Tuesday, April 10, 2018

Dental implant removal code

Dental implant removal code and dental implant removal cost

Dental implant removal code and dental implant removal cost tend to be something that dentists search for so my if you are not a dentist jump down to the bottom and read on the dental implant removal cost.

What is the dental implant removal code?

The ADA dental code for dental implant removal is D6100. This is a dental code that asks for a description. The exact wording in the 2018 ADA is, “This procedure involves the surgical removal of an implant. Describe procedure.” Not sure what description they want as the code seems pretty descriptive by itself. The may be other dental codes that you use with D6100. The most likely would be a bone grafting code. The bone grafting dental code to use is the same that you use when extracting a tooth, which is D7953.

Case I needed to know dental implant removal code for

A mini dental implant that needs removal

What does a dental implant removal cost?

This dental code does not get a lot of use, therefore I am not sure how accurate sites like fair health consumer is. However, they do have dental code D6100 so you can look up the dental code for dental implant removal. Since removal is so rare the thought of what to charge usually does not come up until the situation present itself.

The fees I have seen range from $450-$1000, but I think a lot of it should depend on the severity and circumstances of the case. Another recommendation I have seen is to charge 2x your surgical fee. This seems to fit with what my fair health consumer estimate is. We charge $615 for removal but that assumes straight forward case. That fee is about $300 less than the fair health consumer average for my zip code. Usually my practice is right at or above so it appears we’re doing this for cheaper than we should.

Need the removal of a dental implant?

If you have a dental implant that needs removal, we can help. Typically an implant that needs removal has bone loss and can be done relatively easily, if the dentist has the right tools. Since the right tools are usually owed by a dentist that places that kind of implant, it is best to find a dentist that uses the system of implant that you have. Many systems have specific attachment sizes and require specific tools. However, there are also bits that will remove anything, therefore it is not critical.

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Monday, April 9, 2018

High resolution dental veneers photos

High resolution dental photos of dental veneers

This page has our high resolution dental photographs so that you can see the detail of our work. This page will take longer to load because of the size of the files.

Dental veneers

Before and after photos of dental veneers and replacement of dental veneers.

High resolution of dental veneers that we replaced

Patient had 10 upper veneers placed that he was unhappy with. They were chalky, flat, and unnatural so we removed them all and made new dental veneers just on the front four. He was very happy with the natural look of these veneers.

Replacement of dental veneers

We replaced 2 dental veneers that were likely placed at a young age before the teeth had finished erupting.

Image of full mouth veneers.

Full mouth of dental veneers.

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High resolution dental implant photos

High resolution dental photos of dental implants

This page has our high resolution dental photographs so that you can see the detail of our work. This page will take longer to load because of the size of the files.

Dental implants

Matching a single central incisor is the most difficult thing to do in cosmetic dentistry. Before and after photos of dental implant crowns.

High resolution photo of a dental implant crown.

A single dental implant crown.

Single dental implant crown

Single dental implant crown

Image of a single immediate dental implant crown

Single immediate dental implant crown

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Friday, April 6, 2018

My dental implant fell out

My dental implant fell out!

My dental implant fell out is something we hear from time to time from a patient after we put in a dental implant. Almost always that is not exactly the case.

My dental implant fell out!

Typically when a patient calls to tell us this, something other than the dental implant falling out is what is actually going on. The first thing we really want to see is a photo of whatever it is that came out. In order of things that I have personally seen patients call and say, “My dental implant fell out!” are

  • The healing abutment is without question the number one thing that patients call about when saying “My dental implant fell out!”
  • The rest of these are much less common but the abutment screw is one we have had patients call about.
  • Patients also occasionally call when a blood clot or our perio pack fall out.
  • Finally, probably the least common thing patients call about is the actual dental implant falling out.

The healing abutment is what the patient is calling and saying my dental implant fell out

This is common. I don’t know exact percentage but I would guess around 5% for me. This occurs for several reasons and we can limit the percentage by tightening with our torque wrench. I personally do not use a torque wrench for this but many do. Another reason this occurs is the healing abutment is not fully down all the way because it is tight against bone or tissue. Eventually as the healing process begins the bone and tissue change and the healing abutment loosens.

My dental implant fell out!

Healing abutments are the most common thing to fall out. Their size and shape varies from company to company but most look fairly similar to these two.

The prosthetic screw is what they mistake for the dental implant.

This does not happen often because the the whole abutment would come out as well but in some cases it is possible for just this to come out. The prosthetic screw attaches the abutment to the dental implant, I know that is probably too technical, sorry! Anyway, here is a picture of a prosthetic screw looks like. They are all very similar and very small.

 My dental implant fell out

Prosthetic screw not a dental implant

The loss of the perio pack is what we sometimes see patients calling in about and saying my dental implant fell out.

This basically looks like a bloody clot. There are different versions of perio packs and they look different. I’m not going to show this cause they look like a bloody ball of slime.

My dental implant fell out – yes it really is the dental implant!

If this happens it is a real bummer! This does happen but it is rare. I have seen plenty of failures but it is unusual that a dental implant actually falls out and the patient brings it back. I have only seen it once (well it actually happened twice on the same individual). We made him a dental bridge!

When the dental implant fell out

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Tuesday, April 3, 2018

Too young for dental implants

What is too young for dental implants?

Too young for dental implants? What are the age limitations for dental implants?

Who is too young for dental implants?

This is a question we sometimes hear from patient’s parents and the answer is it depends! The short version is we can place the dental implant when the individual stops skeletal growth, as it turns out his never really stops in the jaw bones but I will touch on that more later. We often state the minimum age is 18-20, however if we can wait until mid-twenties I feel that is safer.

It was once our believe that once the child stopped growing vertically we were fine to move forward with dental implants. However, many cases and a lot or research is showing that late jaw bone growth is common and we have continual movement and growth of out jaw bones throughout life. Unfortunately, a dental implant acts like an ankylosed tooth, in other words it stays in place and does not move with bone growth the way teeth do. This creates a potential for functional and esthetic issues.

In a fantastic lecture seen here from Bahat, you can see what happens to dental implants over the years. They stay put and the teeth move down creating a look of teeth that are too short and do not hit together when biting. It is unknown at what age this patient was but I am guessing she was young.

What is too young for dental implants?

What can you do for someone who is too young for dental implants?

There are several options to temporarily close spaces while waiting for growth to finish. These options are in our alternatives for dental flipper page.

What happens when we place a front dental implant on someone that is too young?

This is far easier to show than to tell, but basically it appears that the crown has sunk into the jaw. In females the tooth may also look too far forward. This is because there is differences in how make and female bone growth occurs. The example shown above is a great example. In reality the bone continues to change and teeth continue to slowly erupt. This leaves the dental implant behind and it’s crown therefore appears shorter. Cases of this can be seen in literature and on dental blogs like dentaltown.

Video on when is too young for dental implants – hint we never stop growing so never totally save!

So is there ever an age where we can guarantee that someone is no longer too young for dental implants?

The short answer to that is NO! The same issues can occur later in life but at this point we can not predict who it will occur to. For instance the case seen below also from Baht’s lecture is someone that I assume is much older based on amount of dentistry they have. I will add that this situation is likely very rare. I have never seen it in my practice and likely have a thousand or more implants in our practice.

Image of patient that had a dental implant too young?

This patient was not too young but had the same growth issue! This was only 2 years apart!!

 

Criteria that helps determine if the patient is too young for dental implants.

Besides age and skeletal growth there are a few other issues that may help us. Even though cranial facial changes occur throughout life they very from person to person. The most prominent changes occur on individuals with long and short faces, so be aware of those people.

More information on dental implant issues including late growth issues can be found on our blog on dental implant problems.

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Pearl Network dentist

PEARL Network Dentist

PEARL network dentist is a dentist that participates in research in private practice through the national organization.

What is a PEARL network dentist?

First of all, PEARL stands for Practitioners Engaged in Applied Research and Learning and that is a good definition as well. The dentists that are in the PEARL network have patients that are active participants in ongoing dental research.

What dental research has a PEARL network dentist possibly been involved in?

The research that any one dentist does varies from office to office, because not every dentist or office is capable of or has an interest in every topic. Therefore the dentist is able to choose what research they want to participate in. A full list of all the studies that the PEARL network has published is found here.

An example of the scope of some of the research that we do….

Thank you for your participation in the clinical phase of the Successful Crowns study. With the help of our coordinators and National PBRN team — and with your dedication to the study — we continue to collect data for single-unit crowns.

A total of 205 PEARL network dentists participate in the study and there are 3,855 patients, which is a tremendous sample size. Since there is such a large sample size we will therefore have excellent information on what makes a successful crown. Furthermore, we also have a strong showing from our laboratories, with over 90% of laboratories actively participating, which is an incredibly high number. To our knowledge, this is the first large-scale study to include both laboratory and dentists assessments in the same study.

Dr. Bauer is our PEARL network dentist

Dr. Bauer is our PEARL network dentist

In conclusion, below is some research from the PEARL network that we are helping with.

Impression techniques used for single-unit crowns: Findings from the National Dental Practice-Based Research Network.

Dentist material selection for single-unit crowns: Findings from the National Dental Practice-Based Research Network.

Treatment Recommendations for Single-Unit crowns: Findings from the National Dental Practice-Based Research Network.

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Tuesday, March 27, 2018

Alternate canal negative apical pressure technique

Alternate canal negative apical pressure technique

Alternate canal negative apical pressure technique is a process of cleaning teeth canals that have a connection apically or through isthmi. This technique is for specific canals of dental root canals in the field of endodontics.

What is the alternate canal negative apical pressure technique?

This is a technique to remove tissue, debris, and bacteria from any connections from one canal system and another canal system within the same tooth root. The most common canals that this technique works for is lower molar mesial roots, upper molar mesial buccal roots, and some premolars. Micro CBCT studies show that a large number of those roots have isthmi connecting them. The complexity of these isthmus make it very difficult if not impossible to truly clean. This method helps to a large degree clean those areas out.

What equipment do I need for the alternate canal negative apical pressure technique?

The best thing about this technique is that you do not need any extra equipment! Your high speed suction with a surgical suction tip is your suction. You will need to add any of the smaller tips that you use for medicament applications. However, the smaller the tip size the better. Finally you need something to get your solution in the connecting canal, so whatever syringe you currently use.

Image of the alternate canal negative apical pressure technique

The image sucks but it’s taken from the very helpful video below. The video will help with understanding what the alternate canal negative apical pressure technique is.

What is the research behind the alternate canal negative apical pressure technique?

There is no direct research on the alternate canal negative apical pressure technique. The closest thing that I can find is research on the modified endovac technique. This is essentially the same thing but using the endovac in the receiving canal instead of using just suction. The modified negative apical pressure study by Thomas 2014 JOE shows it is far superior to both traditional endovac and passive ultrasonic in terms of cleaning out the isthmus. Other studies show that negative apical pressure is superior to other methods when it comes to isthmus cleansing Neelakantan JOE 2016

Finally, if you have an interest in more research on medicaments and irrigation techniques I have many more on my post about root canal irrigation techniques.

Questions the alternate canal negative apical pressure technique research needs to answer

  1. Does it work? I only assume it works because it is very similar to the modified endovac technique.
  2. Do we need to alternate the canals with one having suction then the other?
  3. How long?
  4. What chemicals work best? I currently use all four but I would think EDTA and NaOCl would be best.

Alternate canal negative apical pressure technique video

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