Dental Implants 101 – An Interview with Dr. Ramsey Amin

Photo by Dr. Ramsey A. Amin

I recently had the privilege of speaking with Dr. Ramsey A. Amin, D.D.S., an acclaimed dental implant dentist practicing out of Burbank, Calif. He is a Diplomate of the American Board of Oral Implantology / Implant Dentistry and also runs the Dental Implant Dentistry Blog, where he posts information and case studies on actual implant procedures to help others learn more about the fascinating field. Implants are becoming more and more common, but you still may have questions. We asked them for you, so you can learn a little bit more about the procedure and what to expect. Dr. Amin graciously gave up some of his time to share a little of what he knows:

What exactly is a dental implant?

A dental implant is an artificial tooth root that’s made out of titanium that replaces a missing tooth. It’s really that simple – an artificial tooth root. Dental implants are placed directly into the jawbone. They usually are shaped to look like screws, and they are threaded into the bone. You have to have enough bone to put them into in order to have an implant. If you don’t have the proper amount of bone, you’re going to have to make the proper amount of bone, to build it back.

How often do you need to perform a bone graft in order to do the implant?

It’s quite variable. Bone grafts are going to be more common in patients that have been missing teeth longer. As soon as you lose a tooth, your bone begins to shrink. So the longer a tooth is gone, the more the bone shrinks, and the more likely you are to have a bone graft, whereas the sooner you have an implant after having a tooth extracted, the less of a chance of needing a bone graft. It really is more of a time question than a percentage. Many times implants are placed on the same day of the extraction if they’re in the front of the mouth, and that can reduce the incidence of needing a bone graft. But if you need a bone graft, it’s far better to have the bone graft than it is to cut corners and try to do something without it if it’s necessary.

How long does an implant procedure typically take?

For a single tooth implant, which is probably the most common, if it’s in the back of the mouth you can expect to be in and out of the office within, oh, I would say an hour. In my office that’s what it is – an hour, an hour and a half at the most.

What kind of anesthesia do you have with an implant?

It varies from patient to patient. For most of my patients, the thought of having a screw put in their head is often disconcerting, so many patients opt to be sedated for the procedure. Many times they heal faster and have less pain not only during but after the procedure, because you’re able to administer certain anti-inflammatories by IV (I’m talking about IV sedation) that help the healing process and help you have less pain and less swelling. It’s really variable, but most people are just kind of scared at whole thought of, “I’m going to have a screw put in my head.” Implants on average are about an inch long. Some people are scared of a needle going in their arm that’s skinny and long; Try taking that same long thing and making it 5 millimeters diameter. Most of my patients I suggest to have sedation. It keeps them more relaxed, and if they’re relaxed, they’re safer having the procedure done.

In what cases are implants a better option than bridges or dentures?

Almost 100% of the time dental implants are better than bridges or dentures. 100% for dentures, and almost 100% for bridges. If you’re going to have a bridge, you have to grind down other teeth in order to have a bridge, so if you’re missing one tooth, you have to grind down the tooth on either side in order to have a bridge. So why create a 3-tooth problem when you only have a 1-tooth problem? Or why use a 3-tooth solution for a 1-tooth problem? You’re grinding down other healthy teeth for bridges. Bridges also have a lifespan on average of 7-10 years, then they re-decay, they get cavities around the bridge, and the bridge is subsequently replaced. If you’re getting a bridge replaced every 10 years versus having an implant once, financially it makes a whole lot more sense, and for the health of your teeth it makes a lot more sense. When a bridge fails, often the cavity under the bridge is so big that one of the teeth that the bridge was anchored to needs to be extracted, or needs a root canal, and then you have to grind down another tooth and make a new bridge big enough to fill the gap now. For dentures? I would say that dental implants are the best denture adhesive. Dentures are loose, they wiggle, they don’t hold in very well, but the main reason why implants were brought into the picture in the mid-60s and 70s is because they preserve your jawbone. When you wear dentures, your jawbone shrinks naturally because of disuse atrophy. If you don’t use it, you lose it, so if you’re not using the bone in your mouth –and the only way you can use the bone in your mouth is by chewing with teeth or chewing with implants – if your bone isn’t being stimulated by either your natural teeth or by implants, your bone is going to shrink away. As your bone shrinks away, your denture has to be made bigger and bigger in order to fill the gap till you don’t have enough bone, and then dentures don’t hold.

When did you first know you wanted to work with dental implants?

Definitely early in my days in dental school is when I made that decision, and ever since I’ve been out of dental school it’s been a passion of mine. My practice is very focused around dental implants, and I’m a Diplomate of the American Board of Oral Implantology. It’s very much been my life. I teach on the topic, I enjoy it, and I really think it’s the best service you can provide for a patient.

What is your favorite part about being an implant dentist?

Honestly, you’re helping people make the right decisions in doing things right the first time and avoiding making permanent mistakes by having a bridge and grinding down other teeth. Helping people make the right decisions, and the best decisions for their mouth. Really it often makes a big difference in their self-confidence and their social life, and honestly in their financial success. If a patient has self-esteem and has a confident, secure, handsome or beautiful smile, they’re just going to do better in the world.

What is a mini implant? Are they any easier or better?

Mini implants have a lot of advertising clout. They have some use for patients who are wearing dentures, but they’re only meant for people who have dentures. They are useful, but because they’re mini, they are small and they bend or break, so oftentimes they’re really more intended for a temporary situation, like temporary implants until a person can afford to have real implants made. [How would it bend or break in the jaw? How does that typically happen?] It’s just because the metal is so thin and the jaw is so strong that they just break off and bend, they’re so small. It’s like taking a credit card, you can bend it back and forth until it snaps. A real implant cannot bend or break, or it’s very, very uncommon. They can’t bend, but mini implants can bend or break. Mini implants can only be used for one purpose only, and that’s only for an overdenture, whereas a person that had a denture and they had implants and eventually they wanted to have real teeth attached to their implants, they could reuse their existing implants to be turned into a fixed bridge. The person who has mini implants is going to be stuck having the mini implants and dentures over top. So mini implants are really only used for overdentures and for people that are wearing dentures, but they can’t be used typically to replace a single tooth or any of the other indications for implants.

Does age matter when getting an implant?

Age is not a factor. A few weeks ago I had a 91-year-old patient who I placed 8 implants on. He came to me when he was 88 years old originally, 3 years ago, to talk about it. He came back 3 years later and said, ‘I can’t believe I waited all this time. My brother is beyond 100 and still going strong.” So age is not a factor. On the upper end of age, it’s your health. As long as you’re healthy – if you’re healthy enough to have a tooth extracted, then you’re healthy enough to have an implant. On the opposite end, for young patients, typically you have to be done growing in order to have an implant. Your jaws have to be done growing. Oftentimes for girls that may be 16 years of age and for boys it may be 18 years of age. It varies though. There are ways to confirm that a patient is done growing by taking an X-ray of their wrist. There are ways to tell by how the bone looks in their wrist that they are pretty much done growing.

Do you ever run into situations where people are trying to work around braces?

Yeah, as a matter of fact I was just working with a patient 10 or 20 minutes ago. Some ppl are missing teeth – let’s say they lost a tooth and they waited too long, so their other teeth are tilted or moved into the space where they want to have the implant, and we have to use braces to tilt the teeth back into position or to move teeth out of the way or into better positions to have the implants in the right spots. Orthodontists often use implants as anchors to move other teeth too. Implants can remove the need for headgear in the younger population. Now we put a couple “mini implants,” what we call a TAD (transitional anchorage device), which would be screwed into the jaw from the side. The orthodontist hooks some rubber bands onto the TAD, or “mini implant” that goes into the jaw, and they move the teeth around that way without having to wear headgear.

What is the most difficult or unusual procedure you have done?

The most difficult or unusual procedure I do is called a nerve repositioning or nerve lateralization. It’s for somebody who is missing their lower molars and the main nerve that goes through the jaw which is usually deep inside the jaw is near the surface, so you can’t put implants in the lower jaw because their anatomy pushed the nerve toward the surface or their bone loss brought the nerve toward the surface. There’s no way to put implants in there because the nerve is too shallow. If you were to put it in you would drill into the nerve. So the procedure I do, called a nerve reposition or nerve lateralization, is where the nerve is removed from the bone in its entirety and moved to the side, moved out of the way, and implants are put in where the nerve used to be. That procedure is not done too often, because many patients don’t want to do that procedure because of the risk involved of having a permanent or temporary numbness from the procedure. It’s not for everybody. It’s really for the person who is missing their lower teeth, they can’t wear removable dentures anymore, but they really want their teeth at all costs and are willing to take some extra surgical risks in order to move the nerve out of the way. It’s become more safe with some recent medical devices that allow moving the nerve or cutting bone without using a drill or using mechanical devices

What is the most interesting new technology in the implant world?

It’s a toss-up, really. I would probably say the ability to take a CAT Scan of a person and to simulate the surgery of their mouth on the computer before ever doing it in their mouth. Simulated 3D CAT Scan surgery. [Is that something you would show the patient?] I do go over it with the patient, it’s kinda cool on the screen, it looks like a video game of their skull on the screen. It gives them some understanding because they can see their jaw in 3 dimensions, I can show them ‘Here you have bone, here you don’t.’ That is definitely what I would say is the most interesting technology. It is useful on more advanced cases; it’s not needed for every single person.

Final comments

I would say just do your research on who is going to be doing your implant surgery, because dentists who place implants are not created equal. There are dentists who do this all the time and are really well-versed in this, and there are people who just dabble in it. So do your research and make sure you’re working with somebody really good. That’s ultimately what you’re paying for.

We really appreciate getting a chance to talk with Dr. Amin and learning so much about tooth implants. Visit Dr. Amin’s dental implant blog to learn more!

Would you ever consider tooth implants?

Let us know in the comments section!