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Medical Forum / General / Dentistry / August 2006Implant -- Do I choose Oral Surgeon or Periodontist?
I had tooth #18 extracted and am scheduled for evaluation in a month with the oral surgeon to see how the bone has healed. If there is bone loss, bone graft will be required (I am not sure if the oral surgeon does bone grafts -- I will need to go to periodontist -- but I will have to check on that). But I do know that both the oral surgeon and the periodontist that previously treated my infection, perform implants. In the case that I go for implant, does it make much difference which one of them I select? Is experience very important or are implants a routine procedure that any experienced dentist could do? >I had tooth #18 extracted and am scheduled for evaluation in a month >with the oral surgeon to see how the bone has healed. If there is bone [quoted text clipped - 10 lines] >Is experience very important or are implants a routine procedure that >any experienced dentist could do? I'm not a dentist or oral surgeon, but a patient who did a lot of research before getting implants. I think the #1 factor you should look at is EXPERIENCE; and secondly if that experience has led to good results. I don't care what anyone says, implants are NOT "routine"; there is much room for them to go wrong, if not done properly, or simply if your body rejects them. Seems to me that if a bone graft is used, chances for failures go up, but that's just my anecdotal observation, not medical fact. I'd question both as to how many they have done, ask if you can talk to patients; how many have failed, and why? how much each is going to charge? And make your decision based on these answers. > I'm not a dentist or oral surgeon, but a patient who did a lot of > research before getting implants. > > I think the #1 factor you should look at is EXPERIENCE; and secondly > if that experience has led to good results. Thanks for the reply. I believe that you are the same poster that went to a university for implant. Even though the dental schools are supervised by dentists, aren't you taking a risk by having students (without the important experience you mentioned) perform transplants on you? And is it difficult to get an appointment, i.e., long waiting lists, at these dental schools? >> I'm not a dentist or oral surgeon, but a patient who did a lot of >> research before getting implants. [quoted text clipped - 13 lines] >And is it difficult to get an appointment, i.e., long waiting lists, >at these dental schools? Yes, it is a risk going to a dental school, but probably not a lot more risk than going to any dentist you don't really KNOW. At least at the dental school, there is SOME supervision. I have had my mouth and my wife's mouth majorly damaged by private practice dentists! I am saying that IF YOU HAVE THE MONEY, get an oral surgeon with a lot of experience and excellent reputation! But in my case I could not afford the best, so I opted for the University. It depends on the school, and the time you apply, as to whether there is a waiting list. It sometimes helps if you get a recommendation from a dentist who went to that school. That's what I did, and I got in right away. Not sure if it was "who I knew" or just coincidence, but I was surprised that I got in right away. You should know that getting implants is a LONG process though! In my case, they started out by taking xrays, then they spent months and several appointments building a model of my mouth which served as a way to implant the implants exactly in the right place. That took a month or two to get it done and back from the lab, making sure it fit right, etc. Then I had to have a CT scan of my jaws. All this took many months and at least 8 appointments BEFORE we got to the oral surgery. He did the bottoms (4 implants) in one session. It was pretty painful just due to the amount of time I was in the chair and having 4 at once. The surgery itself was not as painful as the taking photos after spending hours with my mouth open. I could hardly open my mouth at all after that, and they insisted I open "wider" to take more photos. All this is stuff that may not be done in a private office. Certainly you would - I think - have the CHOICE to not have photos taken in a private practice, and I certainly would have exercised that option if I could have. Now I am waiting for my sinus allergies to clear up some, before having a lateral, crestal maxillary sinus lift, and 3 more implants. At least, so far, it seems a bone graft is not going to be necessary. And all the prep work (ct scans, modeling, etc.) has already been done. By the way, CT scans are not always necessary either, I think this is a University thing, to show the "proper" or "best" way to do things... IN THEIR OPINION... My friend had 3 implants and did not have ct scans or modeling done. A question, did you have socket grafting done after the extraction of #18? If not, was it mentioned as an option? The reason I ask, is that socket grafting done just after extraction, can minimize the loss of bone that occurs after extraction. However, I am curious why you would want an implant for #18 at all. I rarely place implants in this area unless there is a specific reason. If all your other teeth are present, then the only major consideration is to watch for extrusion of tooth #2 into the space for #18. Last study I read mentioned it only happens in about 19% of the general population. Can you provide more details? And, as JimSoCal says, EXPERIENCE is the best indicator of competency. Just look the Doc straight in the eye and ask him how many of these he has done, and what your chances of success are with this procedure. And yes, NO surgery is routine...... Dr Abu ================================================ > I had tooth #18 extracted and am scheduled for evaluation in a month > with the oral surgeon to see how the bone has healed. If there is bone [quoted text clipped - 10 lines] > Is experience very important or are implants a routine procedure that > any experienced dentist could do? > A question, did you have socket grafting done after the extraction of #18? > If not, was it mentioned as an option? The reason I ask, is that socket > grafting done just after extraction, can minimize the loss of bone that > occurs after extraction. Socket grafting was not mentioned. There was an infection and bone loss before the extraction. Maybe that is why it wasn't mentioned. > However, I am curious why you would want an implant for #18 at all. I > rarely place implants in this area unless there is a specific reason. If [quoted text clipped - 3 lines] > > Can you provide more details? All the other teeth are present,including wisdom teeth. I think they are healthy as I have never had any fillings or crowns. I asked the surgeon about the "do nothing" option. He said that he would not recommend that. He said there was a risk of movement of neighboring teeth, but that the risk was not predictable. He said that an implant would be good option for me. I didn't know thst the risk was only 19%. Even so, that percentage could still be considered high enough to warrant implant,right? > And, as JimSoCal says, EXPERIENCE is the best indicator of competency. Just > look the Doc straight in the eye and ask him how many of these he has done, > and what your chances of success are with this procedure. And yes, NO > surgery is routine...... Well, not necessarily since that poster got implants through inexperienced students at dental school. What is your opinion of implants performed at U.S. dental schools? > ================================================ > [quoted text clipped - 12 lines] > > Is experience very important or are implants a routine procedure that > > any experienced dentist could do? > However, I am curious why you would want an implant for #18 at all. I > rarely place implants in this area unless there is a specific reason. If [quoted text clipped - 3 lines] > > Dr Abu Dr. Abu, I'm confused. Isn't tooth #2 on the upper right and #18 on the lower left? How would 2 extrude into 18's space? >> However, I am curious why you would want an implant for #18 at all. I >> rarely place implants in this area unless there is a specific reason. If [quoted text clipped - 7 lines] >the lower left? >How would 2 extrude into 18's space? You are correct, I have a chart in front of me: #2 is on the upper right and #18 is on the lower left. The dr. must have meant to say #15, not #2. >A question, did you have socket grafting done after the extraction of #18? >If not, was it mentioned as an option? The reason I ask, is that socket [quoted text clipped - 17 lines] > >================================================ Dr. Abu, I was also going to mention about maybe not NEEDING an implant for #18, but since I'm not a doctor I declined to say it. Now that you've said it, I will add that one of my dentists at the University told me that I really did not NEED the implants in the back, as in #18, that really one does not need those in most cases. For some reason, they ended up doing one there anyway, but I think they added it once they got "in there" for some reason. I also had a powder type bone graft done when #18 was pulled about 6 months previous. >> I had tooth #18 extracted and am scheduled for evaluation in a month >> with the oral surgeon to see how the bone has healed. If there is bone [quoted text clipped - 10 lines] >> Is experience very important or are implants a routine procedure that >> any experienced dentist could do? > Dr. Abu, I was also going to mention about maybe not NEEDING an > implant for #18, but since I'm not a doctor I declined to say it. Now [quoted text clipped - 6 lines] > I also had a powder type bone graft done when #18 was pulled about 6 > months previous. I am dismayed and confused to hear this because both of the dentists I consulted said that I I needed an implant or bridge. I was seriously considering doing nothing as I do not seem to be having any problems after the extraction. But after consulting with them and hearing about the problems with movement, I set aside money for FSA to pay for implant. Do you think that because they have a vested interest in selling implants that they will not give you the straight advice you received from the university dentist? I wish I had known this earlier. >> Dr. Abu, I was also going to mention about maybe not NEEDING an >> implant for #18, but since I'm not a doctor I declined to say it. Now [quoted text clipped - 19 lines] > >I wish I had known this earlier. Maybe one of the dentists will address this question... I think it may depend on your individual case. It might serve you to get a 2nd opinion from another oral surgeon or dentist in your area, maybe one at a University who will give you the straight story, with no vested interest. On 2nd thought, I may be mistaken: It may have been #1 which they said I did not need, and so they are only going to implant #2 (not as far back as #1). In any case, if you have a tooth back behind #18 (#17), it may be more necessary to implant it. Again I am only speculating here, and in fact I think I may be in over my head and maybe I should not be saying anything. I do know that many times dentists want to implant teeth or do bridgework in order to keep the other teeth from SHIFTING, over time. Shifting can cause problems, and by putting in a bridge or implant it can be prevented. That may be why they want to implant #18 for you. I would certainly discuss this with your dentist and let him know if the expenditure is a hardship for you and you don't want to do it unless it is really NECESSARY for the health of your mouth. And yes, I think SOMETIMES dentists/oral surgeons are more interested in making a good profit than anything else and don't mind giving you treatment you don't really need, especially if they can justify it by saying "It IS the BEST (that is, most ideal) treatment plan." Sometimes we cannot afford the "best" treatment plan and sometimes a more budget-conscious (YOUR budget, not his!) dentist might say, "I'm not sure you really NEED an implant there..." Hope I have not caused you unnecessary confusion. IF it were me, I think I'd get a 2nd opinion from an impartial dentist, one who stands to gain nothing. In fact, I would tell the 2nd opinion dentist, up front, "I am not going to have any work done by you, I only want your opinion" so that he remains impartial. I would also try not to give the name of the dentist you are having the work done by, so as not to prejudice his opinion in case he knows the dentist/surgeon. Just be prepared to pay a consultation fee. A second dentist is not going to waste his/her valuable time on opinion unless summoned to do so by a court of law... >>> Dr. Abu, I was also going to mention about maybe not NEEDING an >>> implant for #18, but since I'm not a doctor I declined to say it. Now [quoted text clipped - 57 lines] > the name of the dentist you are having the work done by, so as not to > prejudice his opinion in case he knows the dentist/surgeon. > I had tooth #18 extracted and am scheduled for evaluation in a month > with the oral surgeon to see how the bone has healed. If there is bone [quoted text clipped - 10 lines] > Is experience very important or are implants a routine procedure that > any experienced dentist could do? The level of experience is far more important than the particular specialty. Both specialties existed long before the modern age of osseointegrated implants, and both specialties have fairly equivalent training with regard to implant placement. I may get hung for saying this, but in my experience oral surgeons are less timid about cases that aren't slam dunks. This may be because they generally have more experience in the areas beyond the alveolus--sinuses, working around inferior alveolar nerves, etc. OTOH, periodontists are more acquainted dealing with issues like tissue contour and esthetics. They have worked longer together with restorative dentists in designing appropriate fixed prostheses. For this reason, I have had fewer problems with periodontists placing implants in areas that are difficult to restore esthetically. These are gross generalizations of course, and not terribly useful in selecting a surgeon. But I would talk with your restorative dentist, who will surely have knowledge of the surgeons available, and can advise you. Steve
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