Silicon Valley Surgical Arts, Inc. & San Francisco

Tapered versus cylindrical implants, which is less painful for the patient?

In a recent article in the JOMS, researcher found that the shape of an implant does have an impact on the level of post-operative pain.  As expected the more the implant mimic the shape of the root of a tooth, the less that was noted by the patients!  This was assumed for many year but now this article confirms assertion.

This is why we have been using tapered implants since the inception of our practices.  Although is some cases cylindrical implants are indicated, the majority of the times tapered implants are used.

As the states “Tapered” means the implant tapered towards its end, so it mimic the shape of a root of a natural tooth.  See below:


“Cylindrical” means that the implant does not taper as much towards it end and the outside walls of the implant is more parallel to one another.  This implant is sometimes used if we place an immediate implant into the hole of an existing tooth in orger to engage the sidewalls of the extraction site.  See below:


See the actual article below on this topic:

Should I stop my aspirin before my dental implant surgery?

Many patients ask us this question, but the more recent data is showing us that it is not necessary to stop all the “anti-platelet” medications such as Aspirin.  See the reference to the article below

HOWEVER, we always recommend that patients ask their Primary Care Physician (PCP) that placement them on such medications and let them know about their upcoming surgery.  This is because a patient’s PCP will know their health history and their tendency for bleeding much better than anyone else.


Implant Periapical Lesion (IPL)… what is that?

Implant Peri-apical lesion:

This is an inflammatory lesion at the tip of the implant.  This is a really rare phenomenon and it occurs n 0.24% of the time.  IPL  can sometimes be confused with peri-implantitis, which is something completely different.

Recently implant surgeons have used Guided Bone Regeneration (GBR) to address this.   A combination of surgical removal of the lesion + GBR  and the use of antibiotics has been shown to solve this issue.  If not then implant removal and eventual replacement is recommended.

Please keep in mind that this is different than peri-implantitis, which usually a phenomenon that started from the top of the implant and goes down to the apex of the implant.  See below:

Please see the link to the actual article below.

Bone grafting from the chin

Many patients that present top our office desiring an implant, do not have enough bone to do so.  This is especially true if the tooth was extracted without bone grafting at the time of extraction…this is the reason why we always recommend that you ask the person doing the extraction about bone grafting, especially if you are planning on replacing the tooth with an implant in the future.

In extreme cases where substantial bone is required, we can go to the chin as a source for bone.  This recent article in the California Dental Association Journal (CDA) by Dr Sun an his team summarizes the basics of this technique.  See the following:

Strongest muscle in the body??? Anyone???


Arnold schwarzenegger may you think that biceps or thigh muscles are the strongest muscles in the body, but actually it is not.

The strongest muscle based on its weight is the masseter. With all muscles of the jaw working together it can close the teeth with a force as great as 55 pounds (25 kilograms) on the incisors or 200 pounds (90.7 kilograms) on the molars.

In the most recent article in the ADA, a group of researcher looked at the size of the Masseter muscle using MRI and how it related to gender and age.  Very interesting findings, confirming some of the previous findings that found consistently higher masticatory
muscle thickness in men as compared to women.  Also Among all study participants there was a positive correlation between masseter mass and the amount of force during masticatory performance.  (Age- and sex-related differences in masseter size and its role in oral functions – Chia-Shu Lin, DDS, DPhil, et al.)

But how does this relate to dental implants and your teeth?  Well, this is the reason why we recommend a night guard to help protect your teeth from breakage and to prevent bone loss around dental implants.

So the next time you are the gym, working on your biceps; may be you should just chew gum and work on your strongest muscle and save money on your gym membership…kidding.  Cardiovascular health is just as important.  So do not skip the gym just to work on your masseter!

Do not under-estimate the importance of night guard.  It will save your, teeth, implants and jaw joints.



How to avoid getting a dental implant….hmmmm

This may be ironic, but we do not want you to loose your teeth!  It is natural, with a built in suspension system (the PerioDontal Ligament i.e. PDL) which allows you teeth to “wobble” or move in its location.  Implants however do not have this PDL and are susceptible to excessive occlusal forces.  So the best think is your teeth and even though dental implant are a good replacement option, “it is not like the real thing”

So….we dont want you to loose your teeth.  Here is a paper talking about the association of sugary drinks (sodas) and diabetes, and how it leads to tooth loss.

In the 2017 July edition of the JADA (Journal of American Dental Association) they found that in a survey of close to 95,000 people in 18 states, 12.3% had Diabetes, 15.5% had 6 or more teeth extracted and 22.6% report drinking at least 1 sugar-sweetened beverage (SSB).

Additionally, in those with Diabetes who consumed at least 2 SSB, they had 6 or more teeth extracted; as compared as to those who did not consume any SSB!

CONCLUSION: in adult patients with Diabetes, who consume 2 or more SSB per day, they end up losing 6 or more teeth!

So if you want to avoid an implant, stop consuming sugar-sweetened beverages…

Tooth numbering systems

What are all the different tooth numbering system?  Practicing in San Francisco, we get patients that get referred to us from all across the world for their oral surgical needs.  When we ask for their charts however, on most occasions the teeth numbers do not match up with our numbering system in the US: The “Universal” system.

The diagram below is a great cross reference for the three most commonly using numbering systems.  The “Palmer” system is mostly used by the orthodontic community and the “FDI” system is used by the Europeans and has been adopted by the World Health Organization (WHO).  In any case this is a great reference for any of us that is trying to figure out, what is tooth #47?

“A patient swallowed the crown, what do I do now?”

Being a physician, at times we field calls from the local dentist asking for urgent help with their patients that may have swallowed a dental instrument, crown or a healing abutment that was not torqued down after impression taking.


This is why it is so critical to torque-down anything and everything that sits on an implant.  


Here is an east algorithm to help guide you in terms of what should be done in a TIMELY manner.




Endoret PRGF Recognized Center

We are proud again to be the only a recognized Endoret PRGF Center in the SF Bay area (Northern California).  I offer this service in both my locations in downtown San Francisco and Cupertino.

To learn more about this technology and how its our changing outcomes please visit: