Walton Implants and Periodontics


What is a cone-beam CT and do I need one?

The cone-beam CT is a great example of how a significant advance in technology can directly improve treatment for patients. A cone-beam CT gives 3D imaging of the jaws similar to a conventional CT but with less than 1/100th of the exposed radiation. A traditional CT has a resolution of 0.5 mm voxels (3D pixels) whereas our cone-beam has a resolution of 0.1 mm. This provides a much higher quality picture at a fraction of the radiation, all from a small machine that looks just like a traditional panoramic machine.  A cone-beam CT is about 1/4th of the radiation of a full-mouth series of dental x-rays.

It is rapidly becoming the standard of care to have a cone-beam CT prior to implant treatment, especially in certain areas of the mouth. 3D imaging gives a precise measurement (to the tenth of a millimeter) of vital structures such as nerves, blood vessels and sinuses as well as displaying bone height and width for implant sites. Not every implant needs a cone-beam CT. It depends on the site and what anatomical structures are nearby. This takes the guess work out of implant treatment and greatly increases safety.

How long do dental implants take?

After a dental implant is placed in the bone it usually takes about 3 months before it is ready to have a crown placed on it. It takes at least 3 months for the bone to grow onto the implant and integrate into the surface.

What about the ads I see for teeth in a day?

There are very specific instances where implants can be placed and a restoration can be placed on them in the same day. This is performed on patients that have no teeth in the jaw being treated. Four or more implants are placed and a restoration that covers the entire jaw is placed over them. Because they are all braced together with the restoration, they can be used that day. Providing that explanation in a commercial doesn’t bring the masses in so it is left out.

We usually have our patients wear a removable temporary tooth over the implant site which looks great and does not risk trauma to the implant in any way. We can also place a temporary restoration on an implant immediately, however it is critical that the temporary tooth makes no contact with any other tooth and it isn’t used for chewing in any way. As this is a difficult thing to monitor we usually use a removable temporary tooth so that we don’t jeopardize the longevity of the implant for short term convenience.

What implant systems do you use?

We use Straumann (bone level and tissue level) and Nobel Biocare (Replace Tapered and Active) implants, two of the very highest quality implant systems that can be used. Both systems have a stellar long-term track record. A dental implant is a device that is placed in the bone and the bone will actually incorporate into it. I strongly believe that there is no room for compromising on quality on dental implants. There are literally hundreds of cheaper implant companies out there but none have a longer history of success and few will be there for any future maintenance should it be needed.

Do I need a bone graft after my tooth is extracted?

We often place bone grafts in extraction sockets when hopeless teeth are extracted and an implant is planned for the site. If thin bone is visualized on the side of the socket after the tooth is extracted, there is a high likelihood that the width of bone will collapse into the site where the tooth was, not leaving enough bone thickness for an implant. Thin bone has very few blood vessels within as it is mostly cortical in nature (dense bone without room for bone marrow in the middle). The blood supply from the bone can only come from the gum tissue and from the soft tissue between the tooth and the bone. Once the tooth is extracted, the only blood supply left is from the gum tissue. Thin bone without a blood supply will usually not be able to support itself and resorbs away during the months following extraction. There is a high likelihood that the bone thickness will be inadequate for implant placement after healing. A ridge augmentation can be performed later to gain the width back but maintaining bone width that is already there is much easier than growing it back later. Placing a bone graft in the socket provides a matrix for blood cells to form a clot. Over the following weeks and months, bone cells move into the site and break the bone graft down and replace it with the patient’s own bone. During this process, the width of bone is maintained and there is adequate room for proper implant placement.

What type of bone do you use for grafting?

We use different types of bone grafts for different procedures. The most common bone graft type that we use is a bone graft supplied by LifeNet. LifeNet is a tissue donor bank that has a rigorous screening and sterilization process that provides the very highest quality products. We use this graft material on a daily basis and have seen excellent results.

What type of soft tissue do you use for grafting?

There are three tissue types that work well for soft tissue grafting. Whenever possible I find that the patient’s own tissue works best. A soft tissue graft can be harvested from the roof of the patient’s mouth. This is most commonly in the form of what is called a connective tissue graft and is far less traumatic or painful than in the past. In the past, the skin was actually removed and used as the graft. With a connective tissue graft, the deep tissue is instead removed and the skin is left over the site to protect it in the healing phase. We also fabricate a plastic “retainer-like” appliance that is placed over the roof of the mouth during the healing that greatly reduces discomfort.

Cadaver soft tissue can also be used from a tissue donor bank that is most useful when many teeth need to be treated at once. A porcine soft tissue graft can also be used for this purpose.

What makes your office different than other offices?

Our office is strictly a surgical office and because of that we have raised the bar in many ways. The use of municipal water and compressed air to drive and cool dental drills has been the standard of care throughout the history of dentistry. We believe, however, that in a surgical environment municipal water and compressed air are not appropriate. All of our surgical procedures are performed with state of the art electric driven instruments as well as a completely sterile water source. This removes potential sources of infection and greatly improves the quality of implant treatment. We have also increased the quality of sterilization to a class B sterilizer. Unlike the vast majority dental sterilizers, this provides a significant step up in the extent of sterilization. We feel that the highest quality sterilizer is most appropriate in surgical periodontal office. We also have embraced cone-beam CT technology in our office, which enables us to have spectacular 3D imaging for dental implant treatment. Our state of the art facility is equipped to provide the highest quality surgical treatment.