Dental Implants Archives - Prosthodontist in Johannesburg
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Dental Implants

 Tooth decay is the most common cause of tooth loss in young people, whereas gum disease (periodontal disease) is the most common cause for tooth loss in the elderly.

Although every effort is made to keep a patient’s teeth, sometimes it is unavoidable, and the teeth need to be extracted.
It is now widely accepted that implant prostheses are a great improvement over conventional denture. Unfortunately, millions of individuals can’t afford fixed prostheses and therefore most are still wearing conventional dentures.
When this happens, there are many ways to replace the missing teeth ranging from extensive (and expensive) implant dentistry to complete upper and lower dentures. The complete denture treatment becomes a practical and affordable solution.
The complete dentures are made of acrylic (special plastic).


They rely on the soft tissue and bone in the jaw for retention and support. For many people this works adequately.
However, when there is extensive bone loss in the jaws construction of dentures is much more difficult. Good fit and retention are often very difficult to achieve. Bone loss is usually more pronounced in the lower jaw leading to an unstable lower denture. Generally speaking, the upper denture is less problematic.

Patients without natural teeth are often compromised because of the looseness of their teeth; lack of suction and stability because of their extensive bone loss. The wearing of dentures does not become a pleasure for many people.

Loose and unstable dentures can be managed by placing implants. These implants are strategically placed to support the denture. In so doing there is a vast improvement in the ability to chew foods and gain more retention, stability and support. Such a modified denture is referred to as an overdenture. Like other dentures, overdentures are removable.

This is where implants make a world of difference.

Eating replenishes the body’s nutrients facilitating the maintenance of body composition. Chewing is the first step in this process and prepares a bolus of food for the alimentary tract. The enjoyment of the food is highly dependent on the functioning dentition. A healthy mouth influences diet and nutrition.

Like conventional dentures, one’s facial appearance and smile is improved.

Two-implant overdentures provide patients with increased satisfaction and quality of life. In addition, these simple implant overdentures have been shown to significantly improve the nutritional state of elderly patients.

In broad outline, the treatment protocol involves first making comfortable dentures and then using those dentures to guide the implant positioning. The implants are placed either by an oral surgeon or periodontist. There is a waiting period of several months for the implant to integrate into the bone. Thereafter the denture is then connected to the implants with special attachments. This treatment will give you comfort for many years.

Maintenance of the dentures with effective cleaning is essential as well as careful brushing of the implant connections.

You will really appreciate the difference in the quality of life that overdentures provide.

The teeth, the gums and the bone all function as a unit and all need to be kept healthy all the time. They are all susceptible to the ravages of plaque.

The teeth may develop dental decay and need filling; Caps may be ill-fitting and unsightly; teeth may need to be replaced. The treatment of these challenges is the field of the prosthodontist.

The gums may become swollen, red and inflamed.

The bone may start to erode under the gums.

The treatment of gums and bone and implant placement is the field of the periodontist.

Both the prosthodontist and the periodontist are able to diagnose these changes and recommend the appropriate approach to restoring long-term dental health.

What are the benefits of the prosthodontist and the periodontist working so closely together?

  • Joint diagnosis and treatment planning. The ideal prosthodontic treatment plan based on a sound periodontal foundation.
  • The ease of access of one to the other to your benefit. No need for long distance planning nor a long wait for the next appointment.
  • Close collaboration in the placement of implants in the correct and appropriate position.
  • The choice of implant system
  • Saving you time and expense
  • and many more reasons…

Comprehensive dentistry is multidisciplinary . The best practices seek to provide this service and we strive to do the same. It is all about having the best team.

Dr Rakesh Chandran , periodontist and I as the prosthodontist, work together as a great team to offer you world-class dentistry right here in Johannesburg .

 

Addressing Implant Pain At The Root

Just Imagine walking around for months on end with pain around an implant crown that had been inserted to replace a missing lower front tooth.
The patient went to a couple of dentists, who could not help her. One even suggested the drastic solution of removing the tooth.
Luckily the patient was not happy with that suggestion and declined his offer.
Instead she turned to Dr Google and came across my website and made an appointment to see me.
I took a x-ray and I saw clearly what the root of her pain was (pardon the pun). The missing tooth was replaced with an implant. The implant was too large for the space and was causing unnecessary pain.
I decided to unscrew the crown in order to inspect the implant. I was not surprized to find that the crown that had been placed was too big and too bulky for the space.
As a result, the excess porcelain was pushing down onto the soft tissue, causing the patient continuous pain. I adjusted the crown by trimming the excess porcelain.
The relief the patient felt was instantaneous and she left very happy.
She was even happier with the fact that she hadn’t had to endure the trauma of pulling a tooth.
So, in conclusion, what can I draw from this:
Implant dentistry requires planning and skill.

Make sure to start this journey with a Prosthodontist.
Call us 011-4832281.

It is a common fallacy that implants are always the perfect solution for the replacement of a lost tooth.
Let’s understand why…

An implant is an artificial substitute to provide the root structure of the tooth that has been lost or needs to be replaced.

The success of implant placement depends on the quantity and quality of bone that is available to receive the implant. When a tooth is extracted the implant is placed immediately or relatively soon thereafter, the volume of bone is generally not a problem.

However if there has been a long interval between the loss of tooth and proposed implant placement, the anatomy of the bone foundation may present a problem. When a tooth is extracted, the supporting bone is lost and this loss continues with time.

Another consideration is whether the implant restoration will actually replicate the lost tooth. An implant fixture has a smaller diameter than a natural tooth and therefore limits the anatomy that can be achieved through the construction of an implant crown.

There are complications that sometimes occur. These include a food trap (difficulty in cleansing) screw breakage and loosening; continued bone loss and implantitis.

A major consideration in implant placement is the skill of the operator; the anatomy and availability of the bone foundation; and the appropriate choice of implant system based on the restorative objective that one is trying to achieve.

Implant dentistry has opened up a new world of giving a patient a third chance to enjoy the benefits of a sound healthy dentition. The first chance is with baby teeth. The second chance is with permanent teeth. The third chance is with implant dentistry.

The clinical evidence supports the long-term success of implant dentistry if well done and if the correct protocol is followed.

We are here to help you make the right decisions.

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

By: Dr Gerald Kaplan

Many dentists, surgeons as well as restorative dentists could be confused, because some in the dental implants industry are saying that you can do it all yourself- drill the hole, do the restoration. From a different perspective, why not just scan the implant placement and fill out the lab’s slip to order a final restoration. No problem they say, it’s all done for you. What do you need a team for when it is so simple now, right?

The one-person approach might be fine if you are working with models, but we are working with patients who want to live longer and better. Our patients are becoming more complex, not simpler.

The American Academy of Osseo Integration is dedicated to the principle that there is a great advantage of sitting down with colleagues from all disciplines and seeing things from a broader perspective than strictly within one field.

The restorative dentists need to understand the surgical aspects. They need to understand what the surgeon’s limitations are. In the same way, the surgeon needs to understand the restorative aspects to create a surgical result that compliments the restoration, not complicated it, says Dr Donald S. Clem.

The theme for this year’s annual programme of the Academy of Osseo integration in San Francisco is “Science, Collaboration and Clinical Excellence for 30 years”.

Our practice subscribes to the philosophy of team effort so as to ensure that our patients receive the best treatment possible.

Patients want to be cared for. We want to show that when a patient is missing a part of the body, it is a very personal, emotional journey.

Dr Kaplan answers some commonly asked questions about teeth implants and explains how advances in technology have made this procedure efficient and effective for many patients. If you have any questions that are not covered below, please contact Dr Kaplan.

Q. I’ve heard about teeth implants, what are they?
A. They are an excellent means of replacing missing teeth. The titanium implant osseointegrates (biologically binds) to the bone, and a full crown goes on top. The result is a natural looking, secure means of replacing teeth.

Q. My dentist told me I’ve lost bone in my jaw. . . can it be re-grown?
A. Often the lost bone can be restored –– bony ridges can be augmented and even places where there is no bone can be improved considerably. These procedures are called “guided bone regeneration,” or “bone grafts”. Ask your dentist if you are a candidate.

Q. How do I know if I am a good candidate for teeth implants?
A. An evaluation with diagnostic records and a CT–Scan which is a 3–dimensional type x–ray that accurately measures the amount of bone remaining to anchor the implants.

Q. How long do teeth implants last?
A. Statistics indicate that they may last in excess of 35 years. Once successfully integrated with the surrounding bone, implants have the same long–term potential as natural teeth, if properly taken care of.

Q. How long have teeth implants been around?
A. The current cylinder type of titanium has been used in excess of 30 years. Implants were invented in 1957 in Stockholm, Sweden. They were then tested in the 1960’s and introduced in Europe and the U.S. in the 1970’s and early 1980’s. Implants are safe and provide for an excellent option for people with missing teeth.

Q. What is the success rate of implants?

A. Highly successful. Implants boast low infection potential, no rejection by the body, ninety-five to ninety–eight percent success rate for the lower jaw, and eighty–six to ninety–two percent success rate for the upper jaw. However, implants must be maintained by the patient with proper oral hygiene and frequent dental exams and cleanings.

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