooth consists of a root and a crown. The part of the tooth that you can see and brush is called the crown. Supporting the crown is the root, which anchors the gum tissue and into the jaw bone. When you lose a tooth you lose both the root and the crown. To replace a tooth with a dental implant we begin by replacing the root. A dental implant is essentially a new root. This titanium metal "root' is fitted into a socket that we create in your jaw, replacing the root of your lost tooth. Once an implant has been placed in the jaw, the bone around the implant needs to heal anywhere from three to six months depending how hard the bone is. When this healing phase is completed we will place a support post called an abutment, into the implant itself, then we place a new crown over the implant. If all your teeth are missing there are a variety of treatment options that are available to support the replacement teeth.
The implant surgeon will work closely with Dr. Salah as a part of our team to establish a comprehensive treatment plan. Occasionally, to achieve the very best results, we consult with additional dental specialists. Dr. Salah will be responsible for planning your treatment and placing temporary and final restorations, whether they are individual crowns, bridges, or specialized dentures. In many cases additional pretreatment preparation is required to achieve the best possible result. This may include working with models of your teeth and jaws to help us plan your new teeth, as well as our fabrication of "guides" to help the surgeon place the implants in the best location. Dr. Salah will work closely with the implant surgeon to plan the details of your implant supported restoration.


How Are Implants Placed?

This office procedure usually takes about an hour for one implant and typically no more than two or three hours for multiple implant cases.
Here is what you can expect on your visit:
·    The surgeon will give you a local anesthetic to numb the areas being treated. You may also prefer to be sedated using intravenous medications.
·    Then after you are comfortable a small incision will be made in the gum tissue, revealing the bone into which the implant is placed.
·    Using specialized instruments, a socket will then be very carefully created avoiding damage to the bone.
·    The titanium implant is then inserted into the socket.
·    Sutures (or stitches) will then be used to close up the gum tissue.

After the implant is placed, the area will need to heal for three to six months. The surgeon will see you afterwards until the implants have healed, usually for three to five office appointments. After your surgeon has confirmed that the implants have healed properly, Dr. Salah will be notified and the restorative portion of of your treatment can begin.


How Many Implants Do I Need?

Usually, we place one implant per missing tooth except in the back of the mouth. Because of the great chewing forces involved, most back teeth have more than one root. Again, an implant is just a new tooth root. Since many of the larger teeth in the back of your jaws have more than one root, we tend to replace missing back teeth with more than one implant per tooth, especially if there has been moderate bone loss, or if there is evidence of excessive biting force.

What If I'm Missing All Of The Teeth On My Lower Jaw?

If you are missing all of the teeth on your lower jaw, you may consider a number of treatment options. While many patients have no problem wearing a full upper denture, some find it difficult to wear lower dentures.
The first option is to have the surgeon place two implants into your lower jaw, and have Dr. Salah make you a denture that snaps onto the implants. This option allows your lower denture to be more stable than without implants if your jaws support ridge is big enough.

There will still be movement of your lower denture, and you can still get sore spots if any food particles, especially seeds are caught under your denture. As with all removable replacement teeth, you will still need periodic adjustments.
A second option would involve the surgeon placing four to six implants, depending on your jaw size or shape into your lower jaw. After healing is complete, Dr. Salah will connect the implants with a custom-made support bar. The advantage of this option is that it is much more stable than the first option, allowing very little denture movement. Your denture will still be removable and come in and out for easy cleaning and maintenance.
A third option involves the surgeon placing five or more implants in your jaw and attaching a non-removable denture. Your denture is held in place by screws or clasps, which secure it to the support posts or bar. Your denture doesn't touch your gum tissue, which allows you to clean under the denture without removing it. This option will replace all of your lower teeth, and will not be removed, except by Dr. Salah for maintenance. Although cleaning under your denture without removing it is more time consuming, many patients who want a non-removable denture prefer this option.
The final option is to have all of your teeth replaced so that they appear to be growing out of your gum tissue. This option will most closely resemble the appearance of you natural teeth. This option usually requires eight or more implants. Dr. Salah will make separate abutments, or support posts for each one of these implants, and then make crowns for each missing tooth. The teeth are frequently joined together for strength and support. Overall, it is the most costly option, requires the most implants and may be limited by the current size and shape of your jawbone.

What If I'm Missing All Of My Upper Teeth?


A similar range of treatment options is available for your upper jaw. However, because the bone is not as hard as that in the lower jaw, people frequently need more implants to support their replacement teeth. Depending on the number of implants Dr. Salah and his surgical team place; we may be able to eliminate the need to cover the roof of your mouth like a traditional denture. This option will allow you to better taste your food, and to have a better sense of food temperature. In short it will make eating and drink a more natural, pleasant experience. You will still have a removable denture, which makes cleaning the support bar and denture much easier. If you would like a restoration that is more like natural teeth, and therefore NOT removable, you will probably need eight to ten implants placed. This is followed by the placement of the abutments and crowns by Dr. Salah.

What Can I Use For Teeth While The Implants Are Healing?

There are many options available depending on your needs. Temporary removable teeth or a temporary bridge can be worn while your implants are healing. If all your teeth are missing, we can usually modify your present complete denture or make you a new temporary denture. If you prefer non-removable teeth during the three to six months of healing, temporary provisional implant can usually be placed along with the permanent implants and you can have temporary teeth inserted the very same day.

What Are The Potential Problems?


Although you may be concerned about pain caused by these procedures, most patients do not experience severe or significant postoperative pain. Pain medication and antibiotics will be prescribed for you to make your postoperative course as easy for you as possible. Occasionally some people develop postoperative infections that require additional antibiotic treatment. Additionally there is a chance that the nerve in the lower jaw, which provides sensation to your lower lip and chin, may be affected. If you are missing a great deal of bone, it might be difficult to place an implant without infringing on the nerve space. Although a great deal of care is taken to avoid this nerve, occasionally it is irritated during the procedure resulting in numbness or tingling in your lip, chin or tongue. Although this numbness will usually resolve, it can be permanent.

How Long Will The Implants Last?

Implants usually last a long time. Of Patients who were missing all their teeth, long term studies (more than thirty years) show an 80-90% success rate. For patients missing one or several teeth, six year studies show a success rate of greater than 90%, which compare favorably with other areas of the body that receive implant replacement 9such as hips or knees) If one of your dental implants either doesn't heal properly or loosens after a period of time, you will usually have to have it removed. After the site heals, another implant can usually be placed.

What Happens After The Implants Have Healed?

Usually, after four to six months of healing, the implants are firmly fused to your bone. At this time we will begin the restorative phase of your treatment, during which your missing teeth will actually be replaced.

In some cases, depending on the density or hardness of your bone, it helps to gradually increase the workload or "biting force" on your implants. Various specialized temporary replacement teeth are used during this treatment phase.. The implant surgeon will work closely with Dr. Salah determining the appropriate time frame for the completion of your treatment. The dental work required to complete your treatment is complex. You will however, usually be more comfortable and find it more pleasant than conventional care. Frequently most work from this point on can be done in complete comfort, without local anesthesia.

Your treatment begins with Dr. Salah making specialized impressions that allow us to make a replica of your mouth and implants. Dr. Salah will also make "bite" records to record the relationship of your upper and lower jaws. With this information, Dr. Salah will work with our dental laboratory to make the posts that attach your replacement teeth to your implants. These implant posts are called abutments, ant there are several types. Frequently, we can use "off the shelf " abutments. Other times, customs abutments must be made out of gold or a tooth colored ceramic material. As you can imagine, these custom made abutments add to the cost and treatment time. The choice of abutment often cannot be made until after healing is complete and models have been made.

The number of appointments and the amount of time required varies with each patient. If you are having only a few teeth replaced, you may need as few as three short appointments. However between appointments we will need time to the lab work required to make your replacement teeth. No two cases are the same. Regardless of the number of teeth being replaced, the work must be completed with precision and great attention to detail.

If your final restoration is a removable denture, you will go through a series of impressions, bites, adjustments and checks over the course of approximately five different appointments. These appointments allow Dr. Salah to make custom bars, snaps, magnets or clips that will secure your teeth to the implants. This is usually done when we are making an "overdenture" where the denture snaps into place onto a support bar. If you are going to have a screw-retained denture, we will screw it into place and remove it periodically in the office for maintenance. The completion of a screw retained denture also take about five visits over the course of two to four months. During this period we will make every effort to be sure that you have comfortable temporary replacement teeth.

Once your implants are in place, you can expect approximately six to twelve months of follow-up care before your treatment is complete. For this reason it is difficult to predict exactly how much the restorative phase of treatment will cost. Also, only after the implants are ready for restoration, will we be able to provide you with a specific treatment completion time frame.

How Do I Clean My Implants?

As with natural teeth, it is important for you to clean implant supported restorations at home, regularly with toothbrushes, floss, and any other recommended aids. You will also need three or four visits per year for prophylaxis by the hygienist and an examination with Dr. Salah. As with regular dentures and other tooth replacements, your implants and associated components are subject to wear and tear and will eventually require maintenance or repair, including clip replacements, relines, screw tightening, and other adjustments at moderate cost. As with dentures, even properly maintained implant supported restorations will need replacement.

What Do These Services Cost?

We will charge you for the abutment or supporting post, plus the crown, dentures, or anything else that will be placed over the implants, including temporary restorations. You will also be charged for routine maintenance and hygiene visits.

The implant surgeon will charge you for the implant placement, as well as any procedures required to place the implants properly. You will need to understand that there will be two different doctors working with you, and as such you will have two separate doctor's bills for your dental treatment.



Your restorative choice should be guided by your sense of what's best for you, with implant from Dr. Salah and the implant surgeon. You should also consider the financial impact of each. Some insurance companies offer adequate coverage, while others may only cover specific types of dental restorative procedures.

Every patient is unique and it is not possible for us to discuss every option and every contingency for treatment outcome. This portion of our website is intended to present the general treatment options available to you from Dr. Salah and the Progressive Dental Group. If your specific treatment options are not clear, please call us. We will be happy to answer any questions about your dental care.