Screw-Retained versus Cemented Implant Crowns

October 7, 2015 by

In our office, we restore tons of dental implants. So naturally, we keep abreast of the latest techniques in creating teeth that look, feel, and function like real ones.

And because we like to post so much implant information and photos on this site, we get lots of patients who ask us great questions. Recently, we’ve had a lot of inquiries on cemented versus screw-retained crowns. So we decided to do a post on it!

Screw Retained Implant Crown Photos

Below is a photo of one of many cases we’ve completed recently:

High quality photos of screw retained implant crowns

Photos of screw retained implant crowns. She went from bare implants to two new teeth in 45 minutes. Dentistry and photos Dr. Nicholas Calcaterra.

In the above case, you can see the screw heads peeking through the crowns in the second photo. We then placed a small filling over each screw head. She received two teeth in less than hour. By using this design, we did not need to use cement. But why did we choose screw-retained crowns?

Reasons for Screw-Retained Implant Crowns

dental implant no cement next to it

Excess cement around this implant can lead to failure.

In the past, many dental implant crowns were cemented on. This can lead to two potential issues:

  1. Retrievability: when a crown is cemented on, it cannot be removed without destroying it. So if there is ever an issue down the road, there is no easy way to address it without cutting off the crown.
  2. Implant Failures: research is showing that excess cement remaining on an implant after cementation can lead to implant failure. It can be difficult to find and locate all the excess cement that might remain.

When a crown is held on by a screw, it can be removed within 5 minutes if there is ever a problem. And since there is no cement used, there is no potential for failure due to excess cement.

So why not Use Screw-Retained Crowns all the Time?

That’s a great question! In many cases, the screw hole can affect the esthetics. This usually is not an issue for back teeth like molars. But when it comes to a front tooth crown, we have to take every single detail into account.

front tooth dental implant has to be cemented

In restoring this front tooth dental implant, we had to use cement. Photo and dentistry Dr. Nicholas Calcaterra.

In the above case, the screw hole would have affected the esthetics. And given that it is a front tooth – we want and need perfection. So in these types of cases we typically use cemented-on crowns.

Are you interested in implants? Do you have an implant but not a crown yet? Call us at (203) 799 – 2929 if you would like to know your options.

Reference on the the dangers of excess cement: The positive relationship between excess cement and perio-implant disease: A prospective clinical endoscopic study. Wilson TG Jr., Journal of Periodontology, 2009  80(9) : 1388 – 92).

Filed Under: Clinical Success Stories Tagged With: , , ,

Fixing White Spots after Braces with Bonding

September 3, 2015 by

We see many patients in our office who did not take care of their teeth when braces were on. Before the braces went on, their teeth were fine. Two years later, the braces come off, and everyone collectively winces and says “Oh my!”

White spots, brown spots, and decay can all result from a lack of proper hygiene during orthodontic treatment. Many cases need to be fixed with dental bonding.

Before and After Photos of White Spot Correction

Below are photos showing how we fixed a rather severe case:

Before and After photos showing fixing white spots with bonding

This young woman from Orange did not take care of her teeth when her braces were on.  We fixed it with bonding. Note the orange tongue ring – which we told her not to wear. Photos and dentistry Dr. Nicholas Calcaterra.

In the above photo, you can see both banded white spots as well as brown spots. All are characteristic of poor hygiene during orthodontic treatment. Her case was so severe that correction with MI Paste was not an option. This was completed over two visits with dental bonding and she was ecstatic!

Note the orange tongue ring… which we told her not to wear. Oh well… we can’t win every battle!

White Spots and Decay Already Forming

We thought we would post this photo to show what poor hygiene can look like:

Not brushing with braces on leads to white spots

His teeth were perfectly white before the braces went on. We counseled him and his parents immediately. His orthodontist was aware of this.

Notice the white spots, the brown areas, the inflamed gums, and the actual cavity forming? With a lot of hard work, we were able to turn the ship around. But his teeth were perfect before the braces went on.

We’d Love to do Bonding… Not!

We are always up for the challenge of fixing a patient’s smile after braces. We have dozens of before and after photos we could post. But what we love even more is watching the braces come off and not having to do a darn thing!

So, let’s avoid the need for bonding, correction with MI Paste, and veneers… just take care of your teeth when the braces are on and you’ll be all set!

Filed Under: Clinical Success Stories Tagged With: ,

We use American Dental Labs

August 14, 2015 by
formaldehyde is not found in Chinese dental crowns

Formaldehyde has not been found in crowns from China but other toxic chemicals have.

Most of you reading this probably can remember – or perhaps are dealing with – the Lumber Liquidators scandal involving Chinese products containing formaldehyde.

You may be asking what this has to do with dentistry and dental crowns. We’ll get to that.

Formaldehyde is a known carcinogen that is used to embalm tissue in addition to being employed in many industrial applications. In the Lumber Liquidators case, elevated levels were found in many of their flooring products, which were attributed primarily to lax oversight along with insufficient standards from their Chinese suppliers.

I’ll Take the Dental Crown Without Lead Please.

Unfortunately, dental crowns fabricated in China but tainted with toxic chemicals have been found in the United States.

dental crowns from China can contain lead

Does this crown contain lead?

In this 2008 ABC News story, a woman in Ohio received a new dental bridge with a very poor fit. After talking to the dentist – who worked at Aspen Dental – she had it tested and found it had high levels of lead. The lead levels were five times higher than what is allowed in children’s toys (source: CPSC). But remember, toys are not permanently cemented in anyone’s mouth and are not in 24 hour contact with saliva!

When she talked to that Aspen Dental office, she was told the bridge came from China.

This is not an isolated phenomenon restricted to the United States. This report out of Australia talks about crowns from Asian countries tainted with different heavy metals. And this report from the UK talks about Chinese crowns and the lack of oversight of the materials used.

Why Dental Products from China?

Money is saved by doing dental crowns in China but quality is compromised

Some dental offices – mostly Corporate Chains – use Chinese labs to save money.

Unfortunately, many dental offices, particularly corporate chains, will use Chinese labs because of one thing: $$$.

We get inquiries, fliers, and emails at least once a week from Chinese labs. The numbers are compelling – a Chinese crown can cost approximately five times less than what we pay to our Connecticut labs. But in nearly all cases, the quality is very poor, and there is no accountability if lead, cadmium or other toxic and dangerous materials are permanently embedded in the restoration.

As the saying goes, you get what you pay for.

Our Commitment to You

we use Connecticut labs for our dental crowns

We use Connecticut labs almost exclusively!

In our office, we ONLY use labs that fabricate the restorations in the United States, with most of them based in Connecticut. This allows us to make these commitments to you, our patients:

  • All dental restorations placed in our office will have been fabricated under the strict regulations of the FDA (Food and Drug Administration).
  • We are able to provide you with the exact “ingredients” used in our crowns.
  • You will never have to worry about toxic or improper chemicals being used in our restorations.

And lastly, since we use Connecticut based labs 99% of the time (we occasionally use a lab based in Missouri for special cases), we are helping to support the Connecticut economy and provide jobs to Connecticut based lab technicians. It’s a win-win-win situation for everyone… our patients, our Connecticut dental labs, and us!

 

 

Filed Under: Dental Information Tagged With:

Your Rights to Your Dental X-rays

July 13, 2015 by
In Connecticut, you have a legal right to x-rays like these.

You have a right to your x-rays!

We are a modern, tech-savvy dental office providing no-pressure quality dental care in Orange, CT. Because of this, we’re busy. We’re growing. We get tons of new patients.

Quite frequently, a patient wants to transfer to our office. But they run into roadblocks in their attempts to get their dental x-rays sent to us. This is just not right!

We often have to educate patients that their radiographs belong to them. No office should be withholding them. See below for details on your legal rights to your x-rays.

Your Rights to Your Dental X-rays in Connecticut

We went straight to the source – Connecticut General Statutes on Medical Records. We’ll summarize the key points:

  • Any dental patient may request, in writing, a copy of his/her dental records. This includes dental x-rays. The office must provide the records (except under certain conditions, see bullet #2). From CGS § 20-7c(c).
  • A dental office can only withhold this information if a dentist believes the information could be detrimental to the patient or result in the patient causing harm to him/herself or someone else. From CGS § 20-7c(d).
  • An office may charge up to $.65 per page to copy records, as well as appropriate charges to duplicate x-rays. Note that most good dental offices are digital and will not charge to email x-rays. From CGS § 20-7c(c).
Photo of money - your x-rays cannot be held hostage if you owe money.

An office CANNOT refuse to give you your radiographcs over an unpaid bill or an outstanding balance. Image courtesy Flickr Commons.

Note that even if you owe the office money, they cannot refuse to release your records. This is a common tactic used by corporate dental chains owned by Wall Street firms. They cannot use an outstanding balance as an excuse!

What to Do if an Office Refuses

It is highly unfortunate that some offices do this. We’ve seen this most frequently with corporate offices such as Aspen Dental who offer free cleanings and x-rays. They just don’t want you to go elsewhere! Here’s what to do:

  1. First, ask them politely, either by phone or in person.
  2. You will likely have to fill out a specific HIPAA compliant form authorizing the release. You can fill it out in person or you can fax it or even scan it and then email it. A phone call or email request alone is NOT sufficient. This has to do with HIPAA – see below.
  3. If they refuse, you should politely tell them that CT General Statutes requires them to release the x-rays. If that doesn’t work, you can also indicate you plan on calling the CT Department of Public Health to file a complaint.
Corporate Dental Chains like Aspen Dental often refuse to release x-rays

Many Corporate-Owned dental chains like to illegally deny access to your x-rays.

In one instance, a new patient of ours wanted to get her x-rays from Aspen Dental. When the Aspen Dental receptionist refused, our patient took out her cell phone and began videotaping the interaction. Guess who then got her radiographs immediately?

Note that an office has up to 30 days to respond to the request. But most good offices will gladly respond within 48 hours.

A Note about HIPAA

HIPAA is the acronym for the law passed in 1996 that is responsible for the myriad of forms and signatures that are shoved down your throat at every physician, dentist, or hospital visit.

While the intentions of the law are good, it results in a huge burden for offices and patients. But please note that due to HIPAA requirements, you have to fill out a form authorizing the release of your x-rays.

References

A primer on your rights to x-rays written by an attorney with the CT Office of Legislative Research.

Filed Under: Dental Information Tagged With: ,
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