Dental implants have evolved significantly over the past 30 years. We can do them faster, easier and better than ever before. While many, if not most, go relatively smoothly, having done many thousands of teeth on implants over the past 30 years, and more, I feel it my obligation to let you know that this is not always the case. While restoring comfort, function, health and esthetics is usually very dramatic and many, if not most patients, when done, are sorry they didn't do so sooner, things don't always go or turn out exactly the way we'd like them to. It is very important to be aware of this. I can never make promises or guarantees, especially not that there will "never" be a problem, there most certainly can be. I can say that we have always tried our best to be here for you and manage developments in the very best way possible. 

It is important, as well, to understand that there may be many alternatives to the treatment I am recommending. By accepting my treatment suggestions, you are accepting my opinion based on my past experience as to what I feel will be best for you. There is rarely a "perfect" solution. Most, if not all, treatment plans have their advantages as well as limitations. It is very important that you feel free to discuss the alternatives and considerations if you feel it will be helpful and will not confuse you. We think the most legitimate question you could ask is: 

“Dr. Stern if I were a member of your family what would you recommend”.

Dental implants technically usually take only several minutes each and are almost always placed with local anesthetic similar to that used for routine dental procedures. We can discuss additional sedation if you feel it is necessary. With modern techniques, it is usually not necessary. 

Obviously, every case is different and every person reacts differently. Rarely are there "permanent" side effects, but certainly for several days or more there can be some discomfort, swelling, discoloration among other normal responses. These are usually reasonably managed by routine means of antibiotics, pain killers, etc. While other phenomena could occur, such as areas of the tongue, cheek, lip or other areas having altered or lost sensation, even permanently, this is very rare. While very unlikely, it is possible. Even in these rare cases, it is usually one of sensation not of function and usually not noticeable. You must feel free to discuss this if you have any questions regarding these matters. It is often burdensome to you, for us to go into every "possible" detail, ultimately you are intrusting me to try to do my very best for you. If you need further detail you should not go ahead until comfortable with what you feel you need to know.

It is important that you bring to my attention any medical condition, medications being taken and or limitations that could be significant. Most patients who can have routine dental care or extractions… can have dental implants. Age in itself certainly does not appear to be a contraindication. Smoking definitely can increase the chances of failure and/or complications. It's great time to stop! Many, if not most of our patients have stopped even though they thought they couldn't. They feel great about it!

There is a common misconception as to how implants work. Implants really, for the most part, do nothing. It is your bone that fuses with the implant not the other way around. Most do so well. Sometimes however, your bone does not do what we'd like it to do the first time. Interestingly, if necessary to make a second attempt it often, if not mostly, does do so the second time. This is not usually necessary since the majority do do well the first time. Once your bone has fused with the implant it can almost always be restored successfully. It would be unfair however to say that it can "never" later "fail". It is not pleasant to have an implant fail and fortunately most do integrate successfully. It is, however, important to realize that an implant can "fail" at any point in time. Whenever possible we place more implants than "necessary" so that if an individual implant should fail the restoration itself need not necessarily be jeopardized. Maximum planning minimizes unnecessary problems. With proper care, implants, like teeth often can potentially last a lifetime. 

Implant dentistry usually involves 3 stages:

1) Placement of the implant.

2) Placement of the implant post (in the past usually after 3-6 months now almost always placed the same visit).

3) Placement of the restoration (whether "fixed" or removable – today usually non-removable teeth, immediately using a provisional material, replaced after several months, with a permanent material, usually with porcelain/ceramics).

It is important for you to be clear as to whether the fee quoted to you includes the implant(s), post(s) and/or restoration. An implant is not a tooth: it is the foundation for teeth. There may be more teeth than implants, there may be more implants than teeth. Before we begin any work you will know, in advance, the actual costs involved. 

Depending on whether you've lost teeth only or gums and/or bone, a variety of materials and/or types of restorations may work best for you. Again, you will be entrusting me to use my best judgment as to what might be best for you and this could change during the treatment depending on how things develop and respond. "Fixed" (non-removable) for example is not always best. Again, all alternatives usually have significant advantages and limitations. It may be difficult for you to "know" which will work best for you. We have no choice but to use our best judgment, based on cases similar to yours in the past, along with examination of your individual needs. Everyone does respond differently and we do not always know how you will respond. You may want to talk to others who have had similar treatment and we would be happy to provide you with names of such individuals. You will see the color and form before the “teeth” are completed. We will not complete it until you give us your approval. It is important that you do your best to request any changes before giving your final O.K. to "finish" to avoid any unnecessary additional delays and/or expenses. You usually can try them for a while to be more confident in your choice and be allowed to still make changes – you are not “locked in”.

Having done, as mentioned earlier, many thousands of teeth on implants I can tell you that many go smooth, some do not. My staff and I will do anything and everything within reason, as we see it, to achieve the maximum possible results. We can not promise that you will be happy though you can be sure we will do everything possible to make you happy. We do not know what your expectations are and to what extent they are "realistic". Dental implants are not always perfect. We can do wonders with them but not "everything". There definitely can be an adjustment period of comfort, function, speech, etc. We would like to think that our reputation is based on the fact that most people are ultimately pleased. Patience is so important, especially as we approach finishing. Rushing can be counter-productive and costly. We have almost unlimited patience. Our experience suggests that patients with patience get the best possible results. We're interested in giving you more than you expect, working with us usually gives the best results.

Teeth and dental implants require maintenance forever. Maintaining healthy gums is so important and the key to long term success. Maintenance involves additional costs and time. Usually an examination is required once a year, with gum treatments and adjustments every few months depending on your particular situation. In most cases, after the first year exam and x-ray, an x-ray is adequate once in two years. We try to keep these costs to a minimum. Dental implants and related restorations are mechanical devices with the limitations of man-made mechanics especially due to the small dimensions involved. We try to be more than reasonable when necessary to deal with this. Teeth or parts can break and/or need replacement. This can be a nuisance although usually not very difficult to resolve. There is usually no fee for such repair for at least a year after the insertion of the teeth. For 5 years, if necessary to charge, we try to limit it to the actual "cost" to us. There is a fee for "snaps" that need to be replaced periodically on the "removable" type devices (usually about once a year). They are intended to ware much like tires on a car, to absorb shock and protect the implants. The titanium snap-posts on these need to be changed, on average, once in 5 years.

You may be advised to wear a special "night guard" which is sometimes recommended to prevent/limit problems and give you the maximum benefit of your implants. Teeth and/or parts could need replacement on some people after several years. Implants and restorations often can potentially last a lifetime with proper care and maintenance. 

In summary, your investment of time, money and effort is significant and we would like to achieve the very best possible results. If you have any questions about any aspect you must feel free to discuss them. By assuming treatment you are placing your trust in me and our staff to use our best judgment and experience as we know it. You are aware of our achievements in the past but as well of the possible limitations inherent in treatments of this nature. There are no promises or guarantees due to the individuality of each case and person. We do hope that you will join our long list of satisfied patients and our staff plans on doing everything possible to make things as comfortable as possible for you.

It is important on your part to respect the financial arrangements and to arrive at least 15 minutes before your appointment time so that you may receive the maximum benefit of the time reserved for you. If for some reason you must change an appointment you will need to let us know at least 48 hours in advance. 

We look forward to a fruitful relationship. Together we can hope to achieve the results you desire, the comfort, function, health and esthetics for you to enjoy for many years to come! We appreciate your trust and confidence in having chosen us to help you, we know you have choices. We value the referral of friends and family who can benefit from the type and quality of care and service we offer.

Dedicated to your health and comfort,

Dr. Gedaliah Mordechai Stern and Staff

2013 UPDATE

Many years have passed with much experience, we’ve learnt a lot. Today, usually (but not always), you leave in one to two hours, or less, with non-removable teeth made of a provisional material (almost always without cutting and stitching) that you may eat and drink with (hot, cold, hard, soft…) – without any restrictions. After 3 – 4 months, usually without anesthesia, we take measurements for the permanent “teeth”, permanent material (usually porcelain-ceramics). This stage usually involves 2 – 4 visits, of course, there are exceptions. There are times that one or more implants, screws or posts could need tightening or replacement; this is usually a several minute procedure.

We look back with great pride on thousands of patients who continue to function with their permanent teeth that were made 10, 20 and even 30 years ago.

You should let us know if you are taking medication for osteoporosis (and you should read our write up on the subject).

You should carefully read our article “Implants and Teeth” if we’re considering removing teeth.

Blood thinners are not usually a problem but should be brought to our attention. If you have a pacemaker or other medical issue, please let us know. If you are allergic to some metals or other materials it is important we know about it.

We strongly recommend you visit and study our web site: www.implantsandlasers-r-us.com.

Imagine looking good, feeling good and “being done” in under an hour, in a responsible way. Based on thousands of patients and tens of years of experience, we can help you faster, easier and better than ever before, with true peace of mind!