General Dentistry
Diplomate, American Board of Oral Implantology/Implant Dentistry*

*Dr. O'Roark is the only Diplomate of the American Board of Oral Implantology/Implant Dentistry in the Southern Maryland area and one of the first 35 in the country to receive such recognition.  Implantology is not recognized by the American Dental Association as a dental specialty and peer recognition is important to identify those General Dentists that have taken the training to incorporate implants, placement and restoration, into their General Practices.   The ABOI/ID website (www.aboi.org) says, "The ABOI/ID Diplomate designation  symbolizes the highest level of competence in implant dentistry and certification by the ABOI/ID attests to the fact that a dentist has demonstrated knowledge, ability, and proficiency in implant dentistry through a rigorous examination process."

What Do We Do?

I and my staff are General dentists, trained in all of the disciplines in dentistry.  It is our objective to incorporate these areas of dentistry into a cohesive treatment regimen to provide you with the best dental care we can. Although I have had extensive training and experience in dental implants, they are only one more option in the treatment we can provide for you.  My offices  can provide you with the full range of dental services including restorative  (amalgam,  tooth colored bonding ,  beautiful veneers,  whitening for life,  and crowns/bridges,  dentures/partial dentures), endodontic (root canals), periodontal (gum)  maintenance and routine follow up care.  My exceptional staff  is a great asset in  tending to your dental needs.

On occasion, when a procedure is outside of our comfort zone and requires specialty attention, we will refer you to the proper doctor in that area of treatment.  These referrals are coordinated with the ongoing treatment you are receiving in our offices.  We have access to the latest laser gum treatments, in the Tidewater Dental office.

Dental Implants as incorporated within our General Dental Practice

What Are Dental Implants?

A tooth consists of basically two parts, the crown (what you actually see in your mouth) and the root (embedded in the bone of your jaw).  A dental implant can be thought of as a tooth root replacement.  When a tooth is lost, the root is no longer in place to support a crown or become part of a bridge.  The implant becomes bonded to the bone (Osseointegration) and provides the support for a crown.  The implant is not a tooth, does not look like a tooth and is completely beneath the gum tissue.

Once we gain osseointegration, (not only does the bone grow around the implant, but it actually bonds to it) a post is screwed into the implant and extends into the mouth.  An impression is made of this  post and it is sent to the dental laboratory.  A crown/bridge is constructed to accurately fit the post.  When you return for the delivery appointment, the crown/bridge is cemented onto the post(s).  At this point, the implant and crown will function similar to  a natural tooth.  This entire procedure is provided within our General Practice as part of your overall dental needs.

What Is It That You Want?

In discussing your dental needs, we need to ask the question "What is your vision of your dental needs now and in the future?"  Many of you are wearing dentures or removable partial dentures, or simply have missing teeth,  thinking that is the only option.  I suggest to you that they are not, now or in the future.  How would you like to not have to remove your teeth each evening?  If you should need to go to the hospital, how nice would it be if you can answer the doctor's question "Do you have any dentures or partials?" with a resounding "NO"?

How nice would it be if you do not have to go the restroom to rinse off your removable teeth during a restaurant trip?  How nice would it be if you no longer need to be concerned that your teeth may not allow you eat anything you want to?

We could go on and on and the point is that through implant intervention and modern cosmetic dentistry, you can have the great smile and function you thought was lost to you.  Or if you have most of your teeth now, you can avoid the potential use of dentures and removable partial dentures in the future.

A professor once told me "No one has ever died because they had to wear dentures or partials, but non removable teeth are real nice accessories."  However you view the issue of missing teeth, there are options available to you that you may not have considered.

"What Are My Options?"

First and formost do not loose sight of the fact that a lot of tooth loss is unnecessary.  If you take care of your teeth with good home care and regular (an important point--regular) followup, most tooth loss can be prevented.  We, here at Solomons Island Dental Associates and at Tidewater Dental Associates, can provide all necessary services that can maintain your teeth within our General Dental Practice.

Never loose sight of the fact that in all situations, there is  always more than one way to do everything.  Each option has its own advantages and disadvantages.  You need to understand each of the options available to you in order to decide which will provide  the best result for you.

If, however, the tooth cannot be restored and must be removed, there are several options available to you:  A simple example of this concept is a single missing tooth with a tooth on each side of the space.  There are actually four options for you to consider before deciding which is best for you.  Being as we are General Dentists (we provide bridges, crowns, partial and complete dentures as well as implants) we can suggest the best procedure through experience with all types of prosthetics.

 Your options: (keep in mind, to provide you with advice as to which option is best, the General Dentist is looking at your needs through experience in all  options) 
1) do nothing:  the plus is that it is easy and inexpensive (initially);  the negative is that the adjacent teeth will move and ultimately your bite will be compromised and lead to further tooth loss and/or TMJ difficulties and the cost goes up. 

 
2)  a removable device (i.e. a partial denture):  the plus is that it is relatively inexpensive and easy to do;  the negative is that there will be a metal clasp around the adjacent teeth and perhaps a bar extending to the opposite side of the arch.  This will often put additional pressure on the teeth holding the partial and possibly cause their loss.  It must be removed daily for cleaning and pressure on the bone in the eduntulous areas resulting in potential bone loss.

3) a conventional fixed bridge:  the plus is that it can be accomplished within a short period of time (by your General Dentist, but not necessarily less expensive than the implant option.  It  is relatively easy to perform;  the negative of this is that you are now involving more teeth that do not need to be involved.  If something goes wrong with either of these teeth, you may lose the entire bridge.

4) an implant and crown: place the implant either at the time of extraction, or if the tooth is already missing, place it into the healed site.  The plus of this is that you are not involving the adjacent teeth, it is relatively easy to do, has an excellent prognosis and if something should go wrong with the adjacent teeth, you can deal with them alone and not remake or lose the implant/crown;  the one difference with the implant procedure and the fixed bridge is that it often requires 90 to 120 days for integration between the bone and the implant to occur.   During this integration period you can function normally.   In the long run, this integration  period goes quickly and is not a real negative.

In some situations, it is possible to bring the implants into function without going through the integration period of 90 to 120 days.   It should be noted that you do not necessarily need an implant for each missing tooth.  For instance, if there are three teeth missing, two implants can be used to support a three tooth bridge (non removable).  If all teeth are missing in an arch, the lower needs only 4 to 6 implants to replace 12 teeth and the upper 6 to 8 implants for the same number replaced.  In some cases, only two implants can be utilized to stabilize a loose lower denture (MDI).  Experience has demonstrated that placement of a full arch of teeth on only 4 implants, potentially has the risk of needing further procedures should the implants not accept the full function.

Implant costs are not as prohibitive as you may imagine.  The cost of multiple implant supported bridgework is not a multiple of a single implant.  More implants often cost less per implant than the cost of one.  The cost of one implant, with its crown and attachment post is approximately $3250.  If graft (we use an artificial graft material)  is needed, there is an additional $500.  That cost is often less than the cost of a 3 unit fixed bridge.  If your requirement is for three or more implants plus the bridge work, it is not necessarily 3 or 4 times the single cost. 

Bone Grafting

It is not uncommon for an implant to be placed at the time of the tooth extraction.   Actually I prefer this technique, and it eliminates one surgical procedure.   This will actually preserve bone and reduce the overall time for completion of the restoration of function.  The graft  is an artificial material.

Grafting and immediate insertion of the implant following an extraction, can preserve bone.  If a tooth is removed and not immediately replaced, the bone will fill the socket but it will resorb inward and downward.  This results is 10 to 15% less bone after 6 or more months. 

Who Can Receive Implants?

It is rare that a person cannot receive an implant or combination of implant types.  If a factor appears or if the medical history indicates something influential, the patient will be referred to his or her medical doctor. It is routine for the doctor to prescribe a blood test to identify factors that may influence the outcome of implant procedures.  We will then work with the physician to assure the best treatment is provided.

Just as there are no two people alike in the need for dental reconstruction, there are often needs for different types of implants within the same jaw. Today, we have many types of implants to accommodate multiple problems. The doctor's ability to utilize multiple implant techniques is essential to the successful use of implants. No one design will cover all situations. Which procedure is best for you, or even if a procedure other than an implant is deemed best, only a General Dentist can best make that decision, due to experience with all options.

What Should You Ask?

A patient seeking information about implants should inquire about a doctor's experience.  Inquire about how long he/she has been placing implants, the number placed, and variety of types placed.   Does he both place the implants and restore them?  If he only does one part (either the surgery or the prosthetics), is he familiar with the other part?  Does he work closely with the doctor providing the other part?   Patients should inquire about organizations the doctor belongs to and activities he or she is involved with in that organization. With the American Dental Association not recognizing implantology as a specialty, peer recognition is important.   Does he or she participate in a national or individual database program to identify trends in implant survival?

If the surgery and prosthetics are performed by different doctors, who is going to direct the program to assure they are in concert? Both doctors need to be familiar with and ideally, experienced in both parts of the procedures. If one doctor is not experienced in one part, the other must be experienced in both, in order to direct the procedures. The General Dentist is capable of providing this direction.

How Much Do Implants Cost?

It would be totally irresponsible to quote an exact fee for implants on this site.  There are many factors and variables.   Keep in mind the implant consists of several parts:  the implant body, the healing cap, the healing collar, and the prosthetic post.  In addition there is the crown/bridge that goes on the implant(s).  These additional costs must be factored into the cost you are given.  However, when compared to other costs for dental reconstruction, implants and their crowns/bridges are comparable. 

Whereas the fee for a single implant placement surgery may be approximately $1500, when all of the costs of the single implant and its crown, including the laboratory and component costs the total can range from $2500 to $3500.  This is comparable to the alternative, a 3 unit bridge, which would involve reducing two additional teeth.  Remember, an implant requires a crown (cap).  In my offices you will be quoted for both the implant and its crown/bridge.  That is unless your regular dentist has arranged to place the prosthetics, in which case you will be quoted for everything except the crown/bridge. This does not mean that when placing multiple implants and bridges that you multiply this number by the number of teeth involved.  As explained elsewhere in this site, multiple teeth can be replaced with only a few implants and the per tooth cost goes down.

As regards the MDI implant (discussed elsewhere in this section)  used to stabilize a lower denture, the cost, all inclusive with two implants, can be as low as $1100 and one visit.  If the existing denture needs modification, other than for the implants, there would be an additional cost.  The existing denture can be used if it is reasonably functional and you are pleased with its appearance.  This is a terrific procedure and can change your life.

To get an accurate cost for your needs, it is necessary for you to make an appointment to come into my office and you will be provided with a cost before anything is started.  This cost would include all aspects of the implant(s) and their associated prosthetics.

If you have been given a cost estimate for your implant work by another office, be certain it includes the costs for the implant and also the costs for the crown or bridge that goes on the implant(s).

Insurance coverage varies for each policy.   Generally, implants are not covered or, if they are, to a minimal degree.

We now have financing plans available.  Be certain to inquire about them at your consultation.  One of the programs is even interest free.

Who Can Place Implants?

All dentists are licensed to perform all phases of dentistry unless they have established themselves as a specialist.  An Oral Surgeon is a specialist in oral surgery and can place the implants but  cannot place the crown.  A periodontist is a specialist in periodontal (gum) disease and can place the implants but  cannot place the crown.    A General Dentist can both place the implants and the crown or bridge and has the experience to help you decide which option would best serve you.  These options are discussed elsewhere in this section 

Implants are only marginally taught in Dental School.  Expertise and experience in implantology is obtained through continuous work within the field of implantology.  The American Dental Association does not recognize Implantology as a specialty and therefore the identification of those of us that have extensive experience and training in implantology is sometimes difficult.  The implant organizations around the world confer various recognitions on practitioners that have demonstrated expertise in implants to assist patients in recognizing who has the experience in implantology.  Do your homework before making a decision that impacts your health.  Peer recognition is important to make the identification of General Dentists so experienced. 

As a General Dentist,  I have been granted recognition by the American Board of Oral Implantology/Implant Dentistry whose designation of Diplomate,  is the ultimate recognition one can receive in implantology , as defined by the ABOI.  I cannot, however, advertise myself as a specialist as the American Dental Association does not recognize Implantology as a dental specialty.  The purpose of this and the other peer recognitions that I have obtained is for credibility and your confidence in my experience, without which, it is difficult for you to gauge my ability to provide you with your needed implant procedures.

I always diagnose and place the implants.  The placement of the implant is critical to the ultimate reconstruction, whether it is a single implant or multiple implants.  My  experience allows me to place implants in a manner conducive to good crown and bridge placement .

I can work with your existing dentist, if you wish, where I place the implant and he can complete the prosthetics.  This allows you the comfort with staying with someone you are familiar with for the prosthetics.   Discuss this with your  dentist beforehand and we will coordinate our work.

General Dental Restorative Services

As a General Dental practice, we can provide all of your dental needs from routine semiannual checkups and cleanings to fillings, gum disease management, full and partial dentures, crowns, root canals, bridges and cosmetic procedures as well as working with children.  There will be occasions when your needs may fall outside of our staff's expertise and will need to refer you to a specialist.  We will oversee this referral and make certain you are well taken care of.  Between my two offices we have an oral surgeon, an orthodontist , an endodontist (root canals), a dentist providing the latest laser gum treatment, experience with children as well as full hygiene and preventative care on staff.

We can provide you with oral sedation to make your experience as comfortable as possible.

Cosmetic and Restorative Dentistry covers a wide range of procedures.  If you are not pleased with your smile, the use of porcelain crowns, or porcelain veneers can make a dramatic difference.  Through the use of modern composite materials, old fillings can be replaced with tooth colored fillings that are largely undectable.  These are actually bonded to the teeth and provide excellent long term service.

Dental hygiene is the area of dentistry that is absolutely essental to your long term dental health.  Our hygienist will check for gum disease and with one of our dentists will prescribe a maintanence program suited to the amount of plaque you build up.  The recall interval is predicated on how well you can manage the plaque  at home.  She will recommend procedures to control cavities, good gum health and will refer any restorative needs to the dentist for correction.