Questions and concerns about new dental implant.

[BlackCatLover]

Hi, I am in my early 30's and have a congenital defect where my adult second premolars never formed. I have lived with baby teeth in these areas up until now. Last week a filling fell out of my lower left premolar and my dentist said it would be best to extract and begin the implant procedure. I booked my implant on a Friday, my dentist sent my records in on a Monday, and my extraction was Tuesday. Prior to my extraction I specifically called to make certain an implant wouldn't be put in on the same day and was told it wouldn't. When I came in, they told me it would be best to do extraction, implant, and bone grafting around it the same day. I got nervous and didn't feel like I had time to decide if I wanted this, but I felt like I was putting them behind schedule trying to decide so just opted to do it all. When I left afterwards to get my prescriptions, I found out from my pharmacy that the surgeon had prescribed medication that could kill me if combined with my current prescription (I had given a full list of my prescriptions to the implant facility prior to coming in). This made me wonder if my medical records and specific case was really considered, and I am having a lot of anxiety now. Here are my specific questions:

1. Is it normal to begin surgery on a patient with no prior consultation after just seeing their x ray (the doctor got an x ray from my dentist the day before surgery and took another before beginning the procedure)?

2. Is it safe/common to do extraction, bone grafting, and implant all in one day when a patient has good bone density?

3. Should I be worried about the Doctor just going off the x ray and drilling into my mouth without using the surgical guides that I've seen mentioned here? I don't understand how they can know the correct size implant and placement just by briefly looking at an x ray.

4. Is it normal for the implant to be not directly in the center of my gums, but closer to the side of my gums near my tongue than the side near my cheek?

5. I am 5 days out from my implant and accidentally bit my tongue over the area, pushing my tongue into the abutment. Will this push the implant deeper in or negatively impact osseointegration? I am so worried about doing something wrong and having the implant fail.

6. Finally, I read here about the use of Teflon tape inside the crown portion of the implant. I'm very worried about this since Teflon is a forever chemical that can cause detrimental health effects. Is this a common substance to use, and are there alternatives?

I know this is a lot - I really appreciate any answers to these questions or just support! It somehow feels very lonely to be in this position as I feel like no one I know at my age has had to go through this.

 

[Gordon]

Sorry, I have zero experience of placing implants and can't answer most of these. Apart from 5, no, not a chance

 

[NervousUSA]

@BlackCatLover I have the same congenital missing teeth as you and also lost my lower left baby molar and had it replaced with an implant. In case it was any use, what I learned from research was many sources say it is best that a cone beam xray is done before a dental implant, not just regular xray. My doctor did not use surgical guides and I got a second opinion from another dentist who told me the implant was "beautifully" placed. I was offered extraction and implant in one day (didn't need bone graft), though I didn't go with that doctor, and chose someone who would do them separately. I had teflon tape. My crown was temporized first with a cotton pellet. I believe that cotton pellets can be used long term, it sounds like this dentist does https://www.speareducation.com/spea...s-hole-on-screw-retained-implant-restorations

 

[BlackCatLover]

@Gordon Thank you so much for your response! It makes me feel a lot better knowing I can stop freaking out about ruining the implant with the accidental biting. Do you happen to know if the dentist I saw mentioned here who is skilled in implants is still around?

@NervousUSA I have never heard of a cone beam x ray, but looking it up I don't think that's what they did for me since only a flat picture was produced. I'm really nervous the imaging wasn't enough to guarantee proper placement! The only thing I feel good about is having no loss of feeling, so at least they didn't hit a nerve. I thought if I did more research ahead of time I wouldn't be able to go through with it, and now I regret it. Thank you for sharing your experience - interesting to hear from someone who is missing the same teeth as me! Is your right baby molar still in place? I'm really hoping I can hang onto mine for another 10 years before going through this again.

 

[Gordon]

Do you happen to know if the dentist I saw mentioned here who is skilled in implants is still around?

Dental Phobia Forum

Are you terrified of the dentist? Get support with dental phobia and anxiety at Dental Fear Central.

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Dr Hirst knows a lot more about implants than I do, he's not posted since September but you can PM him.

 

[NervousUSA]

@BlackCatLover The only purpose by dentist told me for the cone beam was to miss nerves, and it sounds like they missed your nerves if you have no change to your feeling. My dentist showed me something like a 3D rendering produced by the cone beam x ray, where you could highlight different things like the nerves. My right baby molar is still in place, when I did my research I found a source saying that women with this congenital problem usually lose the left one much earlier than the right. I was told by a dentist that these baby molars can sometimes last till one is 60 or 70. I have been able to have questions about implants answered by dentists on Quora. Another user on here got questions by dentists answered on Reddit. Though it is not free, I have used Denteractive to message with a dentist to have questions answered. I got my dentist to email me my xrays and then messaged them to a dentist on Denteractive to have them check out my implant.

 

[BlackCatLover]

@Gordon thank you! I am still every bit as anxious so I will reach out tonight. Are you able to answer a question I have about chlorhexidine? I was prescribed this mouth wash after surgery and told to use it for 3 weeks. I am 2 weeks out from surgery and had to go in yesterday to remove stitches because the protective barrier they placed was falling off (they wanted the stitches in 3 weeks). I saw a different, also very reputable Dr this time and he told me to stop using the mouth wash and use any regular mouth wash instead. He said it wasn't needed and would stain my teeth. When I got home, I saw on my patient care sheet that I was not to use any commercial mouth wash for 3 weeks after bone graft. I called and confirmed this with a receptionist, who said commercial mouth wash could ruin the graft and then had my original Dr prescribe more chlorhexidine to use for 1 more week. I'm now very confused - I'm worried about destroying my graft or causing infection if I don't use it, and permanent tooth staining and altered sense of taste if I do. Why would a different wash ruin the graft? I have had issues since a few days after starting the chlorhexidine with my tongue feeling burnt towards the tip, and I'm wondering if the mouth wash is causing permanent damage. I am also meant to start steroids today for a feeling like there is something stuck to the side of my tongue that started as soon as they injected numbing. Would it be possible to get nerve damage just from a shot, before they even started operating? Would the burnt feeling on my tongue be nerve damage too? That started a few days later which is why I'm guessing it's the mouthwash.

 

[BlackCatLover]

@NervousUSA How long have you had your implant for and how is it holding up? I might have to try out this denteractive place to ease my mind! The recovery has been so much more difficult than I expected, mainly mentally. It is interesting to hear losing left baby premolar is more common for women!

 

[NervousUSA]

@BlackCatLover I'm sorry to hear you are having a hard recovery, do you know why? It was really mild for me, I needed tylenol for one day. Maybe because you had a bone graft? I have had the implant about 18 months ish, maybe a little more? It seems fine, very solid, no pain, I am chewing well. I had a little bone loss around it that may have happened during the healing process, and my jaw bone looks a bit narrower where it is. My dentist says that is fine, I guess just have to wait and see. The main issues I had with it were with the crown, that had a few problems like color and size issues, it was oversized enough to shift my teeth which wasn't good. I also wasn't warned the installation of the crowns is somewhat uncomfortable, and displaces your gums. I did not have any mouth wash after my implant, btw, though I didn't have a bone graft. I like Denteractive, of course some dentists on there are better than others, but it is just $10. Another thing I like is "The Teledentists", which is more expensive, but it is a video call, if you want them to look in your mouth, that can be good.

 

[BlackCatLover]

@BlackCatLover I'm sorry to hear you are having a hard recovery, do you know why? It was really mild for me, I needed tylenol for one day. Maybe because you had a bone graft? I have had the implant about 18 months ish, maybe a little more? It seems fine, very solid, no pain, I am chewing well. I had a little bone loss around it that may have happened during the healing process, and my jaw bone looks a bit narrower where it is. My dentist says that is fine, I guess just have to wait and see. The main issues I had with it were with the crown, that had a few problems like color and size issues, it was oversized enough to shift my teeth which wasn't good. I also wasn't warned the installation of the crowns is somewhat uncomfortable, and displaces your gums. I did not have any mouth wash after my implant, btw, though I didn't have a bone graft. I like Denteractive, of course some dentists on there are better than others, but it is just $10. Another thing I like is "The Teledentists", which is more expensive, but it is a video call, if you want them to look in your mouth, that can be good.

The actual dental recovery has not been too bad, I was off pain meds within 10 days and have yet to have any complications besides some hopefully minor tongue issues. I have some underlying health conditions and going through this just really wore me out and has been hard to physically bounce back from. Mentally is where I've struggled the most - I actually went almost a year avoiding looking at my teeth because a dentist shaved off part of my front tooth in 2019 and seeing it has been so upsetting to me. I have a lot of fear about things going wrong, distrust for people providing care, and get anxious about something different related to the implant every day.

It is good to hear you are doing well 18 months post implant! I didn't realize the crown part could cause complications too! I hope you were able to end up with the correct size/color of crown and it isn't causing any more issues! I have a follow up appointment in 1 week and had to get an emergency appointment yesterday where a different doctor saw me, so I probably don't need a video call but I think I will definitely look into denteractive and sending in a photo of my implant x ray.

 

[NervousUSA]

A lot of this I can identify with, my main dental (and maybe my main medical fear) is fear of overtreatment or dishonesty and fear of bad treatment or something goes wrong, one of the bad experiences I had was with orthodontics and it is hard for me to look at my teeth and smile too, because it makes me think of that. That side of things was really hard for me with the implant too. For me the best way to deal with that is information and understanding, and the ability to advocate for myself, which is why I used, and suggest using telehealth dentists and every other possible method of trying to get as much information as possible. I really suggest being careful with the crown and understanding how it will displace your gums, and if it will affect your other teeth. I didn't know enough about that process to advocate for myself properly, as well as not knowing what to expect. My crown got stuck and ended up shifting my other teeth. If I could go back, I think I would insist the dentist cut the crown with a drill to remove it, even if I had to buy another crown, rather than leaving in the oversized crown and having it shift my teeth. I am glad you have a follow up appointment, that is a good sign, I think, that they are following up with you. I didn't have one after my surgery. I hope denteractive is useful for you like it was for me if you end up using it. Best of luck with everything, I hope the follow up appointment goes well, and you continue to improve.

 

[BlackCatLover]

@NervousUSA Hi, I hope it's ok I'm still replying to you! I had a bad experience with orthodontics also, my teeth look fine aesthetically (besides the front tooth a dentist later shaved the bottom of) but the treatment moved my jaw to a crooked position where my top and bottom teeth line up incorrectly and caused TMJ. Do you wish you went with another dentist to create your crown? I have no idea how much experience my young dentist has with implant crowns and it sounds like medical professionals need to be pretty knowledgeable about it for long term dental success. The gum displacement worries me too! I saw your other post about food getting stuck in the implant leading to bad smells - were you able to resolve this? I'm also wondering what your experience is cleaning the abutment. Mine developed a film on just the top today that I cannot wash off, and I'm scared to be at all harsh with it. The surgeon said to start brushing it wish a toothbrush which I'm doing, but VERY lightly out of fear of causing micromovements.

 

[NervousUSA]

@BlackCatLover Of course it is OK! Sorry to hear about what happened to you with orthdontics, that is very rough, tmj is a common issue I have heard of in a facebook support group I am in called "Orthodontic Malpractice Victims" which you might find interesting. In my case my lower jaw and teeth are pulled way forward, so there is a ton of pressure on my front teeth, and they are getting a lot of unusual wear, chips, cracks, and gum recession. This makes me unhappier that my crown shifted my teeth, because it made this situation worse, pushing my lower teeth that were in front of it forward. I was unhappy enough about the crown getting stuck, and shifting my teeth, I went to a prosthodontist for a second opinion on it, who said what happened "wasn't ideal" but could be considered normal "it happens" and he would be OK with having my crown in his mouth, which is depressing they can't do better. With my crown, I do wish I had gone somewhere else, maybe even a prosthodontist, over the crown. My dentist didn't create my crown, it was made at a different business, called a "lab". I certainly woudn't accept anything else made at this lab, and if something happenes to my other baby tooth, I will go elsewhere. The gum displacement thing is normal, basically the way that the crown looks like it has a natural gumline, at least with the type of crown I had, is it very long, so it digs into your gums and displaces them, so they come up around the crown, and it looks like the gumline of a real tooth. Hope this makes sense. When it is first done, it makes your gums around the the crown turn white, called "blanching", they screwed the crown down into the implant with the area numbed so that part wasn't painful. For me, the next week was very painful, both my gums getting used to being displaced, and my teeth being shifted by the crown. I was told the blanching would last for 1 day but it lasted for 5 days. Maybe because my crown was a bit large. When it comes to the decayed food, I can't do anything about that, because it is inside the crown and implant, but can't smell or taste it, because it is inside the implant. It is certainly detectable when the crown or implant is opened by the dentist, but not at other times. I researched it, and, if you look at my other posts, got mixed information but it seems that this is unavoidable. I had a healing cap, and I brushed it, I got a tuft brush so I could carefully brush it, that seemed to go fine, I was pretty firm too, and didn't have any issues.

 

[BlackCatLover]

@NervousUSA I didn't realize I had so much more to be anxious about down the line! I'm so sorry about your orthodontics experience - that is truly awful. I would be extremely upset and frustrated about that as well as the crown situation. I'm glad it is at least functioning ok now.

When you brushed your cap did it ever bleed? I had this happen today. I looked and a small bit of healing gum had come off. I called the dental office and they didn't check with my surgeon, just said it was probably the gum falling off that caused the bleeding and to do the salt water rinses. They don't seem concerned by me still having pain a month after the procedure either. Did you find brushing to irritate the area and cause slight pain? Also, did you have big red holes on either side of the implant? I guess this is the area where the tooth roots were, but it freaks me out because I can see so deeply into either side of the implant. I am really wondering how long it will take the gum to heal over this area.

 

[NervousUSA]

@BlackCatLover When I brushed my cap it did bleed sometimes, but that was within a couple weeks of the surgery. It also just bled on it's own, during the first week. It had stuff like stitches and bits of skin or maybe gum breaking off from the area for a while, though that stopped within a couple weeks. I didn't have pain a month after the procedure. I did find brushing the area irritating within a couple weeks of the procedure, but it didn't cause me pain a month after the procedure, I could brush that area as hard as any other part of my gums by that time. I didn't have any holes on either side of the implant. At first you could see the round healing cap flush to my gums, with a red stitched up slit on either side of it, then the slits looked kind of white and puffy or fuzzy with some peeling tissue, and then you could just see the cap on my gums which looked flat and normal, flush to them. I'm afraid I have no experience of having the kind of holes by the implant you describe, so have no clue how long those might take to recover. I think the procedure might have been different for you because you got a bone graft, at least I think I remember you did? I didn't have one so maybe it was different for me. If this were me, if I didn't feel satisfied by the response of the office staff, I might try again with the dental office or surgeon to get this checked, and see if they might check a photo of it if you sent it in to them, just to be sure it is OK, and with my dentist I always used a teledentistry service if they didn't give me enough information. I'm sorry my experience with the crown brought up more things to worry about, if it is any use, I have only seen one other person with a crown experience like mine on here, and though their teeth were shifted, they didn't mention the position change being enough to make a difference to them, so I don't know in what percentage of cases crowns do that, maybe it is rare. There may be different types of crowns also, for different implant types, I have an implant with no abutment, and some people have abutments. Yes the situation with the crown did make me upset and frustrated, after my experience with orthodontics, and other related experiences over the years, it really messed with my mind for months, I feel better now, but it has been really hard to deal with. Thanks for your comments about that, you are very understanding. I hope your implant feels better and heals up more soon!

 

[BlackCatLover]

I wanted to give an update in case anyone else comes upon this thread. I had my crown put in a week and a half ago (I put it off a bit due to cost and nerves) and it is feeling great! I am really impressed with my dentist who made it. I didn't have any issues with my bite or any need for adjustments, and I had a new retainer made that day to prevent teeth shifting. The first week my gums around the implant were fairly painful and I didn't chew with my new crown to avoid making things worse, but it's much better now. My dentist advised me to get a waterpik to keep it clean so I'm using that. I am pretty happy with how it looks - I can see the access hole in the middle because the part they filled in is lower than the rest of the top of the tooth, but it's not too bad. They used cotton instead of teflon tape to cover the screw. I am really glad to have a tooth back in my mouth and am really hoping I don't run into any issues!

Thank you so much, @NervousUSA for sharing your implant experiences - it was so helpful! Thank you to @Gordon and @drhirst as well!

 

[NervousUSA]

@BlackCatLover So glad things went well! May it long continue!