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MESSAGES TO
Missing Teeth And Dental Implants

Missing Teeth And Dental Implants

A DxD Session with Dr Gerald Tan


Ended on Tue Apr 30 2019
Ended
Have a question to ask?

Get Dr Gerald Tan's opinions on your questions! Only approved questions are displayed.

Top Answers


I'm so sorry this has happened, and I hope you have recovered from your fall.

In the course of my work I have seen so many cases of dental injuries caused by accidental falls and I know how distressing it can be, especially if you have lost a tooth in front.

I really feel for you, and I hope you have already found a good dentist you can trust to restore the missing tooth.

To get straight to your question: "Is a dental implant the best option"?

Well, there is no easy answer to this.

But I would say yes, in most cases, getting a dental implant done to replace a missing tooth would be the best option.

However, there are instances whereby getting a dental implant done may not be the best option because of the following factors:

1. Prohibitively high cost

2. Trauma leading to a significant loss of bone and gum

3. Presence of systemic diseases such as uncontrolled diabetes 

4. Presence of uncontrolled gum disease

So it is often too simplistic to say that getting a dental implant done is the best option for everyone.

A good dentist should be able to to diagnose the severity of the injured area and after doing so, he should be able to advise you on the best treatment option that is best suited for your condition.

Dr Joanne Lam described dental bridges and dentures as viable alternatives to dental implants in her earlier reply.

Lastly, I would strongly recommend that you consider replacing the missing tooth to avoid drifting of your teeth, leading to a collapsed bite.

The more teeth you have missing, the more the remaining teeth have to compensate in terms of supporting your bite forces, which may lead to more wear and tear and other problems in the future.

I hope you found the above information useful, and I wish you a speedy recovery!

Kind Regards,

Dr Gerald Tan

6 Feb 2018
Thank you for your question about mini-implants. Dr Joanne Lam has answered beautifully in her previous post, and I would just like to add a few thoughts.
 
The use of mini-implants has certainly been controversial.
 

In the dental industry, there have been whispers or rumours of a few dishonest dentists offering mini-implants for patients when they are clearly not appropriate, just to persuade patients to undergo treatment at a lower fee.

It is difficult for patients sometimes to discern regarding the appropriateness of mini-implant use, because professional opinions regarding mini-implants can vary from dentist to dentist.

Patients find the low fees very attractive, they get mini-implants done, and sometimes as soon as months later, the mini-implants fail.

Mini-implants have their place in modern dentistry, but it is imperative that the dentist knows when to recommend for their use, in order to achieve the best long term success for the patient.

This only comes with experience, training and an honest mindset.

I hope you find the above information useful and dont forget to visit your trusted dentist for further advice if needed.

Kind Regards,

Dr Gerald Tan

7 Feb 2018

thank you for your enquiry!

I understand that it can be frustrating when faced with a wide range of fees when trying to find a good dentist for your mom.

Many clinics all over the island offer dental implant surgery as a treatment option, from the smaller clinics in the suburbs, to the big group practices in town and finally the government institutions like the National Dental Centre.

I have written several articles about dental implants:

https://www.doctorxdentist.com/dental-implant-singapore

https://www.doctorxdentist.com/dental-implant-costs-singapore-dentist-tells-all

I hope as you read my articles and as you do more of your own research into the matter, you can come to your own decision about which clinic to bring your mum to.

For something as important as your mom's teeth, it may be prudent for you not to go for the absolute cheapest, but at the same time, perhaps at this point there is also no need to go to the top, most expensive dental specialist in Singapore.

My humble advice is for you to find a caring, honest and experienced dentist from a reputable clinic that charges a fair fee for good service as a good point to start. If your mum's case is complicated, you can always see someone more experienced later on, but its fair to expect to pay more then.

Also, you can always get a second or third opinion later if you feel that the first dentist you go to is not suitable for your mum.

Lastly it is my opinion that it is unfair to say that one brand of dental implant is better than another brand. All brands of dental implants available in Singapore have passed through strict HSA regulatory checks and are safe to use.

There are pros and cons to every implant brand available and some dental surgeons prefer to use one brand better than another for various reasons. It does not mean that the most expensive implant brand is the best for all clinical situations and conversely, it does not mean also that the cheapest implant brands are automatically lousy for all clinical situations.

It is more important that you find a good dentist that is able to diagnose the problem accurately and to be able to indicate several treatment options for your mum to make an informed choice. If your mum eventually chooses to get dental implants done, a good dentist should be able to indicate for the correct type and brand of dental implant , that would work best in your mums unique situation.

I hope this information is useful for you and i wish your mum every success in finding a dentist she can trust!

Kind Regards

Dr Gerald Tan

5 Feb 2018

Thank you for your question and for being so candid about your phobia for dental treatment. It takes courage to face your phobia and to try to overcome it, and finding the right dental surgeon is so important in helping you to have the confidence to get the dental implant treatment that you need and want.

To get straight to the point, there is no such thing as a dental implant specialist in Singapore, or anywhere else in the world. The field of Dental Implantology is not recognised or registrable as a specialist field in Singapore or anywhere else in the world. If this changes , i would be the first to take whatever qualifying exams that are necessary to register myself as a dental implant specialist! However, i do not foresee that this change will come anytime soon.

In Singapore, these are the 3 categories of dental surgeons that are legally allowed to perform dental implant surgery for their patients:

1. General Dental Surgeons who are fully registered with Singapore Dental Council (SDC).

2. General Dental Surgeons who are conditionally registered with SDC ( But they have to be supervised ).

3. Specialist Dental Surgeons, regardless of their field of dental specialty, who are registered as specialists with SDC.

For these 3 groups of dental surgeons, it is NOT a legal pre-requisite to show proof of further training in the field of dental implantology, in order to be legally allowed to perform the treatment.

Therefore, in theory, any dental surgeon who falls into any of the 3 categories above, is legally allowed to perform dental implant surgery for their patients even if they have no prior experience doing so. The onus is on the dental surgeon to ensure that he is competent and confident in performing the dental implant surgery for the patient, before actually doing so.

Having said that, it is fair to say that most dental surgeons would be responsible enough to ensure that they are properly trained in dental implants before even attempting to perform dental implant surgery on their patients.

The problem is , the term "properly trained" can be subjective.

There is a myriad of dental Implantology courses, diplomas, degrees and qualifications out there in the dental marketplace today. Some of these courses last only half a day, and the longest ones over a few years. Some are conducted in Singapore, and many others conducted overseas. The vast majority of such courses are NOT recognised by the Singapore Dental Council to be registrable as displayable postgraduate qualifications.

I have written several articles on DxD about dental implants in Singapore, as well as dental implant costs in Singapore.

In your research for a good implant dental surgeon, you may find online or through word of mouth recommendations that there are some dental surgeons who are more " well- known" for being "good" at dental implants. 

It is not fair for anyone to make a sweeping statement to say that all category (3) specialist dental surgeons are better or more experienced than all category (1) and (2) general dental surgeons in performing dental implant surgery. Likewise, the converse is also true, so therefore i do not blame you for realising that finding a dental surgeon whom you can trust in dental implant surgery is not as straightforward as you would have hoped. 

At the end of the day, after you have done your research, it is most important that you find a good dental surgeon that you can connect with, feel comfortable with and whom you can trust to be honest and caring , diligent with his work and skilled and experienced with dental implant surgery.

I wish you all the best and if you have time, do spend a few minutes reading some of my other articles that i have written on dental implants. 

Kind Regards,

Dr Gerald Tan

4 Apr 2018

Thank you for your question and i do not blame you at all for feeling confused, astonished and maybe even angry or suspicious!

There is no easy and straightforward answer to your question as i do not know your specific dental needs versus your friends specific dental needs.

But in general terms , you must understand that just like fingerprints, everyone has unique dental issues and needs, especially when it comes to the complex field of dental implants 

When you go to see a dental professional, you are consuming a service, not a product. This means that there is often no cookie cutter approach to everyones dental needs. Because of this fact, it is reasonable to expect that most dental clinics can only provide you with a range of fees for implants , according to the difficulty of the case, instead of one standard fee for all. 

In your particular situation, you maybe quoted $5k because your case maybe more complex than your friends case .

The key questions to ask is: Why is your case more complex? Is your higher fee truly justified as compared to your friend's case which only cost him $3.5k?

In my humble opinion, the only way to find out for sure, is to ask your dentist. Hopefully, he will be able to explain to you why that in your particular case, it will be more expensive than compared to your friends.

There is a myriad of factors that may result in your case being more complex than others. Some of these factors can be very technical and is beyond the scope of this reply. Some of the easier to understand factors have been mentioned in the previous answers by my esteemed colleagues.

Here are 2 articles that i have written about dental implants that you may find useful in your search for an answer:

https://www.doctorxdentist.com/dental-implant-costs-singapore-dentist-tells-all

https://www.doctorxdentist.com/dental-implant-singapore

I wish you all the best in your dental implant journey and all the best in finding a dentist you can trust and feel comfortable with!

Kind Regards,

Dr Gerald Tan

17 Apr 2018

Thank you for your question about mini-implants. I get this question a lot at my practice and I am happy to share with you and other readers my views on the matter. 

The use of mini-implants has certainly been controversial.

The key to success for any mini-implant case starts with understanding its indications and contraindications and its pitfalls when indicated wrongly.

Latest scientific evidence concludes that Mini implants have limited applications, and should be considered only in certain cases. Here are some common examples when Mini Implants can be considered:

1. Supporting a removable denture

2. Replacing very small lower front teeth in adults , where the stress of the bite is low.

3. In certain orthodontic cases for anchorage, and only for period before they are removed.

Mini dental implants are not indicated to replace back molar teeth whereby the bite forces are high. Mini implants are too narrow and structurally not strong enough to withstand the stress of the bite in these areas.

In the dental industry, there have been whispers or rumours of a few dishonest dentists offering mini-implants for patients when they are clearly not appropriate, just to persuade patients to undergo treatment at a lower fee.

It is difficult for patients sometimes to discern regarding the appropriateness of mini-implant use, because professional opinions regarding mini-implants can vary from dentist to dentist.

Patients find the low fees very attractive, they get mini-implants done, and sometimes as soon as months later, the mini-implants fail.

Mini-implants have their place in modern dentistry, but it is imperative that the dentist knows when to recommend for their use, in order to achieve the best long term success for the patient.

This only comes with experience, training and an honest mindset.

In  your particular case, if you are looking to replace your back molar teeth, i would strongly recommend that you get conventional dental implants done instead of mini dental implants.

I hope you find the above information useful and dont forget to visit your trusted dentist for further advice if needed.

Kind Regards,

Dr Gerald Tan

26 Apr 2018

You may consider one of the following:

1. Periodontal treatment to try to maintain your loose teeth for as long as possible ( This option is viable only if your teeth are slightly loose )

2. Extractions of your loose teeth and replacing them with dentures.

3. Extractions of your loose teeth and replacing them with dental implants.

4. Extractions of your loose teeth and doing nothing else.

It is important for you to note that your dentist should make an attempt to find out the root cause of your loose teeth, so that he/she can implement the correct treatment plan.

The following factors can have a negative effect on your gum health thereby leading to loose teeth:

1. Poor oral hygiene leading to gum disease.

2. Smoking

3. Diabetes

4. A pathological and imbalanced bite

5. Other autoimmune or systemic factors

I wish you all the best in finding a good , experienced dentist that you can trust and build rapport with!

Kind Regards,

Dr Gerald Tan

27 May 2018

Thank you for your enquiry, dental implants are the gold standard for replacing missing teeth but they are certainly not for everybody.

There is a long list of indications and contra-indications for dental implants which is beyond the scope of this sessions, but I will try to mention some of the common ones here.

In a generally healthy person with no systemic medical problems or relevant medical history, here are some common issues that might prevent you from being suitable to get dental implants done immediately.

  1. Untreated tooth decay
  2. Untreated gum disease
  3. Severe bone and/or gum loss around the area planned for dental implants
  4. Severe tooth grinding/bruxism
  5. Severe wear of remaining teeth
  6. Having an imbalanced bite with teeth that are poorly aligned
  7. Dental Anxiety or fear
  8. Having a limited mouth opening
  9. Lacking awareness of the alternatives to dental implants
  10. Lacking research on the best dentist to go to for dental implants with the correct training and experience
  11. Having a limited dental budget

 

The short list above represents some of the factors, concerns and issues that you would have to consider before getting dental implants.

21 Feb 2019

Initial consults for dental implants differ from dentist to dentist. These differences are the result of differences in undergraduate training, postgraduate education, years of experience performing dental implant surgery as well as practice philosophy. Therefore, it is important that you ask questions to clarify doubts during the consultation so that you can make an informed decision.

In my practice, regardless of whether or not a case is easy or complex, I have found over the years that it is always best to be detailed and careful in the initial consult, and to never take short cuts in the treatment planning stage, to ensure the best possible result.

A typical initial dental implant consult in my practice would involve the following:

  1. A thorough discussion about your medical and dental histories, especially regarding dental anxiety
  2. Full frame DSLR intra-oral photography of all your teeth
  3. A 3D intra-oral digital scan of your teeth and bite
  4. Dental Radiographs : Dental Panoramic Xrays, Periapical Xrays and a 3D CT scan of the planned implant site to measure bone height, width and density.
  5. A thorough check on your overall dental health and gum health.
  6. A discussion regarding all available treatment options, other than dental implants
  7. A discussion of risks vs benefits that is pertinent to the case and unique clinical situation.
  8. A discussion regarding unique expectations and concerns

After the initial consult, you should feel that your dentist has presented the information to you clearly, in a way that is easy for you to understand and with all Pros and Cons discussed openly and honestly.

21 Feb 2019

The simple answer to that question is that it depends.

The truth is there are many variables that might contribute to whether or not a patient experiences pain when undergoing dental implant surgery.

Some examples of these variables are:

  1. Subjective pain threshold of the patient
  2. Medical health status of the patient
  3. Whether or not the planned surgery can be done in a minimally invasive way to minimize surgical trauma ( for eg: computer guided keyhole surgery)
  4. Whether or not there are anatomical risks near to the dental implant site, for example: major nerves, blood vessels or the maxillary sinuses.
  5. Whether or not extensive bone grafting and/or gum grafting is needed in conjunction with the dental implant surgery.
  6. Whether or not the patient is known to have a resistance to local anaesthesia
  7. Whether or not the patient has extreme dental fear and anxiety
  8. Whether or not multiple implants are planned in one surgical procedure
  9. The skill and experience of the dental surgeon

The interplay of these 9 variables makes it hard for any dental surgeon to promise with a 100% certainty that the surgery will be absolutely painless 100% of the time for 100% of all patients.

However, from my years of experience, the only way I would guarantee a pain free procedure 100% of the time is by offering Intra-Venous Sedation or full General Anaesthesia. These sedation options are commonly chosen by my patients, and there are instances when I would not proceed with dental implant surgery unless the patient agrees to sedation.

 Any post-surgical pain and discomfort can be easily managed with effective medication and adequate rest.

Again, the risk of post surgery pain and discomfort is also influenced by the variables above.

Generally speaking, the easier and less traumatic the surgery, the less the pain should be.

And this may sound clichéd, but the skill of the surgeon is probably the most important factor!

21 Feb 2019

To list every single risk and complication of dental implant surgery is beyond the scope of this session. But I am happy to mention some of the more common ones here:

  1. Failure of osseo-integration of the dental implant due to poor healing or rejection
  2. Injury to nerves, soft tissues and other anatomical structures around the surgical site
  3. Gum recession or bone recession around the implant with time
  4. Infection of the gum and soft tissue around the implant ( peri-implantitis)
  5. Breakage or fracture of the implant, implant abutment or implant crown
21 Feb 2019

The short answer is that it depends. Every patient is different and each case is decided upon on its unique merits and clinical situation.

Sometimes you can have an immediate implant placed right after the tooth is extracted.

Other times , it is best to wait 3-6 months for the site to heal and regenerate before the implant is placed.

Some factors that would influence this would be:

  1. Skill and experience of the dental surgeon
  2. Presence of any pre-existing infection in the surgical site
  3. The extent and severity of such an infection if present
  4. Whether extensive bone and soft tissue grafting Is required at the surgical site
  5. The level of aesthetic concerns of the patient.
  6. The financial budget of the patient

 

21 Feb 2019

If you do not replace your missing tooth with a dental implant, it is possible that your neighbouring teeth will shift and collapse into the gap.

This will in-turn lead to an imbalanced bite with some teeth subjected to more stress from your bite as compared to others, resulting in unequal wear and tear!

You will naturally chew more on the side with more teeth and the rate of wear and tear on the side that you favour will be significantly increased.

All these issues may not give rise to symptoms in the beginning, but over time, the teeth that have more wear and tear may have stress cracks, accelerated enamel wear and/or sensitivity leading on possibly to a full blown toothache. This would require extensive treatment that could potentially incur a higher cost than if you were to do the implant in the beginning!

Therefore, it is always advisable to replace missing teeth with dental implants to recreate balance to the bite and to ensure that the bite forces are distributed evenly to as many teeth as possible.

21 Feb 2019

It really depends on the complexity of the surgery and difficulty of the case.
In simple cases recovery could be within 1-3 days. In more complex, extensive surgeries, it could take 1-3 weeks !

21 Feb 2019

If maintained well and if the patient has a good balanced bite with no para-functional habits, dental implants can last a lifetime!

21 Feb 2019

Brush and floss your dental implants regularly as you would any natural tooth and have them maintained at professional dental hygiene appointments with your trusted dentist at least 2 times per year. Avoid using your dental implants to open up beer bottles, crush on ice cubes, or pork bones and chilli crab shells!

21 Feb 2019

It might feel abit strange at first, but you will soon get used to it just like how a new pair of shoes may feel strange in the beginning.

21 Feb 2019

Dental implants, when done well, are designed to look and feel and function just like the natural teeth they are replacing.

Dental implants will never decay, however, gum disease around the dental implant may still occur with neglect, just like in the case of natural teeth.

There is absolutely no issue with eating normally with dental implants!

Having said that, I have seen cases gone wrong whereby dental implants were not placed in a good position and alignment. This may give rise to long term problems in terms of the stability and balance of your bite.

The skill and experience of the dental surgeon is probably the most important factor in achieving a good predictable result.

21 Feb 2019

Whether or not dental implants would be “ better” than dentures for your 70 year old relative depends on various factors.

It is true that no one likes to go for surgery, no matter at what age, and for dental implants to be even considered for your father, it must be determined that the benefits of the surgery far outweigh any risks. Generally speaking, dental implants are far superior to dentures in terms of strength, longevity, stability, comfort and even aesthetics.

Age alone  cannot be seen as the most important limiting factor in getting dental implants.

Dental implants would be a good option to consider If your father is :

  1. Medically healthy and cleared by his medical doctors to undergo dental implant surgery.
  2. Not adverse to surgery
  3. Has overall good dental and gum health
  4. Has had a history of significant dislike for dentures with inability to chew well with them
  5. Motivated to commit to see the dentist regularly to maintain and clean the dental implants
  6. Able to accept any risks involved in the planned surgery
  7. Adverse to trimming down his natural teeth to fit a dental bridge.

In my practice, we routinely perform dental implant surgery for patients who are well above the age of 70 with no significant problems, provided the above factors are met.

Older patients take longer to heal so I would make an effort to be all the more careful to make sure that the benefits that they get for going through the dental implant surgery is well worth any risks or inconveniences to the patient and family members.

21 Feb 2019

You can usually claim up to $1250 in Medisave for one dental implant, subject to a maximum of $7500 for 8 implants.

No dentist can guarantee the success of any Medisave claim. We can only submit the request, but the final claimable amount is still subject to approval by MOH. The dentist has no control and no say over the final amount that will be reimbursed, and each claim submission will be assesed by MOH officials.

From time to time, MOH may at their discretion change the Medisave claim rules and regulations and this is also beyond the control of any dentist.

To make a Medisave claim, just bring along your Singaporean Identity Card to prove that you are a Singaporean Citizen or Permanent Resident. The clinic staff will do the rest, including submitting all the necessary paper work. Medisave can only be used for Singaporeans and Singapore PRs.

21 Feb 2019

Top Questions


I have a browned/chipped off surface spot on my front teeth. Could I get a filling done, or what are other good treatment options?

My dad has a few missing teeth in the front of his mouth, and a friend suggested getting dental implants. We’re worried about surgery and thought maybe dentures might be better for him.

My dentist extracted my infected second molar. Do I need a dental implant after extracting my second molar? What are the considerations?