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Multiple Failed Bone Grafts

Yvette, a dental implant patient from New Jersey, asks us:
My periodontist suggested to have a bone graft done before any dental implant placement. When I went back after 4 months, he told me that I lost a lot of bone after he was doing some drilling, and that he has to do another bone graft.

Another six months went by and I went back again. Finally he was able to insert the screw. He then asked me to come back in two weeks for the temporary crown. However, when i came back, he told me that the screw was a little bit loose that he has to do another bone graft for the 3rd time. I took all the necessary precautions such as eating soft food, no pressure on the site etc. Why does the bone graft keep failing? What are the chances of this 3rd bone graft being a success? What should I be asking my periodontist? Thanks for any help.

September 25, 2006 in Bone Grafting, Patient Questions | Permalink | Comments (10)

Should My GP Place Implants?

Ann, a patient, asks us:

I am 48 years old. Last year, my general dentist extracted my top back molar due to "too little tooth structure left to the crown".  He told me that he hoped my wisdom tooth would move in to fill void. So far, it hasn't.

Last month, I bit down on a popcorn kernel, fracturing an upper bicuspid.  The dentist removed the back portion, and agreed to leave the front until I could arrange for a dental implant.  So it looks as if I need dental implants for both teeth. 

My general dentist wants to place the dental implants, and says that he has done a couple hundred of them.  I'm feeling that I should go to someone who does this procedure even more often, such as an oral surgeon.  Am I right to think that a general dentist isn't apt to handle this as well as an oral surgeon? What is the preferred way to proceed with dental implant treatment? Thanks.

September 25, 2006 in Patient Questions | Permalink | Comments (35)

CT Scans: Standard of Care?

Jeffrey, a dentists, asks us:
I  have been reviewing the blogs here on CT Scans for dental implants, and I'm just wondering  if a CT scan was easy to get and read, would you do it more often when treatment planning for dental implants? 

Personally, I have been using a service called Facial Imaging and find it very useful.  Do we all think that this will become the "standard of care" for documentation, if and when it does become easier to use and more available?  If that happens, will we all need cone beam technology in our offices? Won't this then make dental implant treatments even more expensive to patients? Would appreciate any comments that will help elucidate the future direction of implant therapy.

September 25, 2006 in CT Scanning | Permalink | Comments (30)

Maxillary Support of Overdenture

Dr. Sanders asks,
What is the current protocol for maxillary support and retention of an overdenture, assuming four fixtures are to be used?

Are Locator abutments adequate or do the dental implant fixtures need to be connected with a bar? I have concerns that the longevity of the dental implants may be compromised if they are not connected.  Have there been any studies regarding these issues?

September 25, 2006 in Overdentures | Permalink | Comments (4)

Informed Consent

Edward, a dentist, asks:
What procedures are recommended for getting  informed consent on the aesthetic result of the dental implant procedure?

Is it enough to keep notes on the consultation in the patient's file?  Does the patient need to review and sign a two-dimensional drawing?  Is a  3-D model helpful?  How does one avoid the "oh no!" from a dental implant patient upon seeing the final product? Thanks for any comments.

September 25, 2006 in Implant Practice Management | Permalink | Comments (2)

Dental Implant Removal

Mary, a dental implant patient, asks:

I just had a dental implant put in a couple of weeks ago.  I'm experiencing quite a bit of pain.

I would like the dental implant removed, since I don't want to deal with constant pain.  Since the dental implant is not integrated with the bone, will the removal be a somewhat easy procedure? This is for an implant placed in the upper jaw. What specifically are the criteria for dental implant removal? What are my other options? Thank you.

September 19, 2006 in Dental Implant Complications, Surgical Placement of Dental Implants | Permalink | Comments (14)

Dental Implants Covered by Insurance?

George, a patient, asks us:
I'd like to know if it is possible to have medical insurance cover dental implant procedures? If not, what are the  reasons why insurance would not cover dental implants?

I had a bone graft done and the bone graft was 100% covered by  medical insurance. But the dental implants I'm getting will supposedly not be covered by insurance. Logically the dental implants are the final step in the bone graft procedure, somewhat like pins placed in a broken bone. The implants will keep the bone healthy and stable, maintain my facial structure, allow me to keep up a healthy
mouth which supports healthy nutrition. Shouldn't it be in the financial interests of dentists and surgeons to lobby to get dental implant procedures covered? Thanks for any comments.

September 19, 2006 in Costs of Dental Implants | Permalink | Comments (7)

Communicating Effectively with Dental Implant Patients

Dr. Jeffrey Ganeles is a Board Certified Periodontist in Boca Raton, Florida and practices with the Florida Institute for Periodontics & Dental Implants. He is an Adjunct Associate Professor and Interim Director for Post-Graduate Periodontics at Nova Southeastern University College of Dental Medicine in Ft. Lauderdale. Dr. Ganeles and his team developed a computer software program to enable dentists and their staff to communicate more effectively with patients.

Osseonews: Dr. Ganeles, the staff and readers of Osseonews.com would like to thank you for taking time out of you very busy schedule for this interview. Can you tell us how you became interested in this area of communications?

Dr. Ganeles: I recognized some time ago, both as a clinician and teacher, that we were all having problems communicating dental problems and treatment options with patients. This issue increased as our therapeutic abilities improved and the cost of treatment escalated. Many dentists still try to explain what is wrong by showing patients’ radiographs or drawing on bracket table covers. This is really ineffective. It is very difficult to explain sophisticated, expensive dentistry, using crude visual aids. An analogy would be that our patients would never accept a recommendation for a new car from a hand-made drawing, so why do we try to educate patients for expensive treatment from basic visual aids? Some dentists will even show clinical photographs with blood and saliva and holes in the bone where they are going to screw in an implant.

My favorite misguided visual aids are the ten-times life-sized implants and crowns. Dentists think they are great but patients wonder how we are going to put these huge bolts in their mouths! And dentists also think that if a patient can hold a fixed bridge or a partial denture in their hands that this will result in the patient developing a keen desire to own one of these themselves. On the contrary, I believe most of these materials frankly scare many patients. We needed to find a better way to communicate effectively where we could convey all the information necessary for the patient to make an informed decision about treatment without making them feel uncomfortable. And we wanted to bring our presentation format into the modern era.

Osseonews: What did you find when the patients became uncomfortable with the presentation?

Dr. Ganeles: They would typically shut down and stop listening. They would cease paying attention and would start looking around or fidgeting. They usually asked only one question, because they didn’t understand the problem or the value of our recommendations– how much does it cost?

Osseonews: So you were not able to find existing informational material that would enable you to achieve the comfort and level of information exchange that you felt was necessary?

Dr. Ganeles: We decided to create something new that would satisfy all our needs and we came up with cartoon-like illustrations that were life-like in many ways but eliminated the raw kind of photographic representations of actual treatment.

Osseonews: So your software program is patient friendly and easy for the dentist and staff to use?

Dr. Ganeles: Our software program is visually rich with the kind of information we want to provide for the patient. We included information on all kinds of dental procedures, not just implants. The software can simulate fixed and removable prosthodontics and periodontal disease and treatment. It is particularly good at helping to illustrate smile esthetics. Of course it is fairly complete for implant related procedures including bone grafts, sinus management, and nerve proximity.

Osseonews: Is your program interactive?

Dr. Ganeles: Our program requires interaction so you customize the presentation to suit the needs of each patient. There are two ways you can use it. The most common and easiest is to sit down with the patient and click away with the mouse to illustrate for him or her the problem and treatment options. This is quick, simple and very effective in creating dialogue during the consultation. It also allows the dentist and/or staff member to demonstrate knowledge and technical ability, which builds patient confidence in the office. Each screen can be saved or printed for future reference or documentation.

The second method requires some preparation and planning. You can create an individual presentation for a particular patient and then use that during your case discussion. This “Procedure” feature allows you to import images like photos or radiographs from other sources as well and incorporate them into your presentation. You can store it and replay the “Procedure” if the patient returns and would like to see it again.

Osseonews: Are these programs easy to learn how to use?

Dr. Ganeles: Our program is designed to be absolutely user friendly. The creators, myself and my treatment coordinator Linda Reichman, are not digital wizards. We practice in the real world every day. To use DentalImplan in our office, it was essential to design it so you only needed 10-15 minutes of practice. This is not a complicated, sophisticated program only for use by computer geeks. If you knew me, you would appreciate how ironic it is that I created a software program.

Osseonews: Could you describe exactly how you use the software program on Dental Implants.

Dr. Ganeles: The computer software program can be downloaded from the internet to your PC. I use the program to illustrate the problems that the patient has and how we intend to manage them. This takes about 5 minutes. Then my Treatment Coordinator takes as much time as is needed to talk with the patient and to use the program again to reinforce my recommendations and answer any questions or concerns the patient might have. Our objective is to address all the issues the patient might have as well as conveying all the information the patient needs to make an informed decision. We find that when the patient is truly informed, they are far more amenable to accepting treatment.

Osseonews: Do you have a particular agenda for your case presentation?

Dr. Ganeles: I always begin our conversation by explaining and illustrating the patient’s problem. I then explain and illustrate what the patient may look like when treatment has been completed, focusing more on treatment outcomes rather than methods or sequence of treatment.. This enables the patient to have a particular picture in mind, a goal. Once we know the desired end result, we talk about sequence of treatment. I also address concerns for pain and discomfort. I also discuss the estimated timeline for treatment so that patient has an understanding of the length of time required for treatment to be completed. Lastly we discuss the cost of the treatment.
When we complete these steps, patients overwhelmingly schedule their next appointments and arrange their personal finances accordingly, even for the most sophisticated treatment plans.

Osseonews: What is the cost of the software programs?

Dr. Ganeles: The initial cost is $ 2995 for three program activations which are downloaded directly on three of your PC’s in the office.

Osseonews: What is your website address?

Dr. Ganeles: www.dentalimplan.com. The name of the software program is DentalImplan.

Osseonews: Is there anything else you would like to add?

Dr. Ganeles: You can obtain a free one week trial on the website before purchasing the software program.

September 18, 2006 in Dental Implant Interviews, Implant Practice Management | Permalink | Comments (6)

Gum Implants to Treat Periodontal Disease?

Any thoughts on the latest news about a promising treatment for severe periodontal disease in which a biodegradable gum implant slowly releases medicines that fight infection?

Word of the new procedure -- designed to be less invasive and more effective then current surgical treatments -- came last Thursday at the American Chemical Society's annual meeting in San Francisco. "I'm extraordinarily confident that this technology will work," said study co-author Kathryn E. Uhrich, a professor of chemistry and chemical biology at Rutgers, The State University of New Jersey. Although animal and human trials have yet to begin, Uhrich said that the laboratory work already conducted with co-author Michelle L. Johnson -- one of Uhrich's graduate students -- indicates that the plastic implant appears to be both effective and safe.

"We're using antibiotic anti-bacterial properties, which everyone already knows about, alongside aspirin-like, anti-inflammatory properties, which everyone also already knows about," she explained. "So it's pretty easy to make, and I see no real significant technical obstacles." "What's unique here, however, is our plan to treat periodontal disease by combining these properties with a polymer -- or plastic -- implant structure that enables delivery of the drugs with minimal invasiveness," she added.

According to Uhrich, the proposed new procedure would cut the need for invasive surgery in half by relying on an implant that would release both anti-microbial and anti-inflammatory medications over a prescribed time. Meanwhile, the barrier itself slowly disintegrates.

The researchers say patients benefit because the barrier doesn't have to be removed with surgery, and gum tissues are healed with the use of salicylic acid -- the active anti-inflammatory ingredient found in aspirin. "This is absolutely a unique process, " said Uhrich. "There's nothing out there like this right now."

Uhrich said the procedure could be available to patients in as little as two years, depending on U.S. Food and Drug Administration approval following animal and human trials. Primate trials are already being set up.

However, Robert Genco, a distinguished professor of oral biology, periodontology, and microbiology in the school of dental medicine at the State University of New York at Buffalo, had some reservations about the procedure.

"The proof in the pudding is going to be the human trials," he said. "It might be a useful adjunct treatment to the deep-scaling needed to remove tenaciously attached bacteria," he said. "But there is also a possible negative aspect in that the anti-inflammatory impact of this procedure could theoretically reduce the body's ability to cope with the infection by undermining the body's ability to get rid of the most difficult-to-remove bacteria. It's not been shown for sure that this would be a problem, but it's something that would have to be dealt with."

Source: American Academy of Periodontology

September 17, 2006 in Dental Implant News | Permalink | Comments (4)

Protein - Coated Dental Implants?

Bob, a dentist asks us: Does anyone have any thoughts on the recently reported technology of applying a specialized protein to a dental implant to make the bone around the implant regenerate better?

In laboratory tests, Medical College of Georgia (MCG) researchers applied a protein onto implants that directs endogenous stem cells to become bone-forming cells. The result was a nearly complete regeneration of lost tissue, says Dr. Ulf Wikesjö, a professor of periodontics in MCG’s School of Dentistry.

“For the past 20 years, there has been a quest to regenerate tissues around teeth that are lost due to periodontal disease,” he says. “I’ve looked at multiple approaches to achieve regeneration, including bone grafts, root conditioning and membrane devices for directed tissue growth, all resulting in some regeneration. Where we had to look was at the commonalities among these treatments.”

Dr. Wikesjö and his colleagues found that any regeneration requires two characteristics: a stable wound and space for the regenerated tissue to grow during the initial stages of healing.

“If these components are in place, regeneration of the tissues around the tooth may occur within a week or two,” he says. “After that, it’s a matter of the wound maturing – going through the various stages of healing that we’re already familiar with.”

By experimenting with treatments and discerning their effect on healing bone defects, they found some – including some in use today – that actually hinder tissue regeneration.

“Some biomaterials like hydroxyapatite particles, which are chemically similar to the mineral component of bone, may actually interfere with regeneration,” Dr. Wikesjö says. “They may not resorb quickly enough and may block the space for new tissue to grow into.”

The experiments helped researchers narrow down possible treatments to the use of proteins that directed stem cells to become bone-forming cells. Those proteins – called bone morpheonetic proteins – have already shown promise as a regeneration therapy for craniofacial reconstruction.

“None of us had any idea at the time how or if those proteins could be useful in treating tooth loss,” Dr. Wikesjö says.

To find out, researchers placed the proteins around teeth and implants in animal models.

Around teeth, the bone-forming cells grew into existing bone and eventually morphed into bone themselves. However, the root of the tooth was destroyed by the replacement bone. That process impeded regeneration of other essential tissues around the tooth.

Applying the protein to implants proved more beneficial.

“There was almost complete regeneration,” he says. “The generated bone bonded with the implant’s surface and, eventually, existing bone in the gums. That allowed for the regeneration of gum tissues.”

The next step is clinical trials of an implant coated with the proteins, which Dr. Wikesjö hopes to start this summer.

“There are still things we need to learn. In some cases, the protein may rapidly release from the implant, and other times, there appears to be a more gradual release,” Dr. Wikesjö says. “We need to find out what factors cause that. In the end, we may not need to use much protein to make the implant effective. Those are things we’re looking at now.”

September 16, 2006 in Surface Treatments | Permalink | Comments (2)