Dental implants are providing a more reliable and effective alternative to traditional dentures and helping people to successfully replace their decaying or lost single or multiple teeth. When we start to lose multiple teeth, in the upper row or lower row or both, it becomes necessary for us to replace those missing teeth with stable and natural looking teeth. Otherwise, we may have to suffer from the discomfort and embarrassment associated with dentures and bone loss and a disfigured facial structure. The multiple dental implant method is bringing a permanent solution to multiple tooth loss conditions and creating smiles again!

Dental implants are now providing basic treatment to all those who are missing one or more of their teeth in the upper and \ or lower jaw. However, not all dentists are professionally trained in dental implant procedures. So they recommend fixed bridges or removable partial dentures with wire clasps that wrap around your remaining teeth to keep them in.

Fixed dental bridges require grinding down healthy adjacent teeth so they can be used as anchors to support the missing teeth. They are a dramatic improvement over removable partials with their wire clasps but in the long run more than 30% of the teeth used for attachments are lost to tooth decay or other problems. Now where one tooth was missing there are two, and then three and-----------and the process continues to repeat itself more and more rapidly until your smile is disfigured, you can no longer eat the foods you enjoy, and your facial structure is collapsing. Soon you are looking at the need to replace your teeth with full dentures or dental implants.

Why let this happen? If you are missing one or a few teeth have them replaced with dental implants immediately. Not only will they not harm your natural teeth they will help them by eliminating food impaction and distributing the work load of chewing more evenly. People often believe that you need a dental implant for every missing tooth. That isn’t necessarily true. Often three missing teeth can be replaced with only 2 implants by bridging between them. In the amazing All on 4 protocol a full arch of missing teeth can be replace with only 4 perfectly placed implants.

An ounce of prevention is worth a pound of cure!
1. What is a dental implant?

A dental implant is an independent artificial tooth root that is used to replace a natural tooth root that has been lost to accident or disease. Dental implants are typically placed to secure bridges, partials, dentures and crowns. Dental Implants don’t require support from adjacent teeth and thus cause them no harm. Better yet, teeth replaced with dental implants look, function, and feel just like natural teeth.

2. Will dental implants be suitable for me?

Advancements in dental implant design and placement protocols have made dental implants the gold standard for the replacement of missing teeth for almost everyone. Patients with specific health conditions including uncontrolled diabetes, osteoporosis, or irradiation of the mandible or maxilla for the treatment of cancer, may be at increased risk but they are still candidates and can usually be managed by a highly experienced practitioner. Certain cosmetic conditions can be a challenge as well but advancements in cosmetic dental implant procedures routinely produce beautiful, natural, esthetic results that patients often describe as far more beautiful than their natural teeth ever where. One of the most difficult conditions to overcome is actually a habit or an addiction rather than a condition; cigarette smoking. This is an annoyingly difficult addiction to overcome and many wonderful people who have extraordinary will power and a strong desire to quit simply can’t. That is unfortunate because as smoking is a strong contributing factor to tooth loss, smokers form a disproportionate number of those in need of dental implants. The majority of the patients I see for the All on 4 procedure are smokers. So though smoking is not a contraindication the patient and doctor must realize that they will be faced with a higher than normal number of complications. Fortunately if the doctor is highly experienced and the patient is persistent, cooperative, and determined a satisfactory outcome can almost always be achieved.

3. What are the benefits of implants over other dental procedures?
•    Dental implants are permanently fixed and thus the teeth attached to them will not slip or move insuring comfort and avoiding embarrassing moments.
•    Dental implants are easily maintained and are not susceptible to cavities.
•    Dental implants allow you to eat all of the foods you enjoyed with natural teeth.
•    Dental implants look like natural teeth providing a beautiful smile so you don’t have to live with the stigma and embarrassment associated with missing teeth or false teeth.
•    Dental implants promote bone growth and help maintain a youthful facial structure..

4. How comfortable are dental implants?

Dental implants are amazingly comfortable. Most patients are given nsaids such as Ibuprofen and methyl prednisone and report little or no discomfort. All on 4 patients can usually enjoy a light meal the evening after their surgery and most return to work in a day or two.

5. Who is authorized to perform dental implants?

Dental implants can be placed by any licensed dentist but very few offer this service. Significant additional training is required to place or restore dental implants. To provide both the surgical and prosthetic phases of dental implantology the demands for additional training is even greater but the benefits to the patient are substantial. Advanced dental implant procedures such as bone grafting and especially full mouth reconstruction with the All on 4 protocol or traditional protocol requires years of training and extensive experience. In choosing an implantologist you should look for a doctor who has additional post graduate training, has certification by the American Academy of Implantology or the International Congress of Oral Implantologist, has cat scan imaging technology , an in office dental laboratory, and extensive experience. Offices like this are very rare but it is worth your effort to find one.

6. Are dental implants easy to maintain?

You need to care for dental implants the same way you would your natural teeth. It is always recommended that patients meet with their dentist regularly and maintain proper dental hygiene to  insure long term satisfaction with dental implants.


According to dental researchers, advanced research and superior technology will bring radical changes in the dental care industry during the 21st century.

Dental implants are the most notable of these changes. Thirty years ago they were considered “quackery”. Now they are the “gold standard” for  replacing  one or a full mouth of missing teeth.
Most dentists agree that dental implants are a great example of advanced dental care technology. A dental implant is an artificial tooth root that replaces a patient’s missing natural tooth root. It constitutes an ideal treatment option for those who have lost one or more teeth in the upper and or lower jaw due to accident, gum disease or some another traumatic experience. Whether missing only one or two teeth or all of your teeth, dental implants have become the standard of care for replacing them. New technologies, new implant designs, and new procedures have consistently made the use of dental implants quicker, easier, more reliable, and more affordable.

Dentures have been in use for more that 30 years. However, dental implants long ago surpassed dentures in providing a reliable treatment option for those missing all of their teeth. Fixed and removable bridges were once the standard of care for one or a few missing teeth. No more; now single unit dental implants are used to replace one or a few missing teeth and do so without causing damage to remaining teeth. This minimizes the need for further corrective dentistry and the future cost and discomfort associated with it.

There are two basic approaches for placing and reconstructing dental implants. One is called immediate load, the other delayed load. With the immediate load technique a tooth or teeth are built on one or more dental implant the same day the implant is placed. The All on 4 technique is an example of immediately loading. Remaining bad teeth are removed,  implants are place, and the patient leaves that day with a new set of natural looking and functioning non removable teeth. Delayed loading is commonly used when only one or two teeth require replacement. Because of bio-engineering concepts related to force and stress vectors it is often best to let single dental implants integrate for 4 to 6 months before they are loaded. A common exception to this single tooth delayed protocol is when a front tooth is lost by accident. In those cases, whenever possible, the remaining root is carefully removed, the implant is placed, and a temporary crown is secured to the implant all in one appointment. It is essential that this temporary crown not make contact with the other teeth when chewing but if that can be accomplished this technique can be used with excellent success and the patient leaves with an attractive smile. This is appropriate for front teeth were as it might not be for back teeth for two reasons:

1.    When we close together the front teeth do not touch one another so there is less pressure against front dental implants than back dental implants.
2.    The accidental loss of a front tooth results in a sudden and dramatic change to our appearance thus justifying the slightly increased risk [approximately 5%] associated with immediate implant placement and loading

So if you need a dental implant to replace a natural tooth either delayed or immediate loading will be options. An experienced Houston Dental Implantologist will be able to discuss the pros and cons of each method with you so you can make an informed decision.

I’ve been doing the All on 4 procedure for about 15 years.  Eventually it became a weekly procedure and now daily.  During this time there are very few mitigating factors or complications I have not seen or treated. The biggest challenge with the All on 4 procedure is and always has been upper cases. At least 30% of the patients who come to see me can’t have it done on the upper without preparatory bone grafting.

The focus of my current studies is finding ways to make this easier and more predictable. Currently when bone grafting is required to prepare a patient for dental implants the procedure is delayed by 4 to 6 months and over 40% of all grafted sites experience less than a perfect result often times requiring some type of revision surgery and occasionally needing to be completely redone.  Needless to say this adds time, expense, and inconvenience to everyone involved and better solutions are badly needed. The good news is that everyone realizes this. Regardless of what type of dental implants procedures are being done, single dental implants, full mouth individual dental implants, or the All on 4 procedure, adequate bone volume is always the limiting factor.

Tremendous resources are being dedicated to finding better solutions and indeed progress is being made. We can now synthesize proteins and stem cells in the lab that make bone substitutes almost as reliable as natural bone harvested from the patient. New and better techniques are being developed for the use of these materials almost daily. I attended a meeting in Hamburg, Germany recently and much was dedicated to this. I’m going to another one in October in Boston specifically to study new grafting techniques. All in all great progress is being made. But still, over 40% of all grafts have some level of complications. The problem with bone grafting for dental implants is not primarily with the graft materials. It is with the membrane, which looks like a sheet of paper, that the graft must be covered with prior to suturing the tissues over it. All grafts with the exception of autogenous block  grafts, those taken from the patient, require this covering. There are literally dozens of different membranes on the market, each with its’ advantages and disadvantages, but they all become exposed too often. Exposure occurs when the tissue over the membrane develops an ulcer that creates an opening that will allow saliva and bacteria to penetrate into the surgical site.  If this happens too early the graft is likely to fail and if it happens any time before 4 months, and it often does, the graft will be less substantial than initially desired.

The advantage of the new bone grafting materials is that they grow bone faster so the membranes don’t have to been maintained for such a long time. Though I haven’t experienced I have had colleagues tell me they have seen adequate results in some cases with only two weeks of membrane coverage. The advantage of the new bone grafting membranes is that when they do expose infection is less likely to occur and more easily controlled. I think however, that in the near term, the best solution is going to be the oldest solution simply done better; autogenous block grafts. In the past this has been a delicate procedure done by few and mastered by fewer. I did two of them today but only because I had to.  In severe cases it requires both an oral surgeon and an orthopedic surgeon working together in a hospital setting. Amazing new instrumentation which allows the cutting of bone without risk to nerves or blood vessels is going to make this a very safe procedure which can be predictably performed by even the less experienced dental implantologist. The use of autogenous bone in areas where the tissues are delicate and most susceptible to ulceration and bone substitutes in areas where membranes can be placed without a high risk of exposure will provide enough bone without resorting to a hospital operating theater. And minimizing the need for membranes should dramatically reduce complications.

All things considered I see the potential for many patients to be helped who previously could not because the risk – benefit ratio was too great. And on a daily basis more autogenous block grafts will be used because new procedures and instrumentation make them simpler. I am confident that this will open the door for many patients who were previously not good candidates for the upper All on 4 prodedure as well as more routine dental implant procedures.  It looks like another great year ahead with much to be learned and shared in the field of dental implantology.