Investing in a dental implant & Vetting and questions to ask?

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URSnshn
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Investing in a dental implant & Vetting and questions to ask?

Post by URSnshn » Sat Jan 26, 2019 1:52 pm

[Update and new question at end of post] I have a family member who had tooth pain, saw her dentist, had a partial root canal and is being told that the tooth cannot be crowned or capped (no infection, the top part of the tooth (one of the back teeth) simply no longer had the structure it needed and they can't fill it and there isn't enough left for a cap or crown) - and it is recommended that they get an implant. [Note this is NOT about looking for medical advice]

The dentist has been her dentist for a good long time, but he also has an implant business. At the time she went in they simply removed the root and put something on top of the tooth and she was told to come back and see their prosthodontist who would take a panoramic x-ray and give her all the options. The cost for this consultation is about $300 - probably the panoramic x-ray is additional.

She wonders if she is being sold on an "implant" and is concerned that she may be rushing into something and maybe implant surgery isn't needed. Or there might be a viable alternative option. When she goes in for that consultation they'll take the panoramic x-ray, sign some forms and it's off to the races. She feels uncomfortable about having the panoramic x-rays taken prior to understanding exactly what they are proposing, because she may want to get a second opinion and if she wants a second opinion they'll probably want to take a panoramic x-ray as well.

Questions:

1. Are dental implants oversold, what kind of process should a consumer employ to ascertain if they are being sold the Booklyn Bridge or something that they really need with respect to this situation?

2. Will she be able to obtain her panoramic x-ray for consultation if needed?

3. Vetting dentists has been a bit difficult. I have researched and so realize the various types of dentists, the overlap in types of practices and procedures by various types of dentists and different accrediting associations and the like. Still difficult to vet a dentist! Any tips appreciated.

UPDATE:

My family member went ahead with the consultation, but wasn't quite satisfied with the dentist's answers to some of her questions - she said he bypassed some of the questions she had that she thought were important (like: success rate? continuing education? where do the implant, crown, bone graft material come from?) There is a lot of information on questions to ask and the like online, many though aren't written by people independent to the process.

Questions:

1. How do you vet a US dentist if you are considering a dental implant and/or see if the tooth can be saved?

2. What are the important questions you ask at the consultation?

3. Is it fair to ask where the bone graft material is sourced from and manufactured? and similar for crown, abutement and implant?


Edited to add question #3.
Edited to add update.
Last edited by URSnshn on Thu Feb 07, 2019 10:39 am, edited 3 times in total.

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ResearchMed
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Re: Investing in a dental implant or ?

Post by ResearchMed » Sat Jan 26, 2019 2:05 pm

URSnshn wrote:
Sat Jan 26, 2019 1:52 pm
I have a family member who had tooth pain, saw her dentist, had a partial root canal and is being told that the tooth cannot be crowned or capped (no infection, the top part of the tooth (one of the back teeth) simply no longer had the structure it needed and they can't fill it and there isn't enough left for a cap or crown) - and it is recommended that they get an implant.

The dentist has been her dentist for a good long time, but he also has an implant business. At the time she went in they simply removed the root and put something on top of the tooth and she was told to come back and see their prosthodontist who would take a panoramic x-ray and give her all the options. The cost for this consultation is about $300 - probably the panoramic x-ray is additional.

She wonders if she is being sold on an "implant" and is concerned that she may be rushing into something and maybe implant surgery isn't needed. Or there might be a viable alternative option. When she goes in for that consultation they'll take the panoramic x-ray, sign some forms and it's off to the races. She feels uncomfortable about having the panoramic x-rays taken prior to understanding exactly what they are proposing, because she may want to get a second opinion and if she wants a second opinion they'll probably want to take a panoramic x-ray as well.

Questions:

1. Are dental implants oversold, what kind of process should a consumer employ to ascertain if they are being sold the Booklyn Bridge or something that they really need with respect to this situation?

2. Will she be able to obtain her panoramic x-ray for consultation if needed?
There should not be any problem with asking (in advance) if she will be able to have copy of the scan for a second opinion.
ANY medical professional who objects to a second opinion... should become a "prior" provider, IMO.

There might be a charge for the second opinion.
And IF one selects the second opinion provider, I wouldn't be surprised if they then want to do another scan. They *need* to know that "it's the right scan", etc.

Our regular dental practice has another group do the implants, but then they (regular practice) will do the crown.
And both practices, the implant group and the current practice's "crown" specialist are sooooo backed up that I can't imagine they are overselling any of that.

However, *other* practices certainly can be doing that, if they aren't as successful and have "available" time/staffing, etc.

But for anything really invasive and expensive (or just invasive, if serious) - and an implant is - a second opinion should be done if you have ANY qualms (and perhaps even if you don't).

RM
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adamthesmythe
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Re: Investing in a dental implant or ?

Post by adamthesmythe » Sat Jan 26, 2019 2:13 pm

I was in a similar situation. I am getting an implant because I believe it will be the most satisfactory repair.

I was told about a bridge, which would have involved messing with two adjacent teeth.

Nothing was also an option.

dknightd
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Re: Investing in a dental implant or ?

Post by dknightd » Sat Jan 26, 2019 2:40 pm

URSnshn wrote:
Sat Jan 26, 2019 1:52 pm
I have a family member who had tooth pain, saw her dentist, had a partial root canal and is being told that the tooth cannot be crowned or capped (no infection, the top part of the tooth (one of the back teeth) simply no longer had the structure it needed and they can't fill it and there isn't enough left for a cap or crown) - and it is recommended that they get an implant.

The dentist has been her dentist for a good long time, but he also has an implant business. At the time she went in they simply removed the root and put something on top of the tooth and she was told to come back and see their prosthodontist who would take a panoramic x-ray and give her all the options. The cost for this consultation is about $300 - probably the panoramic x-ray is additional.

She wonders if she is being sold on an "implant" and is concerned that she may be rushing into something and maybe implant surgery isn't needed. Or there might be a viable alternative option. When she goes in for that consultation they'll take the panoramic x-ray, sign some forms and it's off to the races. She feels uncomfortable about having the panoramic x-rays taken prior to understanding exactly what they are proposing, because she may want to get a second opinion and if she wants a second opinion they'll probably want to take a panoramic x-ray as well.

Questions:

1. Are dental implants oversold, what kind of process should a consumer employ to ascertain if they are being sold the Booklyn Bridge or something that they really need with respect to this situation?

2. Will she be able to obtain her panoramic x-ray for consultation if needed?
I'm not a dentist. But my wife has had several implants. And I'm thinking about getting one.

IMO your relative should go in for the panoramic x-ray and consultation. If she is uncomfortable get a second opinion.

Bottom line for me was I did not want to have pain. So I paid to have the bad tooth taken out.
I think wife should get dentures and be done with it.
I think I'm OK living without a tooth. I think we'll end up replacing DW teeth one at a time
Dental implants are expensive. And painful. Way more expensive than another xray.

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URSnshn
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Re: Investing in a dental implant or ?

Post by URSnshn » Sun Jan 27, 2019 6:32 pm

Thanks for your thoughts on the matter - I'm passing them along!

investingdad
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Re: Investing in a dental implant or ?

Post by investingdad » Sun Jan 27, 2019 8:04 pm

I'm in the middle of the process right now.

A front tooth was broken as a kid. After the crown and root canal failed recently I developed an abscess without knowing it.

The tooth was extracted and bone graft done. The graft is healing well and the implant is getting placed next month.

Replacing a front tooth is a no brainer for me.

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Summit111
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Re: Investing in a dental implant or ?

Post by Summit111 » Sun Jan 27, 2019 8:08 pm

I had a 15 year old root canal finally go bad...Had an oral surgeon pull the tooth and had an implant installed...$4000 total cost and never looked back...totally worth it.

I suffered with pain and infections for 2 years prior to the implant procedure, and now, all is well...

Summit
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tadamsmar
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Re: Investing in a dental implant or ?

Post by tadamsmar » Sun Jan 27, 2019 8:10 pm

I think one has at least 6 options.

1. No tooth
2. Denture
3. Bridge if the adjacent teeth are sound enough
4. Implant by a dental school
5. Implant in a foreign country
6. Implant in the USA (not a dental school)

I think that is in order of cost.

Edited: to add the dental school option mentioned by miamibeachdentist.
Last edited by tadamsmar on Wed Feb 06, 2019 9:22 am, edited 3 times in total.

miamibeachdentist
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Re: Investing in a dental implant or ?

Post by miamibeachdentist » Sun Jan 27, 2019 8:42 pm

Dentist here:

Without going into a whole explanation. Under most circumstances a dental implant is the best way to replace a single missing tooth

By law, the dentist must give you a copy of your xrays if you request them. They are also allowed to charge you a small fee for duplication

If you cannot find a good referral from a friend or coworker you may want to try the local dental school if you are near one.
The cost will be cheaper. The students working on you have no financial motivation to “sell you” and the work is double and triple checked by the supervising faculty. The downside is that it will take a long time in the chair and many more appointments.

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CWRadio
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Re: Investing in a dental implant or ?

Post by CWRadio » Sun Jan 27, 2019 8:53 pm

I think one has at least 5 options.

1. No tooth
2. Denture
3. Bridge if the adjacent teeth are sound enough
4. Implant in a foreign country
5. Implant in the USA
If the tooth is in the back(#30) and do nothing is your option, what can possible happen?
Thanks

michaelingp
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Re: Investing in a dental implant or ?

Post by michaelingp » Sun Jan 27, 2019 9:53 pm

dknightd wrote:
Sat Jan 26, 2019 2:40 pm
Dental implants are expensive. And painful. Way more expensive than another xray.
Expensive and painful are both subjective. My wife and I have each had two implants, and I wouldn't describe the process as either overly expensive or painful (I know we don't constitute a scientific sample). I had heard people talk about $10,000 for an implant, but ours were in the $2,000 range I think, much of it covered by insurance. As for pain, neither of us took more than 200mg (one regular tablet) of ibuprofen after the procedure and they've been pain free since.

If you can afford it, dental implants are definitely the gold standard for tooth replacement these days. I had the exact same concerns as the OP, that I was being sold something to enrich the dentists, but I'm pretty happy with the results, and doubt anybody is getting rich at my expense.

On the other hand, before I had dental insurance I went many years with a missing molar with no discernible bad effects. I was told that since the tooth that would have normally contacted my missing molar was contacting another tooth there was no harm in just going without the tooth. It didn't affect my appearance or the pleasure of eating food, and as far as I know, nothing bad came of it. Neither my dentist or my periodontist ever mentioned that bad things would happen if I didn't replace the tooth. I would definitely ask one or more dentists, "Is there any problem with just leaving it missing?"

Carson
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Re: Investing in a dental implant or ?

Post by Carson » Mon Jan 28, 2019 10:55 am

CWRadio wrote:
Sun Jan 27, 2019 8:53 pm
If the tooth is in the back(#30) and do nothing is your option, what can possible happen?
Thanks
NOT medical advice, but I have this same situation. I was missing 'adult' teeth in the back half of my mouth. When I was a kid, they pulled the baby teeth, hoping that my wisdom teeth would come in and push the adjacent teeth forward. With some orthodontics this happened, somewhat. The gap is large enough that I can eat without food getting stuck and rotting nearby teeth. It is small enough that it doesn't impact my bite or ability to chew. My bottom teeth haven't shifted too much, but I think the degree one's teeth shifts is personal (at 37, I no longer wear a retainer and have not experienced major shifting; DH did not wear his retainer post-orthodontia and his teeth all shifted back).
30-something personal finance enthusiast, just get getting started on this whole portfolio thing.

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Re: Investing in a dental implant or ?

Post by midareff » Mon Jan 28, 2019 11:25 am

Questions:

1. Are dental implants oversold, what kind of process should a consumer employ to ascertain if they are being sold the Booklyn Bridge or something that they really need with respect to this situation?

I recently had a situation where my periodontist was recommending an endodontist to do a nerve procedure from the tip of the root to quell an occasional throbbing issue. FWIW, that would have been the second root tip that procedure (molar) would have been performed on and he thought that would quite possibly provide a ten year solution. I replied I was hoping to live another 25 or so and wanted a one time permanent solution... the answer was extraction, bone graft, implant and crown, which I opted for. Also FWIW.... these procedures are only expensive if you don't live very long afterwards. If you get twenty, thirty or more years from them the cost per year gets quite reasonable.

2. Will she be able to obtain her panoramic x-ray for consultation if needed?

Yes, never met a doctor, hospital or dentist that refused to give you your records that are your's by Federal law. Whenever I have an x-ray I have an electronic copy sent to my email and retain them myself as well as at the location taken.

3. Vetting dentists has been a bit difficult. I have researched and so realize the various types of dentists, the overlap in types of practices and procedures by various types of dentists and different accrediting associations and the like. Still difficult to vet a dentist! Any tips appreciated.

My general rule for me and wife..... If it's above the gum line it's for a dentist. Below the gum line it's for a periodontist, if it's a nerve issue it may be for a endodontist.

Just my personal water cooler advice not to be confused with anything other than personal conjecture. YMMV. FWIW, your teeth contribute to your general health and wellness inclusive of your personal opinion of you. Don't use shortcuts when these factors are involved.

SimonJester
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Re: Investing in a dental implant or ?

Post by SimonJester » Mon Jan 28, 2019 11:50 am

So I just finished a dental implant a few days ago. In the previous spot I had two failed bridges, the first bridge lasted 12-15 years, the 2nd only 18 months. Total time from implant surgery to final restoration was just under 6 months.

The biggest advantage of the implant is preventing bone loss, and not having to impact adjacent teeth. If the tooth has to be pulled then I dont think the implant is being oversold. It really can be the best solution to replacing a lost tooth. A bridge is basically two or more connected crowns, each crown is $$$ expensive.

When my 2nd bridge failed we were left with a choice of replacing the bridge a third time, or going implant route saving the two crowns. The cost would have been almost the same Crown X3 or Implant an 1 crown.

As far a DDS overlap,
My normal DDS placed the implant and sent impressions off to a lab for the abutment and crown. My normal DDS specialized in implants so I was not too concerned about having it done in the DDS office vs a specialist.

So far after only a few days with the final restoration I am very happy with the results. Looks and functions more like a normal tooth.
Last edited by SimonJester on Mon Jan 28, 2019 11:04 pm, edited 1 time in total.
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ResearchMed
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Re: Investing in a dental implant or ?

Post by ResearchMed » Mon Jan 28, 2019 2:33 pm

SimonJester wrote:
Mon Jan 28, 2019 11:50 am
So I just finished a dental implant a few days ago. In the previous spot I had two failed bridges, the first bridge lasted 12-15 years, the 2nd only 18 months. Total time from implant surgery to final restoration was just under 6 months.

The biggest advantage of the implant is preventing bone loss, and not having to impact adjacent teeth. If the tooth has to be pulled then I dont think the implant is being oversold. It really can be the best solution to replacing a lost tooth. A bridge is basically two or more connected crowns, each crown is $$$ expensive.

When my 2nd bridge failed we were left with a choice of replacing the bridge a third time, or going implant route saving the two crowns. The cost would have been almost the same Crown X3 or Implant an 1 crown.

As far a DDS overlap,
My normal DDS placed the implant and sent impressions off to a lab for the abutment and crown. My normal DDS specialized in implants so I was not too concerned about having it done in the DDS office vs a socialists.

So far after only a few days with the final restoration I am very happy with the results. Looks and functions more like a normal tooth.
Yeah, we wouldn't want our tooth implants done by a socialist, either :twisted:

Cheers!

RM
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SimonJester
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Re: Investing in a dental implant or ?

Post by SimonJester » Mon Jan 28, 2019 11:06 pm

ResearchMed wrote:
Mon Jan 28, 2019 2:33 pm
Yeah, we wouldn't want our tooth implants done by a socialist, either :twisted:

Cheers!

RM
Dang keyboard didn't type what I told it to. :oops:

I really don't care what my DDS political views are, just what their clinical experience is...
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

wcinnn
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Re: Investing in a dental implant or ?

Post by wcinnn » Tue Jan 29, 2019 4:08 am

Was told by dentist and a periodontist in US that I needed $40K worth of work, HCOL city, including 3 extractions and implants - 2 being back teeth. Decided that because I was traveling to Penang, Malaysia this winter, where I have friends who have had implants and other dental work done by a Chinese doc who trained in Germany, I’d see what he said. I sent my X-rays ahead. On the initial consultation, before I’d opened my mouth, I explained what had been recommended in US. He said “here we try to to save teeth, and only pull if we can’t”. He pulled one, a back tooth, and said we can discuss an implant if it bothers me but he didn’t think it would. On the other 2 slated for yanking, he replaced a crown and filled the adjacent tooth. He also replaced some old fillings. The total cost was under $1,000. I am 70 years old and a realist, this mouth doesn’t need to last another 70 years.

sil2017
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Re: Investing in a dental implant or ?

Post by sil2017 » Wed Feb 06, 2019 1:48 am

Just back from Mumbai . I met a New Zealand gentleman who had implants for both upper and lower , fixed all his gum diseases for 17k New Zealand dollars . His dentist recommended India . Highly trained group of dentists majoring in every step for implants. Believe it is called Signature clinic in Mumbai .

Cactuscoug
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Re: Investing in a dental implant or ?

Post by Cactuscoug » Wed Feb 06, 2019 7:32 am

I use Laser Dental in Nogales, Mexico. (866) 861-7056‬; An easy 1-1/2 block walk from the border. Usually a 30-45 minute wait to get back into the U.S.
Extraction, Implant and crown for around $1800 total.

likegarden
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Re: Investing in a dental implant or ?

Post by likegarden » Wed Feb 06, 2019 7:41 am

I had a deteriorated tooth and some bone removed 53 years ago (4 teeth from front) and left it that way. I did not want a bridge then because that would have required work on neighboring teeth. I had no problems eating, etc., can barely see that gap.

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Re: Investing in a dental implant or ?

Post by goblue100 » Wed Feb 06, 2019 8:13 am

I have had a couple of implants. I agree with previous poster who said pain was minimal and results have been good. I have been glad I chose that route compared to a bridge. As far as the money, I was talking to a coworker about his trip to Hawaii and the cost. His response was once the money was gone, you'll never miss it. While one can obviously go too far in that direction, I've found his statement to be true on many occasions. If your family member spends 2 or 3 thousand on an implant will it affect her life next month?
Financial planners are savers. They want us to be 95 percent confident we can finance a 30-year retirement even though there is an 82 percent probability of being dead by then. - Scott Burns

capsaicinguy
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Re: Investing in a dental implant or ?

Post by capsaicinguy » Wed Feb 06, 2019 8:36 am

tadamsmar wrote:
Sun Jan 27, 2019 8:10 pm
I think one has at least 5 options.

1. No tooth
2. Denture
3. Bridge if the adjacent teeth are sound enough
4. Implant in a foreign country
5. Implant in the USA

I think that is in order of cost.
Always get a second opinion if you think you need it. Just expect you will be charged another exam fee. Even if you take the current Pan to a different doc, they may still take another image. AKA the second doc might not want to use a Pan for planning and might want a CBCT or a "3D xray" and charge you for that. Or maybe the Pan isn't up to his standards (distortion/over/underexposed/etc).

Not giving medical advice, just generally discussing risk/benefits of some options being thrown out for anyone considering.

1. Always an option, but doesn't remedy potential for pain/infection/swelling/loss of function/loss of bone/migration of teeth. Extract and do nothing helps with some of these.

2. I assume we're talking partials here. Bulky (lots of plastic and metal), cheaper than implant generally. These are not real teeth, it's plastic and metal that looks like teeth. It will not function the same as real teeth, a learning curve to figuring out how to use it is expected. Some people never can. Expect it to move around, give sore spots, and expect it to fall out when you least want it to. Don't expect to be able to eat everything you used to. Still destructive to other teeth as modifications need to be made to hold it in place. Not always an option and may need special crowns to make it work long(er) term. Shorter timeline than implant to replacing the lost tooth.

3. Sacrificing adjacent teeth to replace the one lost. Not always an option if adjacent teeth aren't healthy or have small roots/etc. Sometimes this is a better/cheaper option than implant, like when there isn't enough bone, or the adjacent teeth already have crowns that need to be replaced. Shorter timeline than implant.

4. Benefit is cheaper than procedure being done in US (maybe). Risk here is upon returning to the US, your current doc might not want to touch it. And if something goes wrong you will likely be told you need to travel back to the doc who did the work to get it fixed. The cheaper initial procedure can get eaten up fast by plane tickets to go have complications managed. Occlusion bad? Go see that doc. Crown/implant is getting loose? Go see that doc. Infection around it? Go see that doc. You get the picture.

5. Possibly the most expensive option. Generally closest to the real deal there is to replacing a lost tooth (not specific to the US). It is still not a tooth. It can still get periodontal disease around it ("peri implantitis/peri mucositis") and fail. May need bone grafting procedures prior to placement. Longer timeline to final replacement, can take up to a year or more. You can't rush biology and bone healing. Not always a good option if someone is a smoker/diabetic/etc. It still needs to be taken care of just like your real tooth (brushing/flossing/xrays as needed/cleanings as recommended by your doc/etc). Convenience of not having to travel for the surgery/crown placement.

Just some things to think about. :sharebeer

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tadamsmar
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Re: Investing in a dental implant or ?

Post by tadamsmar » Wed Feb 06, 2019 9:18 am

capsaicinguy wrote:
Wed Feb 06, 2019 8:36 am
tadamsmar wrote:
Sun Jan 27, 2019 8:10 pm
I think one has at least 5 options.

1. No tooth
2. Denture
3. Bridge if the adjacent teeth are sound enough
4. Implant in a foreign country
5. Implant in the USA

I think that is in order of cost.
Always get a second opinion if you think you need it. Just expect you will be charged another exam fee. Even if you take the current Pan to a different doc, they may still take another image. AKA the second doc might not want to use a Pan for planning and might want a CBCT or a "3D xray" and charge you for that. Or maybe the Pan isn't up to his standards (distortion/over/underexposed/etc).

Not giving medical advice, just generally discussing risk/benefits of some options being thrown out for anyone considering.
...
4. Benefit is cheaper than procedure being done in US (maybe). Risk here is upon returning to the US, your current doc might not want to touch it. And if something goes wrong you will likely be told you need to travel back to the doc who did the work to get it fixed. The cheaper initial procedure can get eaten up fast by plane tickets to go have complications managed. Occlusion bad? Go see that doc. Crown/implant is getting loose? Go see that doc. Infection around it? Go see that doc. You get the picture.
I have a dental implant. Later, I retired from my 40-minute commute and switched to a dentist and periodontist closer to home. No doctor ever suggested that I go back to the original periodontist. And I got treatment for an infection around the implant from my new periodontist.

My original periodontist gave me a fact sheet on the make, model, specifications of the implant specifically so another periodontist would be prepared to address problems. If I lost that sheet then I would need to contact the original periodontist or someone (like my old dentist) who might have this record. It is important to not lose track of that sheet.

But maybe you are thinking the the US periodontists would discriminate against you for going offshore?

Note that miamibeachdentist posted another option: implant from a dental school. That would be added as #4 in my list.

atdharris
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Re: Investing in a dental implant or ?

Post by atdharris » Wed Feb 06, 2019 9:44 am

I broke a tooth down to the jawline last year and had to have it extracted. I chose to go with an implant because it was the best way to restore my mouth to the way it was, and I have no regrets. Yes, it ran me close to $6000 because my insurance considered it cosmetic and did not cover it, but I had no issues or pain throughout the process and cannot tell a difference now that I have had my tooth fully restored. I do recommend you go to a well regarded dentist though. My dentist made my experience pain free and did a great job installing all the components. It did take 4-5 months to fully restore my tooth however.

capsaicinguy
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Re: Investing in a dental implant or ?

Post by capsaicinguy » Wed Feb 06, 2019 10:09 am

tadamsmar wrote:
Wed Feb 06, 2019 9:18 am
I have a dental implant. Later, I retired from my 40-minute commute and switched to a dentist and periodontist closer to home. No doctor ever suggested that I go back to the original periodontist. And I got treatment for an infection around the implant from my new periodontist.

My original periodontist gave me a fact sheet on the make, model, specifications of the implant specifically so another periodontist would be prepared to address problems. If I lost that sheet then I would need to contact the original periodontist or someone (like my old dentist) who might have this record. It is important to not lose track of that sheet.

But maybe you are thinking the the US periodontists would discriminate against you for going offshore?

Note that miamibeachdentist posted another option: implant from a dental school. That would be added as #4 in my list.
I didn't mean that to sound like you would get blacklisted if you went offshore, but you shouldn't expect to have complications managed by your hometown doc for free either. The doctor providing the service should be the one to manage it. It could eat into the cost savings pretty quick. At the end of the day it's all about what risks you as the patient are willing to take, not the doctor.

Implant at a dental school is a good option and probably a good bit cheaper than private practice. You better be prepared for the full recommended wait and healing time for every stage. It could take well over a year for a single implant. Lots of people go to schools expecting the same experience as private practice (aka timelines) and get mad when they don't get to have it cheaper AND as fast. As the saying goes; fast, cheap, reliable, pick two. Dental school = cheap, reliable. Private practice = fast, reliable. Just keep that in mind.

Typical timeline at a (my) dental school: Two three-hour appointments for full exam and diagnostics/xrays. If you have cavities/periodontal disease it must all be addressed and fixed/stable prior to performing any implants/crowns/partial dentures/bridges. This may require several months. Once that is done, expect about a 3-4 month wait to get seen in a surgical specialty department. If necessary, perform bone grafting and wait several months for healing. Go for first stage surgery (placing implant/"post") in bone. Wait 4-6 months for healing. Uncover and place healing abutment. Wait 6-8 weeks. Take impression for crown and send to lab. Possibly come back to redo final impression. Wait 2 weeks for abutment/crown. Have abutment/crown seated.

Full disclosure: I am an upper classman dental student in clinic.

atdharris
Posts: 156
Joined: Wed Jan 02, 2019 3:18 pm

Re: Investing in a dental implant or ?

Post by atdharris » Wed Feb 06, 2019 10:18 am

Weird. I had a bone graft and the post placed at the same time as my extraction. Then I had a healing abatement for about 6 months before having the final crown installed. I had no other dental issues aside from the cracked tooth though.

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Sandtrap
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Re: Investing in a dental implant or ?

Post by Sandtrap » Wed Feb 06, 2019 10:22 am

I have had a bunch of these.
Done well by a "pro", it goes quickly and heals well and lasts long.
Done poorly, where there is a need for a redo, it can be awful. :shock:

When it comes to your health, it is not an "investment", it's a necessity without compromise. :happy
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capsaicinguy
Posts: 123
Joined: Thu Sep 29, 2016 9:00 am

Re: Investing in a dental implant or ?

Post by capsaicinguy » Wed Feb 06, 2019 11:15 am

atdharris wrote:
Wed Feb 06, 2019 10:18 am
Weird. I had a bone graft and the post placed at the same time as my extraction. Then I had a healing abatement for about 6 months before having the final crown installed. I had no other dental issues aside from the cracked tooth though.
I'll give the example of an upper back tooth. The "magic" number for bone in implants is ~7mm. If you have ~7mm, placing a bone graft (indirect sinus lift) at same time as implant placement might be possible because you might get enough initial stability (aka not moving) in the implant for proper healing. As a totally separate issue, some will place the healing abutment at the same time as implant placement if they have enough initial torque. Initial torque is dependent on the existing bone, not the grafted bone (if used). If you have 7mm of really soft bone, they might bone graft at same time as implant placement but not place the healing abutment. If you have 7mm of really dense bone, they might bone graft and place healing abutment as well. This could save you about 6-8 weeks for the soft tissue healing time around the healing abutment. It depends on the surgeons judgement at time of surgery and what you're willing to do.

If you only have 1mm of bone (like around the maxillary sinus for example) you can't do this. You will generally need to graft first, wait for healing, then place implant. Movement during bone healing is bad. If you have low initial torque and place the healing abutment on top and the patient chews on it all the time with nuts/ice/etc and works it loose before the bone could integrate, it's a failure. The most conservative approach is usually to do each step, let it heal fully, and re-evaluate. Some patients are willing to assume more risk for the potential of a faster outcome. Bone grafting at the same time of implant placement sometimes makes sense, but sometimes it doesn't.

Tons of factors to consider and every one is different. Hopefully this helps illustrate how difficult or impossible it can be to compare experiences between people for any procedure. Sorry if this is veering OT.

atdharris
Posts: 156
Joined: Wed Jan 02, 2019 3:18 pm

Re: Investing in a dental implant or ?

Post by atdharris » Wed Feb 06, 2019 12:02 pm

capsaicinguy wrote:
Wed Feb 06, 2019 11:15 am
atdharris wrote:
Wed Feb 06, 2019 10:18 am
Weird. I had a bone graft and the post placed at the same time as my extraction. Then I had a healing abatement for about 6 months before having the final crown installed. I had no other dental issues aside from the cracked tooth though.
I'll give the example of an upper back tooth. The "magic" number for bone in implants is ~7mm. If you have ~7mm, placing a bone graft (indirect sinus lift) at same time as implant placement might be possible because you might get enough initial stability (aka not moving) in the implant for proper healing. As a totally separate issue, some will place the healing abutment at the same time as implant placement if they have enough initial torque. Initial torque is dependent on the existing bone, not the grafted bone (if used). If you have 7mm of really soft bone, they might bone graft at same time as implant placement but not place the healing abutment. If you have 7mm of really dense bone, they might bone graft and place healing abutment as well. This could save you about 6-8 weeks for the soft tissue healing time around the healing abutment. It depends on the surgeons judgement at time of surgery and what you're willing to do.

If you only have 1mm of bone (like around the maxillary sinus for example) you can't do this. You will generally need to graft first, wait for healing, then place implant. Movement during bone healing is bad. If you have low initial torque and place the healing abutment on top and the patient chews on it all the time with nuts/ice/etc and works it loose before the bone could integrate, it's a failure. The most conservative approach is usually to do each step, let it heal fully, and re-evaluate. Some patients are willing to assume more risk for the potential of a faster outcome. Bone grafting at the same time of implant placement sometimes makes sense, but sometimes it doesn't.

Tons of factors to consider and every one is different. Hopefully this helps illustrate how difficult or impossible it can be to compare experiences between people for any procedure. Sorry if this is veering OT.
The surgeon said I had little to no bone loss, so I suppose that's why my procedure went so smoothly. My teeth in general were very healthy. I had never had a cavity or any sort of decay or damage before the fluke tooth cracking which came from biting on something in a jar of capers..

stimulacra
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Re: Investing in a dental implant or ?

Post by stimulacra » Wed Feb 06, 2019 12:20 pm

I would seek a second opinion to see if the tooth or root can be preserved.

My understanding is you do everything possible to preserve the dental root, failing that, implants.

Both are intended to prevent bone resorption and preserve form and function of mouth and ability to chew.

How old is family member? If in 20's or 30's than investing in implants graded to last decades would be a worthwhile investment. If in 60's or 70's the cost benefit might shift a bit. What's the insurance or co-pay situation?

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beyou
Posts: 2845
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Re: Investing in a dental implant or ?

Post by beyou » Wed Feb 06, 2019 12:34 pm

I have a 20 year old son, who has an empty slot where a baby tooth was never replaced by his adult tooth
(never came down, was removed after orthodontist couldn't get it to come down from the roof of his mouth to the correct spot).

I am convinced his choices are either implant or leave as-is, after reading the comments about bridges failing.

He is resistant to getting any work done and has been happy with his toothless look for a long while.
His objection is that he does not handle the pain of the procedures very well, pretty bad patient.
Having his incorrectly placed tooth out, along with wisdom teeth, was one of the worst experiences of his life,
so when it was over he refused to go back to get estimates for an implant to replace the missing tooth.
Even if he forgets the discomfort, there is also the time involved. He is a busy college student who does no spend 6 months consistently
in one location. Back and forth home/college/home/college/home/internship etc. Sees like the type of work that requires you are near the specialist for a period of time, so there is no good location to get the work done.

Suggestions and feedback regarding pain and how to get work done for the transient person on-the-go ?
He may settle down location wise after he graduates and works full time, TBD and at least a year away.

voodoo72
Posts: 70
Joined: Wed Nov 15, 2017 1:20 pm

Re: Investing in a dental implant or ?

Post by voodoo72 » Wed Feb 06, 2019 12:47 pm

capsaicinguy wrote:
Wed Feb 06, 2019 10:09 am
tadamsmar wrote:
Wed Feb 06, 2019 9:18 am
I have a dental implant. Later, I retired from my 40-minute commute and switched to a dentist and periodontist closer to home. No doctor ever suggested that I go back to the original periodontist. And I got treatment for an infection around the implant from my new periodontist.

My original periodontist gave me a fact sheet on the make, model, specifications of the implant specifically so another periodontist would be prepared to address problems. If I lost that sheet then I would need to contact the original periodontist or someone (like my old dentist) who might have this record. It is important to not lose track of that sheet.

But maybe you are thinking the the US periodontists would discriminate against you for going offshore?

Note that miamibeachdentist posted another option: implant from a dental school. That would be added as #4 in my list.
I didn't mean that to sound like you would get blacklisted if you went offshore, but you shouldn't expect to have complications managed by your hometown doc for free either. The doctor providing the service should be the one to manage it. It could eat into the cost savings pretty quick. At the end of the day it's all about what risks you as the patient are willing to take, not the doctor.

Implant at a dental school is a good option and probably a good bit cheaper than private practice. You better be prepared for the full recommended wait and healing time for every stage. It could take well over a year for a single implant. Lots of people go to schools expecting the same experience as private practice (aka timelines) and get mad when they don't get to have it cheaper AND as fast. As the saying goes; fast, cheap, reliable, pick two. Dental school = cheap, reliable. Private practice = fast, reliable. Just keep that in mind.

Typical timeline at a (my) dental school: Two three-hour appointments for full exam and diagnostics/xrays. If you have cavities/periodontal disease it must all be addressed and fixed/stable prior to performing any implants/crowns/partial dentures/bridges. This may require several months. Once that is done, expect about a 3-4 month wait to get seen in a surgical specialty department. If necessary, perform bone grafting and wait several months for healing. Go for first stage surgery (placing implant/"post") in bone. Wait 4-6 months for healing. Uncover and place healing abutment. Wait 6-8 weeks. Take impression for crown and send to lab. Possibly come back to redo final impression. Wait 2 weeks for abutment/crown. Have abutment/crown seated.

Full disclosure: I am an upper classman dental student in clinic.

I was going to write the same things, and keep in mind sometimes if there is a complication, the hometown Doc may elect not to get involved, why? if he touches it, he is responsible and liable, and should soemthing go wrong, a lawyer can easily sue the doctor in the states, but he has no jurisdiction over the dentist in a foreign country, and YES I have seen this happen to a collegue.

SimonJester
Posts: 1999
Joined: Tue Aug 16, 2011 12:39 pm

Re: Investing in a dental implant or ?

Post by SimonJester » Wed Feb 06, 2019 2:12 pm

beyou wrote:
Wed Feb 06, 2019 12:34 pm
I have a 20 year old son, who has an empty slot where a baby tooth was never replaced by his adult tooth
(never came down, was removed after orthodontist couldn't get it to come down from the roof of his mouth to the correct spot).

I am convinced his choices are either implant or leave as-is, after reading the comments about bridges failing.

He is resistant to getting any work done and has been happy with his toothless look for a long while.
His objection is that he does not handle the pain of the procedures very well, pretty bad patient.
Having his incorrectly placed tooth out, along with wisdom teeth, was one of the worst experiences of his life,
so when it was over he refused to go back to get estimates for an implant to replace the missing tooth.
Even if he forgets the discomfort, there is also the time involved. He is a busy college student who does no spend 6 months consistently
in one location. Back and forth home/college/home/college/home/internship etc. Sees like the type of work that requires you are near the specialist for a period of time, so there is no good location to get the work done.

Suggestions and feedback regarding pain and how to get work done for the transient person on-the-go ?
He may settle down location wise after he graduates and works full time, TBD and at least a year away.
I was in the same boat as your son, missing adult tooth. If I could go back in time, and it was an option, I would go with the implant over having the bridges.

As far as pain, after the shots to numb you up there is NO pain during the procedure. He is missing a tooth which has healed up, so there are no nerves to cause pain where the implant is. In fact there is no feeling at all for my implant, its a little strange actually. Even teeth that have had root canals have some feeling where the ligaments are, but the implant has nothing...

There is some pain where they have to cut into the gums to expose the bone and place the implant. I managed this with over the counter pain killers.
I would put in on par with burning your mouth biting into hot pizza for a few days which goes away when you take pain killers. Then for a week or so when you bit down on something that get to the area you get a bit of sharp pain, goes away immediately...

The biggest pain was in the pocket book and fighting the insurance company to cover things.
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

Topic Author
URSnshn
Posts: 205
Joined: Sun Mar 13, 2016 6:10 pm

Re: Investing in a dental implant or ?

Post by URSnshn » Thu Feb 07, 2019 10:35 am

OP Here - Thanks for all the advice! My family member went ahead with the consultation, but wasn't quite satisfied with the dentist's answers to some of her questions - she said he bypassed some of the questions she had that she thought were important (like: success rate? continuing education? where do the implant, crown, bone graft material come from?) There is a lot of information on questions to ask and the like online, many though aren't written by people independent to the process.

Questions:

1. How do you vet a US dentist if you are considering a dental implant and/or see if the tooth can be saved?

2. What are the important questions you ask at the consultation?

3. Is it fair to ask where the bone graft material is sourced from and manufactured? and similar for crown, abutement and implant?

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: Investing in a dental implant & Vetting and questions to ask?

Post by toofache32 » Fri Feb 08, 2019 2:07 am

URSnshn wrote:
Sat Jan 26, 2019 1:52 pm
At the time she went in they simply removed the root and put something on top of the tooth and she was told to come back and see their prosthodontist who would take a panoramic x-ray and give her all the options.
If they removed the root, how is the crown part of the tooth staying in place?

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: Investing in a dental implant or ?

Post by toofache32 » Fri Feb 08, 2019 2:37 am

URSnshn wrote:
Thu Feb 07, 2019 10:35 am
OP Here - Thanks for all the advice! My family member went ahead with the consultation, but wasn't quite satisfied with the dentist's answers to some of her questions - she said he bypassed some of the questions she had that she thought were important (like: success rate? continuing education? where do the implant, crown, bone graft material come from?) There is a lot of information on questions to ask and the like online, many though aren't written by people independent to the process.

Questions:

1. How do you vet a US dentist if you are considering a dental implant and/or see if the tooth can be saved?

2. What are the important questions you ask at the consultation?

3. Is it fair to ask where the bone graft material is sourced from and manufactured? and similar for crown, abutement and implant?
1. My bias is that I am a dental specialist focusing on implant surgery. As is true in every industry, there are general dentists who do a great job with implant surgery, and there are specialists who do a horrible job. While I have placed implants that fail the same as everyone else, a growing part of my practice is managing implant disasters from non-specialists. The dental specialists focusing on implant surgery are oral surgeons and periodontists.
On average, a specialist (oral surgeon or periodontist) has the most training in implant surgery although this is still no guarantee of success. We all have failures. Interestingly, there are now "specialty boards" in implant surgery intended to provide general dentists with an avenue to advertise they are "board certified" in implant dentistry. These boards are not recognized by the ADA Commission on Dental Accreditation. https://www.ada.org/en/coda/accreditation/about-us

2. Ask where they got their implant training. An oral surgeon or periodontist gets this training during their 3+ years of residency after dental school. General dentists most often get this training through weekend courses. Many of these dentists end up being great implant surgeons.

3. I always discuss with patients the details of bone grafting since most of my patients ask about it. There are multiple sources/types of bone grafting. There is human cadaver, cow bone, and synthetics. Some are mineralized and some are de-mineralized. Some are putty and some are granular/particulate and some are solid blocks. Some resorb quickly (<6 months) and some slowly (many years or never). Bone grafting biology is an entire science of its own and is VERY complex and it's not just throwing some bone in there. Every scenario is different and there are multiple reasons why one type of bone will be chosen over others. Sometimes the architecture of the remaining bone and teeth is adequate to place a bone graft and implant at the same time. Sometimes the architecture requires bone grafting first, to later come back and place the implant. Everyone's mouth is different.
As for implants and related components/abutments, there are dozens of manufacturers out there. There were originally 2-3 companies that did most of the research and development 20-30 years ago. Now there are multiple companies that make "clones" of these implants for very cheap. Some of them are just fine. I personally use one of the premium brands that is backed by decades of research. These are more expensive (2x price maybe) than the clones which means my fees are not the cheapest.

Again, my bias as a specialist is that I get referred the disasters from non-specialists to bail them out. I also treat my own disasters. Problems can happen with any surgical procedure with any surgeon. While it's no big deal when everything goes as planned, one mark of a good surgeon is knowing how to manage problems. Personally, I would want to be treated by someone who can take me through the process from start to finish no matter what happens, and not have to be referred to someone else to bail me out.

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: Investing in a dental implant or ?

Post by toofache32 » Fri Feb 08, 2019 2:48 am

voodoo72 wrote:
Wed Feb 06, 2019 12:47 pm
capsaicinguy wrote:
Wed Feb 06, 2019 10:09 am
tadamsmar wrote:
Wed Feb 06, 2019 9:18 am
I have a dental implant. Later, I retired from my 40-minute commute and switched to a dentist and periodontist closer to home. No doctor ever suggested that I go back to the original periodontist. And I got treatment for an infection around the implant from my new periodontist.

My original periodontist gave me a fact sheet on the make, model, specifications of the implant specifically so another periodontist would be prepared to address problems. If I lost that sheet then I would need to contact the original periodontist or someone (like my old dentist) who might have this record. It is important to not lose track of that sheet.

But maybe you are thinking the the US periodontists would discriminate against you for going offshore?

Note that miamibeachdentist posted another option: implant from a dental school. That would be added as #4 in my list.
I didn't mean that to sound like you would get blacklisted if you went offshore, but you shouldn't expect to have complications managed by your hometown doc for free either. The doctor providing the service should be the one to manage it. It could eat into the cost savings pretty quick. At the end of the day it's all about what risks you as the patient are willing to take, not the doctor.

Implant at a dental school is a good option and probably a good bit cheaper than private practice. You better be prepared for the full recommended wait and healing time for every stage. It could take well over a year for a single implant. Lots of people go to schools expecting the same experience as private practice (aka timelines) and get mad when they don't get to have it cheaper AND as fast. As the saying goes; fast, cheap, reliable, pick two. Dental school = cheap, reliable. Private practice = fast, reliable. Just keep that in mind.

Typical timeline at a (my) dental school: Two three-hour appointments for full exam and diagnostics/xrays. If you have cavities/periodontal disease it must all be addressed and fixed/stable prior to performing any implants/crowns/partial dentures/bridges. This may require several months. Once that is done, expect about a 3-4 month wait to get seen in a surgical specialty department. If necessary, perform bone grafting and wait several months for healing. Go for first stage surgery (placing implant/"post") in bone. Wait 4-6 months for healing. Uncover and place healing abutment. Wait 6-8 weeks. Take impression for crown and send to lab. Possibly come back to redo final impression. Wait 2 weeks for abutment/crown. Have abutment/crown seated.

Full disclosure: I am an upper classman dental student in clinic.

I was going to write the same things, and keep in mind sometimes if there is a complication, the hometown Doc may elect not to get involved, why? if he touches it, he is responsible and liable, and should soemthing go wrong, a lawyer can easily sue the doctor in the states, but he has no jurisdiction over the dentist in a foreign country, and YES I have seen this happen to a collegue.
This is the reluctance for many US dentists to get involved with implants placed in other countries. The last person who touches it owns the problems. I have had patients come see me with problems with implants placed in other countries. I tell them "your dentist is in Thailand and you need to see him again about this."

investingdad
Posts: 1665
Joined: Fri Mar 15, 2013 10:41 pm

Re: Investing in a dental implant or ?

Post by investingdad » Fri Feb 08, 2019 8:13 am

toofache32 wrote:
Fri Feb 08, 2019 2:37 am
URSnshn wrote:
Thu Feb 07, 2019 10:35 am
OP Here - Thanks for all the advice! My family member went ahead with the consultation, but wasn't quite satisfied with the dentist's answers to some of her questions - she said he bypassed some of the questions she had that she thought were important (like: success rate? continuing education? where do the implant, crown, bone graft material come from?) There is a lot of information on questions to ask and the like online, many though aren't written by people independent to the process.

Questions:

1. How do you vet a US dentist if you are considering a dental implant and/or see if the tooth can be saved?

2. What are the important questions you ask at the consultation?

3. Is it fair to ask where the bone graft material is sourced from and manufactured? and similar for crown, abutement and implant?
1. My bias is that I am a dental specialist focusing on implant surgery. As is true in every industry, there are general dentists who do a great job with implant surgery, and there are specialists who do a horrible job. While I have placed implants that fail the same as everyone else, a growing part of my practice is managing implant disasters from non-specialists. The dental specialists focusing on implant surgery are oral surgeons and periodontists.
On average, a specialist (oral surgeon or periodontist) has the most training in implant surgery although this is still no guarantee of success. We all have failures. Interestingly, there are now "specialty boards" in implant surgery intended to provide general dentists with an avenue to advertise they are "board certified" in implant dentistry. These boards are not recognized by the ADA Commission on Dental Accreditation. https://www.ada.org/en/coda/accreditation/about-us

2. Ask where they got their implant training. An oral surgeon or periodontist gets this training during their 3+ years of residency after dental school. General dentists most often get this training through weekend courses. Many of these dentists end up being great implant surgeons.

3. I always discuss with patients the details of bone grafting since most of my patients ask about it. There are multiple sources/types of bone grafting. There is human cadaver, cow bone, and synthetics. Some are mineralized and some are de-mineralized. Some are putty and some are granular/particulate and some are solid blocks. Some resorb quickly (<6 months) and some slowly (many years or never). Bone grafting biology is an entire science of its own and is VERY complex and it's not just throwing some bone in there. Every scenario is different and there are multiple reasons why one type of bone will be chosen over others. Sometimes the architecture of the remaining bone and teeth is adequate to place a bone graft and implant at the same time. Sometimes the architecture requires bone grafting first, to later come back and place the implant. Everyone's mouth is different.
As for implants and related components/abutments, there are dozens of manufacturers out there. There were originally 2-3 companies that did most of the research and development 20-30 years ago. Now there are multiple companies that make "clones" of these implants for very cheap. Some of them are just fine. I personally use one of the premium brands that is backed by decades of research. These are more expensive (2x price maybe) than the clones which means my fees are not the cheapest.

Again, my bias as a specialist is that I get referred the disasters from non-specialists to bail them out. I also treat my own disasters. Problems can happen with any surgical procedure with any surgeon. While it's no big deal when everything goes as planned, one mark of a good surgeon is knowing how to manage problems. Personally, I would want to be treated by someone who can take me through the process from start to finish no matter what happens, and not have to be referred to someone else to bail me out.
Thank you for sharing this.

I'm in the middle of the process as I type this. Broke a top, front tooth as a kid. Had a root canal done and a crown placed. Work was by the family dentist and it, unbeknownst to me, led to recurring infection over the years. After 30 years, everything failed and I realized I had a problem. Abscess and bone destruction above the broken tooth led to a soft spot in my palate.

Started with an endodontist who retreated the root canal but warned it may not clear the infection completely. Some healing occurred but not enough and he referred me to an oral surgeon.

Oral surgeon thought the endodontist did an admiral job but thought it was a losing battle in the end. He said the remains of the tooth needed to be extracted and the entire area properly cleaned out and packed with bone graft. He wasn't certain if the neighboring tooth could be saved but consulted with the endo per my request.

In the end, we collectively agreed to extract the broken tooth and leave the other... only taking it out later if need be and that I wouldn't delay if I was told it had to come out.

Five months later and the 3D scan shows solid bone regeneration over the entire area. The gum has healed without collapsing and the soft spot in my palate is gone.

The implant is getting placed in two weeks and the oral surgeon is now confident that the neighboring tooth completely survived the ordeal.

Hopefully the implant goes as well as the graft.

voodoo72
Posts: 70
Joined: Wed Nov 15, 2017 1:20 pm

Re: Investing in a dental implant or ?

Post by voodoo72 » Fri Feb 08, 2019 9:06 am

toofache32 wrote:
Fri Feb 08, 2019 2:48 am
voodoo72 wrote:
Wed Feb 06, 2019 12:47 pm
capsaicinguy wrote:
Wed Feb 06, 2019 10:09 am
tadamsmar wrote:
Wed Feb 06, 2019 9:18 am
I have a dental implant. Later, I retired from my 40-minute commute and switched to a dentist and periodontist closer to home. No doctor ever suggested that I go back to the original periodontist. And I got treatment for an infection around the implant from my new periodontist.

My original periodontist gave me a fact sheet on the make, model, specifications of the implant specifically so another periodontist would be prepared to address problems. If I lost that sheet then I would need to contact the original periodontist or someone (like my old dentist) who might have this record. It is important to not lose track of that sheet.

But maybe you are thinking the the US periodontists would discriminate against you for going offshore?

Note that miamibeachdentist posted another option: implant from a dental school. That would be added as #4 in my list.
I didn't mean that to sound like you would get blacklisted if you went offshore, but you shouldn't expect to have complications managed by your hometown doc for free either. The doctor providing the service should be the one to manage it. It could eat into the cost savings pretty quick. At the end of the day it's all about what risks you as the patient are willing to take, not the doctor.

Implant at a dental school is a good option and probably a good bit cheaper than private practice. You better be prepared for the full recommended wait and healing time for every stage. It could take well over a year for a single implant. Lots of people go to schools expecting the same experience as private practice (aka timelines) and get mad when they don't get to have it cheaper AND as fast. As the saying goes; fast, cheap, reliable, pick two. Dental school = cheap, reliable. Private practice = fast, reliable. Just keep that in mind.

Typical timeline at a (my) dental school: Two three-hour appointments for full exam and diagnostics/xrays. If you have cavities/periodontal disease it must all be addressed and fixed/stable prior to performing any implants/crowns/partial dentures/bridges. This may require several months. Once that is done, expect about a 3-4 month wait to get seen in a surgical specialty department. If necessary, perform bone grafting and wait several months for healing. Go for first stage surgery (placing implant/"post") in bone. Wait 4-6 months for healing. Uncover and place healing abutment. Wait 6-8 weeks. Take impression for crown and send to lab. Possibly come back to redo final impression. Wait 2 weeks for abutment/crown. Have abutment/crown seated.

Full disclosure: I am an upper classman dental student in clinic.

I was going to write the same things, and keep in mind sometimes if there is a complication, the hometown Doc may elect not to get involved, why? if he touches it, he is responsible and liable, and should soemthing go wrong, a lawyer can easily sue the doctor in the states, but he has no jurisdiction over the dentist in a foreign country, and YES I have seen this happen to a collegue.
This is the reluctance for many US dentists to get involved with implants placed in other countries. The last person who touches it owns the problems. I have had patients come see me with problems with implants placed in other countries. I tell them "your dentist is in Thailand and you need to see him again about this."
Absolutely, I actually had a pt go to Thailand to have whats called an ALL on FOur on top and bottom for 10K, I sent her to the specialists here who wanted 35K. She opted to go to Thailand to have it all done, sadly one year later both top and bottom are failing. I told her I cannot help her with this, and now ORal surgeon has to remove everything done, and on top of that she can only pay for regualr dentures on top and bottom, so now she has paid close to 13+K to have regualr dentures in the end. The reason I say this a filing done abroad is easy to treat, a crown done incorrectly can be fixed. Multiple implants done below standard of care not so much. In the US you have a remedy in terms of Dental Boards as well as legal action, abroad whats done is done. I only say this as a caution if you choose to go this route.

voodoo72
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Re: Investing in a dental implant or ?

Post by voodoo72 » Fri Feb 08, 2019 9:07 am

investingdad wrote:
Fri Feb 08, 2019 8:13 am
toofache32 wrote:
Fri Feb 08, 2019 2:37 am
URSnshn wrote:
Thu Feb 07, 2019 10:35 am
OP Here - Thanks for all the advice! My family member went ahead with the consultation, but wasn't quite satisfied with the dentist's answers to some of her questions - she said he bypassed some of the questions she had that she thought were important (like: success rate? continuing education? where do the implant, crown, bone graft material come from?) There is a lot of information on questions to ask and the like online, many though aren't written by people independent to the process.

Questions:

1. How do you vet a US dentist if you are considering a dental implant and/or see if the tooth can be saved?

2. What are the important questions you ask at the consultation?

3. Is it fair to ask where the bone graft material is sourced from and manufactured? and similar for crown, abutement and implant?
1. My bias is that I am a dental specialist focusing on implant surgery. As is true in every industry, there are general dentists who do a great job with implant surgery, and there are specialists who do a horrible job. While I have placed implants that fail the same as everyone else, a growing part of my practice is managing implant disasters from non-specialists. The dental specialists focusing on implant surgery are oral surgeons and periodontists.
On average, a specialist (oral surgeon or periodontist) has the most training in implant surgery although this is still no guarantee of success. We all have failures. Interestingly, there are now "specialty boards" in implant surgery intended to provide general dentists with an avenue to advertise they are "board certified" in implant dentistry. These boards are not recognized by the ADA Commission on Dental Accreditation. https://www.ada.org/en/coda/accreditation/about-us

2. Ask where they got their implant training. An oral surgeon or periodontist gets this training during their 3+ years of residency after dental school. General dentists most often get this training through weekend courses. Many of these dentists end up being great implant surgeons.

3. I always discuss with patients the details of bone grafting since most of my patients ask about it. There are multiple sources/types of bone grafting. There is human cadaver, cow bone, and synthetics. Some are mineralized and some are de-mineralized. Some are putty and some are granular/particulate and some are solid blocks. Some resorb quickly (<6 months) and some slowly (many years or never). Bone grafting biology is an entire science of its own and is VERY complex and it's not just throwing some bone in there. Every scenario is different and there are multiple reasons why one type of bone will be chosen over others. Sometimes the architecture of the remaining bone and teeth is adequate to place a bone graft and implant at the same time. Sometimes the architecture requires bone grafting first, to later come back and place the implant. Everyone's mouth is different.
As for implants and related components/abutments, there are dozens of manufacturers out there. There were originally 2-3 companies that did most of the research and development 20-30 years ago. Now there are multiple companies that make "clones" of these implants for very cheap. Some of them are just fine. I personally use one of the premium brands that is backed by decades of research. These are more expensive (2x price maybe) than the clones which means my fees are not the cheapest.

Again, my bias as a specialist is that I get referred the disasters from non-specialists to bail them out. I also treat my own disasters. Problems can happen with any surgical procedure with any surgeon. While it's no big deal when everything goes as planned, one mark of a good surgeon is knowing how to manage problems. Personally, I would want to be treated by someone who can take me through the process from start to finish no matter what happens, and not have to be referred to someone else to bail me out.
Thank you for sharing this.

I'm in the middle of the process as I type this. Broke a top, front tooth as a kid. Had a root canal done and a crown placed. Work was by the family dentist and it, unbeknownst to me, led to recurring infection over the years. After 30 years, everything failed and I realized I had a problem. Abscess and bone destruction above the broken tooth led to a soft spot in my palate.

Started with an endodontist who retreated the root canal but warned it may not clear the infection completely. Some healing occurred but not enough and he referred me to an oral surgeon.

Oral surgeon thought the endodontist did an admiral job but thought it was a losing battle in the end. He said the remains of the tooth needed to be extracted and the entire area properly cleaned out and packed with bone graft. He wasn't certain if the neighboring tooth could be saved but consulted with the endo per my request.

In the end, we collectively agreed to extract the broken tooth and leave the other... only taking it out later if need be and that I wouldn't delay if I was told it had to come out.

Five months later and the 3D scan shows solid bone regeneration over the entire area. The gum has healed without collapsing and the soft spot in my palate is gone.

The implant is getting placed in two weeks and the oral surgeon is now confident that the neighboring tooth completely survived the ordeal.

Hopefully the implant goes as well as the graft.
Sounds like you are in good hands, best of luck.

SimonJester
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Re: Investing in a dental implant & Vetting and questions to ask?

Post by SimonJester » Fri Feb 08, 2019 12:10 pm

URSnshn wrote:
Sat Jan 26, 2019 1:52 pm
Questions:
1. How do you vet a US dentist if you are considering a dental implant and/or see if the tooth can be saved?
2. What are the important questions you ask at the consultation?
3. Is it fair to ask where the bone graft material is sourced from and manufactured? and similar for crown, abutement and implant?[/color]

I would want to know how many implant procedures the DDS has completed

As far as where the implants are sources from, they are titanium, I was not concerned at all about where it was sourced from. Neither was I for the abutment and crown.

As far as bone graft material, I did ask my DDS what type they were using...
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

investingdad
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Re: Investing in a dental implant & Vetting and questions to ask?

Post by investingdad » Fri Feb 08, 2019 1:24 pm

I believe the graft material is eventually absorbed as bone replaces it, it's inorganic and not organic, but it doesn't stay behind.

Docs... correct me if I'm wrong.

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: Investing in a dental implant & Vetting and questions to ask?

Post by toofache32 » Fri Feb 08, 2019 1:55 pm

investingdad wrote:
Fri Feb 08, 2019 1:24 pm
I believe the graft material is eventually absorbed as bone replaces it, it's inorganic and not organic, but it doesn't stay behind.

Docs... correct me if I'm wrong.
Depends on the type of bone graft. Some never go away.

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: Investing in a dental implant & Vetting and questions to ask?

Post by toofache32 » Fri Feb 08, 2019 1:55 pm

investingdad wrote:
Fri Feb 08, 2019 1:24 pm
I believe the graft material is eventually absorbed as bone replaces it, it's inorganic and not organic, but it doesn't stay behind.

Docs... correct me if I'm wrong.
Depends on the type of bone graft. Some never go away.

investingdad
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Joined: Fri Mar 15, 2013 10:41 pm

Re: Investing in a dental implant & Vetting and questions to ask?

Post by investingdad » Fri Feb 08, 2019 2:03 pm

Thanks. I asked and my oral surgeon told me that mine would be absorbed. It was granular. I'm only guessing it may have mixed with something like water for injection so he could pack it in effectively.

I found little particles in my mouth for the next few weeks, but not too many.

If it was from a human donor, I'm grateful that they made that decision.

Topic Author
URSnshn
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Re: Investing in a dental implant & Vetting and questions to ask?

Post by URSnshn » Sun Feb 10, 2019 6:26 pm

OP here - so much helpful information everyone - many thanks!
URSnshn wrote: ↑
Sat Jan 26, 2019 2:52 pm
At the time she went in they simply removed the root and put something on top of the tooth and she was told to come back and see their prosthodontist who would take a panoramic x-ray and give her all the options.

by toofache32:
If they removed the root, how is the crown part of the tooth staying in place?
toofache, Sorry for the delay. The dentist removed a nerve in the tooth, which removed the pain - he called it a "partial root canal." The tooth has two roots. He removed the decayed part of the tooth on top and then ground down the top part of the tooth removing the decayed area. Finally he put a covering - not a crown/cap over it saying that this would protect the tooth from further decay. He said there was no infection and suggested she make an appointment with their prosthodontist for evaluation. It was the prosthodontist who wasn't as forthcoming as she wished.

This was about 6 weeks ago now. She is looking for a second opinion.

Thank you toofache for answering the questions I posted. They've been very helpful.

investingdad
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Joined: Fri Mar 15, 2013 10:41 pm

Re: Investing in a dental implant & Vetting and questions to ask?

Post by investingdad » Fri Mar 01, 2019 8:43 am

OP,

So I just had my implant placed yesterday. I opted for twilight sedation and I had a very fast recovery post procedure.

I'm a little swollen this morning but not much discomfort at all, just my soft palate where the original abscess and subsequent bone graft was is a bit tender.

Oral surgeon said he drilled through solid bone so the graft healed very well for me, we waited five full months and he was happy with that decision. Twelve weeks now for things to heal with the implant.

Topic Author
URSnshn
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Re: Investing in a dental implant & Vetting and questions to ask?

Post by URSnshn » Fri Mar 01, 2019 9:26 am

Investingdad, Thanks for the follow-up. Glad to hear things are going so well!

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CWRadio
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Re: Investing in a dental implant & Vetting and questions to ask?

Post by CWRadio » Fri May 03, 2019 2:31 pm

Just got my treatment plan for a implant and crown for tooth #30. About $3900 (no insurance, discount card)
My question on dental code D7921 the dentist will be using L-PRF as a type of bone graft.
Has any Boglehead had a bone graft using the L-PRF procedure of platelet therapy?
Google search show little scientific proof of its success as grafting material.
https://www.ncbi.nlm.nih.gov/pubmed/30058532
Thanks Paul

toofache32
Posts: 1868
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Re: Investing in a dental implant & Vetting and questions to ask?

Post by toofache32 » Fri May 03, 2019 4:27 pm

I use PRF on certain cases where I think it will be beneficial. PRF (Platelet Rich Fibrin) involves drawing blood and spinning it down in a centrifuge to extract a fibrin clot which contains growth factors derived from platelets. This creates a slimy membrane similar to snot. The data is better for soft tissue healing than it is for bone healing. Sometimes it is mixed with a particulate bone graft for handling purposes to make the bone more sticky which allows it to stay in position and not migrate as much. I use it mainly for sinus lifts. I usually don't charge extra for it since I am generally using it for an internal sinus lift I am already charging about $750 for. The centrifuge and instruments cost me about $2500 to buy and the disposables are about $20 per case. You're paying more for the extra time it takes and the technique-sensitive skillset required to use it.

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