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Dental Implants

Posted Aug 24 2008 1:49pm 1 Comment
DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. Losing your teeth in an accident or losing them to tooth decay is no laughing matter. Many people with missing teeth are too embarrassed even to smile. But there are a number of cosmetic solutions available for tooth loss, from dentures to bridges. And thanks to advanced dental technology, there is a relatively new procedure available which can permanently repair your smile. They're called dental implants.

Today we have two experts who will give us the details on dental implants and why they are so popular. To my left is Dr. Graziano Giglio. He's the Associate Clinical Professor at the Advanced Education Program in Prosthodontics at New York University. He's also in private practice in New York specializing in aesthetics and implants. I will be calling him Graz from here on out. We don't have enough time to say his whole name.

Next to Graz, is Dr. Paul Kamen. He is the Associate Professor of Clinical Dentistry at Columbia University School of Dental and Oral Surgery. He is also in private practice in Manhattan, specializing in periodontics and implants. Like I said, they're experts on the subject. Guys, thanks for joining me.

Let me start with you, Graz, what are these dental implants?

GRAZIANO GIGLIO, DDS: It's basically a titanium screw that is placed into the jaw bone and then we anchor a tooth to it.

DAVID FOLK THOMAS: So a titanium screw as in some guy breaking his leg.

GRAZIANO GIGLIO, DDS: It's the same material that they use. There are different grades of titanium and it's placed into the jawbone. First, we make an osteotomy which is a hole in the bone and then it's screwed into the bone. After certain amount of healing we place a tooth on top of that.

DAVID FOLK THOMAS: How far down are you going? I'm screwing stuff in my wall and it doesn't take. I mean the bone can actually support this?

GRAZIANO GIGLIO, DDS: If there is enough bone there. It depends on the areas in the mouth, but there are some vital structures that we can't invade such as the sinus or the mandibular nerve. There are nerves inside the bone. We just have to avoid those. Sometimes a patient has to have bone replaced or augmented there prior to placing the implant.

DAVID FOLK THOMAS: Paul, as Graz just said, we're putting a titanium screw into the bone and then as he alluded to, what are we attaching above that?

PAUL KAMEN, DDS: Actually what is attached to that is what is called an abutment. This is what Graz does in his practice. I usually do the surgical placement of the implant.

DAVID FOLK THOMAS: So we're just going out of order.

PAUL KAMEN, DDS: But hopefully each one of us knows what the other one does. What Graz does is to place essentially the titanium screw that Graz is referring to is a hollow screw. Inside of it when ready, he can place something that actually screws or attaches onto the implant that contains the final prosthetic tooth that he has developed.

DAVID FOLK THOMAS: And what is that tooth made out of?

GRAZIANO GIGLIO, DDS: It could be made out of ceramic material which is very aesthetic or it could be made out of a metal with a ceramic on top of it.

DAVID FOLK THOMAS: When does a patient need this procedure? What examples?

GRAZIANO GIGLIO, DDS: There are several examples. Of course, an implant can be used in any situation where a patient is missing teeth. Typically they range from anyone who is completely edentulous. That's actually how implants were first developed. People who lost most or all of their teeth and were until recently were condemned to wearing removal dentures, what people call "plates" for the rest of their lives. They go to bed at night and put the plates in a glass by the bed. That's how they spent their lives. Now we can place implants into the mouth and actually give them their teeth back.

But we can also use implants where patients have lost only one tooth or just a group of teeth due to either dental decay or periodontal disease. Finally, we also use implants quite frequently these days for people who’ve lost a single tooth -- frequently an upper front tooth due to trauma, an accident or sports injury. We can go right ahead and replace that tooth.

GRAZIANO GIGLIO, DDS: What's good about that is that you're not touching the adjacent teeth. Adjacent teeth remain virgin. You're not drilling into them to put some type of anchor on there to anchor the pontic which is the fake tooth. The adjacent teeth remain untouched. That's an advantage with placing an implant.

Whereas before we would file down those teeth and make a bridge or use something removable. That's why it's much better to have an implant available to us in these instances.

DAVID FOLK THOMAS: So in most cases it's one specific tooth. But as we mentioned, say somebody had really bad tooth decay and gum disease, you could put a whole set of these things in.

GRAZIANO GIGLIO, DDS: There is no limit to the number -- obviously there is a limit, we're not going to put more implants in than teeth were there originally, of course. We can put one or two or three or whatever number of fixtures are required to best provide the anchorage that patient needs and to best replace the teeth that are missing.

I think the miracle is that we are literally replacing people's teeth. This is something that science has been trying to do for thousands of years. There are records among the Egyptians and archeological finds where they have tried to put teeth back in the mouth. Of course, nothing has really worked scientifically. Only within the last 20 or 30 years have we gotten to a point where we can do this now with a high degree of predictability.

DAVID FOLK THOMAS: This sounds as if this could be painful. Let’s just deal with somebody who is getting one of these. How long does this take from beginning until they're finally recovered?

GRAZIANO GIGLIO, DDS: The patient comes in if the bone is healed and there is an incision made over the crest of the ridge where the tooth is missing. The area is opened up, dissected and an osteotomy is made -- a hole is made into the bone and a titanium screw is placed there. Then it's usually covered.

DAVID FOLK THOMAS: So how long does what you just told me take?

GRAZIANO GIGLIO, DDS: Half hour, 45 minutes, right? Paul does this all the time.

DAVID FOLK THOMAS: Are you knocked out?

GRAZIANO GIGLIO, DDS: We do it under local anesthesia now. We used to do it under general or in hospitals or in schools, but now it's done as an outpatient procedure right in the office.

PAUL KAMEN, DDS: Novocaine. We call it novocaine. It's not what it really is, but that's how the public knows it. The same thing you'd have even for a crown or a filling.

DAVID FOLK THOMAS: Now is this -- I said when you leave the office, how long -- I can imagine that you're going to feel that for a while if you're having a screw drilled into your jawbone.

PAUL KAMEN, DDS: It's actually less painful than having periodontal disease and having periodontal surgery. That's what most patients will tell you that have gone through both. So it's not a very painful procedure. The patient most of the time -- if it's only one tooth -- can go back to work that day, as long as they can take some medication for it. We usually give some nonsteroidal anti-inflammatory, something like Motrin, Advil, Nuprin or a stronger version of that. They can go to work that same day.

DAVID FOLK THOMAS: How long does it take to fully heal from this procedure?

PAUL KAMEN, DDS: The healing to the patient, as Graz said, is actually very short. It may be a couple of days at the most and without a great deal of discomfort in most cases. But what we are concerned about in terms of healing is what we call the integration. That is, the integration of the bone with the implant itself. This is a biologic process and it involves a very, very close approximation, physical approximation of the bone tissue to the implant. That takes time. That generally takes anywhere from three to six months depending on the part of the jaws that we place the implant in.

DAVID FOLK THOMAS: Do you have to watch what you eat? At that point, I would think I wouldn't want to come close to biting down on --

PAUL KAMEN, DDS: During that three to six months, do you mean?

DAVID FOLK THOMAS: Or even afterwards. Something hard.

PAUL KAMEN, DDS: Right after the surgery, it's usually covered with some type of provisional prosthesis. So you're kind of protected. That area is protected. But remember this implant is now buried or submerged in the bone and the gum is sutured over it. It's like nothing every happened when you put this back. It's a small incision and it's sutured over. So the patient really doesn't even know what happened there after a few days and it heals and you have the sutures removed.

DAVID FOLK THOMAS: What is the success rate for this procedure?

GRAZIANO GIGLIO, DDS: The success rate is very high. For the lower jaw, we generally consider the success rate to be about 95% and for the upper jaw, it's a little bit lower. It's probably about 89-90%.

DAVID FOLK THOMAS: Is that gravity?

GRAZIANO GIGLIO, DDS: Actually it's not gravity. You would think it is. Actually the bone in the lower jaw is more dense than the bone in the upper jaw.

DAVID FOLK THOMAS: Now as far as, I would think that -- is this covered by insurance? I mean it sounds very expensive.

PAUL KAMEN, DDS: It is costly. It depends on the policy so often it is not covered. However, we find that especially in the classic case -- and Graz, I'm sure you see this frequently of a three-unit bridge which means that you're missing one tooth. There is tooth on either side of the space. The conventional treatment would be what we call a three-unit bridge. Graz would do this. He would grind down the two teeth adjacent to the missing space and then place a pontic or a dummy tooth over the missing space. Solder that to the caps on the two adjacent teeth.

The implant would only involve having to treat that one area where the tooth is missing. Therefore the cost is often equivalent -- a three-unit bridge vs. an implant. So while it does tend to become somewhat costly, it may not be any more costly than conventional treatment, a three-unit bridge.

DAVID FOLK THOMAS: As you're saying, this can all be done in the chair and --

PAUL KAMEN, DDS: Getting back to the time. Let's say it's 45 minutes to an hour at the most to have the implant placed. Multiple implants can be placed almost at the same time. So if you're putting in six to eight implants maybe it a little bit more time so maybe it's three hours. That's just the placement.

Then there is an uncovering stage where we uncover the implant and then we put a healing abutment on, or something -- a cap over that. Now there is a second phase of healing. That is relatively -- it's not a really invasive procedure because there we're just opening up the gum, placing this cap on and then you move on after about six to eight weeks of placing a definitive prosthesis on it which is a crown or a cap, just like you would on your natural teeth. This is either retained by cement like a crown or with a screw. It's a screw within a screw system.

DAVID FOLK THOMAS: Well, it's very interesting. I wish we had more time to go into it now, but we've given our audience the quick overview on it. I want to thank the doctors. I guess once these people start going through airports, you got to sign a little note for the security detail there. But thanks to Dr. Giglio and Dr. Kamen. We've been talking about dental implants. My name is David Folk Thomas. We'll see you next time.

Comments (1)
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This is a really interesting article as I didnt know how it is done. I have seen this clinic where my friends fly to have their teeth fixed and they had implants done. I am interested in it as I am planning to get the same. I was bit afraid of it and the pain but people tell me you can use sedation and nothing hurts.


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