Dental Implants

iSmile Implant Center specializes in Implants & Prosthodontics. Our primary implant specialist, Dr. Kimberly Kim (iSmile Dental founder), has placed over 5,000 successful implants over the course of her 20 year dental career.
As a top provider of implants, Dr. Kim is sought out by patients for her outstanding credentials, excellent esthetic results & high patient satisfaction.

Your One Stop for Excellent Implant Placements & Restorations!

Nobel Biocare’s Diamond Partner

iSmile Implant Center is proud to be Nobel Biocare‘s Diamond Partner. This partner status is given to recognize an elite group of doctors who are the most skilled & experienced in handling implant cases. Being the highest level possible, Diamond Partner status is only for those who successfully complete a large number of implant cases.

The combination of our dental implant team’s clinical expertise & experience with Nobel Biocare’s technology & innovative dental products results in more predictable & effective results so that patients can enjoy a better quality of life.

Nobel Biocare is a world leader in innovative restorative & esthetic dental solutions. Being one of the first companies to start making dental implants, it has the largest share of the implant market & has developed numerous advancements in dental implants over the past 40 years.

As an active member of AO (Academy of Osseointegration), ICP (International College of Prosthodontists), & ICOI(The International Congress of Oral Implantology), iSmile Implant Center offers advanced, specialized knowledge of the science & clinical applications of Implant & Prosthodontic dentistry. Learn more about dental implants & AOICP (International College of Prosthodontics), & ICOI(International Congress of Oral Implantology).

Tooth loss may indicate cognitive, physical decline later in life

March 16, 2015
London — Tooth loss may be an early indicator of cognitive & physical decline in older adults, according to a University College London study published January in the Journal of the American Geriatrics Society.

The longitudinal study of 3,166 adults who are 60 years old & older in England showed the memory & walking speeds of those who have lost all of their teeth decline more rapidly than in those who still have some of their teeth.

People with none of their own teeth performed about 10 percent worse in both memory & walking speed tests than the people with teeth, according to the research.

After the results of the study were adjusted for factors including socioeconomic status & physical health, people without teeth still walked slightly slower than those with teeth, according to the research.

The links between older adults losing all their teeth & poor memory & physical function 10 years later were more evident in adults aged 60 to 74 than in those 75 & older, according to the study.

Thus, recognizing excessive tooth loss may help physicians identify adults at higher risk of mental & physical decline, according to the lead author of the study, Dr. Georgios Tsakos, who has a Ph.D. in Epidemiology from the University of London.

“We find that common causes of tooth loss & mental & physical decline are often linked to socioeconomic status, highlighting the importance of broader social determinants such as education & wealth to improve the oral & general health of the poorest members of society,” Dr. Tsakos said.

At iSmile Implant Center, as a practice that strives to provide the best customized services, we pride ourselves on our State-of-the-Art, High-Tech dental equipment & software as well as the thorough & individualized treatments we provide our patients. As such, iSmile Implant Center always uses special custom abutments.

These are the Implant brands that iSmile Implant Center partners with:

Having missing teeth can significantly affect the quality of life, not only because it alters the way you look, but because it can also lead to other physical problems that may affect your health. It is imperative to replace missing teeth as soon as possible to prevent health consequences such as:

  • Loss of bone
  • Shifting & drifting of adjacent & opposing teeth (this can also result in a change in the bite)
  • Complications in the jaw joint
  • Drastic loss of chewing capacity
  • Increased stress on remaining teeth

We find that dental implants are able to improve the quality of life for our patients because they can aid in enhancing our patients’ overall health & enjoyment of food, as well as enable them to gain the confidence that comes with a well-functioning smile that feels good & looks natural. Some specific benefits to dental implants are that they:

  • Prevent recession & weakening of bone structure after loss of teeth.
  • Preserve the health of adjacent teeth, as there is no need for bridgework which requires grinding down the adjacent teeth.
  • Replace ill-fitting dentures, as implants are the closest prosthetics to natural teeth
  • Distribute bite forces evenly throughout the mouth.
  • Improve speech (which missing teeth or bulky dentures can hinder)
  • Improve facial appearance through prevention of bone loss.

Here you’ll see a diagram comparing a natural tooth with a dental implant. The implant fixture is a biocompatible titanium screw, analogous to the anchoring root of a tooth. Just above it is the implant abutment, which we customize for each patient, & which will serve as a connecting agent to the implant crown.

Some patients may have receded bone in the gum area, or the extraction socket may be too large. In either case, the bone foundation is not strong enough to support the implant fixture & must be built up. For a successful dental implant, bone support is critical for stability. Our office uses mineralized ground cortical bone to help your jaw facilitate regrowth of your natural bone in the necessary area.

If you are missing a single tooth, one implant & a crown can replace it. A dental implant replaces both the lost natural tooth & its root. Single-tooth implants will work & look like your natural teeth.

What are the advantages of a single-tooth implant over a bridge?
A dental implant provides several advantages over other tooth replacement options. In addition to looking & functioning like a natural tooth, a dental implant replaces a single tooth without sacrificing the health of neighboring teeth. The other common treatment for the loss of a single tooth, a tooth-supported fixed bridge, requires that adjacent teeth be ground down to support the cemented bridge.

Because a dental implant will replace your tooth root, the bone is better preserved. Dental implants integrate with your jawbone, helping to keep the bone healthy & intact.

If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth & some of the roots.

What are the advantages of implant-supported bridges over fixed bridges or removable partial dentures?
Dental implants provide several advantages over other teeth replacement options. In addition to looking & functioning like natural teeth, implant-supported bridges replace teeth without support from adjacent natural teeth. Other common treatments for the loss of several teeth, such as fixed bridges or removable partial dentures, are dependent on support from adjacent teeth.

In addition, because implant-supported bridges will replace some of your tooth roots, your bone is better preserved. With a fixed bridge or removable partial denture, the bone that previously surrounded the tooth root may begin to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy & intact.

In the long term, implants are esthetic, functional & comfortable. Gums & bone can recede around a fixed bridge or removable partial denture, leaving a visible defect. Resorbed bone beneath bridges or removable partial dentures can lead to a collapsed, unattractive smile. The cement holding bridges in place can wash out, allowing bacteria to decay teeth that anchor the bridge. In addition, removable partial dentures can move around in the mouth and reduce your ability to eat certain foods.

If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth & some of the roots.

What are the advantages of implant-supported full bridges & implant-supported dentures over conventional dentures?
Dental implants provide several advantages over other teeth replacement options. In addition to looking & functioning like natural teeth, implant-supported full bridges or dentures are designed to be long lasting. Implant-supported full bridges & dentures also are more comfortable & stable than conventional dentures, allowing you to retain a more natural biting & chewing capacity.

In addition, because implant-supported full bridges & dentures will replace some of your tooth roots, your bone is better preserved. With conventional dentures, the bone that previously surrounded the tooth roots begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy & intact.

In the long term, implants can be more esthetic & easier to maintain than conventional dentures. The loss of bone that accompanies conventional dentures leads to recession of the jawbone & a collapsed, unattractive smile. Conventional dentures make it difficult to eat certain foods. If the cost to replace all missing teeth is financially taxing, an implant supported denture can be an economic option to provide better retention & function of dentures.

Anyone with missing teeth can be a candidate for implants; however, the amount of available bone, as well as the patient’s age, are important factors. With proper bone grafting, available bone can be regained in cases where there isn’t enough bone for the implant placement. However, if the patient is young & growth is not complete, it is inadvisable to place dental implants.

The best time to place implants is right after extraction, as bone will keep shrinking in volume & height after tooth loss. Usually, when the tooth is extracted, bone grafting is performed as well & implants can be placed right away or 3-6 months later, depending on the case.

Sometimes when we pull out the tooth, we can place the implant fixture right away. Normally when we place implant fixtures we do an osteotomy, which involves drilling into the alveolar bone to make room for the fixture. When we pull out the tooth, the empty socket space sometimes negates the need for the osteotomy. If the socket is too large, there is no way to hold the fixture firm initially. However, for small teeth like front teeth or premolars, it is possible to achieve initial stability right away. In this case, the fixture diameter is almost the same as the space left after the tooth extraction. Because of this, it may take no drilling or minimal drilling to prepare the socket for implant placement. Immediately following an extraction, cellular activity increases as the body tries to fill that empty socket, & this can aid in osseointegration between the implant fixture & adjacent bone.

It varies. According to compactness of bone, treatment duration will change. For example, in the case of an immediate implant, the fixture will be placed & the temporary crown can be made in one visit. Owing to surface & design improvement of implant fixtures, 6 weeks can be enough time for osseointegration. If this is the case, 6 weeks will be the total duration. Over 6 weeks, at least 3 visits to the office are necessary. The first appointment will be to place the implant fixture, the second is to take an impression, & the last one will be to cement the crown. However, if bone quality is not good then osseointegration might take up to six months. Also, if the tooth needs to be extracted first, we need to wait until the bone is filled before we can place implants. It can also take up to six months for large back teeth with inflammation even if we do a bone graft with the extraction.

Titanium allergies are often unrecognized in mainstream medicine, & titanium is considered to be highly biocompatible – yet laboratories using the MELISA® technology have reported that about 4% of all patients tested will be allergic to titanium.* Symptoms can range from simple skin rashes to muscle pain & fatigue.
From foodstuff to medicine, titanium is now an everyday metal. Several brands of candy, such as Skittles & M&M’s, have titanium dioxide in the coating. This ingredient is often described by its E-number: E171. Some brands of toothpaste contain titanium particles. Hospitals use titanium implants to rebuild bones after accidents.
Like all metals, titanium releases particles through corrosion. These metals become ions in the body & bind to body proteins. For those who react, the body will try to attack this structure. This starts a chain reaction which can lead to many symptoms including Chronic Fatigue Syndrome. The MELISA test is the only scientifically-proven test which can objectively diagnose a titanium allergy & measure its severity. Those who test positive are advised to avoid exposure if possible. This may include switching to titanium-free toothpaste & cosmetics, or in some cases, consider removing a titanium implant from the body.

*Valentine-Thon E., et al. “LTT-MELISA® is clinically relevant for detecting & monitoring metal sensitivity“. Neuro Endocrinol Lett 2006; 27(Suppl 1):17–24

The implant placement takes 4-6 months, but can last up to a year if an extraction &/or bone graft are necessary.

iSmile Dental, Inc. does not offer 1-day implants. Dr. Kim does not feel that the immediate implant has enough strength or stability without the necessary recovery time of 2-3 months after placement. Although the process does take longer, allowing for recovery after the placement & before receiving the crown tends to lead to a much higher success rate.

The patient should take one dosage of painkiller & antibiotics one day before the procedure begins. The antibiotic should be taken until there are no more pills whereas the painkiller can be taken as needed after surgery is complete. Dr. Kim will prescribe the medications on the day of the consultation should you decide to begin treatment.

Second surgery is performed to open up the implant area & place the connecting abutment, which will attach to the crown. This can only be done after there has been sufficient time for the fixture to integrate with the bone & stabilize the implant.

Bisphosphonates (BSPs) are used for the treatment of multiple myeloma, metastatic breast & lung cancer, Paget’s disease, osteoporosis, hypercalcemia due to malignancy, & many other skeletal diseases. BSPs reduce osteoclastic functions, which result in bone resorption. Bisphosphonate-related osteonecrosis of jaws (BRONJ) is a newly developed term that is used to describe the significant complication that arises in some patients receiving bisphosphonates. BSPs are known to exhibit an anti-angiogenetic effect that initiates tissue necrosis of the hard tissue. There is currently no consensus on the correct approach to this issue. To determine whether someone may be a candidate for dental implants, a test can be done. This test measures serum terminal C-telopeptide levels (CTX), & is done using the electrochemiluminescence immunoassay technique. It provides an indication of how likely it is that the bone will recover & hold an implant. However, this test does not guarantee success of implants. This issue itself is very controversial; BRONJ itself is quite recently termed & more study is required. Especially in those who have taken BSPs intravenously, there is a higher occurrence of BRONJ. If you have taken BSPs orally or intravenously for a significant length of time, you need to be conservative when you consider implants. Implants might not be successful. However, the failure rate is still relatively low. Even if you took BSPs intravenously for longer than 10 years, the failure rate is less than 3%. However, this is one of the critical factors that can affect implant success, so this medical history should be screened before you decide to go ahead with implant treatment.

Swelling, bleeding & postoperative pain. Usually the discomfort after implant placement is less than that with tooth extraction. The osteotomy done for the implant is very minimal & controlled. With preoperative diagnosis & CBCT, if planning is thorough, the surgery will not be very difficult. If the sinus is involved, nose symptoms can occur, such as a runny nose or bloody nose.

Recurrent decay is the most common complication for the crown of a natural tooth, but for implants, the issues are bit different. Loosening of the implant screw is possible, but this can be resolved with tightening the abutment screw. Another possible complication is porcelain fractures on the implant crown. This is more common in a dental implant crown than in a natural tooth’s crown because implants do not have periodontal ligaments, which can act as a bumper for bite force. These fractures might require crown replacement.

For front teeth, an all ceramic crown is more esthetic because when gum recedes, all ceramic crown can prevent margin darkening. Implants have three components: fixture, abutment & crown. If we choose zirconia abutment & all ceramic crown, it makes the most natural looking crown. Material strength of zirconia is very high.

With x-ray & clinical exam, bone availability can be determined. Also CBCT gives a more accurate view of the dimensions & distances from major anatomical structures like nerves & sinus.

Most of iSmile Dental patients mention that the discomfort during implant placement is less than tooth extraction pain. Sometimes patients ask for general anesthesia. If anxiety & dental phobia is an issue, general anesthesia or sedation should be considered but discomfort during the procedure is very minimal. Also treatment time is not that long. Usually after anesthesia, single fixture placement takes less than 30 minutes.

If you have anxiety or dental phobia, general anesthesia should be considered but if you are okay with other dental procedure like fillings & restorative work, local anesthesia usually works for implant surgery.

There are lots of implant brands on the market. Nobel Biocare pioneered the implant system & many other companies started to produce other design & surface treatment to facilitate osseointegration. More than 20 companies are producing the dental implants. So far the only material which can be used for implant fixture is titanium. According to the company, they treat the surface various ways to induce bone growth in shorter time. In the past, it took a long time to get satisfactory osseointegration. We used to wait 6 months for upper jaw & 2 to 4 months for lower jaw. Still this protocol applies for soft bone but if the bone is compact, & initial stability is good, we don’t wait that long anymore as long as initial stability is good because new technology & design can achieve faster bonding between titanium & bone. Manufacturing companies are competing to come up with better designs & surface treatment by research & experiment. Also they use different design, restorative kit, & instruments to handle things. For example, screw drives which can tighten the screw shape is different. Each company requires its own specific design, too. Certainly products with a long history are more reliable, & you may also want to check complication rates. Irrespective of products themselves, clinician’s familiarity to the products & experience is also crucial to the success of implants. Also the patient’s bone quality is an important factor in deciding the prognosis. iSmile Dental uses Nobel Biocare & Hiossen implants mainly but any implant system can be restored. We are confident that we can take care of all kinds of implants.

As long as we have exact implant fixture brand & size, it can be restored. Sometimes, manufacturing companies go out of business or change the design, & then it might be difficult to get the right tool but there are some other ways to use alternative product.

If the bone is available, your health is good, & you are financially ready, you can replace every single tooth like natural teeth. However, if any conditions don’t allow for it, you don’t need to replace every single tooth. If you want to replace missing teeth with an implant supported overdenture, you need at least four implants for upper teeth & two implants for the lower jaw. For a fixed bridge, usually more than six implants are recommended to support occlusal load. Nobel Biocare has their own concept for full arch fixed prosthesis using only four implant fixtures. This can be a good option with a very conservative approach for fully edentulous case with large maxillary sinuses.

The principle involves the use of 4 implants restored with straight & angled multiunit abutments, which support a provisional, fixed, immediately loaded, full-arch prosthesis placed on the same day of surgery. The All-on-Four treatment has been developed to maximize the use of available bone & allows immediate function. Overall, published data on the All-on-Four concept reported cumulative survival rates between 92.2% & 100%. Usually for an implant supported full arch fixed bridge, six fixtures for upper jaw & four fixtures for lower jaw are recommended. With this concept, the number of fixtures can be minimized but the prosthesis will still be fixed, not removable. Depending on jawbone condition, this treatment modality can be a good option for fully edentulous patients.

We believe that proper planning is imperative to ensuring success. At iSmile Dental, we take meticulous care to ensure the proper distribution of forces in the mouth so that teeth or implants are not forced in the wrong direction or compromised by having excessive force applied to them. We do our best to provide quality service using CBCT & treatment planning using digital software but dentistry is not a cookie-cutter science due to different factors such as patient variability. For example, in cases where the patient has been taking medication for osteoporosis, the fixture may cause issues & healing will be compromised. Also, the upper jaw bone quality is different from that of the lower jaw. The lower jaw is very compact & due to this, the fixture usually integrates more firmly. In contrast, the upper jaw bone has more bone marrow so it tends to be more trabecular & less concrete than lower jaw. This is why waiting periods after fixture placement differ from the lower to the upper jaw. Because of these contributing issues, the fixture might not be firm enough to get bite force in a short time. Unfortunately, if this arises, the fixture may need to be removed in a fashion that is similar to pulling out a natural tooth. However, bone is a dynamic tissue; just as the bone fills up the empty space after a tooth extraction & bone graft, bone grows & fills up the hole of the former implant fixture space. Unlike the natural tooth extraction, the hole following an implant fixture removal is not that wide considering the diameter of implant, which is smaller than that of a natural molar. A shorter waiting period will be required to place another implant. There is also a variety of diameter implant fixtures available. If the condition is right, we can put a slightly larger diameter implant fixture in the same appointment as implant removal.

So yes, if the fixture didn’t successfully osseointegrate with bone or if inflammation occurs after using implants for a while, the implant should be replaced. Just as periodontitis occurs around our natural teeth, if oral hygiene is not maintained, peri-implantitis can arise around dental implants. Hygienic maintenance after implant treatment is very crucial to prevent this inflammation which can lead to loss of the implant later. Just as periodontitis is the number one cause of tooth loss in America, peri-implantitis is the main reason for replacing implant fixtures.

One more thing to consider: implants are mainly three parts. As fixtures sometimes need to be replaced for some reason, abutments & crowns on top can cause some issues later. The screw holding the abutment & fixture together can be loosened as loading continues for a long time & the crown on top can have some issues. The most common issue with the crown is porcelain fracture. Natural teeth are connected with bone through the periodontal ligament. Even if there is accidental heavy force on the tooth, the periodontal ligament gives some cushioning effect & prevents fracture. However, bone & implant are directly bonded so if the force is beyond the threshold, some catastrophic fracture can occur either on the porcelain part of the crown or bone implant fixture interface. Frequency wise, porcelain fracture is a lot more common. Also for the upper teeth, sometimes contact between teeth can open, especially between implant crowns & natural teeth. If a fracture occurs, the chipped area should be checked. If the chip is not that big, it can be smoothed out but if it cannot be repaired, the crown should be replaced.

At iSmile Dental, Dr. Kim has placed over 5,000 implants & restored from one to multiple implants per patient. Especially for patients who have lost all of their teeth, various options can be offered & discussed from dentures to fixed bridges with several implants according to the need of the patient. The best option will be given at iSmile Dental.

There are no long-term restrictions with dental implants, although caution is needed until the bone is completely healed. When dental implants are successfully restored, it is important to avoid biting hard substances, at first. Imagine: if your arm was in a cast for months, you would not want to play a game of tennis right away. Your bones would not be accustomed to having so much force on them & would need to be re-trained gradually. The same is true for dental implants. Initially, a soft diet is best for the first two weeks; after that, you can slowly introduce harder foods. Rest assured, you will soon be able to enjoy all kinds of foods.
There is no special way to clean dental implants. Brush & floss twice a day just like you would your natural teeth, & visit your dentist twice a year for checkups & cleanings. That’s all there is to it! Just one thing about flossing around the implant: compared to a natural tooth root, a dental implant has a smaller diameter. When you floss around your dental implant, you need to follow the crown contour & pass between the crown & gum to remove all possible food debris underneath the crown.

Mini dental implants, or MDIs, are sometimes referred to as SDIs (small diameter implants), as well as NDIs (narrow body implants). This implant is suitable for a narrow ridge, such as the lower anterior region. Denture-type implants are for edentulous patients with narrow ridge or for those cases in which a standard implant is not possible; particularly, in cases where the bone ridge is so knife-thin sharp that it doesn’t support a standard denture comfortably. In fact, under this condition, the denture doesn’t stay well & when patients are eating, it can be highly uncomfortable & even painful. Using MDIs, this problem can be resolved easily.
MDIs can also be a good option to rely on in cases where bone graft success is compromised due to excessive bone shrinkage. With minimal amount of bone, this implant can be the foundation for proper restoration. MDIs require shorter healing periods compared to regular size implants as well.

1: Exam & Consultation A carefully thought-out treatment plan is essential to a successful implant. At the initial exam & consultation, X-rays & CBCT will be taken & reviewed by the Doctor in order to formulate an individualized treatment plan for each patient. Sometimes we may also require specialized imaging to visualize the bone condition to ensure proper placement.

2: Installing the implant At installation, the implant fixture will be placed in the ideal spot for patient jawbone tissue to grow & integrate with the titanium fixture. This process takes anywhere from 3-6 months (depending on the individual patient this process may take longer). In cases when the implant is in a visible area, a temporary restoration may be placed for the patient for aesthetic purposes while the site heals.

3: Second Surgery After the appropriate amount of time has passed for healing, the buried implant fixture will be uncovered with a small incision.

4. Impression A couple weeks later, an impression will be taken of the placed implant to make the individually customized abutment as well as implant crown.

3: Attaching the new crown A few weeks after the impression the custom abutment & implant crown will be placed.

4: End result The new tooth is now installed permanently. The new tooth will fit & function just like a natural tooth. Maintain proper dental hygiene to keep the tooth & gum around the implant healthy & clean.

Please note, the process above is the conventional process.  Based on the patient, implants can be placed to rise above the gum line at the installation and the second surgery process can be skipped.  Depending on the case, the process can be modified and customized to each patient.

For many patients at iSmile Dental, dental implants offer clear advantages over traditional bridgework or dentures. Before dental implants were perfected, in order to replace missing teeth, dentists had to fashion tooth-supported bridges or removable dentures. With bridges, healthy tooth structures had to be ground away to reshape neighboring teeth, which allowed us to use them as supports for anchoring the new bridge.

Unfortunately, these support teeth would be subjected to forces beyond their threshold, so the bone surrounding these teeth would begin to melt away & resorb, thus weakening their natural support system. Esthetically, dark shadows would appear around the bridge as the bone & gum began to pull away from the support teeth. There was also an additional risk that the pressure on the bridge could open up a gap between the tooth & the bridge, forcing bacteria leakage & decay & leading to the possibility of root canals. What’s more, bridges connecting three or more teeth together made flossing difficult or impossible for patients.

The psychological effects of tooth loss are complex & different for everyone. A person’s social life may be severely affected to the point that they will avoid romantic situations for fear their partner will discover the tooth loss. If there is severe bone loss after multiple teeth have been missing for years, facial disfigurement will occur, often accompanied by the appearance of premature aging. While dentures can give a sense of esthetic security, they can also cause damage by placing excessive forces on the underlying bone structure, leading to bone loss. Eventually, the dentures will need relining or complete replacement. All of these problems can be prevented with dental implants!

For patients with bone recession or those who lack adequate bone for implants, we do a bone graft to build up bone density to provide a stable base for implant placement. While saline mixed with bone graft works for patients, using plasma-rich fibrin helps to greatly speed up the healing process. We draw out blood from the arm, just like what is done during a blood test. Afterwards, the blood is centrifuged so that the red blood cells are at the bottom, & the materials we need, the plasma & all of the growth & healing factors, are at the top. This plasma is combined with the bone graft before placement into the jaw or mandible, & the extra growth factors help recovery & bone growth to occur at a higher rate so that the entire implant procedure can be done in a shorter amount of time.

Watch some of our educational videos presented by Dr. Kimberly Kim below!