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Total Graft Failure and Teeth in Day
Dana from Florida asks us:
My wife has been undergoing treatment to place dental implants in her entire upper mouth. She had bone grafts in the back of her mouth 18 months ago to place bone while she still had front her front teeth.
8 months ago she had her front upper teeth removed and that area was grafted also. The periodontist used bovine in both procedures with a pcp mix (I believe).
However, recent CAT Scan shows total failure of the graft in the rear and success in the front. The doctor wants to place dental implants in the front and use a fixed denture. He wants to try grafts in the rear again at a later date. The doctors blames the failure of the graft on smoking.
We then went to see an eminent prosthodontist in Philadelphia. He says he can fix this in a day. The Periodontist in Florida totally disagrees. He says micro movement of the dental implants (teeth in a day procedure) combined with the failure of the grafts and smoking will not work. The Prosthodontist in Philadelphia says it will work and Periodontist in Florida is using old techniques and being overly cautious. What do we do? Who is right here? Thanks for any advice?
May 30, 2006 in Bone Grafting, Immediate Loading | Permalink
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Comments
Made a mistake. The bone graft was autogenous mixed with prp.
Posted by: | May 15, 2006 3:41:21 PM
the "teeth in day" works, and I think very highly of the prosthodontist in phily. i flew out from salt lake city for Dr Balshi to do my dental implant. the key will be to stop smoking! I wouldn't place implants on a heavy smoker-it just doesn't work. there are new medications to help in quiting to smole(zyban combined with nicotene patch works pretty good.
Posted by: scott hamblin dds | May 15, 2006 9:42:41 PM
sorry about the misspelled words-scott
Posted by: scott hamblin dds | May 15, 2006 9:43:59 PM
I am a Maxillofacial surgeon and I do a lot of cases with modified version of "Teeth in an hour" or "All on 4" concept. We convert the denture or make fixed teeth the same day. We have been doing these procedures since 2004 with great degree of success. Prosthodontist in Philadelphia, Dr. Balshi is a reputable doctor and these procedures do work. We have over 50 successful cases.
Gary wadhwa
Posted by: Gary Wadhwa | May 16, 2006 1:58:19 PM
Teeth in an hour or litorim was developed in belgium and it is a pretty good system, and is clearly not the not the same as all on four, wich is also pretty good for fixed prosthesis. I think that she needs to stop smkoing before attempting implants, at least that is the way we do things. It is clear that heavy smokers have extra risks in grafts and implants.
Teeth in an hour can be an excellent solution for her , of course is a technique that wont really allow for grafting since is a minimally invasive technique.
I am not a fan of multi time grafting specially in big areas. Both techniques are viable but litorim is faster and probably safer if she quits smoking.
good luck
Posted by: Alejandro Berg | May 16, 2006 3:01:29 PM
The smoking is indeed a factor. Smoking has been implicated in early tooth loss, and the inability for bone to heal in the mouth. To expect significant healing to occur in the face of this nasty habit is ill-planned. If she doesn't stop smoking altogether, don't put your money and her health at risk. BTW, if you smoke, you need to quit too.
Posted by: Steve Markus, DMD FACE | May 16, 2006 3:37:15 PM
What experience have you had with Novum same day teeth ?
Posted by: | May 16, 2006 4:45:27 PM
In relation to NOVUM, have doing it for some years now... decent results in terms of function but it pretty much sucks in the cosmetic approach. so i do it no more... well only when the patient asks specifically for it.
In profesional terms, is a simple surgical technique that needs a lot of gear and sacrifices a lot of bone(something i dont like), but in the end it works fine as a glorified total acrilic prosthesis.
Today there are trying some adaptation abutments to convert the special implants into regular ones so they can be attached to other implants by a different type of prosthesis such as an ad modum or others , wich are more cosmetic or can be done with porcelain.
Posted by: Alejandro Berg | May 16, 2006 7:38:27 PM
First of all , the patient should stop smoking because it realy affect the success of either the implant and bone graft.
from my point of view, the immediate loaded implant(tooth in a day ) is a wonderful solution for certain selective cases like single missing tooth which you can put the implant out of occlusion for certain time to give chance for osseointegration to occur, the success of dental implant will never be achieved with micromovement of the implant fixture.
my openion for the present case, to put submerged implants and fabricate temporary removable denture to restore function and cosmetics for three months then you can open the implant heads to do your final fixed bridge work.
Dr.Ossama Ghorab
Posted by: Dr.ossama Ghorab | May 16, 2006 8:15:19 PM
Sounds like the DIEM protocol would be best for your wife. This system would allow for a fixed provisional restoration which gives the implants necessary time to integrate based on the systemic factors in play. Teeth in a Day is a great protocol but NOT in this situation. It's has been developed as a final restoration and can be VERY expensive for the patient. If it doesn't work the first time you must start all over again. In this case with the failed bone graft I would avoid it at all cost.
Posted by: Jeff Hancock, DDS | May 16, 2006 10:50:12 PM
Ok...no challenge on the stop smoking. I totally agree. When I smoke, I can feel the bone in my front teeth tinkle. I get my teeth cleaned now every 3 months. Not an excuse though not to quit smoking. However, my wife refuses to quit. She says she can't, too addicted, smoking since age 13. It's the smoking that helps keep you guys (doctors) in business.
However, with that said, please help me understand what you are recomending. some comments seem to believe she needs individual tooth implants. She has no top teeth at all. All top teeth have been removed.
Periodontist in Florida is now reccomending all on four.
Dr. Balshi will be doing teeth in a day with a temp acrylic prosthesis. Then in 3 months replacing temp with a perm porcellan prosthesis. Very expensive. However, even though we will finance this into oblivian, money cannot be an issue when it comes to my wifes well being. I will do whatever is best for her. I will work 24hrs a day to get the funds needed. Therefore, money is not a factor.
One doctors comment is that the prosthesis Dr. Balshi uses "cosmeticaly sucks". Did I understand this correctly? Also, another comment was that Dr. Balshi's technique caused a lot of bone loss. Is this correct?
I've read on this website that all on 4 maybe high risk because the prosthesis rides on 4 implants instead of 8-10. Thus, placing too much strain on the implants. Causing failure later.
What about SLA Active implants in the rear?
Also, her bottom teeth are capped. They are loose. Dr. Balshi wants to remove them and do teeth in a day on the bottoms. I'm not keen on that idea right now. I see that a new solution has been approved by FDA that restores bone. Should her bottoms be treated with this new stuff? And what about using this where her grafts did not take (upper rear)
I love my wife more than anything in this universe. I appreciate your help very much!
Posted by: dana kolodney | May 17, 2006 7:30:40 AM
The new FDA appoved medicine is called GEM 2s. Will this repair her bottom teeth so they won't have to be removed?
And, what about BONE GEN/Calciam Sulfate to repair the rear grafts that failed?
Posted by: dana kolodney | May 17, 2006 8:06:20 AM
If the back failed because of smoking.
Why didn't the front?
Posted by: Peppyone | May 17, 2006 2:20:48 PM
I don't know why the back failed and the front took. I have been told that the back failed because the graft was done so long ago (18 mos.) and that implants were not placed in a timely fashion, that maybe the bone was reabsorbed by the body due to no implant and no support. The peridontist in florida says smoking was probably the cause.
Posted by: dana kolodney | May 17, 2006 2:53:03 PM
However, the cause it not the issue. The cure is. anybody have any answers to my previous posts...GEN2s and SLA Active...bone loss with teeth in a day...cosmetic issues???
Posted by: dana kolodney | May 17, 2006 2:57:37 PM
Dear patient:
As with any treament...there are several ways to approach it, and there really is no "one correct way." There is always a price to pay. The research has shown that implant success rates are affected at about 7% less when smoking is involved. When grafting is involved it is much worse! I'm actually surprised that you were not told to quite smoking all together prior to the grafts. Like Dr. Balshi, my practice is a Prosthodontic/implant surgery practice where I place the implants and provide the restorative work. I tend to agree with him, however, I think that all these discussions are pointless! I can sway a patient's opinion very easily to what I am comfortable doing on a particular case. What you should be deciding is not what type of implants to use or how many. What you should decide is WHO you like as your Prosthodontist! People "push" for what they do best! Their reputation is on the line, and they want to do what they know will work.
So what to do?
1. Pick a Prosthodontist/Surgeon (team or prefferably one person who is cross trained) whom you trust and has a proven track record.
2. Consult and decide with them as to what is more important... the immediacy of an expensive, less esthetic procedure (teeth in a day) or a delayed approach of a staged placement case with proper fixed/removable provisionalization as needed. The staged approach can yeild a higher esthetic result, could be more or less expensive, but is easier to absorb financially as it is done over time.
3. If you are still unsure, come to New York City. We have the largest concentration of Prosthodontists who do implants in the nation, and all within a walking distance. You might find someone with whom you are comfotable easier.
Good Luck!
Dr. Zev Kaufman
Posted by: Zev Kaufman | May 17, 2006 11:30:15 PM
Dear Doctors,
Thank You for your help!!!
Please understand my fear & anxiety.
1. We were told prior to the proceedure to stop smoking. However, easier said than done. And, no help to quit. Counseling & medication should be offered at every dental practice. Isn't this the major reason that teeth are lost?
2. Doctors have egos just like all humans. Most doctors believe there way is the correct way. Probably because they are comfortable with their method (comfort zone). This causes them not to train in newer methods.
3. This being the case, how is a patient to understand what method is the best.
4. The field of Implantology needs to be crossed trained on different methods so they can determine what is the best method for their patients. Instead of me having to go door to door to find out what is best for my wife. Or, at least understand the different proceedures so the Dr. can reccomend the patient to see the right Dr.
4. If i didn't ask questions on this site I would have never known that teeth in a day is less cometically attractive.STILL DON"T UNDERSTAND WHAT THIS MEANS as opposed to other methods. What's the difference cosmetically?
5. to this date, still don't have definitive treatment options, the pluses and the minuses unless we go from doctor to doctor to see who does what, how and why.
Posted by: dana kolodney | May 18, 2006 5:48:28 AM
The one thing that no one has said is that sometimes things are not fixable, and a compromise has to be done. Smoking plays a part, but so does bone physiology and other factors. Lets face it, some people lose their teeth due to multifactoral problems, and to believe all individuals can be restored to perfection is to take a God like attitude. This lady has lost all upper teeth and has crowned lowers with apparent periodontal disease. While we can graft and improve ridge forms, there are still limitations to what we can do. When we get Star Trek type of technology, perhaps we can be more definitive in making statements. Teeth in a day will not work for all people just as all graft procedures cannot be guaranteed to succeed. Our society is developing to expect perfection without failure. When the evnelope is pushed beyond reality, then more and larger failures occur. While we have maginficant accomplishments, they need to be viewed out of the field of a microscope. The bottom line is pick someone who is realistic in expectaions as to what can be done. This may result in some compromise...ie, a removable appliance vs the fixed appliances....and be prepared that your wife may have factors in her physiology where failure of some or all implants occur in the future. That is reality.
Posted by: | May 18, 2006 7:08:15 AM
I would have never known that teeth in a day is less cometically attractive.STILL DON"T UNDERSTAND WHAT THIS MEANS as opposed to other methods. What's the difference cosmetically?
Tissues shrink and change as healing occurs....it is near impossible to get a cosmetic fit due to the changes. The undersurface of the restoration be it fixed or removable play a large part in cosmetics.
Posted by: | May 18, 2006 7:25:20 AM
Dear Dana,
Whenever we are presented with multiple choices on how to treat our patients the answer lies on the scientific literature review.
You have acess to this information through the internet. Search for Immediate Loading of Dental Implants. You will find Dr. Balshi and Dr. Wolfinger are the leading clinicians and researchers in this field.
They have developed surgical and prosthetic protocals that allow patients such as your wife to be able to be restored in a day with a fixed prosthises avoiding bone grafting in the maxillary sinus by placing implants posterior to the antrum. Dr. Balshi and Dr. Wolfinger published an extensive research in 2003 where over 2500 implants were placed using the teeth in a day protocal, 360 of those implants were placed postierior to the sinuses with a 92% sucess rate.
Do the research and you will see this protocol definitly works. You are in good hands with Dr. Balshi.
Dr.Mongalo
Posted by: Dr. Virgil Mongalo | May 18, 2006 8:07:34 AM
Dear Doctors,
Thank you again for your help.
Dr. balshi will be doing the surgery end of May. I have read the studies that Dr. Mangelo suggested as well as other studies conducted by DR. Balshi. I must commend Dr. Balshi for his lifetime of research. For that reason, I will place my wifes success in his hands.
I will keep you posted on the results.
Thank you all for caring!
Dana
Posted by: dana kolodney | May 18, 2006 10:24:17 AM
I was only asking, because I don't smoke.
My back grafts were done first as well.
I lost my front a few months later. Front grafts were 6 months years later than the back
The back needs to be redone.
He didn't choose to blame me.
He just said the bone loss in the back was worse.
He's re-doing the back grafts.
No charge.
Posted by: Peppyone | May 18, 2006 3:49:20 PM
6 months... not years ..
sorry
Long day.
Posted by: Peppyone | May 18, 2006 4:10:28 PM
Peppyone,
I didn't mean to seem curt. I wasn't trying to be. Just a poor choice of words to shorten response.
Smoking is a horrible addiction and a disease. It should be treated as such.
I am very sorry you had a problem also! I will pray that your graft takes. I wish you well. Please let me know how it turns out.
By the way, see what kind of response you get about SLA Active or some new kind of stuff or gizmo that may work.
Best wishes,
Dana
Posted by: dana kolodney | May 18, 2006 6:36:24 PM
Thanks Gizmo for your thoughts and prayers.
I offer you and your wife the same.
I don't really agree with blaming every ill on smoking.
I don't smoke. Never have.
Genes usually win.
Both my parents and one side of grandparents also lost their teeth.
None smoked.
Posted by: Peppyone | May 18, 2006 7:04:35 PM
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