November 13, 2016
For some people, distance is not a barrier to seeking what they feel is the best treatment and dental tourism is the answer. Seattle cosmetic dentist Lance Timmerman DMD helps to make it easy for his out of state or out of country patients to have their treatment with him. From a quick trip to a full on vacation lasting a few weeks, let our 5 star service help!
Since some services are hard to find “the right provider”, many people make the voyage from all over the world to see Dr Timmerman. The more “fastidious” patient can rest easy that the result they seek is usually only TWO visits away! Usually, our international patients make a single EXTENDED trip, but sometimes they choose to do two “brief” trips. To speed up the process and reduce visits to our office, some preliminary work can be done at home. Just because this is a limited and specific procedure, we STILL require full diagnostic work up and records. To streamline the process, x-rays and preliminary impressions can be taken “at home” (in your home country, by your home dentist). This information can be sent to Dr Timmerman in advance to prepare for the case.
The first thing to do is to “arrive”. Most people will fly, so the first step is to choose the closest airport. SeaTac (designated SEA) is a mere 2.5 miles away. Call your travel agent or use a great app like Expedia.
Even MORE convenient is the proximity to a place to sleep. Homewood suites by Hilton is not merely CLOSE, but we actually share a parking lot. Beautiful hotel, walking distance… what more could you ask for? The hotel has its own shuttle service, or we can help arrange for a limo to pick you up.
Our state of the art office is only 12 miles from downtown seattle, and less than an hour for other recreational activities. Here is a list of options:
If your treatment is involved and takes a bit of time, it can be broken up into 1-2 short visits, or a longer visit with some “waiting time” involved. With so much time on your hands, entertainment and distractions may be a welcome diversion. Let us help, with both the treatment AND the things to do.
There are some things that we need:
- Email us x-rays of the teeth. ALL of the teeth. Including a panoramic x-ray
- Impressions of your teeth in PVS (polyvinyl siloxane)
- Bite registration
The above can be done at a local dental office very easily. That office may/should charge a fee for this service.
- Decide on the “style of smile” that you desire (follow the link)
- Documentation that the health of your gums are healthy/stable and no other teeth have pressing issues (nerves of any teeth need root canal therapy? Get it done BEFORE travel here)
- Schedule a skype consultation or email a detailed correspondence of desired goal.
- Decide if you would like US to handle ALL of your travel arrangements, including flights, hotel, and transportation. There will be an additional fee and non refundable.
If you present to us in a manner that is NOT healthy and prevents us to immediately start treatment, we WILL change gears. This normally means that we need to clean your teeth and gums, or whatever treatment is needed to start treatment. This MAY mean that treatment must be rescheduled after healing, or that additional time is needed for the case (instead of 3 hours blocked, we need 5 hours). If treatment changes, the fee may change as well (but may not). Matters like this will be discussed prior to starting treatment so as to avoid any misunderstandings.
June 22, 2016
Pulling teeth is a big step, and losing teeth is never an easy thing. Whether one tooth at a time or all at once, this step is physical, financial, AND emotional. The decision is final and often not made in a single day. This decision often takes time. That is ok. That is normal.
There are many reasons to remove teeth. Gum disease can destroy supporting bone. Tooth decay can lead to broken or painful teeth that can’t be restored. Trauma to teeth can lead to irreparable damage. If only one or two teeth are removed, a domino effect can take place that leads to loss of other teeth, sometimes leading to all remaining teeth being removed.
Initially people assume that removing one tooth at a time will save money. A few hundred dollars is less than a few thousand, right? In the grand scheme of things, the opposite is usually true. When a tooth is lost we should replace it. Often this is done with a flipper (a partial denture that replaces a single tooth). If more teeth are removed, teeth must be added to the flipper, creating a partial denture. This process repeats until the only remaining teeth will not support a partial and a complete denture is required. There is a fee for EACH step, and it adds up to a LOT of money.
Each time we are pulling teeth, it involves discomfort to SOME degree. While we can make a person numb (using the Wand and our special compounded topical gel makes this virtually painless) there is still the following days when the area heals. This can be tender and tedious to keep clean. If one has 28 teeth and decides to remove them one at a time, that is 28 “events” to manage. All at once may increase the effort level to clean and maintain, this step is usually brief. And then it is complete.
When we plan in advance to remove teeth, we can have a restoration created before the removal appointment. An immediate denture is used for the healing phase. A healing denture. This is often worn for 3-6 months, 3 months if dentures is the final phase of treatment and 6 months if implants are desired. The initial 3 months often involves relining the healing dentures on more than one occasion. While the tissues heal, they will shrink and the dentures will not fit as well, and a reline can help the fit. If more shrinkage, more reline.
At this point, we consider this “Phase Two”. Final restorations can be:
- Cosmetic Dentures
- Cosmetic Dentures with 2 locator implants for stability
- Cosmetic Dentures with 3 implants and bar and Marius Pin
- Deutsch Removable Bridge on 4+ implants
- All on Four with Hybrid
- All on Four with Prettau Zirconia bridge
- All on 6+ with Zirconia bridge
June 21, 2016
Wait Time to Restore Dental Implants
Must we WAIT to restore dental implants? The biggest challenge with dental implants is the waiting game. In an era of immediate gratification, dental implants do not fit well. Despite all the advances we have, our bodies ability to heal and healing time can not be altered (as of now. Who knows the future?). Even when offices and clinics state that they can do “teeth in a day” they merely mean a provisional, or prototype/temporary, is placed and the final restoration will be delivered later after everything heals.
Variation in Bone Density
Different parts of the jaw have different bone density. This is important because the density will contribute to the immediate AND long term stability. Lower front jaw bone is VERY dense, but upper back jawbone is very SOFT. Implants can be placed, but the methods are different. So is the delay in restoring.
General Rules of Thumb in Wait Time to Restore Dental Implants
Every person is different, but generally speaking, we have some rules of thumb that we follow when restoring implants:
Lower front teeth: 3 months
Lower back teeth: 5 months
Upper front teeth: 5 months
Upper back teeth: 6 months
The fancy term dentists use for “bone fusing to implants” is osseointegration. The root, os, means bone. So what we are saying is we need the bone and implant to integrate before we — USE them. If we disturb the process, then it simply fails and we must start over, but starting over ADDS to the process, so we start over “from behind”. This is another reason that we tell patients that dental implant treatment is a commitment of both money and TIME.
In some cases, we can “load” implants right away. Load means “use”, or load the implant fixture with stress and bite forces. Not ALL cases can do this, but if we CAN, it can save considerable amounts of time.
Types of Bone
Beyond what you WANT to know is the types of bone. You may hear the term cancellous and cortical when referring to bone. Cortical bone is VERY dense, so while sturdy is “good” it is also difficult to drill into for implant placement. The lower front jawbone is almost entirely cortical bone. Most bone is cancelleous or trabecular bone with an outer layer of cortical bone. This means it may be difficult at the start of implant placement but becomes easier to drill during the remainder of treatment. It also means that a sensation of pressure may be felt while the implant is placed due to compaction of bone to make it more like cortical bone (for stability). If the bone can’t be treated in a way to make implants more stable, then we allow more time to pass to get better osseointegration.
Dental Implant Surface Texture
As technology improves, we are learning that the surface of implants speeds things up. The quicker things bond, heal, and become more stable, the sooner we can finish the case. The current thought is to roughen the surface (not smooth, and after milling the thread design) and bathe in acid. This induces the body’s healing factors and leads to long term success.
May 17, 2016
Dental Implant Restoration Phases
Quite often, the BEST treatment is simply not appropriate RIGHT NOW. This can be due to a busy life, limited funds, fear of “lots of work at once”, and even a combination of these factors. Dental implant restoration phases breaks up treatment over time and can make it more affordable. The fee for dental implant treatment should be considered an INVESTMENT. This kind of treatment is not cheap, but since they last longer than most other dental treatment, it is usually considered cheaper in the long run. Nearly every form of implant treatment will exceed contributions from a dental benefit plan, so I do not encourage basing decisions on information from a dental plan. For whatever reason that YOU decide, it is the right decision for YOU.
Knowing the final goal from the beginning is important. Not only is width and length of implants a factor, but also the LOCATION. The location of implants will vary depending on the type of restoration they support, but can be different when planned. Implants to support a lower locator denture (“snap on“ denture) often are placed at the canine position (22 and 27 in the US). But an all-on-four procedure places the two front implants in the lateral/central area (23/24 and the 25/26 spots) since the other implants emerge from the tissues in the premolar region (20/21 or 28/29) or if enough bone exists, even in molar spots (19 or 30).
One important distinction: TYPE of dental implant. Mini implants are those that are narrower than 3.0 mm. Since they are so thin, they are normally solid and traditional abutments cannot be attached. These implants are normally used with a single intention, from a ball shaped top (secure O rings) to locator interface (snap on attachments), and are not currently approved for supporting crowns or bridges, despite many dentists using mini implants “off label”.
Dental Implants Are Hollow
It may be important to know the geometry of dental implants. Originally they were smooth, hollow cylinders with threads inside so things could be screwed in place after “osseointegration” (bone fusing to implant). This is similar to devices used in home improvement when attaching something to walls (hanging a picture or shelf). The device attaches to the wall, the decoration attaches to the device.
Mini implants are like a nail or wood screw; they are not hollow. This means that by design they rise above the bone, but can complicate things. With implants that allow an abutment to attach, the abutment can correct many problems with angulation or length, so if a mini doesn’t go perfectly, the entire thing must be removed/replaced.
(The take home message is that in most offices, mini implants are very limited. In offices that do NOT view them this way, they are legally correct, but acting off label and is outside Dr Timmerman’s current comfort zone).
Dental Implant Restoration Phases Plan for Future Care
If treatment will be in phases, then implants for the first phase CAN be placed in the lateral/central area. The function won’t be the SAME as if they were where they “should” be, but certainly adequate. To play it safe, the implants can be placed but not — USED until part of the final restoration. This would also be a significant savings due to lower lab fees.
Nearly ALL implant cases start out the same way and have dramatically different outcomes, so some decisions don’t need to be made until further down the process.
A “normal” progression may look something like this:
- All, many, or some teeth in a condition needing removal
- Removal of teeth, grafting of sockets
- Healing dentures placed
- Two implants placed for locator denture
- New denture with locator frame
- Two more implants
- New restoration (Hybrid denture that is screwed in place? Deutsch Removable Bridge?)
- More implants as needed/wanted
- Different restoration as needed/wanted
Sometimes we can overlap. An example is that at the time of extractions, implants may be placed. This saves time, but is not always an option. Or instead of two implants, four are placed. This eliminates the middle stages in the progression example above.
Every Case is Unique
Not every case is the same. Not every condition is the same. Each case is custom designed and usually discussed among colleagues to ensure the best possible outcome. This means that a “free consultation” is normally worth every penny, since most details that are of interest to most patients (Am I a candidate for dental implants? Will my case require extra surgery? How much will this cost?) can NOT be determined without a comprehensive and detailed exam. This requires not JUST the normal x-rays, but also CBCT (cone beam computed tomography) to look at the jaws in 3 dimensions, as well as photographs and sometimes impressions for study models. We DO offer free exams, but they usually lead to an exam, so we encourage simply starting with an exam.
May 25, 2015
Many times when trying to restore teeth and jaws to normal function, implants are the best option. It stands to reason that “more is better” in that the more implants in place, the more stability the restorations have. However, costs can get out of control. Fees for implants increase the more that are used, and sometimes anatomy requires extra surgeries. If sinuses are large, perhaps a lift will be needed. If nerves track close to the surface, then they must be avoided or moved. All-on-four is an approach that uses angled implants to allow fewer implants placed and a significant savings.
Dr Lance Timmerman DMD, a Seattle implant dentist, uses software from Nobel Biocare, NobelClinician, to be certain that when he places dental implants they are precisely where they need to be. Precision is VERY important with dental implants. If the dental implant is in the wrong place, there is a risk that they won’t osseointegrate (fuse to the bone), sever the nerve, fall out or be impossible to restore.
With CAD/CAM precision, dental implants can be exactly where they need to be. Since Dr Timmerman is also a restorative dentist you can be sure that he can actually place a crown or denture on the implants. The same cannot always be said when another doctor places the implants, as many surgeons are only concerned with getting the implant into the bone and are not giving thought to the final restoration.
If you would like dental implants and want to be sure of the most precise placement, call Dr Lance Timmerman DMD for a consultation. He is a leading Seattle implant dentist. Call us to ask Dr Lance Timmerman DMD what can be done for YOU! Learn more about all on four hybrid dentures.