April 2016 - Prosthodontist in Johannesburg
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April 2016

How much does it cost to have an implant done? That is a frequently asked question so let’s answer it fully and honestly.

There are many clinical situations where implants are indicated and they offer a wonderful long-term restorative solution. The procedure is not just like placing a screw in a piece of wood ! It requires great planning and skill.

Let’s do an exercise together.

Draw a large circle and divide up into six segments like an orange cut in half. Make the circle big enough so that there is adequate room to write in each segment. Number the segments from 1 to 6 and label them as we go through the following details.

  1. Diagnostic Phase

It is fundamental to visualise the final restorative outcome right from the start. It is all in the planning which is based on the patient’s request to satisfy his or hers desires and expectations.

The success of implants is dependent on the amount and quality of bone available. Standard X-rays and study models show a great deal to answer this question but nowadays there is an additional diagnostic tool available called a CBCT scan. This tool is a remarkable adjunct in assisting to plan properly.

Many times an implant needs to be placed in an area in which a tooth has been missing for a long time and therefore the bone has shrunk. It is possible to do sophisticated bone engineering to create an adequate implant site and that is where the information gathered by the CBCT scan is invaluable.

The science of bone engineering has advanced exponentially in recent times and there are skilled clinicians who are able to provide an adequate bony foundation by correcting the bony architecture.

Another factor to bear in mind is the arrangement and distribution of the remaining teeth both in terms of the space available for implants and their angulation. Diagnostic study casts are essential. There are many solutions to these problems which all need to be taken into account in the planning stage before any treatment begins.

  1. Surgical Phase

The surgical skill of placing implants requires advanced training through a well accredited institution over a period of at least two years. There are many implant companies that offer weekend courses. Is that the level of skill that you would be happy with?

There is a choice to make regarding which implant system to use. There are many systems available in South Africa. The choice affects the cost and componentry available to handle clinical problems that may arise.

The shape, size and diameter of the chosen implant system is decided on once the surgical site has been exposed. This is a clinical decision which oftentimes can only be made at the time of surgery.

There are various treatment options in shaping the bone to create the appropriate site for the implant placement. This decision is also made at the time of surgery.

It is essential for the periodontist/ oral surgeon to be well prepared for any clinically eventuality by having the appropriate armamentarium of instruments as well as a selection of implants themselves so as not to be caught off-guard.

3. Conscious Sedation

Nobody wants to endure unnecessary discomfort of the surgical phase of treatment. There are several options available to make the procedure more comfortable. This includes the administration of Dormicum about an hour before the procedure or of having an anaesthetist present to administer the appropriate medication for conscious sedation.

In both cases the patient will not be able to drive afterwards and therefore arrangements need to be made for transportation back home.

The option of having an anaesthetist during the procedure adds to the overall cost.

4. Restorative Phase

Before commencing with the restorative phase, the implants should be checked by the peiodontist/oral surgeon to validate complete integration of the implant body to the supporting bone.

Once the go-ahead has been given, the restorative phase can begin. This follows the plan that was established at the diagnostic phase. However it sometimes happens that the design of the final restorative construction may need to be altered because of the unavoidable positioning of the implants during surgery. Fortunately there are a host of implant components available to deal with this eventuality.

5. Dental Implants

There are thousands of implant systems available on the world market each claiming to be better than the next. In South Africa we also have a large choice of implant systems. Some are imported and some are manufactured locally. The choice of implant system affects the overall cost of the componentry but it is important not to compromise the quality of the implant system. Cheap is usually expensive. Each dentist may have a preference for a particular system based on the ease of placement, excellent long-term results and flexibility in altering the restorative design if necessary.

6.Laboratory Costs

Laboratory costs are part of the overall costing. There are very many variables that affect the final cost which are very difficult to anticipate at the diagnostic stage of treatment. The costs may vary because of additional work to accommodate an altered design; the choice of final restorative material; and the nature of the material to be used for the metal substructure.

I hope that you now have a clearer perspective of the complexity of implant dentistry and the importance of choosing a team that has a well proven track record.

DR GERALD KAPLAN

Prosthodontist

I was asked recently to present a talk to nursery school parents about how to look after their children’s teeth. You may wonder why a specialist prosthodontist who is trained to treat advanced restorative problems in patients that have very broken down mouths was so excited to talk to a group of young parents?

The reason is very simple.

Teeth are designed to last a lifetime. The care of teeth begins from early childhood and parent awareness is the key factor in helping young children develop the appreciation and skill of looking after their teeth.

I may be doing myself out of future business but there are enough problems that abound in adults and even teenagers as a result of both ignorance and inadequate dentistry.

In a presentation, diagrams charts and cartoons are entertaining but real-life pictures make the point. And so, I set out to find a suitable example

I wanted a photograph of a young child to include in my presentation. In searching for such a picture I walked past a young lady of five years old sitting with her mother on the pavement of a restaurant and I thought that she would be the appropriate candidate. As she smiled I noticed that she was missing a back baby tooth. That really upset me greatly. Why should such a young person lose a baby tooth ? The loss of such a tooth has major consequences in terms of long-term dental health. It changes the bite and sets the patient up for future orthodontic treatment during her early to late teens.

I suggested to the mother that she bring the young child in for a quick look see. She agreed and the clinical examination revealed the presence of seven teeth in need of restorative dentistry. That begs the question – Why was the decay not diagnosed earlier and why did she have to lose a tooth unnecessarily. Dental decay in a baby tooth should be treated promptly. It spreads fast because the tooth enamel is thin.

Now the young lady needed a general anaesthetic to do the fillings and also have of a space maintainer placed to prevent further loss of space while the jaw continues to grow. The permanent tooth will erupt at the appropriate age and they need space to fit into a healthy dental arch.

If that shock was not enough, I then had the pleasure of meeting her eight-year-old brother. I was aghast. This young man already has a mixed dentition, that is, both baby teeth and primary teeth present in the mouth which are in the process of growth and development.

Not only not only were his teeth laden with plaque and widespread decay on the baby teeth. This was revealed with disclosing solution . Plaque is invisible and effective toothbrushing needs to be checked. ( Has your dentist made you aware of disclosing?)  A permanent molar tooth was ravaged with decay as well.

The first permanent molar tooth erupts into the mouth at the age of between six and seven years of age and they should last a lifetime if properly cared for. These teeth are the most vulnerable teeth in the mouth for a young person and the teeth most frequently lost as the years go by. The problem is preventable with effective dental care both by the dentist and by responsible parents.

Now both of these gorgeous children have compromised mouths. They are fearful of sitting in the dental chair. They can only be treated under general anaesthetic with all the risk and anxiety that it entails. And what about the expense that could have been avoided with effective toothbrushing; regular fluoride treatment; and a proper diet.

The young boy’s mouth will now be the bain of his life. A downward cascade . Whose fault? – The parent or the dentist or both. I wonder. Poor child.

No dentistry is the best dentistry!

Dental problems are preventable with the knowledge of how to look after teeth and exercise effective plaque control. This skill needs to be taught and constantly supervised. Regular dental visits are essential.

There is a prevalent misconception that because one belongs to medical aid, all the costs of dental treatment are covered. This is not true! The fees set by medical aids and the limits imposed are so restrictive. They are unrealistic. Like all things in life, price is what you pay-value is what you get. (Kurt Vonnenberg).

Everything is on the Internet today. Yellow page directories and telephone books continue to shrink.

Want to search for anything? Just Google it.

And so it is with dentistry… Type in keywords like: / implant dentistry/, cosmetic dentistry/, prosthodontist/ and see what comes up . Perhaps that is how you found my website which I trust has been informative.

I also did some Googling and typed in the following: “ You get what you pay for”. Believe it or not, Google even had answers for that.

Amongst the articles that came up is one that caught my eye was one written by Bob Borson quoting from the 19th century English poet, fervent art critic and socialist, John Ruskin.

“There is hardly anything in the world that someone cannot make a little worse or sell a little cheaper, and the people who consider price alone are that person’s lawful prey. It’s unwise to pay too much, but it’s worse to pay too little. When you pay too much, you lose a little money – that is all. When you pay too little you sometimes lose everything because the things you bought were incapable of doing the thing it was bought to do .The common law of business prohibits paying a little and getting a lot – it can’t be done.”

And so it is with good dentistry. Good dentistry may be costly in the beginning but its benefits last and last.

Give us a call on 011 483 2281 . We would love to meet you and offer you real value .

Your teeth should last a lifetime. You deserve it.