Dental Implants

[moosp]

Anyone have experience of these? I have had the #6 molar extraction a couple of months ago and now the orthodontist informs me that I will require a sinus lift and bone augmentation to fit the forward part of the pin.

That requires lifting the delicate sinus lining and adding artificial bone to build up the bone structure, then leaving it to integrate into the bone. He has done many before he says.

I have always been very very wary of letting anyone with a scalpel anywhere near my nasal passages as from the experience of others it never seems to stabilize afterwards.

Anyone had this operation done or have other experiences of it? Thanks

[homonculus]

Get a second and third opinion

Implants will only work if the bone density and bone volume is adequate. This may require drugs or building up the bone but I share your concern as to the need to involve surgery on the sinuses

[homonculus]

I have taken advice from two dental surgeons who do nothing but implants and need to revise my last post

A sinus lift is not that uncommon - someone doing nothing but implants might do 20 a year. It will significantly increase the chance of the implant being secure if it is needed. There are two risks - infection which resolves with antibiotics, and tearing the mucosa. If the tear is large the procedure has to be abandoned for a month

So I stick with my advice of getting another opinion, but think your concerns may be unjustified

[Tableview]

I had this procedure performed about 5 years ago. I was concerned and went and got a second opinion. The alternative was to have a 'bridge' which for many reasons is not as good a solution as an implant, so I went for the implant and consequent sinus lift, although I don't seem to remember needing the bone augmentation.

The procedure was painless (apart from paying!) and I have had no ill effects in any area.

I would advise you to go ahead and I hope yours is a successful as mine.

[screwballburling]

Does the proceed always require a general anesthetic/sedation, or can a local be administered??

[Dufo]

Local. General is only given in case of severe mental disability (which I hope isn't your case :E).
Been there, done that, sans sinus lift. As said, the only thing which hurts is your wallet.

[Tableview]

The procedure consists of three steps, which have to be spaced out over several months to allow the implant to 'take'. The first is the removal of the existing tooth, root, etc. Then they put in a temporary stopper. Next step is to put in the 'post' which is the implant itself, mine is titanium, and there needs to be time for this to integrate with the bone, and finally the actual 'tooth' goes on over the post.

In my case the first two steps were done with local anaesthetic and the third with none. If you have to have a bone graft then it might be different.

[gordon field]

Why do anything most people manage perfectly well with one or two missing molars. Get a 2nd opinion as to the number of sound teeth you have remaining and consider what other work is likely within the next 5 years. Never seen a poor dental surgeon.

[homonculus]

Apart from the cosmetic issue, missing teeth can cause resorption of bone as well as excessive forces on remaining teeth. Implants are expensive and time consuming but last many years

In terms of anaesthesia we normally use local anaesthesia for shorter procedures. However today I spent four hours on just a few implants and some sittings take twice that. I would advise sedation for the longer procedures - just make sure you get a proper anaesthetist (consultant in the UK)

[Pace]

I have had quite a lot of implant work including a sinus lift and bone augmentation.
Firstly go for the best you can find PM me for an excellent implant surgeon who is an absolute perfectionist and lectures on the subject as well as having his own MRI scanner.
Some work is local anasthetic sinus lift twilight zone ;)
Took the most part of a year start to finish but best thing I did sadly very expensive.

[moosp]

Great responses, many thanks for these. Yes I agree about the pain in the wallet as my dental scheme does not cover this so we are looking at about 5,500 USD equivalent in Tableviews country.

The general opinion is that if done well they last you out and you can chew a steak as your last meal. It was the poking around in the sinus that was a concern.

My endontist is one of those who only does implants and a few other more complex maxiliary surgeries so he is well specialized. He recommends local anesthesia and as I have had a couple of root canals done already I am OK with that. (I nearly typed "happy with that " but that is way too positive...)

Thanks for stories of success, they are re-assuring. And modern MRI combined scanners which give a 360 degree view of your head are gee wizz technology- the dental toys are all very impressive.

[Pace]

Its either that or dentures in the Glass by the bed (No way) so I opted for the implants. Do go for the best not the cheapest! They feel like your own and done properly you can swing off a rope with them :ok:

[Loose rivets]

This morning was spent trying to repair my teeth with a kit from Walgreen's. Absolute desperation. Why? My neighbor's daughter trained as a dentist, and earned $300,000 in her first year. So, Mr DIY again.


I don't want to get into an Agony Aunt situation, but suffice it to say the last few years have been disastrous - financially, as well as a slew of other major problems. One thing that's causing me great distress now is seeing my once straight white teeth turning to a mass of broken gravestones. I can not bear the thought of having a mouthful of plastic.

It was my fault - or perhaps my mum's - she just assumed teeth came out c 30 years old, and shared all her toffees and hard boiled sweets the moment they came off ration. I had a lot of fillings by the time I really took control - twenty years too late.

They still looked pretty good at age 50, but their inner workings were obviously damaged by drilling. That's when the decline started.

I've been paying DenPlan for years, and now my hometown (UK) dentist has all but given up on me. "Go off to specialists - cost? Oh, thousands."

Of course, living this splits across the Atlantic doesn't help.

I had wondered if I could do more skilled temporary work, but it would mean laying hands on the proper stuff, not the soft paste that sets with moisture. Is that gettable. ( I can jerry-rig the vacuum kit etc. And I've got a Dremmel:} no, I'm not kidding.)

But now, when I get back to the UK hopefully in the spring what's it going to cost to do it properly? Frightening noises above, but one sum which would be a fraction of what I've been lead to believe. For example, one dentist here suggested it would be a bargain at $1,100 a tooth.

I can't believe anything would be cheaper in the US now - apart from houses _ but some hard data would be much appreciated. I'd travel afar to get a really good professional job done.


5,500 USD Is that one tooth?

[yarrayarra]

Wife had implant fitted last August. Required bone graft (understand bovine bone used) We travelled to Thailand previous February to have the initial work done. Checkup revealed root canal required due infection in another tooth prior to implant surgery.
Keeping it short: fantastic service and first class medical attention. Price well below what would have been expected in Oz.
Root canal and best quality German implant about $3500Aud Two cheap holidays as bonus ( I holiday in Thailand twice a year) - many expats mates retired there due cheap cost of living and great lifestyle- all mad golfers!!)
Could not speak highly enough of the hospital and medical staff concerned.
BTW mate and his lady friend came along too- she involved at a surgery that performs quite radical cranio/facial surgery. She was skeptical before hand having never gone to Thailand before but was full of praise for the hospital and it's facilities
Any further details PM me- more than happy to help out.

[moosp]

LR yes that was one tooth but I think it will be more with the bone augmentation. I had hoped that the root canal and crown that was done in HKG last year would have lasted longer but it didn't settle so had to resort to an implant.

I have heard very good things of the medical vacations in Thailand, indeed my previous doctor in HKG used to go there for all his checkups and minor procedures. I had a bad dental there 15 years ago but the standard has improved vastly in most places in BKK and HKT.

[Pace]

I have heard very good things of the medical vacations in Thailand

Maybe but this cannot be done in a medical vacation as there are a number of procedures over many months and repeat visits before you end up with the completed implants.

There are one shot implants where the whole lot is done in one but my surgeon will not touch those as they are unreliable and do not last for life.
As stated mine was complicated and took the best part of a year to complete the lot with a bill of 18K but I am delighted with the end result which are as good as your original teeth.

Oral hygiene like with your original teeth is important.

The surgeon knew I was a pilot as well as enjoying Scuba Diving as a hobby and hence I was very concerned over the sinus lift and messing around near the sinus but here it is so important to get someone who knows what they are doing as there have been horror stories too.

If anyone wants this sort of work and an excellent UK based surgeon PM me

[Capt Chambo]

I had the same procedure done in Australia about 4 years ago, and has been totally successful.

A couple of observations, the sinus lift is very uncomfortable. Your orthodontist will drill into your jaw bone but not all the way through in case they damage the membrane, and then with the dental equivelant of a hammer and chisel they will break through the last millimetre of bone so they can inject the synthetic bone. That process of hammering through I found most uncomfortable, not painful but very weird!

You will end up with a titanium peg in the cavity and you will be measured for a new molar. In my case this was made in Belgium! After about 6 months it was deemed that I had enough bone for the implant to be successful and the new tooth was attached. Again another observation here, the gap where the previous molar had been removed had started to close up, so when the new tooth was fitted it felt " tight", it wil take a month or so for this sensation to go.

A couple of years later the itooth felt loose and so I went back to the orthodontist who needed to reattach the tooth to the implant. My fear had been the implant had worked free in the jaw. The crown/cap can work loose on the implant so make sure your orthodontist intends to remain in business for the next few years!

One final point, as you no longer have the original molar and its attendant roots, you will notice a slight hollowing of your cheek, the sort of super model look! Other than that it's been fine and I can eat and chew and carry on as before.

[Pace]

Cap Chambo

How It's Done

Your surgeon will cut the gum tissue where your back teeth used to be. The tissue is raised, exposing the bone. A small, oval window is opened in the bone. The membrane lining the sinus on the other side of the window separates your sinus from your jaw. This membrane is gently pushed up and away from your jaw.

Granules of bone-graft material are then packed into the space where the sinus was. The amount of bone used will vary, but usually several millimeters of bone is added above the jaw.

Once the bone is in place, the tissue is stitched closed. Your implants will be placed four to nine months later. This allows time for the grafted material to mesh with your bone. The amount of time depends on the graft material that was used

I think the pushing bone material up through the where the implant will be only works for a small amount! a proper sinus lift involves the above highlighted area where more depth needs to be added but I am no expert or medically qualified.
Also and maybe someone medically qualified can elaborate? There is local anaesthetic and something sometimes referred to as twilight zone where you are partially knocked out and your level of conciousness controlled?

[homonculus]

Local anaesthesia numbs the area injected but doesn't effect the level of consciousness

You can reduce the level of consciousness from fully conscious to sedated to anaesthetised to .........

General anaesthesia means you do not respond to pain or other stimulation.

Sedation is anywhere from a tot of whiskey to anaesthetised and anaesthetists will sedate right up to that level. In other words it is a spectrum and indeed it is often unclear whether I am sedating or anaesthetising.

However, in the UK at least, we only allow non anaesthetists to sedate with one drug and only to a state where the patient remains in verbal contact ie responds to voice alone. This has been called twilight by some. This should only be done by someone specifically trained, who is not the dentist, and with full monitoring and resuscitation equipment.

Some people give oral drugs such as Valium - I would hope the dose is very small and the aim is simply to reduce the level of anxiety

[gingernut]

If there are any kids listening, the message is........brush your teeth at least twice a day, and only drink coke with meals :-)

And visit your dentist often.

[RobertZZ]

Just to help clarify sinus / implant procedures.

A sinus 'lift' is a procedure where the lining of the sinus is lifted from within the prepared 'hole' prepared to take the implant. Implant placement in this area often aims to get the head of the implant just into the slightly denser bone that lines the sinus, the lift procedure is a way of getting a little more vertical height for implant placement.

There is another, much more invasive, procedure which is often incorrectly called a sinus lift but the correct term is "sinus graft". In this procedure a window is made in the bone on the outer side of the sinus, and the thin plate of bone in the middle of the window is folded in and up, hopefully together with the carefully preserved sinus lining. The void that is created is filled with suitable material to encourage healing that will result in bone formation.

In both cases there needs to be time for bony healing to occur, and suitable materials need to be selected to encourage bone healing.

[gingernut]

Get a second and third opinion

Never a bad idea to explore all options.:)

Personally, I mistrust most claims from the "cut & fix it" boys.

[Pace]

Gingernut

I totally agree about brushing teeth as kids and avoiding fizzy sugary drinks that comes down to parental example to those kids which sadly can be lacking.
As for frequent visits to the Dentist ? Nowadays yes but I wonder whether in days past excessive dental work did not create some of the problems?
As for choices and second or third opinions? Its either wearing dentures or implant work if you can afford it? Then IMO its a matter of researching the best oral surgeon not the cheapest deal.

[homonculus]

True Pace

But how do you find the best person

If I had a pound for every doctor or dentist who told me he was the best in the world, I would not need to work.

I recall one American plastic surgeon who had his signature printed on his dressings so patients had to walk round for two weeks with Dr Blog on. He introduced himself to me in a major London hospital with the words 'I am going to show you English what real surgery is all about'. Fifteen minutes later he had to ask for a stool to stand on to reach the patient

Well I did raise the operating table a bit....

In reality many companies and practices work hard to post supportive testimonials on websites. Some are authentic but caveat emptor. I am happy to provide some recommendations in London and I think asking for a recommendation from a doctor or dentist is the best advice we can give

[mrs nomer]

Avoid at all costs the so called "one shot" implants where the procedure is completed all at once.

Having been through this and experienced the results of a badly completed procedure with significant bone issues - the last one I had done with a much more conservative dental surgeon took over 6 months from the initial surgery until the new tooth was completed, but the results were much more successful with no adverse issues after 5 years.

[homonculus]

Six months is a long time in Thailand!!!

[moosp]

To continue the story, yesterday I had the next stage of the implant procedure. I chose local anesthetic as I prefer to know what is going on, to an extent.

All appears to have gone well, and was all as described by you guys above. Modern dentistry being what it is there was no pain but I do agree with Capt Chambo that the hammering process is a weird sensation, and thank you for the heads up on that.

I now have the titanium pin installed which will be left to bed in for a couple of months, which separates me from other remains if a forensics team need to identify me. I also have a moderately sore mouth which is being well controlled by prescription non-steroidals.

It was of great use, interest and comfort to have your replies to my original query, thanks again.

[robertsmarshal12]

Recently, I had a crash in London and I was rushed to London day surgery centre to get my dental implants done. It took me several sessions and before conducting this procedure, I was thoroughly checked and especially, the bone density scan was greatly emphasized but all ended well and I am as good as I was before. It is a fine procedure. One must get it done if it has to be done, without any other thoughts.

[RatherBeFlying]

If modern implant technology had been there 45 years ago, I may have been able to get away with just one implant back then.

Root canal lasted 10 years before tooth packed it in.

Bridges typically break after 10 years and get more expensive each time 'round.

Last year dentist found deep cavity in tooth supporting one end of the bridge and filled it with caution that not likely to last. Last month X-ray showed tooth failing.

Dentist recommended extraction and 4-unit bridge, but actuarial likelihood of 2 more bridges; so 3 x $4,000 = $12,000.

Two implants including mandibular ridge bone graft and crowns estimated at $10-11K. One job and it should outlast me.

I was seriously considering Mexico, but there's at least 4 follow up visits and I can't really move there for 6 months. Those [still] having flight privileges might be able to make it work.

So 06:50 Monday I'm getting it done -- the principal worry is that the failing tooth does not act up before then.

[Radgirl]

Sorry to burst your bubble but implants are just as temporary. The big worry of my dental implant colleagues is that implants done a decade or more ago are failing because the bone around the foreign implant has been resorbed. This is a big issue and despite some new treatments there is no cure. My colleagues consider implants as the treatment of choice for those in retirement but not younger people....

[Mac the Knife]

Had a couple of implants a few years ago (by an expert).

Superb - feel like real teeth & X-rays show full integration so should be for life.

Now gotta have a sinus lift and bonegraft for another.

Actually one of my patients, so we have to trust each other!

Mac

:}

[RatherBeFlying]

Went in for two mandibular implants two weeks ago. The last two needles of freezing got my attention, but no pain after that until the freezing wore off. Tylenol 3s for two days along with Ibuprofen to keep the swelling down.

At checkup all looks good except one coverscrew shows and requires 3x daily Q-tip dipped in Perichlor until next visit in four months. Temporary denture going in tomorrow.

[RatherBeFlying]

The denturist advised putting one in to maintain proper spacing until time for crowns. Also chewing on the denture exercises the bone and graft underneath which helps prevent bone recession.

Mind you, you have to ease into using the denture.

[AeroDreams]

Sorry to burst your bubble but implants are just as temporary. The big worry of my dental implant colleagues is that implants done a decade or more ago are failing because the bone around the foreign implant has been resorbed. This is a big issue and despite some new treatments there is no cure. My colleagues consider implants as the treatment of choice for those in retirement but not younger people....
Temporary? Didn't know about it -well, I have had it done, a couple of years ago, still in my late thirties, not painfull procedure at all (easier than tooth extraction),
Had to have it removed later on as it was infected. It was 2 weeks without it and reimplanted later. My advice, when you decide on dental implants, make it sure that you'll have regular check ups to avoid inconveniences.

[MaximumPete]

My Mum had implants fitted in her late 70's, lots of visits to the University of London but the outcome was excellent and should last forty years. It's a bit of a shame she won't get the full use from them but at 90 isn't getting any problems from them

MP

[Lou Scannon]

I had a couple of implants implanted 12 years ago. No problems since.

[Radgirl]

Hmmmmmm

How do you know the doctors are highly trained? and to what quality level?

Health tourism is big business and here is a flashy website, but very little substance. They liken themselves to the Mayo but have no association with it that I can see.

Thailand has cheap land, cheap building, low business rates and cheap labour. They can buy cloaned equipment from China and Korea we dont buy in the first world, so their costs are low, low, low. Of course their prices will beat the pants off the US, europe or Australasia.

But caveat emptor. They may indeed be up to european standards but you cant tell that from the website, and I am not sure how you tell when you get there.

[RatherBeFlying]

It was a strange feeling as the two joined crowns were torqued down over a period of an hour. There were several pauses to allow the gum and jaw to accommodate. A mild headache afterwards and still some jaw tightness in the morning.

But 30+ hours after it feels totally solid and comfortable -- much better than any of the three bridges that preceded it:ok:

The most painful part is the $20,000 it cost:{

Compared to a 4-unit bridge replaced every 10 years @ $5,000, I will have to be around another 40 years to break even, but the function feels way better.

Annual checkups are required with both the periodontist who does an xray and checks the gum -- and the denturist who can retorque if needed.

Flossing with Superfloss has been prescribed. Superfloss begins with a stiff part that can be fed just over the gum. The second part is fuzzy and the part to be used to clean the implant-gum junction. The third part is normal floss which I have been advised not to use there.

For a younger person who loses a tooth, a single implant @ $10,000 looks a better deal than 4-6 bridges @ $3,000+ -- especially as there's a chance one of the teeth supporting the bridge can fail down the road forcing you to choose between a 4-unit bridge or a double implant.

[Abacus]

Just a quick question. I had a tooth removed six months ago, the first I have had removed, as it happens. A molar on my lower jaw. The dentist suggested I might like to have an implant. Well, I guess he would, wouldn't he! I have to say I don't notice it's missing now and wonder if it is necessary to have an implant. Are there any adverse consequences of just leaving well alone?

[Capetonian]

Depends on many factors and you need advice from a maxillo-facial (sp?) surgeon. Leaving it could cause problems with jaw deformation, but a lot depends on where it is, your age, and so on. Also of course, vanity could be a factor if it's visible.

[RatherBeFlying]

I have to say I don't notice it's missing now and wonder if it is necessary to have an implant. Are there any adverse consequences of just leaving well alone?The usual advice is that adjacent teeth will move to "fill" the gap which will widen gaps between other teeth nearby which will lead to problems with them. Also opposite teeth will come down. Two of my wisdom teeth have been removed and their opposite numbers are considerably elevated.

At a minimum I would want a denture to maintain proper spacing.

[Abacus]

Thanks for the advice. I guess I need to look into this further. Not so straightforward as I thought.

[RatherBeFlying]

Abacus, I would add that over time you get bone recession. If later you go for an implant, you may like me get hit $2,000 for bone augmentation.

Also the original tooth socket covered by the bridge could not be used for the implant site. It had to be offset.

If there is a foreign option, you need to book two trips. I would recommend a three week stay (or flight privileges;) ) for each trip as time is needed for healing.

[Abacus]

Thanks for the the replies. It looks like I need to have an implant then. It's been about nine months now since I had the tooth removed. The dentist said I should leave it at least six months to heal before doing any implant work so it sounds like now would be a good time to get started. Thanks again for your advice.