The PearlFection Blog

Posts for: November, 2020

By PearlFection Dentistry
November 24, 2020
Category: Uncategorized
Tags: Untagged

Here are some frequently asked questions about dental implants and implant supported dentures, also called “all on 4 dentures”

Will dental insurance pay for implant supported dentures?
Often dental insurance will pay for part of the implant supported denture procedure. It depends on the plan of course but most insurances will pay for all or part of certain procedure codes and not pay for others. The issue with dental insurance is that most policies only cover up to a certain dollar figure every year, say $2000. Once that is used up, the patient is usually responsible for the anything above that. But it pays to have a knowledgeable insurance coordinator work with you to try and maximize your benefits. At PearlFection, we have dedicated insurance coordinators who work with you and your insurance company to ensure you get the most you can from your carrier to help pay for your procedures. Sometimes, medical insurance will pay for part as well. PearlFection dentistry will submit to any insurance company we think could help. Also, if you have been in an accident, medical, workers compensation and dental insurance can all come into play.

How do I choose a good provider of dental implant supported dentures?
This is probably the most important question you can ask and please be careful when your decision. Most patients only have one shot to do this right due to expense and biology and if it's done wrong, can really have serious consequences. The questions to ask, are “will a board-certified prosthodontist do my denture?” “Will a board-certified surgeon or periodontist place my implants and do my extractions?” “Will I be sedated?” “Will a lab tech be on site to help facilitate a smooth process?” if the answer to any of these questions is “No” you might want to keep looking or at least ask more questions. Remember, any dentist who graduates from dental school can place implants, make a denture, basically do everything required to perform an “all on 4” case. But the PearlFection Team approach ensures that only the most qualified doctor, is doing the part of the complicated procedure that they spent years training for. And for goodness sake, never get a procedure done in a foreign county. Foreign implant parts are hard to match and with procedures like this you really should have some sort of warranty. Someone needs to stand behind the work. A warranty is only as good as the company backing it and you may have trouble having a USA doctor touch any work done by a foreign dentist, making any repairs down the road more difficult.

Does this work come with a warranty?
Yes, warranties do come with any implant or implant support denture done at PearlFection Dentistry. It covers workmanship for a certain period of time but it's not forever. Dentures and implants take a lot of pounding and it's hard to guarantee anything when the biology of the patient is concerned. But PearlFection does warranty the work as long as certain requirements are followed. Our hope is we do this once and its good for a lifetime but that cannot be guaranteed. That said, there are things that can void any dental warranty, things like neglect, smoking, not coming in for checkups, not wearing a night guard or simply not following your dentist’s recommendations.

Is it safe?
PearlFection takes extraordinary steps to keep our patients safe and comfortable. But like any medical procedure there are risks. Infection control and sedation safety are two areas that PearlFection take very seriously. We always have at least 3 clinicians in the room at all time to monitor safety protocols, we use state of the art infection control devices to ensure instruments are sterile and the operatory environment is kept free of contaminants. Also, patients are screened prior to the procedures to make sure they are prepared both physically and mentally for the procedures. Drivers to and from the procedure is required and PearlFection can arrange drivers and hotel rooms for out-of-town patients. After the procedure, which can last all day, we want as little stress on the teeth and on our patient so preplanning transportation and after-care is important for a good outcome.

Is there an age range?
There is not an age range, we have placed implants and dentures on children and all ages of seniors. Its less about age and more about the overall health of the patient. Patients with compromised health need additional consideration but we can usually accommodate even patients with health conditions.

How much is it going to cost me?
The unique thing about Pearlfection Dentistry's denture, dental implants and implant supported denture team is we can accommodate almost any income level. Sometimes patients come to us and simply can’t afford to go right into implants and implant supported dentures. That’s ok. We can offer simple dentures for a fraction of the price of implants supported dentures and that’s a perfectly good option. When you have a team of cosmetic dentist and prosthodontists, the outcome for our simple dentures patients is outstanding. Many patients come to us with dentures made years ago from a lab that didn’t take the time to really understand the patient’s occlusion (bite). The result was a poorly functioning appliance from day one. That’s a shame and that doesn’t happen at PearlFection. When you come to PearlFection, you work with a team who understand both function and form. Our end game is a denture that works and looks great. So even if you don’t get implants right away and get a simple denture its ok. Those same dentures can be converted later to implant supported dentures when and if the patient decides to move forward with the dental implant supported denture option. The beauty of having an on-staff prosthodontist and general and cosmetic dentists is we don’t try to steer our patients to one option or another. We work within the patient’s financial means and tailor a program that works for them.

So, to give more specifics about price, a simple denture (without extractions) is less than $3000. If a patient wants full extractions, IV Sedation, implants and zirconia denture, it can be over $70000 for both arches, add zygoma implants (implants that secure into the cheek bones) and the price can surpass $80,000. So, as you can see, it really depends on what the patient wants and what they can afford. But cost should never stop you from having a consultation to see what your options are. Consultations with our team are free.

Do I need to do everything at once?
No, you don’t need to do everything at once. Although many of our patients get IV sedation and wake up with a full mouth rehabilitation and a movie star smile, it can be done in stages. Full mouth rehabilitation involves all the teeth extracted, bone reduced, implants placed and denture fixed to the implants via abutments. It’s a lot to do at once but we do it all the time. Sometimes we have 7 clinicians in the room at the same time. While other patients take a more gradual approach. Some start out with a simple denture and wear it for a while to get used to it. Then they come back in for the implants. Others start out with an implant supported denture on the top or bottom and leave the other arch alone. How you do it, and the speed you do it at, really depends on the decision you and your dentist make together. There is no “right” answer. Every patient is different and PearlFection Dentistry custom designs every patient’s dental treatment plan specifically for that patient. Dental implant supported dentures, “All on Four” dentures are a big decision. We encourage anyone who is interested to work with the PearlFection team of clinicians, treatment coordinator and financial coordinator to map a path that fits your time line, budget and needs.

Can PearlFection put me to sleep so I avoid any discomfort?

Our doctors provide IV Sedation, Nitrous Oxide and oral sedation and most of our patients are sedated during the process. One of our mottos is, “you sleep, we work” and you wake up with the movie star smile you have dreamed about your entire life.

What if I can’t afford it?
We get it! Implant supported dentures are not cheap, so let’s not kid ourselves, “all on 4” is not an option for everyone. But PearlFection is not your typical dentist. Many of our patients start out with a simple denture option. Dentures are fairly inexpensive and within the financial means of most patients. If you start out with a simple denture, our skilled team of prosthodontists, lab techs and cosmetic dentists can convert that denture, at some point in the future, to an implant supported denture. This process gets our patients both the functional and aesthetic outcome they need in the short term, with the hope of a true implant supported denture in the long term.

Are there financing options at PearlFection Dentistry for implant supported dentures?
Yes. We have some of the most competent and compassionate financial coordinators around. They will work with you to figure out how to make your goals become reality. We work with several outside financing companies who bend over backwards to try and get patients approved for financing. PearlFection even pays for the first 6 months of interest for patients. It's our way of saying thank you for choosing us. We cannot guarantee that everyone will be approved, but we can guarantee that we will help facilitate the process.

What’s a prosthodontist and why should I care?
Prosthodontics, is the area of dentistry that focuses on dental prostheses. Most people seek a prosthodontist when they have a complicated dental device requirement, like a denture that requires a skill set above and beyond what a general dentist might have.

According to the American College of Prosthodontists, a prosthodontist is a dentist who:

  • Specializes in the aesthetic (cosmetic) restoration and replacement
  • Receives three to four years of additional training after dental school.
  • Restores optimal appearance and function to your smile. The planning, surgical placement and restoration of implants and rehabilitation of occlusion with prostheses all fall under the field of prosthodontics.

Becoming a prosthodontist requires an additional three years of postgraduate specialty training after obtaining a dental degree. Training consists of rigorous clinical and didactic preparation in the basic sciences, head and neck anatomy, biomedical sciences, biomaterial sciences, implant surgery, function of occlusion (bite), TMJ, and treatment planning and experience treating full-mouth reconstruction cases, and esthetics. Due to this extensive training, prosthodontists are required to treat complex cases, full-mouth rehabilitation, TMJ-related disorders, congenital disorders, and sleep apnea by planning and fabricating various prostheses.

It's important to remember that any dentist in Maryland can legally treat a patient and provide a denture and many good dentists do this every day and do a good job at it. But when it comes to something as complex as an implant supported denture, it is our strong advice to seek a team with a prosthodontist on it, working in conjunction with other specialists to achieve optimal outcomes.

Why do people want an implant supported denture vs a regular denture?
We get this question a lot and it deserves some understanding of what a traditional denture is and what it's not. A traditional denture is held in place by the structure of a patient's gums, adhesives and gravity. Sometimes, depending on the skill of your dentist and lab, the outcomes are better than others. But no traditional denture fits perfectly and it's not a substitute for natural teeth. Dentures just don’t allow the wearer to enjoy all the functionality as real teeth.

A traditional denture is a good option when a patient has a need to replace all or most the teeth in their mouth and finances are limited or they just can’t find a dentist with the skill set to do “all on 4 implant supported dentures”. A denture allows patients to eat most foods, but there are some serious restrictions that patients complain about when it comes to traditional dentures. The main complaint we hear is that dentures simply don’t stay in place and therefore make it hard to eat certain foods. The other issue is maintenance and cleaning of traditional dentures. And finally, without the need to support teeth, the bone structure in the upper and lower jaws tend to deteriorate over time resulting in bone loss, which can affect the way a person looks. With Implant supported dentures, patients can eat any food and the dentures function like natural teeth. Some implant support dentures, called “over dentures” are removable and other are permanent and can only be removed by a dentist. Cleaning of implant supported dentures is similar to regular brushing and the fact that implants are secured to the bone triggers the body to realize it needs to preserve bone wherever there are implants and impact. The bottom line is that implant supported dentures might be considered the gold standard for functionality and esthetics, while a regular denture is good but it has limits. PearlFection Dentistry will work with any patient and find a solution that works and stays within a budget. And remember, if you start out with a regular denture, PearlfEction is one of the few dental practices that can convert that denture to an implant supported denture, saving you thousands of dollars down the road.

What is the “team” approach to dental implant supported dentures?
There are some really good dentists out there that can do many procedures, including dental implants, dentures, braces, crowns, and bridges. But even if they are very skilled, it's hard to perfect a skill unless you do it a lot. So, some dentists will do a crown in the morning, an extraction in the afternoon and place braces in the evening. That might sound like a superstar dentist who can do all those things, and maybe they are, or maybe that dentist is biting off more than they should. The “team” approach that PearlFection Dentistry uses is one where the specialist, who has spent years and years of additional training perfecting one skill set, does that procedure and another dental specialist does their specialty. So, for implant supported dentures, our oral surgeons or periodontist, does the extractions and implant placement and bone reduction surgery and IV sedation, our prosthodontist does the denture design and placement and our lab does the actual manufacturing of the denture itself. This team is all on standby during the process and comes in to the operatory when it's their time to do their thing.

Prior to the day of surgery, the team has taken Cone Beam CT scans, and used those scans to three dimensionally design the entire process and map out exactly how they will proceed. The 3D technology allows us to analyze bone density and structure and determine the optimal position for implants and which areas to avoid. It allows us to determine with extreme accuracy what level of bone reduction to make and the prosthodontist and surgeon will have had extensive discussions about implant placement, and implant size, bone level reduction and the best way to proceed. By doing this virtually prior to the actual procedure ensures a more likely positive outcome, with no surprises, and reduces the patient’s time in the chair. If you're considering implant supported dentures, it's important to know who your team is and if they have all the equipment and skills to arrive at the outcome you desire.

Why makes PearlFection Dentistry the best choice in the United States for Implant supported Dentures?
PearlFection has been in business for over 30 years. We started small and have added specialists as time has gone on to meet our patients’ needs. We now have every dental specialist working under roof. This results in an unprecedented level of dental care. We are not your parents’ dental practice. We have the best of the best in both general/cosmetic dentists and specialists and they work in conjunction to provide the absolute best in dental care, utilizing the state of the art in diagnostic tools, equipment and the best materials. Our doctors have performed the most complicated implant supported denture procedures and dental implant placements, including zygomatic implants, often times rebuilding soldiers injured in combat zones. Patients come from around the world to receive the quality of care only offered by PearlFection. It might sound like we are a huge corporate conglomerate, but we are owned by our doctors and only provide implant supported dentures in one place, Frederick Maryland. Whether you are from across town, from another state or from another country, we provide the level of concierge service that is second to none, with a staff dedicated to your complete satisfaction.

My teeth are in really bad shape. Am I still a candidate for dental implants?
PearlFection Dentistry specializes in the cases that other dentists can’t or won’t do. We are the dentist other dentists refer their tough cases to and we welcome that responsibility. Whether you’re missing one tooth or many or need all your teeth removed because of decay or neglect, dental implants may be the best choice for you. PearlFection’s doctors are experienced in treating patients with complex cases that may even have been turned away by others. Call us to schedule a consultation and see what your options are.

I don’t want people to know I have a denture or implants. Will my smile look like I have real teeth?
Every patient is different and has different goals and preferences about shade, size and overall look of their new teeth. We are starting over with your teeth so think about exactly what you want and we will do everything in our power to deliver. During the design process you will work one-on-one with our prosthodontist to develop a product that meets your goals.

Tell me about the doctors who will be doing my implants and the implant supported dentures.
The doctors at PearlFection are true experts in their specialties. And the PearlFection Dentistry “Team” approach is unique to the field of dentistry. Each patient is assigned a treatment plan coordinator, a prosthodontist and an oral surgeon or periodontist, a lab tech and a general dentist. Each of these professionals has a unique role to play and has extensive training, experience and professional designations that ensures you that you have the absolute best care money can buy. At PearlFection Dentistry, no patient is ever treated like a number. Every patient is unique and has different concerns, budgets, time frames and goals. We will guide you through every step of the process and make sure you fully understand why we are doing things and what to expect.

How long does the procedure take?
This depends on the patient’s needs and your plan. We can actually do most of the operatory work in one day, but it’s a misnomer to say it just takes one day. Be suspicious when you hear it's all done in one day. Yes, most of our patients come in the morning and leave later that same day with a new smile but there is some serious preparation work that needs to be done up front, including agreeing on a plan, designing the dentures and coordinating the process. It's not something anyone should rush into. If you are getting pressure to move along too fast, it should raise a red flag. But in a nutshell, here’s what to expect (Steps 1 to 4 can take a few days or a few weeks depending on the patient and team schedule):

  1. Consultation with dentist or prosthodontist to determine options. in this step we determine what is possible and what's not. X-rays are taken and CT Scan is done.
  2. Treatment plan options are presented to the patient and the patient selects how they want to proceed. Financial considerations are figured out and deposits are made and impressions taken.
  3. Consultation with Surgeon and consent forms signed. (This can be done remotely if necessary). Surgery is scheduled
  4. Extractions, bone reduction, implants placed and temporary or permanent denture secured to implants
  5. Follow-up (a week to a few months depending on healing)

Will my dental implants function just like real teeth?
Your new teeth will not only look and feel like natural teeth, they’ll also function like real teeth. PearlFection Dentistry's Team approach will result in an outstanding, functional set of teeth. Teeth you will be proud of and allow you to eat any food you can image.

How do I get started with exploring if implant supported dentures are right for me?
Getting started is easy. Just call our office at 301-336-5550, say you would like to come in for a free “all on 4 implant supported denture” consultation, and we will do the rest.

By PearlFection Dentistry
November 03, 2020
Category: Uncategorized
Tags: Untagged

I need dentures. I really want implant-supported dentures but I have been told I don’t have enough bone in my upper jaw to secure a dental implant, what can I do?

We see this situation all the time. A patient presents with severe periodontal disease or trauma but still has her natural teeth or has had a denture for a long time and it’s just not working for her anymore. She has substantial bone loss as a result. She has already been to dentist that offers dentures but dentures are uncomfortable and don’t feel like real teeth and the patient is tired of not being able to eat what she wants. Her mouth hurts all the time. The dentist has told her that dental supported dentures (All-on-four dentures) are not an option due to the severe bone loss. The patient is frustrated and about to give up and is almost resigned to living with a sub-par smile, a sub-par denture, sub-par dental function and a sub-par overall experience. She just doesn’t know where to turn. Read on……we have a solution.

Are there solutions if I have severe bone loss?

There is something called a zygomatic implant or zygomal implant or zygoma implant. It is an extra-long implant that doesn’t screw into the maxilla bone (upper jaw bone), but instead, passes through that bone and attaches to the Zygoma (the cheek bone in laymen’s terms). The advantage of this is the surgeon who places the implants, does not rely on weak or deteriorated maxillary bone but instead uses the strong Zygoma bone to secure the implant and in return secure the denture in place. These zygoma implants work in conjunction with 3 to 5 other implants placed in the upper jaw to support the denture, which can be permanently fixed in place. The result is a strong structure that allows implant supported dentures to be worn, when otherwise they would not be an option.

See pictures of zygoma implants


What should I look for in a dental practice that does Zygoma implant-supported dentures?

The challenge with this procedure is finding a dental team that can perform this procedure. Remember, every dentist in the State of Maryland is legally allowed to place implants. This does not mean they do, will or should. Even fewer dentists are able to place zygomatic implants. That’s because very few dentist, or even oral surgeons, have the training and experience to confidently place these unique dental implants. When choosing a doctor to place these implants here are a few things you should ask.

1) How many of this type of implants has the doctor placed. Not how many regular implants has he or she placed but how many zygoma implants has he/she placed.

2) Do they have an onsite CBCT system to accurately map the bone structure in 3D? This is important because guiding the implant screw to the proper spot is measured in millimeters and placement is critical

3) Who is going to design, secure and build the denture (also called the hybrid or implant-supported prosthesis)? Is that person a board-certified prosthodontist or just a general dentist? Be careful here, again, all dentists in Maryland can legally make and insert a denture, but prosthodontists go to school for years and years, even after their 4 years of undergraduate university and 4 years of dental school to learn the art and science about dentures, even fewer prosthodontists are well versed in implant supported dentures and even fewer with Zygomatic implants. So make sure you ask, how many zygomatic implant supported dentures have you done Doc?

Choosing your materials:

So now you have your team of surgeons and prosthodontists who are going to do the zygomatic implant-supported denture. You’re not done. Now you need to understand the materials that the denture is going to be made out of. There are a lot of choices from acrylic to zirconia, to dental ceramics. They all come with a different price tag. Make sure you ask, who is going to fabricate my denture and are they using the best material? Is the lab tech going to be on site when we do the procedure, in case there are modifications that need to be done?

The actual procedure:

Ok, you have made it this far and you’re ready to have the work done. It's going to cost you about what a nice foreign sports car costs so be prepared and don’t get sticker shock, somewhere between $20K to $40K per arch (you have two arches, upper and lower) is what you should expect. The practice schedules you for almost an entire day and makes the arrangements.

First comes the oral surgeon.The surgeon will do a few things depending on your situation. Most patients want to be sedated during the surgical part of the “all-on-four” process. This is usually done with IV sedation, this will bring the patient to a level of sedation that will allow the procedures to be done comfortably and most patients have no memory of the surgery. Most cases involve extracting any teeth that are still in the way, from just a few stragglers to a full mouth extraction including wisdom teeth. The surgeon will then use a special bone saw to “table the bone” also called alveoloplasty. This is done to make sure the denture has a good level surface to adhere to once the implants are placed. When the bone is nice and level, the surgeon will begin placing the implants. Using tools that resemble a miniature ratchet and drill set the dental implants are placed in the bone. Some implants are placed with a guide and other can be done free hand, depending on the judgement of the surgeon. Most implants penetrate somewhere between 8 and 14mm into the bone, Zygoma implants are a lot longer, they will range somewhere between 35 and 60 mm depending on the patient’s facial structure. The entire surgical process can take a few hours. Once it is done its time for the prosthodontist or the prosthodontist and lab technician to do their thing.

The prosthodontist.The prosthodontist is the quarterback who will do most of the planning, selection of materials, and communication with the patient. And, now that the implants are secured in the patient’s jaw, the prosthodontist will begin the custom work of securing the temporary denture to the implants. The temporary denture was fabricated previously in anticipation of the patient walking out with a “same day denture”, which is kind of a misnomer, because getting to this point took more than one day. Working carefully the prosthodontist and dental lab tech adjust the denture so it fits properly onto the implants and the gum, using something called an abutment. Abutments are devices that secure the denture to the implant. Abutments often will be angled in this type of scenario because the zygoma implants will likely be at such an angle to ensure it properly penetrate the zygoma bone and ends up in the right location so it meets the denture exactly. The angle of the abutment corrects for this angulation so the denture fits squarely on the newly tabled bone. The prosthodontist will make a few more modifications to ensure a comfortable fit and tightens the denture to the implants.

High 5s. At this point, the prosthodontist holds up a mirror to the patient so they can see their new teeth. It’s a pretty special moment. Here is a patient who for years has been embarrassed by their teeth. The teeth have been barely functional. The patient has been in pain due to periodontal disease and in the course of 6-8 hours, their life has been changed. The patient, who is still in a bit of discomfort due primary to the extractions and bone reduction work, still manages a big toothy smile, high 5s the dental team and is scheduled for a follow up in a few weeks to make sure everything is healing properly. But right now, the patient walks out of the practice with a brand-new set of teeth and a new outlook on life.

A few months later, after the swelling is down and the implants have integrated better and the gums have healed, the permanent denture is placed. This denture is made out of more permanent materials and if all goes well, will last years, even decades.

Who can do this type of work?

There are very few dental practices with the type of expertise to do “All on 4, implant supported dentures”. And even fewer that can do Zygoma implants for patients with severe bone loss. There is however a team of dentists, oral surgeons and prosthodontists called the” PearlFection Team” in Frederick Maryland, about an hour drive from Baltimore or Washington DC that is a world leader in this type of procedure. The doctors who do these procedures have perfected their technique at Walter Reed Hospital, yep, the same hospital that takes care of the President of the United States. They either did their rotations through Walter Reed, or were the leaders of the dental clinic, achieving notable distinction and perfecting their art. They have taken these skills and joined forces to provide the patients at PearlFection Dentistry in Frederick Maryland a quality of care that is second to none.

Who can get a consultation? Do I need to be famous or rich?

PearlFection Dentistry in Frederick Maryland, offers free consultation for anyone who wants to learn more about dentures, implant supported dentures, implants and zygoma implants. PearlFection doctors will even consult by phone for patients who live in other states or other countries. The team speaks English, Korean, Spanish, Hindi, Farsi, Tagalog and American Sign. If you or someone you know is frustrated with the level of care you have received, or have been told you are not a candidate for implant-supported dentures due to bone loss, or simply want options regarding dentures, give the PearlFection Team a call and get a consultation. They can make you smile.

The office phone number is 301-663-5550. The office is open 6 days per week and patients’ first appointment is usually a one on one screening appointment with a doctor, to better understand the patient’s goals and usually lasts about an hour.