Re: do implants *really* feel natural?

On Mar 24, 3:34 am, Steven Bornfeld <dentaltwinm...@xxxxxxxxxxxxx>
wrote:
fr...@xxxxxxxxxxx wrote:

The following is from Open Wider: your wallet not your mouth page325

There is a trend in dentistry that is starting to emerge from all this
success wiht implants. If you go to a surgeon for an extraction, often
they are selling you a bone graft so they may place an implant in 6
months rather than waiting for bone to fill the space where the root
of the tooth was. Of course there is a charge for the bone graft.
These holes will almost always fill on their own. Extraction sites
have been healing and filling with bone since the first teeth were
extracted. It just takes a little longer, say 9 months.

        This is at best an oversimplification, and at worse dishonest.  I do
not necessarily recommend ROUTINE placement of bone grafts in extraction
sockets.  Furthermore, I have never done this myself.
        However, crestal bone loss ALWAYS occurs after extraction; furthermore
in most areas of the mouth the loss causes a spiny, thin residual ridge.
  In many cases, grafting helps preserve both the height and the width
of the alveolar ridge.
        Yes, they almost always heal, but there is bone loss.  The quoted
paragraph is difficult to believe was written by a dentist.

Steve





I had one patient who went to a surgeon to have a tooth extracted. The
surgeon insisted on doing the graft even though the patient had no
interest in replacing the tooth. Six months later the graft was loose
and there was an infection in the area. The graft was being rejected.
The patient now needed to have the graft removed and was left with a
larger bone defect than if it had just healed normally without the
graft. He still does not want
the implant. Surgeons with somewhat elastic ethics insist on grafting
all extraction sites. It does add a fee of about $300 per extraction.

Endodontists, those specialists who do root canals, are getting into
the game. Some of the more aggressive among them will look at a tooth
that will be a difficult root canal and simply extract it and place an
implant. Of course the cost of the implant is about 3 to 4 times the
cost of the root canal.
I can understand this if the root canal is impossible but I have a
little trouble when it is done just because there is a difficult root
canal.
Some restorative dentists also do implants. If they see decay that is
difficult and will require extra time to do a crown and maybe an
implant, they will do an implant instead. The argument is that the
crown may not last, so let's do the more predictable implant. Of
course we will never know that the crown will not last if the tooth is
removed and an implant is placed. Of course, the implant fee is many
times that of a difficult crown and possible root canal.

Implants work, but I fear they are being over prescribed. They are
much more invasive and costly than a root canal or a difficult crown.
Who should place implants?

Well, clearly, oral surgeons are trained to do implants. The problems
I have seen are that they sometimes do not align the implants very
well. This makes restoring the case with crowns very difficult if not
impossible. They also tend to be rougher with the gum tissue and the
bone. Periodontists are my favorite implant placers. They tend to be
much kinder to the tissue and the bone. Perio surgery is a much more
precise surgery than removing teeth.

I think general dentists should place implants. The techniques are not
that difficult and the average dentist who is willing to take some
continuing education courses and purchase some additional equipment is
capable of doing implants.
If you need an implant, I would suggest that you have someone who does
10 a month not someone who does 5 a year. They are technique
sensitive. Do not do them just because it is easier to do than a root
canal or a crown. While they are very predictable they do occasionally
fail.

Fred Quarnstrom, DDS
Author Open Wider: your wallet not your mouth- Hide quoted text -

- Show quoted text -

Yes, bone loss always occurs after an extraction, but the question is,
how significant is that bone loss? Will it affect aesthetics? Most
importantly: How much can a post extraction graft help? Nowadays, I
only place bone grafts when I need to open a window to remove a deeply
retained root tip. Other than that, bone grafts under such situations
are not cost effective at all. While you are right to say that crestal
bone loss always occurs after extraction, I've also noticed that there
is hardly any gain in bone width or height with post-extraction
grafting. The bone graft supplier must have duped me. Next, a spiny
residual ridge only forms after many years of tooth loss. Patterns of
bone loss can be found in any textbook on prosthetic dentistry.

I may recommend post-extraction grafting only under 2 circumstances.

1. There is significant bone removal during the extraction
2. The patient is unable to afford the implant yet, but wishes to have
it done in a couple of years.

Even then, the second reason is not always justifiable. Bone loss will
occur as long as there is no tooth or implant there. Grafting it does
not protect the ridge from bone loss over time.

http://www.luckyplazadental.com
New Age Cosmetic Dentists (Singapore)
.

Relevant Pages

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  • Re: do implants *really* feel natural?
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  • Re: do implants *really* feel natural?
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