Texas Oral Surgery Group

Why Replacing Lost Teeth is Important

Why Replacing Lost Teeth is Important

Tooth Replacement PlanoFor those that have lost their teeth or have been suffering from missing teeth, it is important to understand the critical nature of this issue.  The reality is, that nobody wants to live their life with missing teeth.  In addition to it looking unsightly, it also affects your self-confidence, hindering you from being able to smile openly. Even though aesthetics are important, there are several other reasons why you should seriously consider replacing your lost teeth.

Reason people lose teeth

Why do people lose their teeth?  One of the most common reasons is changes associated with aging. As an individual becomes older, the strength of the outer shell of the teeth (known as enamel) diminishes, along with deterioration of jawbone support, reducing our ability to maintain our permanent teeth. As a result, the teeth become more fragile and progressive tooth loss occurs over time.

Some of the other common causes of teeth loss include: dental decay and (gum) disease.  Dental decay increases in older patients because of several factors: loss of manual dexterity, medical issues and medications along with changes in the saliva are big contributing reasons. Saliva is a “miracle mixture” having buffers, minerals and antibodies which protect the teeth. Saliva becomes diminished as we age, bringing with it a host of dental issues.   Periodontal (gum) disease increases as we age and often results in a person losing one or more teeth over the course of time.

People also struggle with losing their teeth because of sports injuries, accidents, and trauma that has been sustained to the mouth. As we all know, there is no age limit to slipping and falling, being involved in an accident, or experiencing physical contact to the mouth.

Importance of replacing lost teeth

Throughout adult life, it is imperative for those individuals who have lost teeth to have them replaced as soon as possible since missing several teeth can severely influence your daily life. It can affect your general health, your appearance and self-esteem.

Tooth loss disturbs the natural balance between teeth and bone. The jaw bone starts shrinking, once a tooth is lost and your gum recedes. This bone loss can weaken neighboring teeth causing further tooth loss! Opposing teeth, if left unsupported, can then move into the missing tooth space causing orthodontic and restorative problems.  Missing teeth and a diminished jaw bone can make your face look older than it should, causing your cheeks to become hollow and saggy.

  • Digestion

Chewing, food transport, and swallowing are a continuum. There is no doubt that the teeth are necessary,] to be able to tear, chew, grind, and bite food in your mouth. If you lose teeth, then it prevents your ability to conduct all these actions in an effective manner. Tooth loss also indirectly disturbs the coordinated execution of swallowing food. It has been shown that elderly people with reduced numbers of teeth complain of difficulty in chewing and swallowing, often opting for softer foods which have less nutritional value and are higher in calories. With a lack of teeth, it often becomes quite difficult to consume nutritional foods on a regular basis and a constant worry with what types of food to eat.  As a result, tooth loss reduces your ability to live life to the fullest!

  • Speaking

Even though it might be slightly hard to believe, your teeth play an important role in your ability to communicate and speak in an effective manner.  Teeth working in a coordinated fashion with your tongue and lips are used to enunciate properly, offset certain words, and form certain patterns of speech.  Individuals who have lost one or more teeth often find it quite difficult to talk properly. Since the holidays are near, you may remember the classic   song, “All I Want for Christmas Is My Two Front Teeth”. The humor is that the child singing the song can’t pronounce the word “Christmas,” because they have no front teeth. As a result, tooth loss can be very frustrating at times.

Best options for teeth replacement

If you are missing any teeth, it is in your best interest to look at all the options available. This is something which you should do at your earliest convenience. The longer you wait to get your teeth replaced, the more severe problems may become and the more challenge there is to deal with the consequences.

  • Dental implants

Amongst all the tooth replacement options available, most find dental implants to be the best option. This is because dental implants most realistically replicate natural teeth.   Dental Implants replace both the crown and the tooth and the root. Since the replacement tooth is embedded in the bone, it helps prevent the further loss of bone structure.  Simply put, an implant is an artificial tooth, and functions like a natural tooth.

In terms of its drawbacks, the only significant downside with dental implants is the healing time. From the time the procedure is completed, the healing process can take anywhere up to three months.  However, since you are obtaining permanent teeth, the implants are designed to last the rest of your life.  Implant treatment is a long-term investment into your health and your wellbeing – in short, an investment in your quality of life. Compared to other dental restorations, implants can seem more expensive initially, however, higher maintenance costs for other type restorations, the potential increase in jaw bone loss, and potentially, the loss of even more teeth can make other restorations more expensive over the long run.


No one should die with their teeth sitting in a glass of water”


In Memory of Per-Ingvar Brånemark (May 3, 1929 – Dec 20, 2014)

Father of modern Dental Implantology

If you are interested in restoring your mouth to good health, The Texas Oral Surgery Group can provide you with some great tooth replacement options.  We encourage you to contact one of our four office locations in Plano, Denton, Decatur, or Gainsville, to schedule a consultation and we can discuss the best options for you!


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5 Common Dental Implant Myths and the Facts

5 Dental Implant Myths and the Facts

Dental Implants PlanoWith the entire world becoming obsessed with their outward looks and appearance, you might also find yourself jumping on the bandwagon. While increased exposure to media and the Western world have been credited with this changing trend, there is no denying the fact that people independently are also becoming more aware. The days of just jumping out of bed, throwing on some clothes, and jumping in the car are long gone.  In current times, much more thought and planning goes into the entire process so that everyone can step out looking picture-perfect.

The same thing could be said in the case of our teeth as well. This is because a smile is considered to be one of the most important assets that we possess.  If that smile is tainted or damaged in any way, then our entire look and appearance is ruined.

In earlier times, damaged and misplaced teeth were treated with dentures, root canals, and bridges. While all these procedures were definitely effective, these treatments also tended to harm the adjacent teeth rather than supporting the damaged tooth. In addition, root canals were also considered to be one of the most painful procedures that one would be able to undergo. Even after the procedure, the patient would experience immense pain and only be permitted to have liquid food for a certain amount of time.

All this seems to have changed with the introduction of dental implants. To describe it quite simply, a screw or metal post is surgically positioned into the jawbone, located right beneath your gums. Once these are in place, it allows the dentist to mount the replacement teeth or cap on to them.  As a result, dental implants have been found to be the most effective procedure for tooth replacement and smile correction. With just one streamlined procedure, you are be able to restore your teeth and smile to its formal glory.  It does not get much simpler than this!

Despite the simplicity and effectiveness of implant treatment, you still find a large number of people remain hesitant when taking advantage of dental implants. This hesitance often results from a large number of implant myths that continue to float in the outside world.

If you are seriously considering dental implants, it is important to have a full understanding of this misunderstood procedure.  The first step is to discover if there is any truth to the numerous dental implant myths.  Specifically, we examine five of the most common myths that seem to exist for dental implants, along with the facts:

  1. A painful procedure

The group of people who are against dental implants would say that it is a painful procedure, both during and after the procedure. However, this has been found to be completely untrue. This is because dentists now provide this service under local anesthesia, which means that you are not subjected to any pain. Also, an experienced and knowledgeable dentist would be familiar with the entire process of tooth implantation. As a result, they are able to offer you a wide variety of anesthetic options to suit your preferences and needs.

  1. Risky

Again, this is another common dental implant myth!  The fact is that dental implant technology has been continuously evolving for the past thirty years, with new advancements being introduced almost every other year. As a result, dentists are able to guarantee a success rate a whopping 95% of the time. This high success rate is due to experienced dental practitioners carefully performing the procedure in order to avoid any complications. All you need to do is select the right dental professional!

  1. Extremely expensive

When choosing dental options, it is quite normal to select the most affordable option. Most individuals would prefer to not spend an exorbitant amount of money, unless it is absolutely  necessary.  While dental implants are definitely not as expensive as you may be thinking, there is some investment involved.  However, when you examine the big picture and other alternatives, the investment is well worth it.  When you compare dental implants to other treatment options, it is important to remember that most people only need dental implants once.  So if there is a little more cost involved than some implant alternatives, it would definitely be worth it!

  1. It takes too long to heal from dental implant surgery

This myth has also been found to be misleading for a number of dental implant patients. This is because the complete healing time could span from one day to six months, depending on a number of factors.  In addition, the healing time can vary greatly from one patient to another. It is surprising to see many patients opting for same day implants, also known as immediate loading implants. This quick implant treatment option allows patients to solve their tooth problem without having to disrupt their busy schedule.

  1. Involves special care and maintenance

This myth has been found to be completely baseless. This is because dental implants do not require cleaning, extraneous removal, or any sort of maintenance hassle. All you need to do is take care of your implants – the same way you take care of your natural teeth. This entails brushing, flossing, and going for regular dental checkups.

Hopefully, this shed some light on some of the most common misunderstood aspects of dental implants.  While you will definitely come across more dental implant myths, you should now understand that most of these myths are completely baseless and do not have any solid evidence to back up their claims.

Before you proceed with any type of dental implant treatment, it is always a good idea to schedule schedule a consultation with a dental professional so they can walk you through the entire process and assist you with selecting the most suitable option for you.  With over 40 years of combined experience, Dr. Larry Stewart and Dr. Wayne Michael are considered the leading providers of dental implants in Plano, Denton, and the North Texas area.  Individuals in need of dental implants enjoy being able to choose from one of our 4 convenient office locations in Plano, Denton, Decatur, and Gainesville. We encourage you to contact us for a free consultation and ask about our dental implant specials!  The Texas Oral Surgery Group will make sure your implant experience is an enjoyable one!

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An Interesting Case of an Unusual Radiologic Finding

An Unusual Radiologic Finding

Last year in June, I saw pleasant 18-year-old young lady or consultation regarding removal of her impacted and malposed wisdom teeth. At the consultation a thorough history was taken and her past medical history reviewed. Everything was negative except for a history of cavernous hemangioma involving lower lip and buccal mucosa. There was no obvious clinical involvement of the mandible or the area of the wisdom teeth.



The patient successfully underwent removal of her wisdom teeth and had an uneventful recovery. On routine examination at her dentist this year, he noticed some unusual calcifications in the area near the extraction site #17, and referred the patient for evaluation. Upon clinical exam of the patient I could palpate no obvious mass around the extraction site and the tissues in the area appeared within normal limits. Her hemangioma had not appeared to increase in size, but it did have a somewhat lumpy consistency in certain parts of the mass. The remainder of her oral examination was within normal limits.

Based upon my examination I referred the patient for a CBCT and obtained the following images:

What is your diagnosis of this interesting finding?

Answer: Phleboliths in the cavernous hemangioma of the left buccal mucosa.

Phleboliths are a rare finding in hemangiomas and are areas of dystrophic calcification within the mass of the hemangioma. Their cause is not clear, but thought to be due to altered blood flow hemodynamics, with areas of venous pooling which then go on to calcify. Because this particular hemangioma is not facially disfiguring for the patient, no further treatment is recommended. Treatment of facial hemangiomas is a challenging effort and most often involves a team approach including interventional radiology and surgery.

If you are experiencing any discomfort or pain with your wisdom teeth, we encourage you to contact the Texas Oral Surgery Group.  With offices in Plano, Denton, Decatur, and Gainesville, our elite oral surgeons have extensive experience providing wisdom teeth treatments to residents of the greater Plano region.  We look forward to assisting you!


All Dental Implant Companies Aren’t the Same

3 Tiers of Dental Implant Companies

Dental Implant

I’ve been placing dental implants for over 35 years and, unfortunately, I’ve noticed a disturbing trend developing in the industry. It seems that the dental implant industry has become segregated into 3 basic tiers.  The 1st tier is what I call “Industry Leaders”.  These are predominantly long-standing players in the field, with big market penetration, extensive research in their products, and great field representative support with high manufacturing/ distribution standards.  Obviously, these implants are the most expensive!  You’re paying for that marketing and for their expertise.  The 2nd tier is the ‘Me Too” group. This group of implant companies say that they are just as good as the market leaders, have equally high standards and are “just as good’ as the industry leaders. It’s possible that their manufacturing is as good, although not guaranteed, but they clearly don’t have the research and education budgets of the market leaders. Their implants may be more price competitive.  Additionally, they will commonly have less field representation for the surgeon and restorative dentist. The 3rd tier implants, the “We’re Cheaper” group, are companies that primarily market directed to the doctor, and compete on price only. They have limited to nonexistent sales staff and are supported with minimal research.

The part of this trend that concerns me the most is, the “race to the bottom” based on cost.  Dental implants are a business and a significant portion of many dental practices.   If costs can be reduced, this saves on overhead and ultimately improves profit.  Nobody wants to hear about profit in healthcare. Unfortunately, it is a reality, and the balance between what is best for our patients and the cost of providing those services is always part of any decision.  If it was as simple as saying, the cheapest implants are equally as good as the best implants, then the decision would be a “no-brainer”.  However, this is not the case. The tier 1 and tier 2 implant companies have spent millions of dollars in research and development to make sure that their devices are optimally manufactured and delivered.  Hey, aren’t these just machined titanium screws?  Hardly!  The fit and finish of these devices is highly engineered and specific to brand.

Dr. David A. Burt, at CDEworld.com wrote an interesting article recently entitled,” The importance of using authentic implant parts”. Find it here at https://cdeworld.com/ebooks/download/the-importance-of-using-authentic-implant-parts . In this article, he talks about some of the marvelous engineering that goes into dental implants and, in particular, the abutment/ implant interface issues such as micro gaps, appropriate implant screw preload forces, abutment mechanical tolerances, elastic deformation, and cyclic fatigue.  All of these issues can affect the dental implant or restoration and can lead to premature failure if protocols are not followed.  Mixing aftermarket components with existing dental implants invalidates the manufacturers research and voids warranties. Being penny wise can certainly be pound foolish.

Another issue of using 3rd tier implants, is that if the patient moves to a new location, the new treating doctor may have no clue as to the type of implant utilized. This creates issues in trying to repair and/or replace existing implants. We have certainly seen this to be the case, as we commonly see people referred to us who had implants done either out of the country or somewhere else and they have no clue what is in their mouth!  In the rare cases where we can identify the implant, often times finding the components becomes a challenge.  If we are unable to identify the implant system, then repair is not possible and the implants must be removed.  This makes for a very unhappy patient!

I’ve reached the point in my career where I have many patients who have dental implants in place that are 35+ years old.  It makes me realize that, when I place an implant it’s going to be there for a while- in all probability, and I want to be able to have another treating doctor know exactly what is in this patient’s mouth, and be able to obtain components for this implant in the future.  For this reason, you can be assured that the doctors at Texas Oral Surgery Group will never use the “3rd tier” type implants. Your mouth and your dental health is too important to cut corners!

If you are searching for high quality dental implant care, we encourage you to contact one of our four convenient office locations at Plano, Denton, Decatur, or Gainesville and schedule a consultation.  We look forward to providing you with the care you deserve.


The views expressed, are mine and mine alone, and I might be wrong…but I doubt it! I’m open to hearing opposing points of view and have been known to change my mind… from time to time. 😊

Larry R. Stewart DDS, MS, FACD, FICD

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All on Four

All on Four

What is the” All on Four” procedure?
This is a technique whereby we can place four implants in the upper or lower jaw to support a fixed bridge. This means that the patient can have implants placed and new teeth to chew with, the same day. This innovative procedure is not new, in fact it is over 30 years in the making. It was developed in Europe and has attained worldwide acceptance as the “standard of care” for implant supported bridgework. The refinement of dental implants and their components has allowed us to be able to bring this technology to our patients.

Who is a candidate for “All on Four”?
Essentially anyone who can safely undergo a dental implant, could be a candidate for the All on Four procedure. The ideal candidate for All on Four, is a person who has multiple failing teeth and they do not want a denture. We have seen our parents and grandparents struggle with dentures, and now we have options to avoid these problems! Dr. Michael and Dr. Stewart, with their background in surgery and years of experience, can evaluate you to determine if you would be a good candidate for the All on Four technique.
How does the “All on Four” procedure work?
We work closely with your referring dentist to coordinate a team approach to implant dentistry. We believe this offers optimal patient care. The first step in All on Four involves your dentist taking impressions of your mouth and certain records. From this a bridge will be fabricated for use at the time of surgery.
Our office will establish a surgical time once the bridge is ready, and we will have the dental lab present at your surgery. The actual surgical procedure takes about 1 ½ to 2 hours per arch. Once the implants are in place, the dental lab helps us by converting the bridge to the newly placed implants. This conversion process can also take several hours. As you see, if we do upper and lower jaw in one day, it can take the full day to complete the process.
The All on Four procedure is different than single tooth implants in that, loading of the implants is accomplished the same day. How is this possible? First, it requires four implants that are firmly anchored into the bone. We measure insertion torque of the implants when they are placed. Secondly, we utilize the bone of the anterior part of the jaw which is denser and usually has greater volume. Thirdly, the implant supported fixed bridge “’unifies” the four implants, spreading the load of chewing across all four implants. This allows the bridge to be placed on the implants the same day. Immediate function is a huge benefit of the All on Four procedure!
Most patients experience very little pain with the surgery and the postoperative process. In fact, they have less pain than they would normally have if they had chosen a removable type prosthesis. Our office will see you several times in the immediate postoperative period and coordinate visits with your dentist.
The implants must heal for 4 to 6 months and then your dentist removes the bridge that was placed at time of surgery, takes a new impression, replaces your bridge: so that you never go without teeth! A new permanent bridge is fabricated. Once this bridge is back from the lab, your dentist will schedule an appointment to seat the new bridge. Our patients report to us that the All on Four bridge “feels and chews” like natural teeth. Studies show that the all on four bridge gives patients a chewing efficiency nearly equal to that of natural teeth.

How long does “All on Four” bridgework last?
The procedure has been around long enough that we now have published 10+ year data that shows success rates for All on Four bridgework in excess of 98%. There is no other dental restorative procedure that has documented higher success rates than the All on Four procedure. As with any dental implant procedure, the All on Four is designed to be a permanent restoration, with the goal being, for you to have this implant bridge for the rest of your life.
What do I have to do to take care of my bridgework?
As with any dental implant, close attention to good oral hygiene is imperative for the longevity of the implant supported bridge. Our staff will review with you the necessary protocol for oral hygiene and maintenance of your prosthesis. We recommend an ultrasonic toothbrush, the use of chlorhexidine rinses, and a WaterPik type oral irrigation device for use in oral care. Additionally, flossing aides can be of benefit cleaning the implants. With good home care and regular professional follow-ups, you should be able to take excellent care of your implant supported bridge.

What does “All on Four” cost?
The total fee for all on four fixed bridgework normally runs about $24,000 an arch. This cost includes our surgery fee, a lab fee, and the restorative dentist fee. Each dentist chooses the amount they want to charge for their portion of this treatment plan, but this is a good estimate of the fee. While this may seem high, no less of an authority than Dr. Charles Babbush-a world-renowned implant expert, has stated, “When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.”
When you consider that in the era prior to All on Four, many patients had to undergo lengthy treatment plans with multiple tooth extraction, bone grafting and multiple implants, there is no doubt that the All on Four procedure is the best option for a patient who wants an implant supported fixed bridge.