Do I Need Custom Dental Implant Abutments?

Do I Need Custom Dental Implant Abutments?

Do I Need Custom Dental Implant Abutments?

There is a lot of confusion with patients that have come to me for 2nd opinions. The question is whether or not their dental implants need custom abutments or not.

I will try to make this as non-technical as possible. If you are confused, comment below.

Most implants have three pieces. The implant that goes in your bone, the abutment the holds the tooth, and the crown tooth that attaches to the abutment.

 

 

Implant_anatomy basic pic

In my practice the additional expense of a custom abutment is  not always necessary. It can increase the cost of the dental implant by about 10%.

The best way to avoid making a custom abutment is for your implant to be placed correctly. Many implants are placed incorrectly at a incorrect angle and require a custom abutment to make it straight again.

Nothing beats a well-placed implant!

In today’s day and age of 3-D crown fabrication often times a custom abutment and/or screw retained crown can be a nice upgrade.

A well-placed implant allows me to use a pre-fabricated  or semi-custom abutment and reduce cost to the patient. This type of abutment also has a better fit than a custom one since the titanium mating surfaces was manufactured to fit very tightly. Well made dental implants have a very tight connection between the implant and the abutment. This is very important for the long-term maintenance of your bone around the implant.

Here is case of the back molars replaced with dental implants and prefabricated abutments:

 

IMG_8576

IMG_8580

I use custom abutments for the following scenarios:

  • An implant for an upper front tooth where the gum may be thin and the titanium would show through. (White zirconia abutment)
  • The space between your upper and lower teeth is really small and the implant need to be held by a screw instead of by cement.
  • Multiple or full mouth bridged dental implants.
  • Overdentures that have a bar to hold them in.
  • Excessively thick or thin gums.
  • Excessively “scalloped” gums.
  • Implant that is very deep

Here is a picture of a custom white zirconia cementable abutment and the final crown that I made:

IMG_3696

IMG_3699

IMG_8813

Sometimes the way the gum heals from the surgery may change an original plan for a prefabricated abutment to a custom one.  Sometimes a screw retained custom crown is a better option then a cementable.

I teach classes to other dentists about dental implants. Most dentists are not aware when you should use a custom or prefabricated abutment.

As a Diplomate of the American Board of Oral Implantology (the highest certification acheivable), dentists and patients seek me out for education and opinions on what is the best treatment.

My goals are to simplify and streamline the procedure for patients. I do see an overuse of customized abutments when the prefabricated one would have been just as good or better.

232 Comments

  1. Christine

    I had a interim abutment D6051 and provisional implant crown D6085 placed yesterday. I was told by the dentist office that “we do not submit these claims to insurance as it is not covered” I insisted that it be submitted and found out that the code D6051 submitted was “a fee for this service is included in the fee for another service and I was not responsible for the payment”. But the dentist made me pay the full $525 for D6051 and D6085. Do you know what that other service is and is it common for dentist office to not submit certain procedures? Is this a way to get out of the “contract” with insurance companies?

    October 17, 2019 at 4:59 pm Reply
  2. Jennifer

    Hello. I had 2 implants placed last year, #13 and #20. I waited extra long as I wanted to make sure my jaw had plenty of time to heal around the implants lol. I just made my appt for the next step and was told to plan on the whole day there (office is about 3 hrs away) as they do the abutment in the am then place the crown that evening. They do have a lab in this office where they make the crowns. I am all for completing this process and being done but don’t the gums HAVE to heal around an abutment first? I am just wondering if this is somewhat common, issues with it, etc…or am I just worrying for nothing 😁. They are both in the back of mouth but as these are used for chewing..I really don’t want to loose or break something after paying all this money. T hank you!!!

    September 19, 2019 at 7:41 am Reply
    1. Ramsey Amin

      Abutment and crown are usually delivered on the same day 😊

      September 21, 2019 at 11:48 pm Reply
      1. Edward Tasi

        I have a front bridge that is held by two implants,not only do the abutments partly show but there is a significant gap between my bridge and gums creating a giant food entrapment, would custom abutments snug the bridge to the gums for a tighter fit?Thank you

        August 14, 2020 at 8:19 pm Reply
        1. Ramsey Amin

          You would have to remake the bridge if you place new abutments but yes that will fix the problem!

          August 16, 2020 at 7:34 pm Reply
  3. Grace

    My son requires dental implant on tooth no. 5, in your opinion, does that require a custom fabricated abutment to be done. The dentist is recommending this and of course, raises the cost. I am conflicted if I should go ahead with custom abutment.

    Await to hear your advice. Thank you.

    May 9, 2019 at 1:35 am Reply
    1. RamseyAminDDS

      In a young patient they are even more important. In today’s day and age as of 2019 custom computer aided design and fabrication makes custom abutments an excellent choice.

      It is best for front teeth

      May 14, 2019 at 4:42 am Reply
      1. Steve

        Is your son a candidate for orthodonture? When I was 12 in order to make room for all my teeth my orthodontist had four bicuspids pulled, one in each quadrant. I’m wondering what dental changes your son is expecting. I’m 71 now and it’s been my experience that bicuspids are the least durable of all.

        May 17, 2019 at 1:53 pm Reply
        1. Grace

          No. He is 18 years old and his root canal failed and his last resort is for the dental implant.

          May 23, 2019 at 6:30 am Reply
  4. Tampa

    I went to the very best holistic dentist in my town and they gave me a quote for an extraction, bone graft, biomat aid/soft tissue, sedation, stem cells, and zirconium implant. It has been a long process and I was willing to pay the $8k for the procedure because I wanted the very best. They could not sedate me after trying to get a line four times, and did not do the stem cell procedure. I had a rough recovery after the bone graft. I overlooked that they still charged me for the sedation and stem cells, because I wanted this specific dentist to do the work. My last appointment, the office manager told me they gave me the abutment for free and it is normally $1200+, which rubbed me the wrong way. They should have included it in the original quote, and they did not include the price of the crown either, so she handed me a $2k bill…after I already paid for the entire procedure because she left it off the quote and did not tell me until now. They gave me an entire care plan for all of the things I need to have fixed in my mouth. The crown for this implant was not included ever, (without my knowledge) so they would have fixed my entire mouth (a few older fillings that need to be redone) for the $20k they quoted, and I would STILL be without the crown. I don’t know what recourse I even have, because I am without a crown and the procedure is one step away from being finished. I still believe the dentist is the best. I have an appointment tomorrow, where they are redoing the abutment because the lab found two bubbles in the impression, so they are doing it again….and it was extremely painful even with the shots. I was willing to pay more and drive out of my way to do this, (nearly 20 visits) and I just wanted it done well and for the amount I was quoted. Any advice? Do I pay the $2k and not return after the crown is placed? Talk to the dentist? Contact the Better Business Bureau? Also, the abutment cord impression part was ridiculously painful. I do not want to have to go through it again.

    July 17, 2018 at 1:26 am Reply
    1. RamseyAminDDS

      I would just go elsewhere to have the crown and final abutment made. All of this seems a bit strange. Some of the holistic practices do some very shady billing in my opinion.

      July 22, 2018 at 5:41 am Reply
  5. Angela L Rose

    What is the purpose of an “upgrade to Custom Abutement”? It was not billed to the insurance company so I paid an additional $347 out-of-pocket upfront. Thanks

    July 5, 2018 at 7:15 pm Reply
    1. RamseyAminDDS

      your on the proper forum/post. It should answer all of these questions. Please be more specific to the exact location in your mouth where this was done. It is a small price to pay for sometimes a massive improvement for long-term stability, health and cosmetics. They’re not always needed though.

      July 7, 2018 at 7:44 pm Reply
  6. Diana Le

    I have strausman implant on #7 and had gone to see two different prosthodontists. One wants to place a custom abutment while the other one only use the abutment already attached to the crown (prefabricated?), so which route do I choose?

    June 12, 2018 at 7:41 pm Reply
    1. RamseyAminDDS

      Custom abutment for front teeth is always a better option!

      June 14, 2018 at 3:22 am Reply
  7. Don

    Hi doctor,

    I have about 2mm difference between the two bottom pre-molars—the gums shrank clearing the decay trying to save the tooth firstly. The first pre-molar (the one getting the implant) is closer in gum line to the canine, though I know it’s supposed to start above the canine on the gums. I do not want my final crown to be too big as if I have two canines. Pink porcelain is a last last last resort. Can the abutment for the implant be placed at an angle that will manipulate the gum line and have the premolar be higher on the gum line? Any other solutions would also be appreciated.

    Thank you

    June 7, 2018 at 8:11 pm Reply
    1. RamseyAminDDS

      without seeing you in person, this is impossible to answer…so sorry

      June 10, 2018 at 12:33 am Reply
  8. Taylor Smith

    Why is the abutment necessary what does it do

    June 6, 2018 at 5:35 pm Reply
    1. RamseyAminDDS

      It connects the implant to the crown or bridge. You cannot connect porcelain directly to the implant without some sort of metal interface that transitions from the bone to the tissue surface.

      June 6, 2018 at 10:48 pm Reply
  9. Martin

    Hello I do hope that you are able to offer me some advice. I had all four wisdom teeth removed but the lower right had caused damage to the next molar and despite attempts to save it, I lost that tooth. I had an implant restoration but it has always been problematic. I get food trapped around the base of the crown and I am constantly having to remove the trapped food outside of my normal dental routine. Also the implant crown is noticeably smaller than the opposing molar. Aesthetically I don’t like the size difference either as the tooth to me does not look natural. It may be at the back of my mouth but I want it to at lest resemble the other teeth in my mouth. What are my options please? Thanks for taking the time for me.

    February 6, 2018 at 10:27 am Reply
    1. RamseyAminDDS

      Have the crown remade to be more broad. As long as the implant is not too far away from the tooth or has peri-implantitis, a simple change of the crown should remedy all of this.

      February 8, 2018 at 4:45 am Reply
      1. Martin

        Thank you Dr for your reply I really appreciate it. With this information I feel able to move forward with my situation. Thanks again.

        February 27, 2018 at 2:44 pm Reply
  10. Bobby

    Hi Dr. Amin,

    Thank you for taking the time to respond to all these comments. I hope you have the time to answer to my situation. I will try to keep it short.

    – I got my front tooth implant done when I was 18 years old
    – Now I am 30, and I still grew. The tooth is now sticking out in a forward angle, and my tooth is a bit shorter (not too bad, just enough to make we want to make it look better)

    I went to the dentist, and they started taking pictures, and impressions and she said she spoke about my case at her focus group.

    While she said she will try to see how good she can do with a custom abutment, she said her colleagues recommended redoing the implant which is a 100% no, I will not move forward with the procedure if that is the only way.

    Here are my questions:

    1. Is it possible that a custom bent abutment would not be good enough?
    2. How risky is replacing the implant might cause more complications? (mine has been great for 10 years)

    The other thing is, my lips hang low and I am not looking for the Hollywood smile. I am just looking to make the tooth the same size, and improve the angle a bit.

    I would like to know your thoughts!

    Thanks!

    January 26, 2018 at 3:11 pm Reply
    1. RamseyAminDDS

      Yikes..don’t take it out for those reasons! Seek an expert. There are so many modern ways to design implant teeth and abutments. Angulated screw channel is an option that did not exist at the time of this writing. Unless you have bone loss and gum reccesion I would not remove it.

      January 29, 2018 at 12:05 am Reply
  11. Lora

    Dr Ramsey ,
    How can a dentist tell a difference between custom and prefabricated abutment if he removes my implant crown to redo it? I suspect my prostodontist charged me for a custom abutment but put a prefabricated one.
    This prosthodontist placed an implant crown with “custom abutment”. He evaluated my case on first appointment. Reviewed implant scpecs from a surgeon. For my second appointment ordered some measuring device. He did not take impressions, only measurements.
    Then they told me my abutment was ready and I came to third appointment to take impressions. So abutment was done without impressions, and I suspect it was prefabricated.

    August 27, 2017 at 5:34 am Reply
    1. RamseyAminDDS

      he may have had to buy a custom titanium base to build the custom abutment onto. This is very common. It is best that the connection base is prefabricated and the top part customized. This is definitely considered a custom abutment

      August 30, 2017 at 9:49 pm Reply
  12. Nikita Bush

    I had two implants placed in my lower jaw. I was wearing dentures. Do I have to go to another dentist to have the abutments placed once I am healed? I am confused. I already paid the surgeon and now the second dentist is acting like he did the initial surgery and I have to pay him. This doesn’t sound right.

    August 26, 2017 at 1:25 am Reply
    1. RamseyAminDDS

      You have to find out if there is confusion between the temporary healing abutments and the final abutments. They are different.

      August 26, 2017 at 5:21 am Reply
      1. Nikita Bush

        The implant is under the gum and there is no abutment yet. He is not an oral surgeon but he is charging me as if he is. Should I just work with the oral surgeon who is very good I might add and have the regular dentist construct my dentures as he used to in the past to fit the abutments. Also how much does a lower denture cost to fit the abutments.

        August 26, 2017 at 4:13 pm Reply
  13. Marie lucia

    A prosthodontist told me my. He said my gums are too thin for implants and need building up. What is the building procedure and how long will it take to recover

    April 2, 2017 at 2:25 pm Reply
    1. RamseyAminDDS

      if you are missing all teeth then this is a better answer…..bone leveling or zygomatic implants.

      April 13, 2017 at 5:14 am Reply
  14. Jane

    Are custom abutment-incl placement cost more than prefab abutment-incl placement?

    January 21, 2017 at 12:41 am Reply
    1. RamseyAminDDS

      Yes..because they have to be custom made

      February 1, 2017 at 11:41 pm Reply
  15. Kate mealy

    I need a dental implant. I have been told – and am not surprised, but nervous about – that the structure will have to be placed at an angle which would be a custom abutment from what I read above. My gums have receded a great deal and my sinuses hang low. The tooth is the last one on upper right. Any advice?

    December 20, 2016 at 3:30 pm Reply
    1. RamseyAminDDS

      My only advice would be to see a very skilled and experienced dentist to alleviate your nervousness. This is a procedure where it is worth having the best person. In nature, all of our sinuses hang low for the most part so this is a normal thing that I dentist will encounter. The thin gum tissue needs to be managed by placing the implant a little bit closer to your tongue making sure there is plenty of bone on the outside.

      December 26, 2016 at 3:28 pm Reply
  16. Michelle

    Dentist tried to get abutment out because it was too short implant was in front wound up pulling implant out HELP

    September 22, 2016 at 11:09 am Reply
    1. RamseyAminDDS

      Ugh….it sounds like the implant wasn’t even integrated because that does not happen. Did you have an x-ray on the implant before this started working on it? That would allow you in the dentist to evaluate that the implant is integrated to the jawbone before doing such a procedure to make the actual tooth. If the implant came out, he will need to start from scratch again.

      September 28, 2016 at 10:21 pm Reply
  17. Karin

    I had 4 implants in the upper front 6 years ago and then was unable to go forward with placing the crowns. The dentist who placed the implants is no longer in business (that’s another story, and the quality of the work goes with it). Will it be possible for a new dentist to complete this work and get proper abutments without the information on the original implants? Thank you.

    August 3, 2016 at 6:15 pm Reply
    1. RamseyAminDDS

      thank you for your question. It is a good one. Typically you will need to work with an experienced restorative implant dentist to solve the mystery your implants…..someone who has restorative many thousands of implants usually can just look at an x-ray and or unscrew the top of the implant to identify the brand and manufacturer

      August 10, 2016 at 11:56 pm Reply
  18. Sara Masuga

    I had implant surgery on front tooth at the end of October, ’15. At the end of February, ’16 I was okayed to get my crown. Since I had bonding on my other front tooth since 5th grade, I thought this was finally the time to also get a crown placed on that tooth. I thought I would achieve the best results from all that I had read. When I arrive at dentist for next phase at end of Feb., she had planned on custom abutment, but realized oral surgeon put on a “stock” abutment. I didn’t know the difference as far as anterior teeth aesthetics. So, she does my impressions, sends out to the lab, the crowns come back and lo and behold the crown for the implant will not fit in the space after repeatedly trying to jam it in there. Then she replaces the temporary and come back in a week and oral surgeon comes to dentist’s office to see what’s going on. He can’t get it in there, either. He says maybe he should have put in a longer screw? He has me writhing in the chair messing with his “stock” abutment taking it out and replacing it. Then he comments, “Well, at least it’s north and south now.” I don’t know what exactly he meant, but if it’s what I think, that didn’t sound good. They finally decide to prep me for a custom abutment at “fixture level” (I think) and I am pleased because meanwhile I learn of the benefits of the white color for one thing, not to mention the tissue and aesthetic component for an anterior tooth from what I’ve read. So, once again I come back in a month for placement of the custom abutment and crown. Ever since the custom abutment was placed, I have had pain, which went from a 9 down to a 4 in the area of the gum tissue and even on the palate area underneath. I even asked after a couple weeks could it be infected? I hadn’t had pain like that since I had a fractured tooth and could hardly stand the pain. Now a month has passed and they tell me it’s just because of a 2 millimeter difference, it will take time, ride the wave, maybe you have sinus issues, see an ent, which I did. They finally have me come back in and they x-ray it and it is full of infection. He says we have to get the abutment out. I could go on about all the inappropriate, unprofessional things he said in my humble opinion, but I won’t other than the fact that he’s trying to blame the lab for a mis-pour of the first attempt at putting on a crown. I have actually been to the lab 3 times for color matching and also because of the fact that I was having the problem after the custom abutment was made. It was made clear to me from the lab owner that he and this oral surgeon don’t always see eye to eye. Now the oral surgeon is pointing fingers at the lab. All I know is I feel like I don’t know who to trust. I am on antibiotic (which is awful for me because I have RA and I have to go off my meds anytime I have to take an antibiotic) and we are in a wait-and-see if the implant can be saved over the next 8 weeks. I feel I have lost trust in the surgeon because of some of the crazy things he has said to me which I won’t post online. What is a person to do if I don’t trust him at this point but I’m in this state of limbo? Any suggestions would be appreciated. Hoping my implant can be saved, but also concerned what the aesthetic outcome is going to be with this stock abutment since it didn’t work the first time. Thank you for your time.

    June 26, 2016 at 12:08 am Reply
    1. RamseyAminDDS

      Why not see someone else who you trust instead?
      Front teeth implants are not easy and should be done by a very experienced Dentist.

      July 8, 2016 at 2:03 pm Reply
  19. Ruby

    Hi Dr. Armin,
    I want to know how much would it cost to have a full
    Mouth reconstruction?
    Right now i have fixed brigde on my upper jaw an lower jaw partly dentures and real teeth.
    My insurance would only pay maximum of $1000 per year.
    Could you please advie what is tje best thing that i can do.
    Thank you so much

    March 16, 2016 at 4:27 am Reply
    1. RamseyAminDDS

      refer to this link

      March 20, 2016 at 11:34 pm Reply
  20. Ruby

    Hi Dr.
    I just want to know whats the best thing to do. I have fixed bridge on upper teeth and lower back is dentures. My lower front teeth are real. Right now i am experiencing pain in my upper front fixed bridge.
    I want to know what is the best thinh to do and how much estimated cost for it.
    Thank you

    March 16, 2016 at 4:05 am Reply
  21. Denise

    Dr. Amin,
    Thank you for your article. I previously had crowns on #8 and #9 and due to root decay required an implant on #8. I chose to replace #9 crown at the same time due to decay above the surface under the crown. The implant angle doesn’t seem ideal but there was bone shortage and a previous bone graft had failed so I was happy the implant worked.
    After the placement of the implant, my lower teeth hit the healing screw. My previous crowns had not hit the lower teeth so I assumed after the implant crown was placed, that would again be the case. The dentist indicated a custom abutment was needed. What was the purpose of the custom abutment? Could the abutment have been made to avoid the contact with my lower teeth? The dentist ground down the back of the crown as much as he could to avoid making it too thin and even ground down some of my lower tooth but they still hit.
    I am so disappointed after a cost of over $6000. My previous crowns looked and fit better. What can be done now that the crowns have been seated? They seem crowded as well. Was I wrong to expect more with an implant? I want to understand my options before going back to my dentist in a couple weeks.

    March 6, 2016 at 12:08 am Reply
    1. RamseyAminDDS

      Hmm… Custom abutments are very often needed for the critical front center teeth. It helps create a beautiful emergence from the gum. All the adjustments in your lower front teeth are normal and recommended most of the time.

      Upper front teeth are very challenging. I spend an extraordinarily long time making sure each is as perfect as possible. Your dentist may be very experienced or may not be for this type of work. Each dentist has different standards too.

      It is possible that your situation is compromised and this is the best possible result.

      Did they take a ton of photos along the way?? This is a good sign that a lot of effort was used in my opinion.

      March 11, 2016 at 4:48 am Reply
  22. Samuel Goldstein

    I need an implant for tooth #3. It already has a crown and had a root canal 6 years ago but and abscess in the tooth root has brought these on. I went to one periodontist who wants to do a custom abutment while another periodostist will just do a pre-fab. What is the best route?
    Also one of the periodontist is not coding for the use of Bio Materials (code D4265 ) during my first bone graft appt. while the other one is. Both doctors seem very knowledgable and both get high reviews. I just don’t know what to do or who to use?

    January 20, 2016 at 11:47 pm Reply
    1. RamseyAminDDS

      Hmm….why don’t you ask each one of them? There must be rational for the decisions.

      Are they using products made from your own blood like PRP PRF??

      January 23, 2016 at 5:57 am Reply
  23. Nervous Nellie

    Dr. Amin,

    Thank you for an informative article and website! I hope you can assist me with some questions I have regarding my implants:

    I have a dentist that extracted two back molars and gave me implants. Instead of healing caps, I have the abutments in my mouth currently. I remember he put them in and ground them down a bit with a drill, but then told me I needed crowns on the top… in order to fit the implants… I have a second opinion that tells me the top two crowns are not needed.

    I have now moved out of state and have a new dentist that has taken two impressions. He first quoted me a price of $2075. to complete my implants. I agreed and said I would be back after the holidays to do the work.

    I am just coming back from said appointment today. I am shocked. He now tells me that price has doubled to $4340 because I need ‘custom’ abutments… He says he wishes he could use the abutments that the other dentist installed, but he cannot. His office give me a care credit form to fill out as I cannot afford the double in price. I called back to ask exactly what abutments I have. I was told I have legacy abutments, and that I would need custom abutments. I asked what kind of custom abutments I would be receiving for $1085. ea and I was told that the abutments in my mouth would be removed and “customized”? I am really confused. Isn’t that essentially using the abutments I have? The assistant tells me they have to be customized by the lab in order to fit, or the top teeth would need to be ground down. At my appointment today, he removed the abutments I have in my mouth currently and put in other taller ones and took exrays and an impression (I guess for measurement?). He removed them then reinserted the abutments I have in my mouth. I’m feeling uncomfortable with the 100% jump in price.

    Any chance you can shed some light on this situation and let me know what questions I should be asking, and what I should expect to pay? Could the office assistant have given me the wrong information and they are in fact building custom abutments, hence the x-rays and measurements? I’m not familiar with the process and think the jump in price without any warning is a red flag.

    Your advice is appreciated.

    January 19, 2016 at 9:10 pm Reply
    1. RamseyAminDDS

      In order for the teeth to be retained by cement, the abutments have to be tall enough to hold the crowns on. Many dentist who only practice implant surgery or not aware of the restoration needs and sometimes try to give you a ”value added” free abutment. Most of the time this abutment does not work.

      Generally speaking, custom abutments are mostly unnecessary but prefabricated abutments that can be chosen and a number of different sizes can be used. Custom abutments that are fabricated from a CAD/CAM milling process are excellent and will give you a very good result.

      It is very unlikely that your new dentist is trying to do something out of ill will. I just think things were poorly planned and of course there was no communication between the restorative dentist and the surgical dentist. I hope things work out well for you.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 7, 2016 at 8:00 pm Reply
  24. Mark

    Hello Dr. Amin,
    I had implants put in #21 and #28. X-rays were taken immediately after and the Dr. was not happy with the angulation of #28. He removed the implant and put a longer one in at a different angle. Can this be a problem in the future? Also, I was told I was getting custom abutments. The abutments were both put in the same day. How do I know if they were standard or custom.
    Thanks

    January 4, 2016 at 11:57 pm Reply
    1. RamseyAminDDS

      Sounds like they did the right thing!!

      You likely had temporary “healing abutments” placed and will later have custom abutments. I assume you have the rest of your lower teeth.

      January 6, 2016 at 4:36 am Reply
      1. Mark

        Thanks for your speedy reply. #21 is being replaced as well, and #20 is being capped (4 teeth total). I was concerned that reinstallation of #28’s implant might cause problems in the future. Is that a common error?
        Thanks again

        January 6, 2016 at 4:47 am Reply
        1. Sorry, I meant #19 instead of #21 again

          January 6, 2016 at 4:49 am Reply
        2. RamseyAminDDS

          Sounds like you have a doctor that cares about you.

          It is not completely uncommon

          January 6, 2016 at 4:55 am Reply
  25. Angela

    I am having tooth two and four extracted and implants placed at the time of extraction. The surgeon was going to use stock abutments and the dentist would make a bridge for tooth three (it has a bridge being removed with the teeth). The dentists recommends custom abutments instead of the stock ones, the biggest issue is this is a new town, new dentist, new oral surgeon so I am leary of recommendations basaed on the cost difference. The surgeon’s stock abutments are about $400. each, the dentists custom abutments are $900. each, a signaficant difference when we are talking two abutments and a new bridge. Is there a reason to go with the custom abutments in this situation?

    December 9, 2015 at 2:07 pm Reply
    1. RamseyAminDDS

      Most bridges made on dental implants and need custom abutments. Prefabricated abutments often do not work for Bridges because the implants often diverge away from each other. In order for a bridge to be made all of the abutments must be angulated exactly in the same direction. This is usually not possible especially in the upper jaw because the bone slants that a different direction then wear the teeth are supposed to be. This makes it so that the straight prefabricated abutments can’t have the proper path of insertion of the bridge. The only way the prefabricated abutments can be used is if they are heavily drilled and forced into position.

      Most single teeth back molar implants can be restored with prefabricated abutments.

      If the implants are only minimally divergent, then the prefabricated abutments will need to be drilled that much and they may be able to be used. Custom, CAD milled titanium abutments would be the way to go. The dentist who is making the teeth has a better understanding than the surgeon typically when you are dealing with 2 different dentists.

      In my office, I do both. I make the teeth and I do the surgery. That way there is one single person in control which is the best way my opinion.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      December 29, 2015 at 6:10 am Reply
  26. Anna

    What is the CDT code for Porcelain fused ceramic 4 unit bridge without using an implant but only pontic.Same with Porcelain used ceramic crown 3 unit bridge (Abutment without an implant placement CDT code.Thanks

    November 22, 2015 at 3:04 pm Reply
    1. RamseyAminDDS

      Anna,
      your question is not completely clear to me to think you’re asking for the code for a porcelain fused to metal pontic which with the D6240.
      D6071 -would be a noble porcelain fused to metal retainer for the bridge.
      These codes are variable depending on what you’re dentist chooses to do. There is a lot of overlap so don’t fret at the codes don’t match exactly. There are many codes that can be used for the same thing for billing dental insurance. Unfortunately dental insurance does not cover very much at all.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      November 26, 2015 at 4:13 pm Reply
  27. Misty

    I just had my crown put on a back lost molar. It is like a child’s tooth, super small. No one said it would look like this. And I can see the metal abutment and the crown was pretty shallow and it looks like it’s just sitting on the gum and does not look real at all. I had told both the dentist and oral surgeon that I wanted the tooth to look natural no matter what. I called the dentist and he said the crown “has to be a lot smaller” on an implant. Is this true? I’m sick over my mouth. And it was not cheap. Over $6,000 for one tooth. Thanks.

    November 14, 2015 at 8:18 am Reply
    1. RamseyAminDDS

      I would seek another opinion. Occasionally the tooth has to be smaller but with today’s Tech and materials I find that to be quite rare. The tooth should look awesome.

      December 29, 2015 at 3:49 pm Reply
  28. brenda carey

    I am done with an implant and need a crown. I initially went to the one my oral surgeon recommended but his cost 2400.00. Everywhere else I called ranged from 1100.00-2000.00. I don’t really know what to do and I’m in the process of moving so I need to know if an abutment should cost approx. 800-900…? and the crown is the remaining 1500.00? Do I need something from my oral surgeon to move on to my new job and get the crown in another state which is highly likely to cost less (cost of living is significantly lesser). I’ve had other crowns and implants before and abutment has never been mentioned and I’ve never paid anywhere near this amount. Please advise. Thank you.

    November 4, 2015 at 4:49 pm Reply
    1. RamseyAminDDS

      Hi Brenda,

      The cost you mention does not sound out of range. The dental implant abutment is required whether it is prefabricated or customized. Keep in mind that a crown and abutment need to be designed, fabricated and installed perfectly for you will have future problems with the implant itself. In fact so many patients end up having problems with the implant that is caused by a bad crown or abutment. I would suggest doing your due diligence and having the best possible person make your crown and abutment to avoid long-term problems such as peri-implantitis.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      November 27, 2015 at 7:04 pm Reply
  29. Rod

    I am having dental implants. The implants will be placed in the immediate extraction site of tooth #29 and edentulous site #31. Tooth #32 will also be extracted at the same time. Will I need custom abutments on tooth #29 and tooth #31?

    November 2, 2015 at 5:11 pm Reply
    1. RamseyAminDDS

      You will likely need to custom abutments because it sounds like you’re having a bridge made on two implants. These two implants will support A three tooth bridge.

      Custom abutments will allow the angulation of the implants to parallel each other so that a bridge may be placed. Occasionally it can be done with prefabricated abutment but usually one or both abutments on a bridge require custom abutments . This is strictly due to trajectory of the implants in relationship to the trajectory of teeth which often differ because bone angles are different than tooth angles.

      November 7, 2015 at 3:05 pm Reply
  30. Ana

    You mentioned getting multiple implants as a reason for getting custom abutments. Can you elaborate? What if they are all back teeth? I will be getting multiple back implants restored and was told the cost for each abutment will be around $800. Seems super expensive and I’m unsure how much I can push back on that.

    September 29, 2015 at 5:30 am Reply
    1. RamseyAminDDS

      If the implants are being connected, the angle of ‘draw’ often does not permit the use of regular prefabricated abutments.

      This applies for back and front teeth.

      Be sure to get custom CAD rather than custom Cast abutments. One is made by robotics (CAD) while the other is man-made.

      You will have less problems with the CAD abutments.

      October 12, 2015 at 10:17 pm Reply
  31. Diane

    My husband needs dental implants for a bridge that is continuously getting loose and the dentist can’t recement it anymore. My question is, would going to a dental school be all right. It would be less costly. He was thinking of going to Midwestern University Dental in Downers Grove Illinois. Any thoughts will help.

    September 29, 2015 at 5:12 am Reply
    1. RamseyAminDDS

      Yes…dental schools are good…but you won’t save that much money. You may only save 10 – 15 percent but the procedure will take about five times as long to do.

      I taught at UCLA for many years, so I know how it works.

      You will receive good work though….just be very patient!!

      October 12, 2015 at 10:13 pm Reply
  32. Joni

    I have a question. I am in the process of getting an implant. My dentist and oral surgeon work together. I have been seeing the oral surgeon for the bone graft and the placing of the implant. I am now at the stage where I am waiting for the implant to heal (?). My next step which is not until November was to go back to the oral surgeon for him to put in the abutment. He suggested I call my dentist and make an appt right after the placement of the abutment to start the crown. When I called my dentist I was informed that the abutment that the oral surgeon puts in is considered a healing abutment and when I see my dentist 4 days later he will put in the permanent abutment. Is this true?

    September 9, 2015 at 8:33 pm Reply
    1. RamseyAminDDS

      yes this is true. Because you are working with 2 different dental providers this creates a more confusing and often more costly replacement. Typically the restorative dentist is by far the best person to choose the proper abutment. This will generally depend on the skill level and experience of the restorative dentist. The crowns and abutments are extremely important in can make or break the long-term outcome of your dental implant

      Ramsey Amin DDS

      September 9, 2015 at 8:45 pm Reply
  33. Shirley Van Noy

    I have a dental implant #8 tooth that the gum has receded and now the abutment is starting to show, how can this be fixed???

    August 22, 2015 at 3:48 pm Reply
    1. RamseyAminDDS

      This is going to be a challenge. Something is definitely going on. As long as the implant has bone on the outside wall, this can be corrected. Oftentimes there is bone missing on the outside because of inaccurate implant placement or genetically thin gum and bone that dissolved over time. There are many reasons this can occur. The thing I focused on most in my personal practice is to avoid this from ever happening .

      This post on peri-implantitis and threads showing may help you.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      August 31, 2015 at 1:15 am Reply
  34. Victoria

    Dear Dr. Amin,
    I had 3mm Biohorizon implant placed in the front upper jaw in February. I just moved to CA from NYC and I’m looking for a dentist to place an abutment and a crown. I had a couple consultations and both dentists recommended gold alloy custom abutments. I’m worried about esthetics of gold alloy and would prefer custom zirconia abutment instead. Do you think it’s possible in my case to have zirconia abutment?

    Regards,

    Victoria

    August 11, 2015 at 9:54 pm Reply
    1. RamseyAminDDS

      the newer version of the bio horizons dental implant at the 3 mm diameter does have a removable abutment. In the past it was a solid abutment that was nonremovable. The problem occurs when you get down to a small diameter is the wall thickness of the abutment begins to decrease. Zirconia does not perform well when it is very thin. So the bottom line if this is a very skinny tooth like a lower incisor, the abutment may be so thin that it fractures over time. Sometimes you have to sacrifice a bit of aesthetics for strength depending on your unique situation.

      August 20, 2015 at 4:13 am Reply
  35. Yvonne Alvord

    I will be a patient for an implant procedure in 2 wks. I want to thank you for taking the time to explain what you know as true about this. Like every service that is done for and around people the ones that want to get it done right and give it 100% are appreciated by the consumer. I thought it was interesting that you said the custom implant sometimes isn’t needed but maybe an inexperienced dentist just does it. To get it straight the first time is always best. Of course location is tricky for sure. Mine happens to be #30 so might be easier to get at. I checked two dentists and one was indeed going for the custom and doesn’t do very many implants, while the other one does them often in a larger city. I am going to go with his experience and hope all goes good. If something goes on funky I might get back to you and see what you think. Is that ok? I’m not worried just trying to be prepared. Thank you again…

    July 26, 2015 at 4:26 pm Reply
    1. RamseyAminDDS

      thank you for your very kind words. Good luck. I’m sure you are very good hands

      Take care,

      Ramsey Amin DDS

      July 27, 2015 at 4:13 am Reply
  36. mehta nitin

    which implant-abutment convection is best? role of screw length on screw loosening?

    June 28, 2015 at 8:17 am Reply
    1. RamseyAminDDS

      Hi Mehta,

      Great question! I’m assuming you meant to say connection not convection.

      The best types of connections are either internal connections or morse taper connections. The engineering of the implant should be such that the connection is extremely tight and limits micro-movement. Believe it or not, the screw does almost nothing except clamp the pieces together. As long as the connections manufactured very tightly, the screw should not loosen. If custom cast UCLA type abutments are used, these become loose fairly regularly if used in a single tooth situation. I would suggest a CAD/cam titanium based abutment if you do need a custom abutment.

      These are decisions made by your implant dentist. Of course those of more experience will use an excellent implant system that has long-term data to support it. There are tons of cheaply made implants which have loose fits.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      June 28, 2015 at 4:03 pm Reply
  37. christina r

    does the same dentist who placed the implant need to be the one who places the abutment and crown?? i was looking into finding a new dentist because i haven’t been happy with my current one but i’m in the middle of having an implant placed. the implant itself is already in, and i’ll be ready to have the abutment placed in july but really don’t want to continue seeing my current dentist. any advice on what you think is greatly appreciated…

    June 18, 2015 at 3:00 am Reply
    1. RamseyAminDDS

      No.

      Make sure you are comfortable with the dentist that restores the implant. This is a critically important part of the process. There is so much that goes into it to end up with a good result that lasts a long time. I personally design all teeth that I make. All fixed teeth are deigned in a 3D computer program through scanning.

      Find someone you like and that really understands implants!!

      Good luck!! 🙂

      June 18, 2015 at 3:14 am Reply
  38. jeanne braverman

    hello –
    i had a dental implant on my front tooth in november 2014…….
    end of april 2015 ( 5.5 months)…. i had the crown put on
    ( my dentist used a custom abutment…..because it was a front tooth).
    …. i have no pain… but have on and off “”throbbing”” a couple of weeks
    after getting my new crown.
    is this normal or do i have a problem?
    my dentist is in florida and i am in idaho for the summer…..
    any suggestions greatly appreciated.
    thank you.
    jeanne

    May 19, 2015 at 4:45 am Reply
    1. RamseyAminDDS

      Hmm…very odd. Don’t wait. Get an X-ray with someone local to you.

      June 18, 2015 at 3:24 am Reply
  39. Brook Hurd

    Could you explain why the additional expense of a custom abutment is only necessary about 10% of the time? If It can increase the cost of the dental implant by about 10%, I’d definitely like to learn how to avoid it. I’ve been looking into dental implants a lot lately. I feel like getting dentures could really boost my confidence. Could you tell me more about the price of implants? I’ve heard each individual tooth can cost up to $3000.

    February 25, 2015 at 2:31 pm Reply
    1. Ramsey Amin DDS

      Hi Brook,

      Custom abutments are needed. There are times when a prefabricated abutments will work and there are times when custom abutments are absolutely necessary. This particular post does outline many of the reasons but each patient has their own unique reason. If multiple implants are being placed and being bridged together, almost always custom abutments are needed in order for the bridge to fit down the path of draw. This is a technical term that dentists understand well. There are other reasons such as interarch space, dental implant angulation, tissue depth, splinting, multiunit screw redirection, aesthetics, color, length, width, Emergence Profile… And a whole host of others.

      Having an entire dental implant cost only $3000 is probably being performed by a dentist or facility that is not very skilled or they are focused on a supercenter type of practice where volume is all that matters. I would not suggest having your body parts replace this way.

      Rather than considering dentures, look at having fixed teeth such as the Prettau dental implant bridge. Attached is some information to help you make an informed decision.

      Prettau Dental Implant Full Mouth Bridge

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      March 2, 2015 at 12:25 am Reply
  40. Victoria

    Dear Dr Amin,

    Could you please tell me your opinion on gold abutment vs zirconia one. Is one better than the other? Does zirconia abutment make crown look more like a natural tooth?

    Thank you.

    February 13, 2015 at 6:27 pm Reply
    1. Ramsey Amin DDS

      Hello Victoria,

      Custom abutments of the past were mostly made by custom casting a Gold alloy. Nowadays most custom dental implant abutments are made of titanium or zirconia and process through a CAD/CAM computerized milling process. This increases strength and is far more accurate then custom casting with gold.
      Occasionally, on a **small**diameter implant, zirconia can be weak but most of the time it is the most ideal material to use for custom abutments in the front of the mouth as long as it meets the manufacture’s minimum thickness. At times a can be a little bit thin and at that point it would be suggested to use a metal type of custom abutment made of titanium.
      Links of interest:

      Very respectfully,
      Ramsey Amin DDS Reviews Solid Zirconia Custom Dental Implant Crowns and Abutments Instead of Metal
      Disadvantages of Dental Implant Abutments – Burbank Board Diplomate, Ramsey Amin, Reviews

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 15, 2015 at 1:14 am Reply
  41. Leonard Fisher

    Read some but not all messages and was impressed with how you are helping people. I live in a rural area with few choices. I require major reconstructive work. I have been presented a dental plan by 2 veteran, skilled dentists that calls for 5 implants, 2 pontiks and 8 crowns (3 on existing implants) for my upper month.
    1. How do you judge the following prices?
    $1850/implant, $1110/custom abutment, $1460/crown, $1460/pontik.
    2. Do I need custom abutments when I do lower mouth.
    I’ve heard that may be less necessary there?
    I don’t have insurance and all in, we’re talking $75K.
    I just want to feel that I am getting a fair package.
    I have no problem paying for quality but want to know what’s fair.
    Please advise.
    Thank you for your help.
    Len

    February 12, 2015 at 1:26 am Reply
    1. Ramsey Amin DDS

      Hello Len,

      As of 2015, the prices that you list are well within range for a skilled implant dentist.
      If teeth are being bridged together for a full mouth reconstruction type of restoration, custom abutments are very often needed. Prefabricated dental implant abutments often do not function when restoring a full mouth or a full jaw such as utilization of a Prettau dental implant bridge.

      In general full mouth reconstruction of the upper jaw requires custom abutments when doing a case of your magnitude. I routinely do procedures that range from $60,000-$120,000 when it gets complex with bone grafting and complex dental restoration.

      Hope this helps you. Good luck with everything. I am sure you are in good hands!!

      Links of interest:

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 15, 2015 at 1:30 am Reply
  42. I am experiencing sensitivity in the area of a dental implant where the filling for the screw-in crown was sealed after the filling fell out.

    Is it imperative that this implant crown be filled again?

    Another question I would like to ask you is if you use “flippers”? My experience with them is that they are awful – terribly uncomfortable, costly and make you talk like you have a speech impediment.

    Thank you

    February 5, 2015 at 10:32 pm Reply
    1. Ramsey Amin DDS

      Hello Valerie,

      The source of your sensitivity is probably not due to the screw access hole filling the came out. It is possible though, because bacteria could leech down through the whole into the abutment, implant junction closer to the bone. This would be a little bit far-fetched though. Be sure to take a new x-ray of your implant to make sure that you do not have peri-implantitis happening that may be unbeknownst to you.

      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Dental Implants –Do I Have To Be Without Teeth While They Heal?

      Yes I agree with you. Flippers are awful…. But sometimes they are necessary and can be either the best or worst temporary solution. Each situation is extremely unique but there are many other options besides a removable temporary denture that people referred to as a “flipper.”

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 15, 2015 at 2:12 am Reply
  43. Lisa Michaels

    I have a unique situation. I have a top notch oral surgeon and dentist who I have worked with for years. Have had a sinus lift and many implants with absolutely no complication to date. All of them were Porcelain/Metal cemented on

    Now I have 4 front teeth ready for implants. Porcelain/metal were used – they look fine – they are NOT cemented in.

    After just a day – I started to develop a severe case of burning mouth syndrome. I tried tolerating it but after a while I could not. I had them removed and the problem went away. Neither the dentist nor the surgeon think I have an allergy to the metals or I would have reacted to the ones in the rear of my mouth (all on both sides of the upper. I agree that that is likely. We are considering replacing this case with all ceramic but my dentist feels it’s quite possible that won’t help.

    My thought – if the cement in option worked in the past perhaps the problem is the method of placement. With the screw in method, is it possible that the teeth are going in further under the gum than they would if they were cemented on and thereby creating some irritation and/or nerve disturbance. I do definitely feel the teeth in mouth – sometimes a slight throbbing – in a way that I don’t feel any of the other implants. Seems to me I should always be aware of the teeth in my mouth.

    A pharmacist said patients they go under chemo sometimes have BMS and use a rinse 4xday of 1-1 ration of Bendryl and Maalox. Presumably if that works for some of them then once they stop the chemo the BMS should also stop. For me to try this, I have to have the crowns put on again and see if it works. And of course will it work and cure it or will I need to use this everyday for the rest of my life. If it’s not a cure then it’s not a viable option in my mind.

    Do you have any thoughts. Do cemented on crowns NOT go as deep under the gumline as the all-in-one crown and abutment? Do you think I should give the ceramic a try and if so do you think it makes sense to stick with the cement in which I never had a problem with or do you think this all-in-one is the way to go.

    Thank you for your time.

    January 12, 2015 at 6:48 pm Reply
    1. Ramsey Amin DDS

      Hi Lisa,

      The burning mouth syndrome may be caused by a reaction to the type of cement used or it could be a coincidental occurrence of an underlying medical condition. You should also see your Dr. and be evaluated for an underlying disease conditions such as diabetes.

      It is also possible you have an allergy to the specific type of metal that was used for the front teeth that may be different than the metal that was used for the back teeth. Porcelain fused to metal crowns and Bridges are all alloys. That means they are mixed with different metals to gain strength and other physical properties. I don’t think you need to rinse her mouth with the special mouth rinse for the rest of your life.

      Take off the porcelain fused to metal bridge and try on a temporary bridge. If the issue goes away than you know the answer.

      Screw versus cement retained should only be determined after you figure out if you are going to be using metal or nonmetal.

      Disadvantages of Dental Implant Abutments – Burbank Board Diplomate, Ramsey Amin, Reviews

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      January 18, 2015 at 11:00 pm Reply
  44. Ava

    Great website. A lot of helpful dental implant info here.

    January 11, 2015 at 7:47 pm Reply
  45. M Martin

    Hi Dr. Amin,

    I had titanium implants done about 7 years ago on teeth #s 7 and 10 when I was 18. Now that some years have gone by, I realize more and more that I am unhappy with the color of my teeth and gums. Firstly, my gums above these teeth are dark and gray looking – browsing through your comments it seems that this is most likely from the titanium showing through the thin front gums. Besides that, I wish I would have gotten my teeth whitened before choosing the color of my caps. They are more on the yellow side than I would like them to be and I work in the entertainment industry, so this is important to me.

    My questions for you are: how can these problems can be solved and what might that cost? Wish I could come see you in person, but unfortunately I’m on the east coast.

    Many thanks in advance! Looking forward to your response,
    M. Martin

    December 22, 2014 at 3:15 am Reply
    1. Ramsey Amin DDS

      Hello M Martin,

      There is no reason that you need to continue to live with this. If you do not like it, the area can likely be corrected with whitening, new crowns, custom zirconia abutments, and or gum grafting to add bulk. Some cases are not correctable just due to your genetic bio type. As long as you have bone on the outer wall of your existing dental implants, there are many options to cosmetically enhance your smile.

      Yes, this will cost several thousand dollars, but ultimately happiness is priceless.

      Thin Receding Gums And Dental Implants – What’s Important? Video by Ramsey Amin, DDS

      Front Teeth Dental Implant Samples

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      December 30, 2014 at 6:14 am Reply
  46. Carmen

    Hi Dr Amin,

    Long story short- I’ve had two implants put on lower left side when I was living in Europe a few years ago. Now I live in Usa and I want to finish the job but my dentist can’t find the right abutments for the Alpha Bio implants that i ready have and he is hinting that he needs to remove them and place new ones in. My previous dentist in Europe says that he doesn’t have any info on me anymore (or doesn’t want to be bothered). What other options do I have without paying a small fortune for new implants again?

    Thank you in advance for your time and consideration.

    November 10, 2014 at 7:16 pm Reply
    1. Ramsey Amin DDS

      Hello Carmen,

      Many dental implants use a universal internal hex. Some implants use a proprietary connection. The dental implant made by Alpha bio may fit into this category. Regardless, a dentist well experienced and restoring dental implants will be able to find components to restore your implants. Do not just remove them without a really good reason. I would strongly suggest you consult with another dentist.

      Here are some links that show some of the differences of screws and connections:

      Types of Tooth Implants – Burbank Expert Explains the Differences

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      November 17, 2014 at 2:48 am Reply
  47. Ramsey Amin DDS

    Hi Teekay,

    It sounds like you need a great orthodontist. When you lose a tooth and your bite shifts, oftentimes your midline will be off center making your smile look crooked. After the orthodontist corrects your shifting teeth, they may or may not create space for the teeth that were lost which can be later replaced with dental implants. You need to be seen in comprehensive manner. If you don’t do anything, things are likely to get worse over time

    Braces, Orthodontics and Front Teeth Missing From Birth…What You Need To Know Before Having A Dental Implant

    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow-American Academy of Implant Dentistry
    Burbank, California

    September 29, 2014 at 3:56 am Reply
  48. Joe cochran

    Too many decisions!

    @ seperate treatment plans, ones charging 4374 per tooth 4 and 5, )bonegraph done, ready to go with implant.) Seems the one that is more expensive is less experienced.

    So im thinking to have the implant done by one(Most experienced, 1200.00 fee each), and abutment crown by the other. (similar fee but more of general dentist) The gen dentist charging 2160 just for implant) So a more experienced implant doc charges less.

    Thanks

    What info do I need to know in order to make sure the implant will match the abutment?

    September 22, 2014 at 11:19 pm Reply
    1. Ramsey Amin DDS

      Hi Joe,
      Choose your dentist based on training, skill, education and experience in treating your situation. Sometimes the most experienced dentist are able to reduce costs because we do this very routinely.

      Of course you need to have a good relationship and like each other since you will be spending quite a bit of time together!

      How to Choose an Implant Dentist

      You will need to have any information regarding the implant matching the abutment. Your dentist will know how to mesh the 2 parts together.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      September 29, 2014 at 4:06 am Reply
  49. Rava Graves

    Dear Dr. Amin,

    Thank you for taking time to help those who are not your patients. #19 fractured so my dentist removed the crown and I am scheduled (with an oral surgeon) to have it extracted and a bone graft for an implant. The dentist is planning to place the implant at some point after healing. The oral surgeon’s staff indicated that the implant could also be done at their office. I am wondering what your thoughts are about a ‘1 step surgical implant procedure’, thereby eliminating a second surgery which is appealing to me as I am not crazy about being anesthetized twice if it is not necessary. I also read that the post-surgical discomfort and pain are much less than in a 2 stage technique procedure. Your thoughts, please? Thank you so much and God bless you.

    September 19, 2014 at 9:47 pm Reply
    1. Ramsey Amin DDS

      Hi Rava,

      Thank you for your kind words. I enjoy talking to people around the world. I believe that knowledge should be shared.

      If you’re having a combination socket bone graft and extraction, the pain typically comes from the extraction and not from the socket bone graft. Doing these 2 procedures together is great. Sometimes 3 procedures can be done together which would include the extraction, the socket bone graft and the implant simultaneously.

      The choice should be made based on what is most predictable and safe that will yield the best result rather than making his decision based on money or pain.

      Having IV sedation and intravenous anti-inflammatories will greatly reduce your pain afterwards. Using your own growth factors made from your own blood also decrease pain and swelling quite tremendously.

      ocket Bone Grafting….Do I Need It for My Dental Implant? Ramsey Amin DDS Reviews

      Sleep Dentistry for Dental Implants and Bone Grafting

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      September 29, 2014 at 4:41 am Reply
  50. Denise Fournerat

    Hello Dr. Amin
    I so appreciate you taking time to answer so many questions. I live in the Southeast which makes it geographically difficult to see you. Here is my situation and question. Thank you in advance for your time and gift of your knowledge
    I am have 19 teeth extracted ( bad crown procedure left my teeth over prepped to hold the crowns and all the crowns are falling off and the teeth are fracturing ) having said that I am having two lower and four upper implants placed for holding dentures, this will be done in stages, First – extractions- bone grafts- aveloplasty and aveloectomy – and implants- temporary dentures. 4 months later – expose the implant and healing abutments placed – 4 months later final abutments and final dentures. My question is why do I need two sets of abutments? Is it really necessary? Why can’t the final abutment be placed at the time the implant is ready? This will save me close to 5,000.00 thank you again.

    August 22, 2014 at 1:30 pm Reply
    1. Ramsey Amin DDS

      Hi Denise,

      It sounds like you’re having upper and lower over denture suture replace all of your teeth. Healing abutments and final abutment are different and you generally need both of them.

      Healing abutments are used to allow the titanium dental implant to pass through your gums. In allows see her gums to heal around the implant. In your situation, you’re implants will be buried in a traditional two-stage technique. When they are exposed it is generally not a good idea to place the final abutment at this time. This is because he did not know the shape and measurement of the gums and angulation of the implants to place the proper abutments. Oftentimes the fee for the healing abutments is built in to the surgical dental implant placement.

      I would to speak your dentist in clarify the treatment plan before you start so there are no surprises. Occasionally an immediate load denture is attached to abutments to allow you to not have to remove the denture. These are usually done when a fixed dental implant bridge is performed.

      Abutments -Burbank Dental Implants Expert -Dr. Ramsey Amin – Case Follow up

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      August 25, 2014 at 4:00 am Reply
  51. Heather

    I have a successful #5 implant of many years. 8 months ago I had extraction of #14. Complications ensued, with fistula. Revision surgery 4 months ago. Successful, currently with bone regrowth 2mm thickness at narrowest point. Now getting around to #15 which started having intermittent pain about 2 moths ago. On exam yesterday discovered it is cracked in 3 places, perhaps to root. Maxillary sinus is low-hanging. If extraction of #15 becomes necessary can bone grafting be successful and strong enough to tolerate 2 implants despite originally thin bone and further compromise by piece of bone coming out during extraction of #14? If so, how soon could bone grafting commence? I am 68 and generally in good health. If I can keep #15, do you have an opinion of benefit of bone graft and implant for #14 versus no bone graft and partial?

    August 14, 2014 at 5:35 pm Reply
    1. Ramsey Amin DDS

      Hello Heather,

      The health of your dental implants is largely predicted by the health of the natural teeth right next door.

      If a dental implant and bone graft are done for #14, and #15 flares up in the process, your likely to have more complications. It sounds like tooth #15 is questionable. At your age of 68 years, you need to have dentistry that is solid, predictable and long term. The last thing you need is a dental abscess while your 80 years old. Without seeing you, I might suggest extraction of #15 and placement of 2 dental implants with a lateral window sinus bone graft.

      This will allow you to place long implants and split the teeth together for long-term function and durability. This also allows transmission of the load of your bite into the bone properly. It will become far more costly uncomplicated to have to replace each of these teeth as separate surgeries rather than to do them together.

      The upper molars are considered the most complex teeth in the mouth to replace with dental implants due to the nature of the soft bone marrow and your bite being very strong in this area. Failure is common if it is under designed.

      And lateral window sinus bone graft in the right hands, is a very predictable procedure with a high degree of safety and effectiveness.

      Sinus Lift Bone Graft

      Connected Dental Implant Teeth or Separate Crowns …What is Best? Dentist –Ramsey Amin, DDS Explains

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      August 17, 2014 at 11:52 pm Reply
      1. Heather

        Hi Dr. Amin
        Thank you for your reply. I called your office today about perhaps going forward with implants for 14 and 15. I understand that the earliest time you might have for a procedure is in November. As I mentioned, 14 is already extracted and healed. I was wondering if I could go ahead with an extraction for 15 locally and then come down in November for a lateral window bone graft for both teeth (and also later on have you do the impIants). In other words, is it okay to have a delay between extraction and this type of bone graft? I would like to have the extraction as soon as possible.
        Thank you for your thoughts.

        September 5, 2014 at 2:54 am Reply
        1. Ramsey Amin DDS

          Hello Heather!

          If this is the Heather that I think it is… It was great meeting you in person!!! I look forward to seeing you soon. I’m glad things worked out well. Thank you for traveling the distance to be treated by me… I was very flattered by that.

          Very respectfully,

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          September 10, 2014 at 5:44 pm Reply
  52. Ann

    I had the first part of my implant completed. It healed well. When I went to my dentist for the final crown measurement he told me the post was at a 30 degree angle. He said, I will need an abutment. Will this weaken the tooth or will it be as strong as if there wasn’t an abutment?

    July 25, 2014 at 8:50 pm Reply
    1. Ramsey Amin DDS

      Hello Ann,

      Some dental implants are purposely placed at 15-40° angles. I often do this when placing implants for a full mouth dental implant bridge such as a Prettau.

      https://www.burbankdentalimplants.com/prettau-dental-implant-full-mouth-bridge/

      Custom abutments as of 2014 are wonderfully strong as most of them can and should be made by CAD/CAM milling technology. This allows a computer to design the abutment in for it to be cut out of a solid block of titanium by essentially robot that has 4-9 arms. A CAD cam milled abutments made of titanium is better than a custom cast abutment if it can be made this way.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      August 3, 2014 at 11:07 pm Reply
  53. joy

    I had tooth #14 missing and planned to have an implant. I was told by an implant dr that she would open my gum to do a bone graft to lift my membrane, which I totally understand. But I recently just finished my invisalign treatment and will have to wear a retainer for the rest of my life. I am wondering if I still need to have the implant done since the retainer basically will secure the teeth in places and as long as I keep my teeth healthy, maybe I don’t need an implant? What is your opinion? Thank you so much.

    July 17, 2014 at 8:44 pm Reply
    1. Ramsey Amin DDS

      Hello Joy!

      It is not realistic to wear a retainer your entire life. Tooth number 14 is the upper left first molar and is one of the most important teeth in the entire mouth. The longer you wait, the bone will shrink even more. This will make lifting of the sinus membrane more complex, risky and costly. The sooner you have it done the more straightforward this procedure will be.
      An orthodontic retainer can not support your bite as a dental implant or natural tooth can. Even people that have partial removable denture still have tooth movement. God gave you all these natural teeth for reason.

      https://www.burbankdentalimplants.com/why-even-have-missing-teeth-replaced-dental-implants-etc/https://www.burbankdentalimplants.com/sinus-lift-bone-graft/

      😉
      Very respectfully,
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      July 20, 2014 at 8:52 pm Reply
  54. Allison O.

    I had several upper front teeth get implants and we are in the process of getting the crowns and bridges made. Earlier in the week we did what we thought was going to be placement of the permemat crowns but they were way way off and the two front teeth were angled incredibly froward.. my dentist was really surprised that the lab would do that.. but in the process I asked why they would even look like that at all. And she stated that the surgeon had to place the feont ones at an angle somewhat because basically they would have gone through the top of my jaw I guess she was implying. Itru my dentist and the aurgeon has always been very thourough and has great respect here..t couldthat true?
    and i do have asmall face and even with bone grafting my dentist said theres no way to make hem the same exactly because of the original bone loss

    July 11, 2014 at 10:03 pm Reply
    1. Ramsey Amin DDS

      Hello Allison,

      I’m sure your dentist in dental implants surgeon know what they are doing. Upper front dental implants are by far the most difficult situation to replace so that it blends perfectly with your other teeth.

      What is created by god in nature is always different than what can be created artificially by man. I am not saying that a near perfect result cannot be done, I’m just saying that there are realistic expectations and limitations to all dental implant reconstructions.

      In my private practice and Burbank, the planning of an upper front tooth takes 2-3 visits prior to ever doing anything whatsoever. There are photographs, 3-D scans and 2 meetings with the patient prior to doing any treatment at all. Virtual renderings are made of the teeth so that every possible compromise or complication can be addressed prior to them ever happening. I know, it is a lot to do for just one tooth, but it is such an important tooth being in the very front of your mouth to be done as good as possible.

      It is essential that the implant is placed in the most ideal position possible as that will have the greatest affect on the final aesthetic outcome. Most upper front teeth require bone and/or gum grafts in order to make them look perfect with dental implants.

      I hope I helped answer some of your questions. Please visit my smile Gallery webpage to get some examples:

      https://www.burbankdentalimplants.com/smile-gallery/

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      August 3, 2014 at 11:49 pm Reply
  55. Mike S

    Hi,

    Hi Dr. Amin,

    I have five implants. My question is regarding the implants for teeth 28 & 29, especially tooth 28. It sometimes feels like the crown comes out too far and can rub against my lower cheek and touch my upper cheek just inside the lip. I’m wondering if an angled abutment could could help to move the tooth in and away from my cheek and lip.

    Thanks,
    Mike

    June 27, 2014 at 6:41 pm Reply
    1. Ramsey Amin DDS

      Hi Mike,

      It sounds like your crown is just too bulky. You can likely Just change the crown and leave the abutment intact.

      The dental implant crowns made in my office are scanned into a computer, designed on a computer and milled through multiple robotic arms. They are then hand glazed and tinted for color and character.

      This attention to detail will provide a tooth which is designed for proper contours, function and esthetics.

      The dentist must guide the lab on how each tooth is to be designed. There is A LOT that goes into this.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      June 30, 2014 at 2:41 am Reply
      1. Mike S

        Thanks for the response. I think you might be right that it is a little bulky, but I also think part of the problem is where the implant is placed. The placement might have been necessary due to what bone was available. I have crowns that are retained with a screw at the top, so I can see there isn’t much room for the crown to be brought in and away from my cheek. That is why I’m wondering if an angled abutment with a crown cemented to it could possibly be a better way to go in this situation. What are your thoughts? I will probably make an appointment to discuss this with someone in my area (Chicago), but would appreciate any insight you have.

        Thanks again,

        Mike

        June 30, 2014 at 9:21 pm Reply
        1. Ramsey Amin DDS

          Hello Mike,

          A custom titanium abutment and cement retained crown may be the answer. I would suggest that the abutment be fabricated by milling it from a solid block of titanium rather than a custom cast abutment. a screw retained crowns and would only be needed in this area if you’re teeth are really short.

          https://www.burbankdentalimplants.com/abutments-burbank-dental-implants-expert-dr-ramsey-amin-case-follow-up/

          The abutments in this link above are not custom. You can see that the abutments are in line with the teeth and don’t stick out at all. It sounds like your implant was put in had a funny angle.

          Ramsey A. Amin, D.D.S.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          July 7, 2014 at 2:46 am Reply
  56. Jay Laflamme

    Dear Dr. Amin,
    I also meant to ask when I should start flossing under my crown? As I just had stitches under it five days ago I do not want to interfere with them
    thank you
    Jay Laflamme

    June 9, 2014 at 11:03 pm Reply
    1. Ramsey Amin DDS

      if the area was surgically altered you should wait about 10 days to floss

      June 11, 2014 at 1:15 am Reply
  57. Jay Laflamme

    Dear Dr. Amin
    I’ve read your website and it is very informative and you are very kind to take so many questions. I too would like your opinion. I had a Standard Titanium Implant (#19,30) placed on molar number 30. It healed with no problems and after four months my dentist said he would check and see if we could proceed to the next stage of abutment and crown. He opened the gum; removed the healing cap and said the implant looked very good and he then placed the abutment. He then took an imprint for the crown and I came back later in the week to have it placed. While I waited for the crown I had no pain with just the abutment. When he placed the crown he packed some bone grafting around the abutment and added some self disolving stitches before he cemented the crown. The crown fits very nicely and looks beautiful. Today is day five and though there is not really pain the gum feels very sensitive all around the crown and I’m not sure if I’m imagining it but it may be slightly receding on the outside side of the crown?? The tooth is very solid and does not hurt if I put pressure/chew on it at all. Is it normal for the gum to be very sore after the crown is placed ? Is it normal to put bovine bone graft under the crown when placing it? Is it normal to open the gum and put in the abutment and then the crown 4 days later? Is it normal for it to hurt more at night? My dentist office has a message that my dentist is on holiday for three weeks and I am asked to go to another dentist if I have concerns. I am not sure if this is all just normal healing and will settle soon.
    Thank you very much in advance
    Jay Laflamme
    British Columbia Canada

    June 9, 2014 at 10:14 pm Reply
    1. Ramsey Amin DDS

      hello Jay, I will try to answer your questions!!
      I’ve read your website and it is very informative and you are very kind to take so many questions. I too would like your opinion. I had a Standard Titanium Implant (#19,30) placed on molar number 30. It healed with no problems and after four months my dentist said he would check and see if we could proceed to the next stage of abutment and crown. He opened the gum; removed the healing cap and said the implant looked very good and he then placed the abutment. He then took an imprint for the crown and I came back later in the week to have it placed. While I waited for the crown I had no pain with just the abutment. When he placed the crown he packed some bone grafting around the abutment
      and added some self disolving stitches before he cemented the crown.

      this is definitely a bit strange–Sometimes the gum will be opened slightly just to allow the crown to sit on the margin and remove residual cement.

      The crown fits very nicely and looks beautiful. Today is day five and though there is not really pain the gum feels very sensitive all around the crown and I’m not sure if I’m imagining it but it may be slightly receding on the outside side of the crown??
      I would not be surprised about this because he basically had surgery on the same day the new tooth was put in

      The tooth is very solid and does not hurt if I put pressure/chew on it at all. Is it normal for the gum to be very sore after the crown is placed ?
      not normally

      Is it normal to put bovine bone graft under the crown when placing it?
      no
      Is it normal to open the gum and put in the abutment and then the crown 4 days later?
      no not really
      Is it normal for it to hurt more at night?
      all of this is just a bit abnormal. The fact that bone was put in at the same day the crown was cemented is definitely odd

      My dentist office has a message that my dentist is on holiday for three weeks and I am asked to go to another dentist if I have concerns. I am not sure if this is all just normal healing and will settle soon.
      Thank you very much in advance
      Jay Laflamme
      British Columbia Canada
      I wish you weren’t so far away. Make sure you see your dentist soon as possible. My guess is most of that bone is going to get rinsed away.

      sorry for all the bad news… Keep me posted please

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      June 11, 2014 at 1:21 am Reply
  58. Steph C

    I recently had the all on 4 procedure(about a month ago). The way the prosthodontist placed the abutment causes me to look like I have awful buck teeth & dramatically changes my appearance- for the worse!
    I hate it! When asked, the dentist replied he can’t “push it back” for 6 months. I’m VERY upset. Can you please advise? I don’t even look like me anymore.

    April 6, 2014 at 12:26 am Reply
    1. Ramsey Amin DDS

      Hi Steph,

      This video link should help answer some of your questions. It is a review on all the on four procedure

      Your comment about not even looking like yourself is a really common after having the all on four dental procedure. It is all about planning and a really good surgical abilities to avoid this.

      The reason for this is that oftentimes the final teeth are attached on the same day of the surgery. It is my opinion after doing this procedure for 15 years, that the final teeth should not be attached on the same day of the surgery. It is okay to attach temporary teeth, but just don’t do the final ones.

      The all on four dental procedure is very under engineered. The reason your dentist cannot correct things is it is too risky to unscrew the bridge while the implants are so new. The implants themselves could unscrew because they haven’t been given time to integrate to the jawbone.

      Typically we try to do a try-in procedure prior to extraction and same-day dental implant replacement. I routinely do this with my patients so they can see their teeth in their mouth before the actual procedure takes place. It is best to pre plan all surgical and prosthetic stages of complex implant dentistry.

      I have found over the years that the all on 4 procedure in **some** clinics is a really quick and dirty procedure that is poorly planned out.

      Be sure to find out if you’re final teeth will be plastic denture teeth or porcelain/zirconia teeth.

      Good luck and hang in there!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      April 29, 2014 at 4:35 am Reply
  59. Rebecca

    What is a healing cap?? When showing your basic 3 part implant
    1. implant
    2. abutment
    3. crown
    When is a healing cap necessary.

    February 24, 2014 at 5:23 pm Reply
    1. Ramsey Amin DDS

      Hello Rebecca

      A healing abutment is an intermediary piece used during the dental implant treatment. If the implant is placed in a single stage, meaning through the gum, the healing abutment prevents the gum from closing over the top of the implant.

      It is typically a titanium domelike structure that is screwed into the top of the implant. It will be replaced when the final crown is seated.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 25, 2014 at 12:04 am Reply
  60. Teresa M Halperin

    I will apreciate if you could answer this question:
    After almos 1 year my implant on the upper front start having an odor,I do keep good oral cleaning, but still that odor ,,my dentist tell me I should have done a Custom Abutman,as he told me in that time ,but I did not,because I was told by others it was not need and it will only be more money. Now he think I should remove it and place a custom abutman and a new crown if I continue having this problem after I finish the antibiotic he told me to take….Could you please advice me ? I really apreciate so much if you could do it…….And pardon my spelling, thank you very much

    February 18, 2014 at 7:44 pm Reply
    1. Ramsey Amin DDS

      Hello Teresa,

      Your dentist is probably right. A custom abutment likely should’ve been done the first time to prevent the margin from being so deep which can create an odor. Without seeing you it would be impossible to know this for sure, but I have seen this many times before.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 25, 2014 at 1:14 am Reply
  61. joanne

    Thank you, I’m glad I asked about the pink porcelain, I thought it was something that would be preferred for people with high lip lines where it is obvious the gum shrinkage.

    Today I met with the dentist, everyone is of different opinions. She thinks it would be best to remove 8, 9, and 10. But, she would add implants at the time of extractions. Her suggestion is a bridge on the four teeth, but implant on teeth 7, 9 and 10, I had thought it was too many implants in the four tooth spot. She doesn’t think the two on the outside will support the four teeth. I agree with her, that why should i buy 2 teeth now, and then a four tooth bridge in a few years, my only concern is that it will look funny if there are too many implants. what do you think?

    Thank you very much,

    January 31, 2014 at 12:38 am Reply
    1. Ramsey Amin DDS

      Hello JoAnne,
      If you are going to extract #8 and 9 it is probably better to only place two implants on the ends 7 through 10. The main thing you’re trying to avoid his having implants that are too close to one another. Ovate pontics work great here!

      https://www.burbankdentalimplants.com/the-ovate-pontic-ramsey-amin-dds-of-burbank-explains-this-dental-implant-bridge-detail/

      It works great if you have very large wide teeth, to have one implant per tooth. So without seeing you I couldn’t tell you what is best.

      Respectfully,

      Dr. Ramsey Amin

      February 5, 2014 at 6:17 pm Reply
  62. joanne brown

    Hi, thank you for this informative forum.

    I need to get implants in tooths #7 and #10, I already have quite a few in my mouth, but they’re all in the back, and i wasn’t nervous, nor did I question any of the placements, implants abutments or crowns.
    #8 and #9 still have some life to them, although the gums have receded significantly over all of them including the cuspids. I had tooth #10 pulled and bone added already, and will hopefully do the same to #7 this week.
    I have a big smile and so much of this recession has been making me keep my mouth closed for a long time. It’s been periodontal issues.
    My mouth is on the larger side, but never wore braces (or needed) and all my teeth are relatively a nice shape and fit well in my mouth. I’ve had the stuff fillings are made of filled in on a lot of the area where gums recede (another mess), I don’t know if this should be removed from 8 and 9, before I begin all this, or if that will make the final 7 and 10 to small, or leave it, and get 7 and 10 made with pink porcelain on the tops of the crowns-any advice on that?

    My other question is since i have a good size mouth and what will be ample bone, do you think a standard implant, abutment will do? What are your favorite implants (size, and make) for #7 and #10.

    Thank you again

    January 28, 2014 at 4:50 am Reply
    1. Ramsey Amin DDS

      Hi JoAnne,

      Thank you for your very kind words. It sounds like you have fillings up at the gumline to cover over abrasions of your roots. Those are done with white fillings.
      Unless you have a very low smile line and don’t show any gums I would not suggest using pink porcelain for the single teeth numbers 7 and 10. He really don’t want to see the pink transition zone in the smile as it is really difficult to hide. I use pink tissue porcelain on dental implants a lot, but she have to be very careful how it is placed, where it shows and a host of other factors. It looks really awesome when used correctly and really horrible when used incorrectly

      You may be able to have gum grafts over the roots on teeth 8 and 9 therefore lowering the gumline and evening out implant 7 and 10. This all has to be considered before ever placing the implants on 7 and 10 so that they can be placed at the right tissue depth.

      A standard abutment rarely works well in the front of the mouth. A custom dental implant abutment will shape to your unique gums. The scalloping of the tissue and emergence profile of the custom abutment can’t be matched in the front of the mouth. In the back of the mouth prefabricated abutment or screw retained abutments will work just fine in many situations where the implant is well placed.

      Good luck!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      January 29, 2014 at 5:14 pm Reply
  63. Ismy

    Hello doc,

    I recently had an implant (straumen) of my front tooth (1:1 as the doctor says). The surgery went fine and i was also given a denture to wear and it was relieved from the area of the implant. I was told by my doctor to do the mouthwash regularly and just today while i was doing mouth wash the cap ( white thing on top of implant) it broke. Although it didnt cause any pain i need to know if i should have a new cap on the implant as i still have to wait for around 4 months for crown etc? Secondly if my implant is exposed will it cause infection and shall i wear denture in this instance?

    Many Thanks
    Ismy

    November 14, 2013 at 11:53 am Reply
    1. Ramsey Amin DDS

      Hi Ismy,

      I am guessing the white part is just a cover cap and shouldn’t be an issue for you. I would see your call your dentist and discuss this so they are aware. The implant may need to be re-exposed at the time of your crown placement.
      😉

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      November 20, 2013 at 5:21 pm Reply
  64. Bev

    If the abutment fits perfectly in the implant in the impression tray, but does not fit the implant in your mouth, why would that be?

    November 3, 2013 at 9:31 pm Reply
    1. Ramsey Amin DDS

      Hi Bev,

      From the impression to the final tooth there are about 500 things that can go wrong. Examples would be, rotated analog in stone, warped cast, void in impression material, adjacent tooth movement, platform damage and many more.

      I’m sure your dentist will correct it. These things happen and sometimes the exact reason can not be determined.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      November 13, 2013 at 8:54 pm Reply
  65. marguerite

    My general dentist instructed the implant specialist to put install the implant at a particular angle so that she could do custom abutment. She told me that it was necessary for a perfect fit. “Custom abutments are smaller” and will give a better fit, she says. That seems logical but expensive-740. per abutment . Shouldn’t the implant specialist be installing the custom abutment? Do the healing caps need to be custom also? Implant specialist is putting on healing caps prior to the custom abutments. I am waiting on an answer from him regards this question. Can’t see how a custom abutment would fit over a standard implant.

    Reply
    – See more at: https://www.burbankdentalimplants.com/do-i-need-custom-dental-implant-abutments/#comment-2756

    October 22, 2013 at 12:39 pm Reply
    1. Ramsey Amin DDS

      Hi Marguerite,

      When a custom abutment will improve the final outcome of your tooth it is definitely worth it. You can make a custom abutment for almost any standard implant.

      I would suggest a CAD milled custom abutment rather than a custom cast abutment.

      Sometimes an implant tooth can ONLY be made with a custom abutment. If a prefabricated abutment would work well, I’m sure your dental implant dentist would be done.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      October 27, 2013 at 3:11 pm Reply
  66. burd cleary

    Please help me – I had an implant put in 5 months age. First part healed beautifully (also had bone graph) with no pain or problem. When abutment was put in 6 weeks ago, I have had grade 4/5 pain off and off. Surgeon has cleaned out gum in that area twice and put in new abutment. I still have pain and hesitate to go to my dentist and have final tooth put in. I am very concerned about this as the pain will not go away. There is not swelling, redness and surgeon said there is no infection. As soon as the cap is put on the abutment, pain starts in a day.
    Thank you so much for help

    October 17, 2013 at 12:50 am Reply
    1. Ramsey Amin DDS

      Hi Burd,

      The implant may have rotated when the abutment was placed. Your implant may be failing. Have you taken x-rays or a 3D scan yet?

      https://www.burbankdentalimplants.com/cone-beam-3d-ct-scan-x-ray-basics-for-dental-implants/

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      November 13, 2013 at 9:54 pm Reply
  67. Loretta

    I have learned much from your website and would like to ask you a question or two on implants…I have had a lower back molar ectracted (by a periodonist) (375.00) and he also did a bone placement graft weeks later for 1,250.00 …I will be ready for the placement of the implant in November with a cost of 2400.
    Then my new dentist ( I consulted with him for some cosmetic work) is going to finsh the implant with a custom abutment ($500.- $1,000 ) charge, and lastly an implant crown for $2300.
    All in all, a total charge of $6825.- 7325.00 for one implant….this seems a little high to me….what are your thoughts? …(2300.00 for a crown seems a little high to pay)
    Thanks so much for all of your time and effort!
    Loretta

    October 15, 2013 at 3:10 pm Reply
    1. Ramsey Amin DDS

      Hi Loretta,

      It sounds like you don’t have a straightforward implant!!! Those fees are not out of line for a *VERY* experienced implant dentist in 2013 doing a very difficult case.

      I am often able to save my patients a lot of money by doing both the surgery and the teeth process myself. Most people are surprised!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      November 13, 2013 at 10:00 pm Reply
  68. Brooks

    Your article lists 5 major reasons when custom abutments are required but also implies in the beginning of the article that implants placed at an incorrect angle require a custom abutment. Is this correct. What about a situation where the implant has to be placed at an angle because the teeth on either side are at an
    angle? FYI implant was performed on #31. Thanks in advance.

    September 25, 2013 at 10:42 am Reply
    1. Ramsey Amin DDS

      Hi Brooks,

      Yes, angulation is another reason to use a custom abutment. I place many implants purposely at alternate angles to maximize your available bone. #31 usually leans toward your tongue naturally.

      Your teeth and bone are not straight but implants are. Sometimes you need to accommodate this difference with an angulated custom or prefabricated abutment.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      September 26, 2013 at 1:48 am Reply
  69. marguerite

    Please advise. I had one implant with a standard abutment on the upper side last year. I had to have ridge augmentation and bone transplant on the lower two on same side. The implant specialist was instructed by the regular dentist to position the two implants for custom abutments. The bone transplant was only 5o% successful(not sure what that means!) Additionally, one of the supporting teeth will be crowned but will have to be removed eventually because it is too small and will fracture. What should I do?

    September 10, 2013 at 12:18 am Reply
    1. Ramsey Amin DDS

      Hi Marguerite,

      Can you explain your implant and abutment situation more clearly? I don’t really understand what you are trying to say buy I want to help!

      Sorry,

      Dr. Amin.

      September 11, 2013 at 3:23 am Reply
      1. marguerite

        My general dentist instructed the implant specialist to put install the implant at a particular angle so that she could do custom abutment. She told me that it was necessary for a perfect fit. “Custom abutments are smaller” and will give a better fit, she says. That seems logical but expensive-740. per abutment . Shouldn’t the implant specialist be installing the custom abutment? Do the healing caps need to be custom also? Implant specialist is putting on healing caps prior to the custom abutments. I am waiting on an answer from him regards this question. Can see how a custom abutment would fit over a standard implant.

        October 22, 2013 at 12:36 pm Reply
  70. Ines

    Dr. Amin –your work is great. I am a dental lab technician in Germany finishing my implant training. Thanks for the inspiration.

    August 11, 2013 at 9:19 pm Reply
    1. Ramsey Amin DDS

      Thank you for your kind and flattering words Ines!

      🙂 Dr. Amin

      September 4, 2013 at 10:05 pm Reply
  71. Nancy

    My husband is in the process of getting implants. He has already had work done by the oral surgeon and now he is going to our regular dentist to fix the rest. The oral surgeon was not one of the dentists in our dental plan so we had to pay out of pocket. Now our regular dentist is putting in 2 implant supported porcelain fused to metal crown and 2 custom fabricated abutment. Since he is a participating dentist in our plan and to which we have been going for over many many years, my husband thought that these would be covered but we have found out recently that they are not. The fee charged for each was $2,000 which is a total of $8,000 which we cannot afford at all! As I have been researching prices, I have seen that these can be less than $2,000. We are at our wits end. I saw in your blog that you mentioned that the standard prosthetic abutment can support a crown in the posterior molar region and is less money than the custom. My husband’s implants are in the back of his teeth. Is there anything else than can be done – like just get regular crowns now. We are just not able to pay this large fee.

    July 16, 2013 at 6:05 pm Reply
    1. Ramsey Amin DDS

      Hi Nancy,

      Something seems a little off here. I would speak to the office. There may be a miscalculation. The dental implant custom abutment alone should not cost $2000.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      August 8, 2013 at 4:07 am Reply
  72. Kate

    Dr. Amin,

    I have 7 dental implants 3 in each upper sides (left & right) molars next to the K9’s. My dentist just finished putting the crowns in the right side. She claimed she put custom abutment that is why my bill was very high. However, I see metal in the top of my teeth and in your illustration seems white abutment for custom? Can a custom still be all metal?

    July 5, 2013 at 3:30 am Reply
    1. Ramsey Amin DDS

      Hi Kate,

      Yes, custom abutments are often made of titanium and look like metal. Not all dental implant custom abutments are white. The white ones are typically zirconia.

      😉
      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      July 5, 2013 at 2:15 pm Reply
  73. Julia

    Dr.Amin,

    I have an implant on tooth #19 seven months ago. Now it is time to put on the crown. I had consultation with 2 different doctors. One told me that I need a custom abutment and the other said it’s not necessary. Can you please have a look at my X-ray and give me your opinion?

    Thanks,

    Julia

    July 1, 2013 at 3:47 pm Reply
    1. Ramsey Amin DDS

      Hi Julia,

      From X-ray alone it will be impossible to tell if you need a custom abutment. There are so many factors that are important.

      Here are just a few factors:
      Shape of the gum, thickness of gum, space from top to bottom, angulation, implant depth, multiple splinted implants.

      In most simple situations, if the dental implant is placed by an experienced dentist, a custom abutment an be avoided.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      July 4, 2013 at 1:38 pm Reply
  74. Carina Aitken

    Dr Amin,

    My apologies, I just looked on my dental record and I gave you the wrong teeth numbers. It’s my upper front left central tooth and the one beside it that were extracted. My records say these are #21,22. It is #21 getting the implant.
    Regards,

    Carina

    March 8, 2013 at 4:00 am Reply
  75. Carina Aitken

    Hi Dr.Amin,

    I will be getting a titanium implant for tooth #10 in a few weeks. (My front left one, I hope I said the correct number). My perio is charging $3800 for the surgery as he said there is a little bone grafting he will need to do at the same time. My dentist who is wonderful referred me to him as she had performed a root canal and crown on that very tooth 3 years ago. It was extracted along with tooth #11 (right beside it) because I developed a draining cyst on the gum between these two teeth, which was not at all painful but wouldn’n’t heal.
    The maxillofacial surgeon and perio referred me back to my dentist to determine whether 2 implants for #10 and #11 were preferable. Perio said for longevity 2 implants were better, however 1 implant with a bridge attached to my canine tooth was better aesthetically. My dentist agreed with the bridge option and said because my tooth #11 was very small before, 1 implant and a bridge on the canine would be better for me. She doesn’t usually like to damage good teeth but said she felt it was better for me. I would very much value your professional opinion and think that is wonderful of you to take your own time and answer queries from patients who you’ve never met. What a great man you are!
    Regards,
    Carina

    March 8, 2013 at 3:01 am Reply
    1. Ramsey Amin DDS

      Hi Carina,

      Having two implants side by side in the front of the mouth is challenging aesthetically. This is because the triangle of gum between them often recedes leaving a hole or square teeth.

      A cantilever is not a bad idea at all. I do this also. Keep in mind you can also cantilever off of an implant or use some really awesome gum colored porcelain. How low or high your smile is a major part of that decision.

      Good luck and thank you for your kind words. 😉

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      March 9, 2013 at 4:34 am Reply
  76. cathy

    Dr. Amin,
    I had an implant (biomet3i) on tooth number #19 last July and went back to my general dentist to get abutment and crown. The general dentist ordered a custom abutment but the shape of abutment is square. The surgeon that put the implant in, had a cylinder healing cap. When the general dentist tried put the square shape abutment into cylinder shape implant, it was so painful. I refused let him to put it on because I’m wondering if it’s custom abutment, how come it will be square shape. I want to get an second optional. Is sounds right to you that come with different shapes on abutment. I look forward hear from you. Thank you very much!

    February 19, 2013 at 7:11 pm Reply
    1. Ramsey Amin DDS

      Hi Cathy,

      A square abutment is not a bad thing! The top of the abutment is made square to prevent rotation of the crown. If it was circular, the crown would spin and likely come off easily.

      The gum part is often bigger than the healing abutment in order to provide a better emergence of the crown. You may have to get numb to insert it.

      It is best to let your dentist proceed.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 27, 2013 at 5:18 am Reply
  77. John

    Greetings:

    After having two root canals and two crowns on #30 we opted for extraction and implant. It was about one year between extraction and setting the implant. It has been 5-months since the implant was set in the bone. We are getting reading to start working on the restoration. It appears that I have a very large gap between #29 and #31, #31 is possibly migrating backwards. My regular dentist in the USA recommended a custom abutment. I live out of country in Colombia and the doctor performing the work is trusted and professional. The implant appears to have been set correctly and straight. What are the options I have for abuments materials, what is recommended and what is most successful? Will a custom abutment do anything to help with a possibly over sized gap? And make material would you recommend over it for the crown? I am not sure if a custom abutment can even be fabricated here. I have a Biomet 3i implant…does they do the abutment and crown or does some private lab do that part. Should the abument and crown come from the same place? Thanks for all you help…

    Regards,
    John

    December 8, 2012 at 11:59 am Reply
    1. RamseyAminDDS

      Hi John,

      The custom abutment might help. The lab can fabricate an Atlantis custom titanium abutment for you. Over this you can make a monolithic zirconia crown. These are both modern methods to achieve your goals. Gold is another strong option if you don’t mind metal in the mouth.

      The large space will put some extra force on the bone and the crown. This is called a cantilever force.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      December 25, 2012 at 4:44 am Reply
  78. Mary

    Dr. Amin,
    I just had a broken bridge removed from my lower right teeth. #31 is missing. I discussed getting an implant with my dentist. He agrees this is a great option for me as I have very strong bone to work with. However, he says he will need to place two implants in order to correct the one missing tooth. I do not understand this and have found nothing to support this method online. Do you have any input for this treatment?

    December 1, 2012 at 1:47 am Reply
    1. RamseyAminDDS

      Hi Mary,

      You probably had a three tooth bridge from 31 to 29. You were already missing the middle tooth 30 and now you lost 31. You will be missing the very back two teeth.

      It is strongly recommended not to attach implants to natural teeth. That being said, two implants are necessary to replace teeth in that area.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      December 3, 2012 at 3:49 am Reply
  79. sustain internal bevel implant

    August 17, 2012 at 1:29 am Reply
  80. Dr. Amin,
    what a nice and informative site you got here!
    To help you answer Robert`s question (if you do not mind)
    Atlantis is a great system, however ,some brands may not be covered by it.There are some dental labs or milling centers that will make custom abutments for most of brands. At HiCeram dental lab we make these custom abutments in any size and for any brand using our own facility. Depending on the brand name some custom made abutments may be even less expensive than prefabricated ones.

    August 16, 2012 at 6:28 am Reply
  81. Is there a company that handles hard to find abutments?

    August 10, 2012 at 1:57 am Reply
    1. Hi Robert,

      What brand of implant do you have? You can always custom make one! Atlantis is a popular company.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      August 13, 2012 at 3:29 am Reply
    2. RamseyAminDDS

      Atlantis abutments can usually be custom made for you.
      What is the brand of implant you have?

      November 16, 2012 at 5:04 am Reply
  82. Glenn

    Dear Dr. Amin,

    I just had #19 pulled (It had had a root canal and became abscessed). My periodontist charged $345 for the extraction and $510 for the bone graft. In four months, he will place the implant. He quoted $160 for the stent and $2200 for the placement.

    Four months after that, I will return to my regular dentist. I was quoted $795 for the custom abutment (code 06057) and $1850 for the crown (06058). So altogether, this is over $5000. I am experiencing “sticker shock.” I see much lower prices quoted here and elsewhere. I live in Laguna Niguel. Is this a more expensive area for such work? Or is #19 a more expensive tooth? Both doctors are very good. I don’t have insurance but I do have an Aetna dental plan, whose prices for the abutment and crown are only $400 lower, but I was told my dentist would not honor those prices for this work. A friend had similar work in this area for similar prices. I don’t understand why the prices I read online are so much lower. I don’t want shoddy work that will cause more problems later, but do I have to pay this much?

    July 15, 2012 at 2:38 am Reply
    1. Hi Glenn,

      I think your last line says it all. Choose your dental implant dentist based on their skill, training, experience and judgment. These are body parts you are replacing. The fees are within a normal range as of 2012 for a very skilled implant dentist.

      There are several areas in my own practice that I am able to save my patients a significant amount of money since I do the surgery AND make the tooth.

      Sorry for the sticker shock!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      July 15, 2012 at 8:05 pm Reply
  83. jodi

    Hi Dr. Implant of molar was successful. No pain at all. 6 months later when abutment andhealing cap werqere put in…….major pain! Feels like healing vapid on too tight. Oral surgeon and dentist are stumped. He has removed cap 3 tq

    June 21, 2012 at 8:32 pm Reply
    1. Hi Jodi,

      You question was cut off. Can you resend it?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      June 24, 2012 at 9:46 pm Reply
  84. Joy Yang

    Hi Dr. Amin,

    I had a post several weeks ago and thank you so much for the response. That helps a lot!

    I still have several more questions would like to get your opinions:

    -is that fine to just have local anesthesia? the doctor I went to told me that they do offer oral conscious sedation (which is a mix of different pills that leaves you conscious but you have no memory of the procedure). It is a bit more expensive for that and there is more paperwork that needs to be filled out prior to the appointment.

    -the doctor also told me that for an implant #14 a Sinus augmentation would be ideal but you can get away if you use a shorter implant. Most likely the sinus membrane will be broken. Post-Op Anti-biotics will ensure against any sinus infections. Do you think that makes sense? I’m a bit intimidated by what he said. will i get infection or chronicle nasal problem in the future?

    Joy

    June 21, 2012 at 1:42 am Reply
    1. Hi Joy,

      Some type of sedation is the way to go. Depending on the method of placement, the surgery can be tough for you. I would suggest sedation for dental implant placement. Some upper implants are placed with compression which is a feeling that can not be numbed.

      If a sinus lift bone graft is needed, that is the right way to do it. The upper jaw is best served with longer implants. The membrane is not usually broken. If the sinus lining is broken, it will most likely repair itself.

      Ask how many sinus procedures he has done.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      June 24, 2012 at 11:28 pm Reply
  85. Christina

    Hi Dr. Amin, It’s been almost a year since I had a 3mm implant for tooth #7. For six months now, I have been working with the dentist and lab to get a good shade and shape for the crown. I am told that I have to have the metal abutment because of the 3mm implant. This abutment shows blue/grey through the crown. I have taken several trips to the lab and dentist office and am now on my third trial crown. They just can’t seem to get it right. If it’s not the color then it’s the shape that keeps changing. I am so fed up!!! Now the lab says I will have to pay for another crown if I want them to do it over. Why should I have to pay twice for them to actually make a wearable crown? My dentist says that I am focusing to much on #7. Well, for paying over $4k out of pocket for the whole procedure, I think I am entitled to getting a good looking crown so that I can smile confidently again. With all the technology today I feel that the lab should be able to make a crown as far as shape and color. It seems as though the dentist blames the lab and the lab won’t work with the dentist and I am stuck in the middle. Please Help!!

    June 13, 2012 at 10:24 pm Reply
    1. Hi Christina,

      Can you get a custom zirconia abutment from Atlantis? If anyone can make it, they would be the ones. The problem is the narrow 3.0 platform.
      You can always make a PFM custom abutment to get some white color under the gum.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      June 24, 2012 at 9:57 pm Reply
  86. Jennifer

    Hi Dr. Amin,
    What would you charge to do an implant on the top front upper jaw. It is one of the two front teeth in the center of the mouth???

    I sent more than 20 mintues reading through all your comment and decided I would like to ask another question. Can u think of a reason why a dental practice that is in-network with my dental insurance ask me to pay up front for my abutement crown??? They have all my insurance information and have over 1 week to verify that I am who I am. Obvious they can get the information that I have enough money to cover the 60% of the crown. And this denist is not my regular dentist I go to. My regular dentist can do abutements ,but when I told him the implant that was placed in my front lower jaw tooth is a Legacy , then he said he never heard of it and didn’t go any futher. It sound like he is familiar only with the popular brand implant and worked only with those implant types or could it be that he just don’t feel comfortable with working with brands that he never heard of or maybe he doesn’t do custom zirconia abutement. I am tryng to figure is there a big different between a legacy 3.0 implant than other brand implants of the same size. I don’t know if I am confusing with this question.
    I am hoping you can help to answer some of my questions. I am getting really stress from the issues of dental work. I like honest dentists and those that is up front with me. I only found out about zirconia abutement through my own internet research and the same goes fro the zirconium abutement crown. Never in the past had any dentist told me there is different types of crowns. The ones I used before I had internet access (13 or more years ago) kept putting procelain over metal on me. They never even told me there are different types of crowns. I wish more dentists would tell their clients of the different choices available, but most just don’t.

    Again Thank you so much for spending your precious time in reading emails from people and god bless. I believe honestly is what will get dentists free referals to their services and the bad ones get ding on yelp and other review sites.

    June 1, 2012 at 8:00 am Reply
    1. Hi again Jennifer!

      It is customary in today’s dental practice to collect your portion up front. Keep in mind that your crown and abutment is being custom made and hand crafted by a dental lab technician. Your dentist had to do a lot to get an impression of the implant. As an analogy, if you order a custom upholstery for a piece of furniture it is customary to pay a portion in advance too.

      Insurance companies play games and your 60% is only an ESTIMATE. They may not pay at all even though you are in-network.

      Legacy is an excellent dental implant. You have one of the best implants made in your mouth. It sounds like your dentist did the right thing to refer you out if he is not comfortable doing the work. That is a sign of a good dentist!

      Good luck!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      June 4, 2012 at 4:54 am Reply
  87. Jennifer

    Is there a way to tell a zirconium abutement crown from an all porcelain abutement crown?

    Also I noticed you refer to the zirconia abutement as white zirconia abutement. I thought zriconia abutement mean a white color abutement. I also thought that zirconia is made from a very strong type of material(procelain/ceramic).
    I am really worry cuz the dentist I went to for these items did not put the correct description or a valid dental code. The young lady told me that she had to do that cuz I didn’t know the dental code to give her. I thought that didn’t make any sense cuz I am not in the dental business and why would I be supplying her with the right dental code for insurance purpose. I am very worry cuz inital consultant they did give me a piece of paper stating exactly what I want, but after they made me pay the lump sum and when I got the receipt it says totally different items.
    I paid a few hunderd 10 days ago with a debit card, but the remaining balance on tuesday with a charge card. Am I glad I did that cuz credit card and debit card is a total different. With the few hundred dollar I paid I cannot even get it back even thought if the dentist is attempting to give me something different than What I asked and thought I paid for. Anyway, I was told by another denist on youtube that they should know the code. He also think it sound fishy that they don’t know the dental codes for the items that I paid for. Please advice. I am so frustrated and depress over trusting dentists. Last year I paid for a lava crown and the dentist put in a procelin over metal despite the fact I paid the different amount of the total implant restoration package. This dentist website disappear , but her business is still there.

    June 1, 2012 at 6:29 am Reply
    1. Hi Jennifer,

      Zirconia is white. Not all custom abutments are zirconia though. Some are still titanium metal for good reason.
      Unfortunately, not all procedures have a dental code that is ideal. It is not uncommon to change a code, but the fee should not change without you being aware of it. Often after a procedure is completed, some things change and you have to use a code that is the closest match if it does not fit the mold of insurance codes.

      Some dentists and dental offices only dabble in dental implant treatment, while others specialize in it.

      I’m sure your dentist is ethical and not trying to pull on over on you.

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      June 4, 2012 at 4:47 am Reply
  88. Joy Yang

    Hi, Dr Amin
    I had #14 extracted and am going to have a dental implant. I had consultation with 2 different doctors. One told me that I need a sinus augmentation and the other said it’s not necessary. Will it be okay with the implant screw-end stick out in my sinus? Will it damage the sinus membrane if I don’t have the sinus lift?

    May 31, 2012 at 5:24 pm Reply
    1. https://www.burbankdentalimplants.com/sinus-lift-bone-graft/
      Hi Joy,

      Generally speaking it is not a good idea for an implant to be sticking into the sinus without bone around it. The sinus bone graft needs to be done for a dental implant to hold well for the long term

      Attached is a link for you to learn more.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      June 4, 2012 at 4:57 am Reply
  89. Rekha Pawar

    I had two implants placed 3 months ago. My oral surgeon told me one month back that I needed to see him in one month and give me abutments. Well I saw him today..I said I might be going to a different dentist to place the crowns..I have bee shopping around. Anyway he didnt give be the abutments and said to let me know the name and he’ll have to talk to him. He said the dentist will be making abutments. I’m confused.
    These are for my canines..I never had permanent teeth and at age 50 I had two dentists tell me they were getting lose so I had the implants.

    April 17, 2012 at 11:36 pm Reply
    1. Hi Rekha,

      Every dentist has a different technique than the other so it is a good idea that the surgeon speaks to the new dentist. Shop around based on experience and expertise rather than price. You want this done very well to avoid long term issues.

      Let me know what happens.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      April 19, 2012 at 4:32 am Reply
  90. Sarah R

    Hi Dr Amin! Thank you so much for responding to my post! The gums don’t look gray. I think my tissue are thick enough around the implant. The tooth does look gray though. Its a temp crown with a metal abutment. But my implants are 2 pieces. So I can get a new abutment. Sadly I don’t live near you. I’m in Indiana. I wish I did! I need help! I’m still in the same boat I have been in. I want my permanent crowns but my dentist can’t find ceramic abutments for my type of implant. He says I won’t like the gold abutments. But I’m just tired of waiting. I don’t know what to do. I want it to look good but I don’t want to wait anymore time for the ceramic. Its been 2 years! He just keeps telling me that I wont like the gold ones. He says that the crowns he would have to make me will have to be a special with metal in them and it sounds ugly. Should I go somewhere else?

    April 17, 2012 at 1:55 am Reply
    1. Did you or the dentist talk to ATLANTIS abutments? They should be able to make them if it is a two-piece implant from a major company.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      April 19, 2012 at 4:27 am Reply
  91. Liz Whitlock

    Dr. Amin,
    I had two root canals/crowns on #29 &#30 less than a year ago. #30 had to be repeatedly reattached and still loose with pins inserted, # 29 has broken off at gum. Dr. says I need implants & still paying for original work. Can the broken tooth be removed and left for a while or dones it need to be replaced immediately? I do not have any molars on my left side. Should I consider implants there first?

    April 9, 2012 at 1:56 am Reply
    1. Hi Liz,

      That is a story I hear all too often. It sounds like the teeth were very “borderline” when you had the crowns. Crowns are great as long as there is substantial tooth under them.

      It is important to replace both teeth asap to avoid big problems and expense in the future.

      https://www.burbankdentalimplants.com/dental-implant-or-root-canal-cost-and-value-comparison/

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      April 12, 2012 at 1:13 am Reply
  92. Sarah R

    Hi Dr Amin. I have 3 implants. #7, #10 and #11. I have been wearing temporary abutments and crowns for the past year because my dentist cannot find a custom abutment for # 7 and #10. My periodontist used biohorizons 3.0 implants in these areas and he said that no one is currently making zirconium implant abutments and I need to wait. I don’t want to wait any longer but I also don’t want a metal abutment! I hate my temporaries, my teeth look gray. Please help. Are you aware of any labs that will make custom abutments for 3.0 implant size??

    March 21, 2012 at 1:02 am Reply
    1. Hi Sarah,

      Is it the gums or the teeth that look grey? Look VERY closely. If it is just the tooth, a titanium abutment should work easily. If not, a company called ATLANTIS abutments should be able to make them if it is a two-piece implant. The problem is the small diameter which is good for the front teeth. Also, if the implant is one-piece, then there are no options for zirconia. Do you live near me? Let me know what happens.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      March 21, 2012 at 8:00 pm Reply
  93. shay sams

    thanku for your input it has been very helpful

    i found he has me fixed with abutment crowns and abutments
    if this clarifies things a little better.

    March 2, 2012 at 4:44 am Reply
  94. betty

    So after paying $2,500 for dental work & another $2,500 for braces.. also paid paid $1700 for a front tooth implant & it covered the bone graph, the screw looking thingy & the actual “tooth” to be implanted now I’m being charged almost $1,000 for something called the abutment which I’m just finding out was left out from pricing by error, do I really need it? Am I being over charged? Or should I consider myself lucky?

    March 2, 2012 at 1:02 am Reply
    1. Hi Betty,

      It sounds like it was an honest mistake. You need the abutment. There is no way around it unless it is a one-piece implant. The fees are reasonable.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      March 2, 2012 at 4:54 am Reply
      1. Bob

        Dr. Amin,

        Your website is great…very informative. I am currently contemplating implants on my two upper front teeth. Both have had root canals and crowns. I recently broke one tooth off at the gum line. My dentist removed the adjacent front crown in order to support a temporary crown for the tooth I broke. My questions are the following: 1. can two adjacent implants be placed at the same time; 2. is a bone graft and tissue regeneration required if there are no apparent bone problems; 3. my dentist is suggesting using the #7 & #10 teeth to support a temporay crown during healing; and 4. the total cost is $13K which seems high based on my research.

        Thank you.

        March 3, 2012 at 6:55 pm Reply
        1. Hi Bob,

          Thank you for your kind words.

          Yes, two adjacent implants can be placed at the same time and the right way to proceed. A bone graft is often necessary even when you don’t see a problem. There are often voids between the socket walls and your newly placed dental implants that should be filled in. If 7 and 10 are untouched teeth, I would not make crowns out of them for temps. Temporary bonding or other conservative options are best.

          As for the cost, the front and center upper teeth are the most complex teeth in the mouth for implants and can run from 8 -15K to replace. Make sure your dentist is highly experienced in this area of the mouth. Ask to see similar cases results that they have done.

          Respectfully,

          Ramsey A. Amin, D.D.S., D.A.B.O.I.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry

          March 11, 2012 at 5:33 am Reply
  95. shay sams

    hi dr amin
    this isnt coming from the implant doctor, but from the primary dentist
    i dont understand a charge of $7000+ for crowns and impressions of three teeth
    thank you

    February 26, 2012 at 6:20 am Reply
    1. Hi Shay,

      Keep in mind that often times, making the teeth and abutments is more costly than the implants themselves. This is normal.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      February 29, 2012 at 9:28 pm Reply
  96. PAT DRURY

    I HAVE A QUESTION ON IMPLANTS , IM HAVING IMPLANTS PUT IN SOON AND I KNOW THEY TAKE A FEW MONTHS TO HEAL #29 #30 , THEN SOON I WILL HAVE THE CUSTUM ABUNDMENTS DONE , CAN THEY PUT A TEMPORARY CROWN IN FOR A FEW MONTHS UNTIL MY INSURANCE KICKS IN A GAIN THE NEXT YEAR ? TO PAY FOR THE CROWNS? OR DOES THIS PROCEDURE HAVE TO BE DONE ALL AT ONCE CROWNS AND ABUNDTMENTS ? IS THERE SUCH A THING AS TEMPORARY CROWNS ON ABUNDMENTS ? TRYING TO SAVE SOME MORE MONEY AND USE MY INSURANCE AS WELL.. THANKS

    February 24, 2012 at 7:02 pm Reply
    1. Hi Pat,

      This is a wonderful idea that I use very often! Not only will it help you save some money, but it also allows the gum tissue to mature and form around the implants. In addition, it allows the bone to be “loaded” slowly if it was an area that was bone grafted for the dental implants.

      🙂 Dr. Amin

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      February 29, 2012 at 8:08 pm Reply
  97. shay sams

    when is it necessary to have a prefabricated abutment in conjunction with a custom abutment?
    thanks

    February 3, 2012 at 5:07 am Reply
    1. Hi Shay,
      You either have a prefabricated OR a custom abutment on a single implant, not both.

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      February 8, 2012 at 6:28 pm Reply
      1. shay sams

        i thought so from your readings but im being charged with both on each tooth
        now im being told i will receive abutments on the teeth and just the prefabricated abutments

        is this correct?
        thank you for taking the time to address these concerns

        February 10, 2012 at 3:10 am Reply
        1. Hi Shay,

          Just speak to your dental implant dentist. I am sure there is just a misunderstanding and your dentist is not trying to fool you. If you are having a bridge, some dentists call the anchor an abutment, but the real word is a retainer. That is my best guess. Keep me posted!

          Ramsey A. Amin, D.D.S., D.A.B.O.I.
          Diplomate of the American Board of Oral Implantology /Implant Dentistry
          Fellow-American Academy of Implant Dentistry
          Burbank, California

          February 15, 2012 at 5:49 am Reply
  98. galina

    I am going to put zirconium crown on tooth #12. My dentist want to use titanium abutment with zirconium crown. But I think, that abutment should be zirconium too.
    He told me that zirconium is fragile.

    January 16, 2012 at 7:39 am Reply
    1. Hi Galina,

      If your gum is thick, the zirconia will block the metal from showing through. Yes, having a titanium abutment is stronger but zirconia abutments are not fragile at all.

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      UCLA and Western U. Dental School Faculty

      January 18, 2012 at 5:56 am Reply
  99. Pete H.

    I have been told my wife needs a molar replaced with an implant. We dont have alot of money to pay for this. Groupon has a deal going on that reads as follows…$999 for Titanium Dental Implant and Prefabricated Abutment (Up to $2,100 Value) this is from a company called Dental Masters. 24hr cancellation notice required. Services are non-transferable. Not valid for bone grafting, bone augmentation, or any further diagnostic aids or treatments. Consultation required.
    Does this offer seem valuable?

    December 29, 2011 at 8:45 pm Reply
    1. Hi Pete,

      This ads are like teaser rates on credit cards. Based on the ad, there is no “tooth” crown on the implant so it is misleading.

      Many of these facilities are “mills” where patients are just churned out. Remember you are replacing a body part…time, skill and planning need to happen in order to have a lasting, great result. I have personally had to redo many implants done in these “super-center” type of offices. You will probably see many different dentists.

      I would not do it.

      Ramsey A. Amin, D.D.S., D.A.B.O.I.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Fellow – International Congress of Oral Implantologists
      UCLA and Western U. Dental School Faculty

      January 8, 2012 at 6:21 am Reply
  100. Hi Linn,
    The “two” abutment part sounds odd if it is only one implant. It may be a “two-piece” implant or abutment.
    Keep in mind the the crown and abutment usually cost MORE than the surgery.
    Respectfully,
    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow of the American Academy of Implant Dentistry
    Burbank, California
    https://www.burbankdentalimplants.com

    August 3, 2011 at 8:41 pm Reply
  101. Linn

    I just finished the process of having the surgical portion of the implant done (which involved a bit of bone grafting, so it’s taken 7 or 8 months to get to this point). I phoned my dentist to schedule having the tooth portion (sorry don’t know terminolgy) made. I found out that just this portion is going to cost $3000. The dentist’s office told me that it is “$1500 per abutment.” I only have one tooth missing, and only one implant, but apparently my dentist “always” uses two abutments. Does this make sense to you? Is this normal? I’m suffering from sticker shock. (This is, of course, completely separate costs from the surgical part.) Is there a cheaper acceptable option? It will take me at least a few months to save this much. Is there a time limit?

    July 25, 2011 at 12:50 pm Reply
  102. Hi MH,
    The x-ray you are looking at is a two-dimensional image of a 3D object. Sometimes implants on x-rays can look like they are on top of one another or touching things that they really arent.
    Please make sure your dentist, knows about the tender tooth.
    Some immediate implants are bigger or smaller than the original tooth.
    Please keep me posted with your progress.
    Dr. Amin

    May 31, 2011 at 8:20 am Reply
    1. MH

      Hello Dr. Admin,
      Since the last email the tooth next to the implant stopped hurting and I am finally after a year and a half in the process of restoring the tooth. I do have a question for you. The surgeon that put the implant in, had to take out the healing cap off because it was moving around to much. So he let the gum close over the implant. He told me that I would need custom abutment and that the dentist that would do the crown would make that for me. Before restoration I had to go back to the surgeon so he could recover the implant and put in a healing cap on. Instead, he put in the abutment that initially came with the implant (that was too big) and said that he was using it as a healing cap. I went to the restoration dentist today, and he told me that all he is going to do is adjust this abutment by making it smaller. He said he has to shave it down from the top as well as around because it is too thick. Does this sound right to you? I thought that custom abutment meant that it was going to be made to fit the implant and much smaller. The restoration dentist is also restoring #20 tooth at the same time by putting on a crown on that one as well. This tooth is not the one that was hurting (that was the tooth #22 I think) the tooth #20 and #21 are little on top of each other. #20 came in late so it looks like a smaller tooth and it is so close to the implant that the restoration dentist wants to do both at the same time. I am only concern in how much would he have to shave down the abutment to be able to place a nice crown on it. When the abutment is in place, it looks like its about 2mm away from #22 and maybe 1mm away from #20 and of course way too tall. The abutment almost feels like a tooth. What do you think doctor? Am I missing something here? Is it normal to shave down the abutment like this? I just don’t want to compromise the strenght of it. Any advice?

      May 31, 2012 at 5:42 pm Reply
      1. Sometimes you have to drill on the implant abutment in the mouth. Often times the results turn out even better than a traditional coping tpe of impression. Are you local enough for me to see you?
        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry

        June 24, 2012 at 11:36 pm Reply
  103. MH

    Dr. Amin,
    I just had an immediate implant put in the place of tooth #21. That tooth few years ago had a root canal done and crown put on top and just few months ago it broke at the gum level. So the specialist recommended immediate implant and it was placed at the same time when he extracted the rest of the tooth. It has been 3 weeks from the surgery and I am little nervous because the tooth next to it is still tender ( the tooth that is on the right side of #21 when you facing me) As I looked at the ex-ray it looks like the implant is pretty large and its right up to the tooth that is tender. Should I be worried? Is that normal for the implant to be so close? I do not have very big teeth or bite so I am also some what worried that the healing cap seems to be taking the whole space between the two teeth. When the doctor placed the abutment just to try it out right after the surgery I could not even close my mouth because it felt larger than a tooth. He mentioned something about getting a smaller abutment. Is the immediate implant usually larger than the two stage implant? I know that the general dentist will have to put on a crown in about 3 months. how much room is it necessary around the abutment for the crown to fit? Please let me know if you have any recommendation or should I just let the professionals worry about what they have to do.
    Sincerely
    MH
    M.

    May 29, 2011 at 7:40 pm Reply
  104. Hi Phoung,
    The need for a custom abutment does NOT mean the implant was placed wrong!
    Sometimes you have to use them to make a tooth just right.

    May 18, 2011 at 2:07 pm Reply
  105. Phuong Le

    Dr. Admin
    My mom had a implant on her lower right canine n her doc says she needs an custom abutment Bc her gum line is the same level as her implant . He used a 5mm He recommended her to get a gum reduction but says she must pay 650. I was informed that he probably inserted the implant wrong n he shouldn’t even charge us for it. What can I do if He says she has to pay?

    May 13, 2011 at 8:22 pm Reply
  106. sms

    You own a amazing flair .Best of luck and keep going.And yes i have tweeted your site

    April 15, 2011 at 11:43 am Reply
  107. annie jackson

    My dentist did not give me the price for the crown and abutment until after the implant was placed. He is charging me 4,200k for 3 teeth is this too much?

    October 26, 2010 at 7:40 pm Reply
  108. Hi Emma,
    A periodontist does NOT need to do this. Who ever is making the crowns should make the abutments for the best results. The #10 and 11 area is a very tricky area of the mouth when two implants are right next to each other.
    See this post: http://www.dentalimplantdentistryblog.com/2009/04/the-triangle-of-gums-between-teeth-and-implants.html
    Don’t just find “any” dentist to do this. Look for someone who is a Diplomate of the American Board of Oral Implantology /Implant Dentistry and a
    Fellow of the American Academy of Implant Dentistry. You will be in good hands with them.
    From the cost perspective they may be around $750.00 each.
    Does this help?

    September 14, 2010 at 8:02 am Reply
  109. Dr. Amin,
    I too am about to have abutments and crowns fitted on teeth #10 and #11 when I can find a dentist to do this.
    Firstly – does a periodontist need to fit the abutments I currently have healing abutments and a flipper) and crowns or can any dentist do this?
    Secondly – can you give me a rough price scale for a custom zirconium abutment? (I am assuming that i would need custom as these are 2 front teeth).
    Many, many thanks if you can help me with this, Emma (CA)

    September 13, 2010 at 10:31 pm Reply
  110. Hi Mike,
    What is the charge for the crown if the abutment is $1250?
    This will help me answer your question!

    July 20, 2010 at 10:32 pm Reply
    1. Mary Corbett

      Hello,
      I am having an implant on my front tooth starting with surgery to remove old front tooth # 8 ,it has a post and crown now. The tooth fell out suddenly ,dentist re-cemented tooth till I start this procedure. I will have bone grafting done during first surgery and a interim partial made to get me through all of this. How soon after first surgery do they begin a custom abutment procedure.When does the implant procedure begin,after four months of healing if I heard all this info correct?

      Thank you,
      Mary Corbett

      August 13, 2014 at 3:57 pm Reply
      1. Ramsey Amin DDS

        Hi Mary,

        The timing of your upper front tooth dental implant is variable. If the bone is in better condition, an immediate, same-day dental implant with same day bone graft can be done and in fact may yield the best result.

        If there is any compromise whatsoever in your existing tooth and surrounding bone, the procedure should be done in stages. From what it sounds like, you’re tooth will be extracted, bone will be added on that same day and the area allowed to heal for approximately 4 months. 4 months later the dental implant will be placed and allowed to heal for approximately another 4 months. So about 8 months have gone by. That is about the time that the crown and/or custom dental implant abutment can be fabricated along with a temporary crown in order to “groom” the gum tissue back to its original shape.

        So all in all Mary, it is really going to depend on your unique situation. The upper front teeth tend to be the most expensive of all the dental implants if you want to turn out well. They are extremely complex and require extreme attention to detail.

        Immediate Front Tooth Dental Implant Example -(Difficult Case)

        Immediate Dental Implants…Things To Consider

        Good luck,

        Ramsey A. Amin, D.D.S.
        Diplomate of the American Board of Oral Implantology /Implant Dentistry
        Fellow-American Academy of Implant Dentistry
        Burbank, California

        August 18, 2014 at 12:17 am Reply
  111. MICHAEL

    DR. AMIN,
    I HAD AN IMPLANT PUT IN ABOUT 6 MONTHS AGO AND I AM GETTING READY TO HAVE THE ABUTMENT AND CROWN PUT IN. MY DENTIST IS CHARGING ME 1250 FOR THE ABUTMENT ALONE. I ASKED WHY MY PERIO CHARGED ME 477 FOR THE SAME PIECE 6 MONTHS AGO (WHICH HE SENT TO HER OFFICE). SHE TOLD ME IT WAS BECAUSE SHE USES BETTER MATERIAL AND THERE WAS A PIECE THAT WENT IN BETWEEN THE ABUTMENT AND THE CROWN. THIS IS ALL NEW TO ME AND I AM JUST WONDERING IF SHE IS OVER CHARGING OR IF THIS IS CORRECT. MY PERIO SAID HE WOULD CREDIT ME THE 477. I AM JUST TRYING TO FIGURE OUT WHAT THE DIFFERENCE IS BETWEEN HIS (477) AND HER (1250) ABUTMENT. ANY INFO WOULD BE HELPFUL. THANKS, MIKE

    July 19, 2010 at 10:59 pm Reply
    1. barbara

      an excellent oral surg. did 2 adjacent sinus lift + bone and implants. my reg. dentist said i needed a custom abutment (2,000 each) plus crown. he charge $2,000 each for custom abut. (i didn’t know this beforehand and did not have choice). the implants are excellent. but the crowns and custom abutments are on order. why would i need “custom” abuts.? I’ve had other implants w/o any custom abutments. thanks for you imput. barbara

      December 2, 2014 at 9:15 pm Reply
      1. Ramsey Amin DDS

        Hello Barbara,

        $2000 for an abutment alone in the year 2014 seems \costly. Are you sure it is not the abutment and the crown combined together? It is not uncommon for the abutment and crown together to reach into the mid $2000 range.

        Sometimes custom abutments are absolutely necessary. This could be due to gum depth, gum thickness, whether the implant is connected to other implants, degree of scallop, angulation, aesthetics and about 50 more other things.

        Abutments -Burbank Dental Implants Expert -Dr. Ramsey Amin – Case Follow up

        Very respectfully,

        Ramsey Amin DDS
        Diplomate of the American Board of Oral Implantology/Implant Dentistry
        Fellow of the American Academy of Implant Dentistry
        Burbank, California

        December 8, 2014 at 2:35 am Reply
  112. Morgan

    Dr. Amin,
    I greatly appreciate your response to my email. Per your request I have a clear photo of the x-ray for your review but i would like to know how to send it to you.
    Look forward hearing from you.
    Regards,
    Morgan

    November 6, 2009 at 9:37 am Reply
  113. Hi Morgan,
    The angle of placement of a dental implant is very important.
    Unfortunately, without examining you, I can not tell you if it is a good plan.
    Anyway to post some pictures or x-rays for me to look at?
    Sorry,
    Dr. Amin

    October 26, 2009 at 10:15 pm Reply
  114. Morgan

    Dr. Amin,
    I have a situation that I would appreciate in getting your professional opinion on.
    Tooth number #19 I had an Implant that was placed incorrectly at an angel. Very uncomfortable because there is a big gap by the gum line between 19 & 20, food gets trapped all the time and there is a major gum recession on #20 which has become extremely sensitive to cold & Air . After I expressed my concern to the performing Perio, he suggested custom made Abutment in supporting the new crown that would fill the gap between 19 & 20…
    In your professional opinion, would you say it would be better for me to go with custom abutment and new crown or have the implant removed and bone graphed again and redo the whole implant in its correct position????
    After reading the information about custom abutment and the draw backs I am concerned that this may be a temporary fix rather than a permanent one. Btw, he also suggested in having gum Graf on facial of #20 to reduce the sensitivity..
    Look forward hearing from you.
    Morgan

    October 26, 2009 at 2:56 pm Reply
  115. Dr. Andrew

    Beautiful coverage here…the pics are so descriptive…thanks a ton for this nice update it can almost be a study material.

    August 24, 2009 at 9:41 pm Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!