Category Archives: Dental Implants

maryland bridge before a dental implant

I’m trying to figure out what to do. My daughter has a congenitally missing lateral incisor. We did orthodontics to open the space. Now we’re working on the temporary tooth replacement. Our dentist decided on a Maryland Bridge. We did non-metal wings because I wanted them to be as natural-looking as possible. The problem we’ve had is the bridge has fallen off twice in just a couple of weeks. After the first time, she (our dentist) tried a different bonding cement, but that didn’t make it any stronger. Now she wants to try doing it with metal wings. Here’s the thing. My daughter is 14. She’s going to have to wear these for a few years. I don’t want her to feel self-conscious. I have two questions:
1. Will these stay on better? 2. Will the metal be a better choice?


Dear Karyn,

I’m a little concerned about some things I’m hearing here. First, I would not consider a Maryland Bridge a temporary replacement. This requires tooth preparation, which means you’re reducing tooth structure. If you’re doing that, you might as well stick with a dental bridge and not get a dental implant.

Another thing is the bonding issue. It doesn’t sound like your dentist understands bonding principles. She placed the bridge with a cement and it fell off. Then, she gets (I’m assuming) a stronger cement and it still falls off. Her next thought is to switch to metal wings.

Maryland Bridge Preparation

That’s not likely to work out any better for her. The non-metal (zirconia) wings are usually easier to bond than the metal ones. My guess is the problem is with her tooth preparation. If you look at this image on the left. You can see that a groove should be cut into the tooth to support the wings. Without this, she’s likely to have trouble no matter what type of bonding she uses.

While she could go back and make the correct grooves, I am going to recommend a completely different direction. While you can go ahead with the bridge, once she gets her dental implant, you’re going to need another procedure to have these grooves filled in. Why do that when you can instead get a temporary tooth which will not require any modification to her adjacent teeth?

I’m not trying to discourage you from your future plans of getting her a dental implant. It is the best tooth replacement around. It will be a great solution for her when her jaw is fully developed.

I am trying to discourage you from the dental bridge. Instead, I’m going to recommend something else.

Removable Partial Flipper

A removable partial flipper will be perfect for her situation. When well cared for it can last long enough for her to get her dental implant. Even if something happens, it is significantly less expensive than any other tooth-replacement option. You could replace several of them for the cost of a single Maryland Bridge.

They can be made to look beautiful too, so your daughter won’t look self-conscious.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

can I get a beautiful smile after 3o years of Dentures?

I’ve had dentures for about thirty years. Back then, I don’t think dental implants were available. If they were, my dentist should have told me about them. I have a friend who has them and her smile looks so much better than mine. I’d love to get a beautiful smile now if that is possible.

dentures and dental implants

I’m going to give you the great news first and then tell you how to make it come to pass. You can absolutely get a beautiful smile again. I’m going to tell you something which may sadden you, but I want you to understand it for the smile you’re going to get with dental implants.

You could have had a beautiful smile with dentures as well. The beauty of the smile doesn’t depend on whether you have crowns for dental implants or dentures. What makes the biggest difference is the artistic skill of the dentist.

Implants After Dentures

When your teeth are removed, your body recognizes that and begins to resorb the minerals in your jawbone in order to be as efficient as possible with your body’s resources.

This has the unfortunate effect of slowly shrinking your jawbone. This is known as facial collapse. Eventually, there won’t be enough jawbone left for you to retain your dentures at all, leaving you a denture cripple.

This creates a problem for dental implants too. As you can see from the image above, when an implant is placed, it requires the bone in your jawbone to integrate with it in order to retain the implant securely.

After 30 years, you will probably require a bone grafting procedure in order to have enough bone to secure them. This is an outpatient procedure. Then, when you’ve had time to heal, it will be time to get your implants then.

Getting a Beautiful Smile

As I mentioned above, getting a beautiful smile requires a skilled, artistic dentist. My suggestion is for you to look on the website. This is run by an accredited cosmetic dentist. He screens each dentist who wants to be listed on their site for both technical knowledge and training, as well as an artistic eye and hand. Any one of them can give you a gorgeous smile.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

dental implant perforated my sinus cavity

I’m a little concerned about some things. I was several months into my “healing period” from my dental implant being placed when the dentist removed it. He said it wasn’t integrating with the bone and the implant perforated my sinus by a few millimeters. He gave me flonase and instructions not to blow my nose, etc. Then we’ll try again after a while. Is this okay or will the same thing happen again?


Dear Miranda,

dental implant diagram

I’m a little concerned by some things I’m hearing. While it may seem a matter of semantics, the dental implant didn’t perforate your sinus cavity, your dentist did. Plus, he did it by several millimeters which by dental standards is quite a bit.

When your dentist was doing the diagnostics for this procedure, did he take any three-dimentional x-rays, such as a CT scan? This is a necessary step to prevent sinus perforation.

Additionally, the implant didn’t integrate with the bone. This is a nother cause of concern. Yes, it should have been removed, but before you go forward, I’d like to know what your current dentist will do to prevent this from happening again before moving forward.

When a Dental Implant Fails

In order to move forward, you are going to need to make sure the sinus cavity is properly healed. After that, you’ll need some bone grafting done. Without that, there is not enough bone there to inegrate with your implant.

I’d like you to get a second opinion on this situation to see what another implant dentist says.

From there, you can either go with the other dentist to replace this or you can get assurances from the second dentist with specifics as to how he’ll take steps to prevent another perforation.

If he was planning on replacing the implant without any bone grafting, I suggest you find another dentist completely. Make sure the new dentist has specific training in dental implants. Dental school isn’t enough. It needs to be post-doctoral work.

Cosmetic Consideration with Dental Implants

Whatever color the implant crown is made will be permanent. If you are happy with the color of your smile, then you are good to go. However, if you have contemplated whitening your teeth, you’ll want to get the teeth whitening done before having the porcelain crown made.

This will save you money while allowing your smile to match from the beginning. The other option is to whiten your teeth later, but then you will have to redo the crown to match the newer, white color of your teeth.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

help avoiding dental implant failure

I’m looking at dental implants. One dentist is insisting on a CT scan but he uses a brand of implants I’ve heard a lot of good things about called Straumann. The other dentist says the CT scan isn’t necessary, but he uses a brand I can’t find much about called Southern Venturi. I like the idea of saving money on the CT scan, but want to make sure the brand is okay first. Do you have an opinion on that brand?


Dear Keith,

dental implant diagram

CT Scans and Dental Implants

I’m glad you are asking these questions. Both have important implications for a successful dental implant case. Let’s start with the CT scan. I would spend the money on that. The big reason is getting dental implants is a 3-Dimentional procedure. In order to get the right placement, it helps to have 3-Dimentional scans.

A lot of dentists are willing to place the dental implants without the scan but here’s what concerns me about that. If you’re talking about a an implant for a front tooth, without the scan the dentist risks it perforating your sinuses. Some dentists try to circumvent that issue by using a small implant, but they aren’t always able to retain the tooth in the long-term.

Another important piece of information is the depth and thickness of the bone. You only get that with the CT. This one additional step can prevent a host of problems.

The Brand of Dental Implants

The first brand you mentioned, Straumann, is one of the brands the top implant dentists prefer. Other good ones are Nobel Biocare, BioHorizons, Zimmer, and Astrotech.

The second brand you mentioned has me a tad concerned. I don’t know any of the top dentists who use this brand. It may be a cheaper brand which saves the dentist money, but you have to be very careful with “cheap” implant fixtures.

Often, it goes fine at the procedure but fails later and the patient has no idea it’s because the dentist used a cheap implant fixture. You also have no real recourse if that happens. It’s much better to pay a little more and get a proven fixture.

The Importance of a Skilled Implant Dentist

Another huge factor in the prevention of dental implant failure is the skill of the dentist. You want a dentist with extensive dental implant training. You can look at some of Dr. Delaune’s credentials to get an idea of what you are looking for in a dentist.

Don’t hesitate to ask where they received their dental implant training. Dental school isn’t enough. They must have post-graduate training.

You also want to make sure they do a significant amount of cases and have a lot of experience. Additionally, ask about their success rate. I’d want someone with a 98% success rate.

I hope this helps you. This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Is It Too Late For Dental Implants To Help My Sagging Face?

Is it too late for dental implants if I’m 64 years old and have already experienced facial sagging? I’ve been wearing dentures since I was 50 and have had continuous problems with them. This situation is difficult for me because my face looks uneven. I want to try to avoid cosmetic surgery if possible. It’s easier for me to get implants rather than have my face cut. Besides that I want the results to look natural. I’m not trying to look 44 again like cosmetic surgery might do. I just want to give my face a natural-looking lift. Thanks. Leilani T.

Leilani – As you may know, when your teeth are missing for years, your jawbone will progressively shrink. This is because tooth roots stimulate the bone, so when teeth are missing, it’s a signal to your body that the bone isn’t needed. Your body will resorb the bone and use the minerals from it elsewhere.

When dentures are resting on your jawbone, the pressure from them accelerates bone shrinkage. Although cosmetic surgery may eliminate excess facial skin, jawbone shrinkage can continue. And if it does, so will facial sagging. The good news is that it’s not too late to receive dental implants.

It’s Not Too Late for Dental Implants to Help with Facial Sagging

If you’re already experiencing facial sagging, your jawbone has begun to shrink. But dental implants need to be placed deep enough in the bone to be stable. It’s likely that you’ll need bone grafting first.

Side-by-side profile photos of a middle-aged woman that show the effects of facial sagging and how dental implants can help; from Dr. Duane Delaune of New Orleans.
Dental implants can prevent or improve facial sagging
  • Bone grafting – Even after jawbone shrinkage occurs it’s not too late for dental implants. Bone grafting can be used to replace the missing bone. In a few months, the grafts will heal and dental implants can be placed. The implants will stimulate bone and prevent further shrinkage. Four to six implants will stimulate a wider area of the bone.
  • Support for your dentures and facial muscles – The built-up jawbone will support your facial muscles. Dentures will be attached to the dental implants. Implant-supported dentures don’t rest on your jawbone and put pressure on it.

What’s Next?

Before you receive any treatment, 3-D x-rays will be taken to determine the extent of bone shrinkage and the best way to treat it. Both bone grafting and dental implant surgery have a healing period of three to four months, so be patient. Your oral health and your facial appearance will improve.

We suggest that you schedule consultations with
at least two experienced implant dentists to discuss your options for implants and natural-looking dentures.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Dr. Delaune is a sustaining member of the American Academy of Cosmetic Dentistry.

considering dental implants

I need to replace three teeth. I’ve been considering dental implants but wanted to know what things I should consider ahead of time about them. Any input?


Dear Laurie,

Abutment and crown being placed on dental implants
Dental implant parts and placements

While dental implants are the top of the line replacement there are some things to consider. First, are you committed to the long haul?

The journey starts with the surgery to place the dental implants. From there, is a healing period. This is to allow the bone to integrate with your implants, keeping them secure. Once that’s completed, your dentist can place the dental crowns. That process takes a while.

You also want to be committed to a lifetime of good oral health. You don’t want to invest all that time and money on something if you’re not willing to take care of it. It would be like buying your dream house, but never bothering to clean or care for it until it sits there, nothing but a shambled ruin.

A third consideration is your long term smile goals. If you want a white smile, it’s important you have any teeth whitening done before you get the dental implants. While a skilled cosmetic dentist can match your implant crowns to the color of your teeth, the color is permanent. If you want them white, you’ll need to make sure you do that before the crowns are created.

All that being said, the most important consideration is the dentist.

Finding an Implant Dentist

Dental implants are an advanced procedure. Too much can go wrong if you have an inexperienced dentist. It’s something which requires extensive post-doctoral training.

Never hesitate to ask a dentist about their implant training. if they name their dental school, that’s not enough. If they seem offended, they don’t have enough. No dentist with skill minds those type of questions.

Instead, they want patients to feel confident and secure going into any procedure. You can take a look at just some of Dr. Delaune’s credentials to get an idea of the type of dentist you’ll want to do your implants.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Premedicating with Dental Implants

I’ve got two conflicting opinions and I’m not sure which direction is the right one. I had a hip replacement about ten years ago. Now I need to get some dental implants. One dentist says I’ll have to pre-medicate with antibiotics; the other says that’s nonsense. Who’s right?


Dear Beth,

dental implant diagram

Oh…the medical community. Don’t you love them? They all claim to be experts and none of them agree with one another. That’s a lot of experts who see things differently. Here’s what is going on in your situation.

It used to be that the standard recommendation was any time someone with a hip replacement had anything invasive done, including a dental cleaning, they were to have antibiotics so there was no risk of any bacteria being introduced which could make its way to the replacement site.

However, that changed in 2012 when both the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) released a new study which said recent studies showed there was no direct evidence to continue to make that recommendation.

That simply means it’s up to the dentist. It sounds like the dentist recommending the pre-medication likes to take every precaution possible. Which you do is up to you. There’s not a right or wrong answer. I would say if you’re a healthy person who doesn’t easily get sick it won’t matter. If you tend to catch things more easily, I’d pre-medicate.

Cosmetic Care and Dental Implants

I want to give you a heads up on a cosmetic issue that recently came up with a patient I know. She’d planned on getting dental implants and teeth whitening. Even though her dentist knew she wanted both procedures, he didn’t warn her that the teeth whitening needed to be done first.

The reason for that is the gel used to whiten teeth only works on natural tooth structure. While her natural teeth were getting whiter, her dental implants stayed the same color they were the day they were placed.

Only then did her dentist tell her to get her smile to match she’d have to replace her implant crowns. If he’d have advised her to get her whitening done first, she wouldn’t be in this situation having to spend unnecessary money. Her crown could have been made to match her new, white color from the beginning.

I don’t know if you were ever going to want teeth whitening, but as this just happened to someone I know, I thought I’d warn you just in case.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Dental Implants in Mexico

Why are dental implants so much cheaper in Mexico than in the United States?


Dear Brent,

dental implant diagram

Good question. Many people complain about dental costs in the United States. In fact, there is a whole dental tourism industry. Much of the higher cost is due to regulations. However, most of those regulations are there for the protection of the patients. Let’s use Mexico as an example.

There are no laws regarding sanitation or the quality of the implants. It’s completely up to the dentist as to whether or not they sanitize their equipment between patients or even at all. Plus, the patient has no recourse if the procedure goes horribly wrong.

For instance, let’s say a dentist doesn’t sanitize his equipment and the patient develops a horrible infection as a result and loses half of his jaw. In the United States, they would be shut down. Additionally, they’d have to pay compensation to the patient.

When it comes to the implant itself. Ones from the United States cost several hundred dollars because of quality control. However, you can purchase implants from outside the U.S. for just a few dollars. They’re much more likely to fail or even break.

However, getting quality dental implants can be made more affordable.

Finding Affordable Dental Implants

One thing that helps with paying for dental implants is finding a dentist who will let you pay for it in stages. Almost every dentist allows you to break up the cost of the surgery and the implant crown. However, you could also ask your dentist to allow you to break up each of those two large payments into monthly payments.

If they’re unwilling, you could try applying for Care Credit. They’re a medical credit card which allows you to have low and even no-interest payments depending on your credit. There’s also no penalty for early pay off if you come into some money and no longer want the payments hanging over you.

Just don’t make the mistake of thinking cheap dental implants are the same as affordable. Your safest course of action is to find an experienced and skilled implant dentist and breaking up the cost.

Teeth Whitening with Dental Implants

If you’re having a dental implant placed in a visible part of your smile, you may want to consider having your teeth whitened ahead of time. Once the implant crown is made, the color is permanent. If you whiten your teeth afterward, the color of the implant will not change.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

Tooth Replacements for Clumsy Stuntman

I’m a stuntman by trade. Lately, I seem to be losing more teeth than usual. I’ve been losing one a year. I don’t know if dental implants will help that or if I should get a dental bridge. But, that’s a lot of teeth to grind down unnecessarily. What do you think? Will dental implants hold up?


Dear Carl,

Abutment and crown being placed on dental implants

I’m sorry you’re having such bad luck with your teeth. I don’t know if that’s common to your particular field or if you’re just in an unusual spate right now. If it’s unusual, the first thing I’d do is talk to your dentist and see if you can figure out if there is something else contributing to your tooth loss. At a rate of a tooth a year, it won’t be long before you’ll be in serious danger of facial collapse.

One of the leading contributors to teeth coming out early is gum disease. If you’re suffering from that, treating that is your priority. You won’t be a candidate for dental implants while having gum disease anyway.

If it’s a matter of just being unlucky at the moment, I’d make sure you’re wearing some type of mouthguard. This will give your teeth a bit of a buffer when things are going wrong.

Will Dental Implants Hold Up?

Before we go into dental implants, I want to address your comment about a dental bridge. When you’ve lost a lot of teeth, it’s not really a great option. If the teeth are all in the same area, you would need quite a large bridge. If one part of it breaks, the whole thing has to be replaced. It’s a better option when you’re missing a single tooth.

But, you’re missing several teeth. If they’re all in different places, you will have to crown two adjacent teeth for each false tooth. You were right in being concerned about grinding down healthy tooth structure.

While dental implants are a fantastic tooth replacement and they’re as stable as your natural teeth, they are only as stable as your natural teeth. This is another reason to wear a mouth guard and address the root cause.

Who Should Place Your Dental Implants?

You don’t want just any dentist placing your implants. Look for two particular skill sets, both of which require post-doctoral work to be significant enough to make a difference. The first is training in reconstructive dentistry. The second is training in cosmetic dentistry. It isn’t encouraging to replace your teeth but to end up with an ugly replacement.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

Switch to Dental Implants?

I’m wondering if I should switch to dental implants, but I’m not sure they’re worth the investment yet. I have three missing teeth and two of them show when I smile. I generally wear a partial denture and I’m quite bothered to go without it. I don’t like to take it out, even at night, because I’m self-conscious about missing those teeth. I also worry that people notice I’m wearing a denture when I talk to them. I’ve actually started worrying so much that I have been refusing to dine out with my acquaintances. I don’t know if it’s all in my head or if people really can tell. I’m having a tough time justifying the costs, though. Is it worthwhile for me to switch to dental implants or am I going to face the same problems?

Beth – Detroit

Dear Beth,

The hard truth is that nobody knows how you, personally, will feel about them if you switch to dental implants. If you’re someone who normally suffers from any kind of anxiety, it could stick around afterward. However, there are some big benefits to switching and it may be enough to help you resume your normal activities. Based on what you’ve expressed, dental implants will be a great option for you. Peace of mind is often worth a little extra cost.

First of all, you won’t be taking them out. They’re permanent, so there’s no concern about going to bed without teeth. A lot of people worry about losing dentures during a meal or about what they can eat without getting food trapped or breaking the denture. This is another thing you won’t have to worry about.

It’s also worth noting that people who have lost teeth start losing bone in that area as well, and this leads to facial collapse. Facial collapse makes people look older than they are, but dental implants can stop or slow down bone loss, so you’ll retain a youthful look longer.

Considering only the teeth, yes, they tend to look cosmetically better as well. The crowns are generally made of layered porcelain, which does a good job of mimicking a natural tooth. They reflect light differently and have some translucency. Dentures are typically made of acrylic or another plastic and they don’t have the same depth to them.

All in all, you’ll probably be much happier because so much of your concerns surround being without teeth, but it’s a good idea for you to see a cosmetic dentist for a consultation on this. You’re going to want someone with extra training and lots of experience doing the work, so you get the best results possible.

This blog is brought to you by Dr. Duane Delaune.