If you’re currently missing one tooth or more, you’re definitely not alone, as it’s estimated over 120 million Americans are in your exact same position. Thankfully, Dr. Lorenzana is able to provide a solution that can make you look and feel like your teeth never went missing in the first place: dental implants. Using his decades of experience and the finest dental materials available today, he can rebuild your smile, your bite, and your confidence for a lifetime to come. To learn more about dental implants in San Antonio, T and what it could do for you, give us a call today.
Why Choose Lorenzana Periodontics for Dental Implants
Board-Certified Periodontist & Implant Specialist for 20+ Years
Sedation Dentistry Guarantees a Comfortable Visit Every Time
100% Personalized Treatment Plans for Each Patient
What Is a Dental Implant?
A dental implant is actually a prosthetic tooth root made of titanium and zirconium. It is inserted directly into the jawbone in the space left by the missing tooth, and then it is topped with a custom-made crown, bridge, or denture. Once in place, the implant actually bonds directly to the adjacent bone much like a real root, ensuring it will provide trusted support for the new teeth, in most cases, for life.
The Dental Implant Process
While some practices have to refer their patients out to other doctors just to have dental implants placed, Dr. Lorenzana has many years of experience in placing and restoring dental implants. That means he can handle all phases of your care in one location, making your tooth replacement process all the more easy and convenient. To learn more about the steps that go into placing dental implants ahead of your consultation, you can read about them below!
Initial Dental Implant Consultation
Dr. Lorenzana will need to perform an in-depth exam and consultation to confirm if you are eligible to receive dental implants. He’ll examine your mouth and facial structures as well as your current gum and bone health. In some cases, patients need to complete preparatory procedures before they can undergo dental implant treatment. After these procedures (such as bone grafts, gum disease therapy, gum grafting, etc.) have been completed, he can schedule you for your implant surgery.
Dental Implant Surgery
Placing dental implants is a relatively straightforward process. After administering local anesthetic to numb the mouth (as well as any sedation, if requested), he’ll create a small incision in your gum tissue, then create a tiny hole in your jaw so the implant has room to integrate. Once the implant has been placed, the gums will be sutured shut so the post can begin to heal. A protective cap is also placed over the implant to maintain the shape of your gums and shield the implant as it heals.
Dental Implant Osseointegration & Abutment
Over the next three to six months, the osseointegration process will occur. This step is essential to the longevity of your tooth replacement. Osseointegration is when the titanium post physically fuses with your bone tissue. After the post has fully integrated, you’ll come back to our office to have an abutment attached. This small metal connector acts as the foundation for your permanent restoration. Your gum tissue will need a few additional weeks to heal around the abutment before the crown, bridge, or denture can be placed.
Delivery of Dental Implant Restoration(s)
Your permanent restoration is designed based on the impressions we captured of your mouth ahead of your surgery. Whether you need to have a crown, bridge, or denture placed, you can expect it to fit exactly and feel incredibly natural once it is attached. We work with a trusted dental lab in the area to create your implant restoration, then send it to us once it has been fabricated. We’ll be happy to make any modifications to your restoration ahead of time if needed. Once your implant is covered, you can expect it to be indistinguishable from your natural teeth!
Benefits of Dental Implants
Stability: Dental implants sit in your jawbone just like your real teeth, so whenever you take a bite of food, you can rely on them to always stay in place and never shift.
Lifelike Appearance: Because they are completely self-supporting and topped with porcelain restorations, implants resemble natural teeth in every way you can imagine, easily blending into any smile.
Permanent Solution: With just regular, routine brushing, flossing and professional cleaning visits, a dental implant can be trusted to last for 30 years, and they often endure for a lifetime.
Are Dental Implants Right For You?
Thanks to Dr. Lorenzana’s experience and expertise, basically anyone with missing teeth can benefit from dental implants. All a patient really needs is good oral health and stable overall health. Once these have been confirmed, our team can help you choose from one of the following treatments to restore your smile.
Missing One Tooth
Instead of using a bridge to replace a single tooth that puts pressure on the teeth around it, Dr. Lorenzana can simply position an implant between two healthy teeth and attach it to a crown. The crown itself will be shaded to match the rest of the smile, and it won’t affect the nearby dental structure at all.
Missing Multiple Teeth
Whether you’re missing a few teeth in a row or throughout your mouth, just one to two implants can be used to replace them all at once. Prosthetics like bridges and partial dentures can be secured to the jawbone to give the new teeth much more strength compared to traditional removable ones.
Missing All Teeth
Even patients with complete tooth loss can be good candidates for implants. A full denture can be anchored to the jawbone using just four to six strategically placed posts, creating a new row of teeth that looks natural, feels secure, and can be trusted to stay that way for decades to come.
In many cases, before a patient can undergo implant surgery, they need to be treated for ongoing dental issues like periodontal disease or failing teeth. Or, their jawbone may not be strong enough to support the new roots. Dr. Lorenzana can provide all types of procedures to address these issues so that when a patient finally receives their implants, success is all but guaranteed.
Even though dental implants might already sound like the perfect solution for you, we’re sure you still have plenty of questions! We love educating patients about their treatment options so they can feel confident about every care decision they make. If you want to learn more about dental implants, follow the link below to find our responses to some of the most popular questions we receive every day.
Every dental implant treatment provided by Dr. Lorenzana is completely customized based on the needs of a particular patient, and because of this, the price will always vary from person to person. How many teeth are missing, where they are located, and the type of restoration needed are just a few of the factors that can influence the final cost. While it’s true that dental implants tend to be more expensive compared to regular bridges and dentures, they are an investment that is designed to last for decades, while other treatments typically need to be redone every five to ten years. Over time, implant patients tend to save thousands because they don’t have to replace their teeth as often.
Our patient was born missing her lower left second premolar (#20). She did not want to damage her natural adjacent teeth in order to make a bridge so a dental implant was her first choice. Orthodontics (braces) were used to obtain the optimal space and, following appropriate radiographs and treatment planning, a single dental implant was placed.
Illustrations courtesy Straumann AG
Restorative work by: Dr. Jason Gillespie (San Antonio, TX)
Initial Presentation - Born missing tooth #20
Options: Bridge vs. implant
For a “bridge” the teeth must be “cut down.”
Then a three-piece bridge is cemented in place.
A dental implant is a new titanium “root.”
The teeth are not touched.
When healed, the dentist makes a crown on the implant.
When this patient found himself missing three teeth in his lower left jaw after his bridge had failed, he had one simple request: He had not had teeth he could floss normally for over fifty years due to the bridges he’d been wearing so could we please give him something close to what he had way back when.
That’s just what we did. Three dental implants so that he could have three single teeth, just like when he was a young man.
Restorative work by: Dr. Michael Miller (San Antonio, TX)
Theresa presented to our practice upon referral from her General Dentist, Dr. Diane McKeever, after failure of her previous three-unit bridge. Her options were:
(A) A new bridge, but making it a four or five unit span. This would require changing one crown and cutting down one or two virgin teeth.
(B) A partial denture that is removable and comes in and out of her mouth.
(C) Two implants replacing the two missing teeth, making each tooth self-supporting.
Theresa decided that two implants were a more cost-effective way to replace her two missing teeth because:
(A) She could save money by leaving one crown alone;
(B) She could keep her two unrestored virgin teeth from being cut down in any way;
(C) She would once again be able to floss each tooth individually;
(D) She would save money in the long term because long-span bridges are known to not last as long as implant-supported crowns and bridges. In fact, after 7 years, implants are cheaper to maintain than conventional bridgework.
It is true that implants are not for everyone but talk to your dentist about your options or call our office for a consultation.
Restorative work by: Dr. Diane McKeever (San Antonio, TX)
Healed implants in place
Impression components
Impression taken
Implant analogs in place in impression
Master cast with implant analogs
Customized abutments on master cast
Final crowns on master cast
Abutments in place
Photo showing limited inter-arch space
Final crowns in position
Crowns in occlusion
2-year radiograph
Advanced Solutions
Implants placed at time of extraction in non-esthetic situations
With today’s digital technology, challenging clinical situations can oftentimes be precisely planned using CT scans with minimal radiation exposure, also known as Cone-Beam CT scans, implant planning software, and CAD/CAM technology. This gives the restorative dentist and periodontist implant surgeon the utmost control in 3-dimensional implant placement. the result is improved precision, reduced surgical time, and increased satisfaction with the overall outcome in difficult situation.
Guided surgery is not necessary in every case, but Dr. Lorenzana may recommend it if there is minimal bone available, if multiple implants are being placed simultaneously in close proximity to each other, or in esthetically demanding situations.
Restorative work by: Dr. Lane Walsh (San Antonio, TX)
CT scan imaging by iMagDent (San Antonio, TX)
This patient was referred to us following the traumatic fracture of her upper left first premolar (tooth #12). Complicating the situation aesthetically and functionally was the presence of advanced gingival (gum) recession on the tooth in question as well as the adjacent canine #11. Careful implant placement in conjunction with soft and hard tissue augmentation yielded excellent tissue contours that her restorative dentist could confidently guide to a successful, aesthetic outcome.
When unfortunate accidents happen that result in the fracture of one or more teeth, we prefer to place the implant(s) immediately upon tooth extraction whenever possible in order to preserve the native tissue architecture and achieve the best aesthetic result.
Restorative work by: Dr. Lane Walsh (San Antonio, TX)
Extraction of a Failed Lower Front Tooth and Immediate Implant Placement
Melissa also had a long history of treatment for her lower left front tooth (#24). The tooth had been previously traumatized and a root canal and crown had been done previously. Unfortunately, the tooth failed, resulting in swelling in the gums directly over the tooth and constant discomfort.
Again, the tooth was carefully removed, the socket was thoroughly cleaned, an implant was placed, and the socket and surrounding bone were augmented with not only bone grafting material, but also with a soft tissue (gum) graft to help recreate the ideal contours of the surrounding tissue. After 4 months of healing, she was referred to her prosthodontist where the restorative phase began. A temporary crown was made and an impression was taken of the implant in order to make a custom abutment and crown.
Melissa was very concerned about the esthetic result of the final crown, even though the tooth is not visible when she smiles or speaks. Thanks to the collective efforts of both the surgical and restorative teams, her fears were set at ease with a much better result than how she began.
Restorative work by: Dr. Jason Gillespie (San Antonio, TX)
Initial Presentation - Note Swelling from Infection
There are many advantages to placing a dental implant at the time of tooth removal - saves time, can save cost, a single surgical procedure. However, there are occasions when placing a dental implant at the time of tooth removal is not possible, either due to the surrounding anatomy, the amount of infection present, incomplete treatment planning, among others. When this is the case, Dr. Lorenzana may recommend a procedure called ridge preservation.
Ridge preservation involves the placement of bone grafting material into the extraction socket in order to preserve the dimensions of the bone for future dental implant placement. The scientific literature states that 50% of the natural bone width is lost within a year (Schropp et al, 2003b) and 2/3 of that loss occurs within the first 3 months. When ridge preservation is utilized, those bone contours are preserved, resulting in improved function, reduced damage to adjacent structures, less invasive procedures, less cost, and potentially better esthetics (Nevins et al, 2006; Darby et al 2009)
In the Case #1 below, tooth #13 (third unit from the right in the first x-ray) had a fracture that had effectively split the tooth, causing the patient pain. The tip of the root of the tooth was in close contact to the maxillary sinus. Dr. Lorenzana decided that there was too much risk for a sinus perforation to place the implant at the same time as the removal of the tooth. Therefore, a ridge preservation was performed (x-ray #2), and the graft was allowed to heal 4 months. At that time, the implant could successfully be placed away from the sinus. The final photograph shows the final result, with the implant restored with an all-porcelain crown.
In patient Case #2, a ridge preservation was necessary due to a fracture on molar tooth #19 that had caused loss of bone around the socket. A ridge preservation was performed to repair the defect at the time of the extraction. Following 4 months of uneventful healing, the appropriate dental implant was placed into the healed bone and restored.
In patient Case #3, the patient’s situation was deemed unsuitable for simultaneous extraction and implant placement. However, he was also unsure when he would be able to have his implant placed due to his busy schedule. The decision was therefore made to perform a ridge preservation to allow implant placement at a later date without losing significant bone while he waited.
Restorative work by: Dr. David Karbach (Case #1), Dr. Joan Dreher (Case #2), and Dr. Kurt Riewe (Case #3) Special thanks: Osteogenics Biomedical (Lubbock, TX) for the diagrams
Sometimes, when there is just enough bone to secure the implant, but additional bone is necessary to place a sufficiently long implant, a more conservative osteotome sinus lift procedure can be performed.
In this procedure, rather than making an opening through the side wall of the maxillary sinus, the sinus lift is performed through the same opening through which the implant will be placed. In the photos below, Figure 2 shows how the implant site preparation stops just short of the floor of the sinus. Using surgical osteotomes, the floor of the sinus is gently displaced upward to create room for bone graft material and the implant (Figure 3 and 4). The main advantage of this procedure is that a smaller incision can be made and there is usually less discomfort to the patient post-surgery.
It is important to note that this procedure is not for every indication and its success is dependent on prudent case selection. Please feel free to discuss this and any other procedure with Dr. Lorenzana.
Improved Retention of a Denture with Dental Implants
Most denture patients will tell you two things about their dentures: (1) the upper ones stay in OK, and (2) the lower ones don’t. By placing 2 -4 dental implants in the lower jaw, we can turn lower dentures from a nuisance to a success by providing fixed anchorage, leading to better function and renewed confidence. Upper dentures cover the entire palate and that can change how food tastes and feel bulky. 4-5 dental implants can improve this situation by allowing the elimination of the section that covers the palate, allowing patients to feel more freedom and taste their food as before.
Patient #1 presented with only 3 teeth remaining to hold her lower partial denture. When one fractured, it was time to make the transition to an implant-supported denture. Locator attachments fit onto dental implants to provide a secure, removable, and cleansable solution for patients who cannot afford more implants or have limited available bone for implants.
Patients #2 and 3
As retentive as upper dentures usually are, oftentimes patients would like to have their palate free of coverage. This would allow them a more natural feeling of function as well as improve their taste sensation. Some patients, such as Patient #3, have bony growths in the roof of their mouths (tori) that do not allow the use of a conventional denture. By placing 4-5 dental implants in the upper jaw, these patients got the best of both worlds: (1) no painful, complicated surgery to remove the palatal tori, and (2) no palatal coverage so they could enjoy and taste their foods as before.
Patient 1 Restorative work by: Dr. Alfonso Monarres (San Antonio, TX)
Patient 2 Restorative work by Dr. Michael Rothstein ( San Antonio, TX)
Patient 3 Restorative work by Dr. Kurt RIewe (San Antonio, TX)
Dental implants are very versatile. This patient was not ready to commit to a denture so we placed two implants in order to help hold his partial denture until he is ready for a denture or for fixed bridgework. By simply replacing the components that fit onto the dental implant, the configuration and type of restoration can be changed depending on the patient’s wishes.
Restorative work by: Dr. David Lewis (San Antonio, TX)
Only 3 Remaining Upper Teeth
Two Implants Hold Partial Denture
Security, Stability and Function (2005)
Transitioned to full upper denture - 3 years post-transition (2013)
Implant Placement at a Lower Molar Site at the Time of Extraction
Implant placement in molar areas is made more complicated by the fact that molars have 2 to 3 roots as opposed to single-rooted teeth. In most cases, the failed molar has to be extracted and the socket carefully preserved for at least 3 months before an implant can be placed. Advances in surgical techniques and materials, as well as clinician experience and careful case-selection have made it possible to place implants at the time of extraction in certain situations.
Dr. Lorenzana uses a Piezosurgery® unit to carefully remove the molar and its roots in the least traumatic fashion possible and to prepare the implant site, again causing minimal damage to the native bone. In the example below, the patient’s lower right molar needed to be removed due to painful cracked-tooth syndrome. A Straumann® Tapered Effect Wide-Neck implant was placed at the time of molar removal and the voids around the implant grafted with Bio-Oss® xenograft. 1 year follow-up photos and radiographs show the success of the procedure.
The advantage of this technique (when possible) is that a patient only has to go through only one surgery, only one recovery period, and only one time off from work. This saves our patients time and money. You can read this patient’s testimonial here.
Failed Lower Left - First Molar #19
Immediate Implant Placement W/ Bone Graft
Final Result At One Year
Final Result At One Year
Final Result At One Year
Complex Solutions
Implant placement in esthetic situations
Implant placement in areas with significant bone and/or soft tissue defects
Anytime it is possible, we try to replace failed teeth immediately with a dental implant. This is called “Immediate Implant Placement.” Unfortunately, certain situations can arise that require what we call “Staged Implant Placement” in order to more predictably obtain the desired esthetic result. In this procedure, first, the tooth is removed and the extraction site is allowed to heal over with soft tissue. The site is then re-entered after a short waiting period to place the implant and rebuild the lost bone structure.
What type of situations might necessitate staged implant placement? These may include:
Esthetically important situations
High lip line (patient shows a lot of gum tissue)
Gingival (gum) recession at the site of the extraction
Presence of a large infection
Significant loss of bone
Other situations...
Generally speaking, Staged Implant Placement is the preferred mode of treatment when the desired esthetic outcome is considered unpredictable due to a few of the circumstances listed above.
In the case presented here, Karla presented to our office with a failed central incisor (tooth #8). She had both a high lip line that showed the entire length of her tooth, and the gingival margins of the two front teeth did not match. In fact, the tooth to be removed had a slight amount of recession, creating the potential for further tissue loss upon removal, Staged Implant Placement was performed in order to more predictably obtain the result Karla most wanted: A beautiful, natural-looking smile.
Restorative work by: Dr. Jon Oefinger (San Antonio, TX)
CT scan imaging by iMagDent (San Antonio, TX)
Note the high lip line and gum exposure
Recession, exposed crown margin, uneven gum line
Initial x-ray and CT scan
Root resorption visible after extraction
Minimally traumatic tooth removal, collagen plug in socket
Customized temporary partial denture (flipper)
Temporary in place, adjusted to support tissues
2 months healing, ready for implant
Bone Level dental implant
4.1 x 14 mm
Extraction socket at time of implant placement
Bone defect leaves implant partially exposed
Bone grafting of the defect is performed
First layer of collagen membrane in place
Second layer is placed to add volume and protect graft
Radiograph after implant placement
3 months healing
Uncovering of the implant
Tissue profile prior to shaping
Temporary crown adjusted to create ideal tissue profile
Provisional in place, tissue shaping begins
Tissue shaping complete; ideal tissue profile created
Before tissue shaping, and after
Tissue profile mimics the natural teeth
Recording tissue profile: provisional on master cast
Impression material captures tissue contours onto cast
Tissue profile recorded on cast, ready for laboratory
Tooth in a day! Replacement of a Resorbed Front Tooth w/Immediate Temporary Crown
Few things are as traumatic as moving to a new city. Now move to a new city and find yourself with an emergency involving your front tooth. This is the situation our patient found herself in after being transferred from Washington D.C. Her dentist in DC spoke with the Program Director of the prestigious Graduate Periodontics Department at UT Health Science Center at San Antonio Dental School, Dr. Brian Mealey, and he referred the patient to our practice and that of prosthodontist Dr. Jason Gillespie.
The initial examination revealed a deep pocket on the palatal side of her front left central incisor (tooth #9). Her previous dentist advised that he had observed root resorption occurring previously and recommended we discuss removal of the tooth. After discussing the options with the patient, it was decided to remove the tooth, place an implant, and if possible, create a temporary tooth on the same day for the patient. Although not always possible for every patient, fabricating a tooth or several teeth in a day is a reality. Contact us for more information.
During the pre-surgical evaluation, it was noted that the gingival levels were uneven, with slight gum recession on tooth #9 (see photo 2). It is usually expected that the gum recedes at least 1 mm once a tooth is removed. In this patient’s case, that would have been disastrous for her smile, as she has a high lip line. This is where our ability as periodontists to diagnose and treat esthetic dilemmas becomes important in dental implant surgeries where the final esthetic outcome is critical. Therefore, along with the requisite bone grafting within the socket, it was decided to add soft tissue in the form of a gingival graft in order to help preserve and enhance the final esthetic outcome (see photos 6 and 7 below). As you can see, it was well worth it in the final result.
Restorative work by: Dr. Jason Gillespie (San Antonio, TX)
Extraction of a Fractured Tooth and Immediate Implant Placement
Similar to patient #13, Linda presented to our office upon referral from her dentist for a failed front tooth. In this case, Linda found herself with a fractured left front tooth (tooth #9). She had long ago traumatized both front teeth and had multiple procedures done over the years to try to hold on to them: at least 2 root canals, root canal surgery, build ups, pins, and multiple crowns. Finally, tooth #9 fractured. Figure 2 shows arrows pointing to the fracture line visible on the x-ray.
Following careful removal of her tooth root, an implant was placed and the socket grafted with bone grafting material. A customizable healing cap was also placed to help preserve the overall tissue contours by preventing tissue collapse. After 3 months of healing, an impression was taken of the implant in order to fabricate the custom abutment and crown (Figure 6 and 7). In contrast to Patient #13 in the previous album, a temporary crown was not made the day of surgery. There are many reasons as to why an temporary crown might not be made at the same time as implant placement: the patient’s own wishes, cost, an unfavorable bite or tooth position, presence of infection, or lack of stability of the implant, among other reasons.
The final photo shows an esthetic result that is a significant improvement over what Linda came in with. Note the ideal tissue position as well as ideal crown contours and color match provided by her dentist. The gray crown margin visible at the gumline at the initial visit is gone as well. After two years, the results continue to look fantastic.
Restorative work by: Dr. Michael Miller (San Antonio, TX)
This patient was referred to us for dental implant placement to replace congenitally missing (meaning she was born without them) lateral incisors #7 and #10. Aesthetic recontouring was performed to create the ideal tooth length for all of the front teeth and tissue sculpting was expertly performed by the restorative dentist to create the impressive final result. Her dental reconstruction was the beginning of a complete transformation for this patient.
Restorative work by: Dr. Will Martin (Gainesville, FL)
Tiffany presented to our office upon referral from her orthodontist. Tiffany had lost her front tooth (#9) traumatically years earlier and had just finished orthodontics (braces) when she was referred for an evaluation for an implant. Tiffany had a bridge before and was unhappy with the function and esthetics of the bridge so she chose to pursue dental implant treatment.
Prior to surgery, Tiffany was referred to iMagDent Digital Dental Imaging Center for a cross-sectional CT scan and virtual implant planning. This allowed us to visualize the proposed implant position, as well as the bony contours, prior to surgery. With the CT scan, many possible complications can be avoided and we can obtain a more predictable esthetic result. We partner with iMagDent to provide all our implant patients state-of-the-art imaging technology.
In addition to implant placement, we also performed esthetic crown lengthening on Tiffany’s adjacent teeth to help her get the esthetics and function she was looking for.
Orthodontic work by: Dr. Brad Bruchmiller (San Antonio, TX)
Restorative work by: Dr. Jason Gillespie (San Antonio, TX)
Our patient had an old Maryland bonded bridge that had decayed and fractured. Rather than further damage her adjacent teeth in order to make a larger bridge, she chose a dental implant in order to get closer to natural function and aesthetics. Her treatment was documented and chosen to be published as part of a dental implant aesthetics competition in 2005 titled “Esthetics Casebook” published by Institut Straumann AG.
Restorative work by: Dr. Jason Gillespie (San Antonio, TX)
When there is insufficient bone in the area of the back molars in the upper arch and an implant is the preferred choice to replace missing teeth, a sinus lift procedure is used to create additional bone. The photos below show a typical case where CT scanning from iMagDent Digital Dental Imaging Center was used to evaluate the existing bone available, the amount to be augmented, and the presence of any irregularities or pathology.
After the relevant information was collected and analyzed, a treatment plan of simultaneous sinus elevation (a.k.a. sinus lift) and implant placement was presented to the patient. In a sinus lift procedure, a small opening is made on the side of the upper jawbone that exposes the fragile sinus membrane. This membrane is carefully preserved and then elevated to create room for bone grafting material. Once the bone grafting material is placed beneath the membrane, the implant can be placed if sufficient bone is present to allow for stable implant placement. The access opening is sealed with a resorbable barrier membrane and the area sutured. Following 5 months of healing, the patient presented here was referred back to her general dentist for fabrication of the final crown.
Restorative work by: Dr. Lane Walsh (San Antonio, TX)
Images courtesy the International Team for Implantology (ITI) - unauthorized use is prohibited.
Outline of the right and left maxillary sinuses
Side view of a normal maxillary sinus
Expansion of the sinus when molars are missing
Initial Presentation. Note lack of bone for implant