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Medical Forum / General / Dentistry / May 2007Suture Questions and Concerns
Hi everyone, I am new here. Looks like an great group. I have some questions about sutures. I just had surgery on a back Torus last Wednesday and the dentist sutured my cuts after he was done and said to come back in a week to have them removed. As an aside he does waterlase surgery, including implants - interesting, since I thought only oral surgeons and periodontists did implants - but not true - this person is a regular dentist. I live in Maryland. He is a nice guy, and he travels all over the world teaching the waterlase stuff for Biolase (interesting since I live in a redneck town in western Maryland - lol). Anyway, he pared down the Torus using the water laser and osteotomy, and put the sutures in and I was to come back in a week to get them removed as I stated. Today is Saturday (three days later), and the stitches are gone (I mean not even a trace of them - I have checked very closely over and over). When I got home I immediately looked at the surgery of course, and I could only see a stitch on the inboard side of the jawbone where the Torus was, and I could see a stitch (ie black thread) on the top surface with what appeared to be a knot in it. I do not know what type of stitching method he used. I have no teeth behind my second premolar on that side (lower left), and will be getting an implant in the forward molar spot after the Torus heals. I don't see how he will be able to remove the stitches if he can't see them, and I don't see how they could be totally covered up with tissue in 3 days. The inboard side stitch seemed to disappear within a day (and there is a lot of white dead skin there from the laser I guess), and all I could see was the knot on the upper surface. I saw the knot last night, and this morning it too is totally gone. Not even a sign of any kind of thread anywhere. This is rather alarming to me. Like I said how will he be able to get the stitches out if they are buried and not visible - without digging them out, which to me would open up my closed wound and would be self defeating. I am still in pain now, but not bad, but it is still quite inflamed, and a lot of white dead tissue. I do not believe it is swelling that is covering the stitches. They seem to have disappeared somehow. Is it possible he used absorbable thread by mistake - but I don't see how, since I believe it takes approx. 3 weeks for absorbable stitches to dissolve in tissue. I am not suppose to go back until Thursday to get them removed, so I guess I will call Monday and try to find out what is going on (ie, if they are buried within three days I don't want them getting buried deeper). Can someone please tell me what is going on here. Is it normal for the removable type dental stitches to disappear like this (within three days). I seriously doubt it. I would appreciate your comments, so I can talk more intelligently when I call Monday. Or am I worrying about nothing and you don't think it is necessary for me to call. Sorry this was so long. Thank you...Pete PS - why do dentists use removable stitches instead of absorbable. > Hi everyone, > [quoted text clipped - 50 lines] > > PS - why do dentists use removable stitches instead of absorbable. It's very likely some stitches have fallen out. If not, it will almost certainly be easy to remove any remaining with direct vision and bright light. Steve > It's very likely some stitches have fallen out. If not, it will > almost certainly be easy to remove any remaining with direct vision > and bright light. > > Steve Thanks Steve...but how would they fall out, if they are a strong synthetic thread. And like I said there is no sign of any thread left at all, anywhere, so doesn't that mean the dentist will have to dig for them, and upset my surgery. I really don't see anything at all, looking very closely with a bright flashlight, flashing directly on the area (they are gone). Is it possible the dentist botched the job somehow. I was hoping for a more detailed answer (ie do stitches normally get buried after a few days or not - and if not I don't see how he will be able to remove them if they are not visible). Sorry for the repetition, but this doesn't sound right to me. I have had several stitches removed on bodily cuts in my life, and the stitches are always visible. Thanks...Pete >> It's very likely some stitches have fallen out. If not, it will >> almost certainly be easy to remove any remaining with direct vision [quoted text clipped - 16 lines] > > Thanks...Pete Obviously I have no way of knowing what suture material was used. I use mostly silk because it's easy to use. Synthetic materials usually require more knots, and when I've used them they're a little more difficult to tie without tearing the tissue. However, sometimes they provoke less tissue reaction, so there is good reason to use them, and I don't do much surgery in any case. The mouth is a difficult place to retain sutures--unless it is covered by a dressing, think of all the stuff rubbing up against them--food, tongue, etc. Anywhere else on the body the sutures would probably be covered by a bandage for a few days, and you wouldn't get the surgical wound wet. I can tell you that within a week of suturing, I can count on about 1/3 or the sutures I've placed to have come out by themselves. On the plus side, the soft tissue of the mouth heals wonderfully almost always--in a wet, septic environment. Specifically to your situation, you didn't say if the torus removal was on the palate or the lower jaw. The tissue is usually very thin around these, and prone to breakdown. In this case you'll get a whitish-greyish fibrin pseudomembrane covering the area, and it will eventually granulate in. There is nothing in your description to make me think your surgeon "botched" anything, but by all means have him/her look at it to make sure the healing is OK. I'm guessing it is--but if there is increased swelling after 48 hours or any drainage from the area for sure get it checked sooner. This tissue--as thin as it is--you shouldn't have any worries about sutures getting "lost". Steve >>> It's very likely some stitches have fallen out. If not, it will >>> almost certainly be easy to remove any remaining with direct vision [quoted text clipped - 47 lines] > > Steve Thanks Steve...I don't know if he used synthetic thread (I just used that term). The thread seemed relatively thick, and dark color. The torus was in my lower left jaw, all the way in the back. I had the second molar extracted (same lower left jaw) a couple months ago by my regular dentist, and had a lot of trouble afterwards with bone chips in the adjacent torus (lingual side), which kind of caved in after he picked a chunk of bone chip out with his dental pick a couple weeks later. I went back to him twice, and the first time he said everything was okay (NOT), and then I started draining a lot of pus through the torus and went back to him again, after a round of Pen-Vee K didn't help, and that is when he picked out the chunk of bone. I thought for sure it would be okay then, but not with my luck. The torus I just had surgery on (by the new dentist) is all the way back (in the wisdom area next to the second molar I just had pulled, lower left jaw - I have no wisdom tooth there). The previous extraction impacted that torus also, and it was bothering me, so I went to the new dentist I mentioned that does laser implants, and is more like an oral surgeon, even though he is not an oral surgeon. I have a large amount of the white membrane you mention on the lingual side where he used the laser and the osteotomy drill to cut the tissue, and knock down the boney projection. I could clearly see the sutures right after the surgery - now all I see is white membrane, and the knot at the top is gone also. I still don't see how a strong thread can come loose unless they are just laying in there in some kind of half a.s fashion. I guess it may depend on the skill of the surgeon also - dunno. You said the sutures shouldn't get lost. But how will he find them without digging in with a dental pick or some other sharp tool. This is what bothers me and is what I am concerned about. Also I don't know how many stitches he did, versus being continuous - I'll have to ask him. He is 53 years old, and very experienced, and like I said, he travels all over the world teaching the waterlase stuff. My main question is how will he find the stitches without digging in with a pointed tool and disrupting my surgery. Is it possible that the stitches are truly gone and no longer there, and if that is the case, could that mean that he may not be proficient at stitching (he was awesome at injecting the prilocaine - went really slow and I couldn't feel anything - I praised him highly for that). I am not asking you to bad mouth him, I am just trying to find out what the norm is. If the dentist can't do stitches right - I may have to reconsider having him doing a laser assisted implant on me - since that will also involve stitching :-) . I just joined the group today, and have read some bad things in here about implants, so now I am wondering if it's worth the risk. Right now I have no molars on my lower left side and that is not a good thing to be chewing on one side for the rest of my life. The off center forces will mess up my jaw, and needless to say cause premature failure of the teeth on the other side, which already has two crowns, with a root canal through one of them. I am 60 years old. Sorry for rambling. Thanks again for your help...Pete PS - I am very impressed with this newsgroup, and it is so refreshing to see all the dentists volunteering their time. It is rare to see that with your counterparts, the medical doctors (ie MD's). Thank you to all of you, and please continue to volunteer your time if you can. It is greatly appreciated. >>> Thanks Steve...but how would they fall out, if they are a strong >>> synthetic thread. And like I said there is no sign of any thread [quoted text clipped - 101 lines] > please continue to volunteer your time if you can. It is greatly > appreciated. Pete-- I think your concerns about sutures are misplaced. They are generally easy to see if present, and pretty painless to remove. No digging should be required. If deep sutures are placed, resorbable materials should be used. However, the lingual of the lower third molar area is not a really typical area for tori--in the lower jaw they are much more likely in the canine/premolar area. The blood supply to the bone in the rear part of the mandible is not so great--doubtless a contributing factor in your difficulties with the extraction. I'm assuming the sequestration (pieces of bone coming out of the area of the extraction site) had stopped and the area well-healed before the torus surgery was done. I am personally a retrogrouch, and this means that I personally don't think lasers fully warrant the buzz they're getting. This may be partially because I don't "get it" myself, and I DO believe there is a place for lasers in dentistry, but not such a big place. Clearly (to me) for many dentists it's an attempt to distinguish themselves from the crowd in a very competitive field. Personally, I would be much more interested in the particular implant training a dentist had than whether a laser is used or not. Oral and maxillofacial surgeons (OMFS) and periodontists get extensive training in implantology, and it's becoming a bigger and bigger part of the daily practice of both these specialties. There are some stand-alone implantology training programs and some of them are doubtless terrific. However, there is no specialty of implantology as such; and so if you go to an OMFS or periodontist for implants you know they have successfully completed a program which must meet certain standards; though there is an academy of implantology, I don't know how their certification stacks up against the other specialties. There are medical reasons that implants could be contraindicated, but the average healthy 60-year old male should be a good candidate, given adequate bone where you need it. Steve > I think your concerns about sutures are misplaced. They are generally > easy to see if present, and pretty painless to remove. No digging [quoted text clipped - 32 lines] > > Steve Thanks Steve...the torus was in the last position (I have other lingual tori the full length of each side of my lower jaw, and they have been there for many years and they don't bother me), and I had the torus surgery about two months after the extraction, and the extraction area appeared healed, except for the problem with the torus in back which I needed to get removed. The torus was bothering me, and the problem was caused by the extraction. I still don't know where the stitches went. I will have to wait and ask him. I say they are gone, or buried (or both), and they are not absorbable, because he told me to come back and get them removed. You may be right about the laser hype - but I believe it may be less invasive (he said it was), and I have an immune deficiency. I initially called his dental office to make an appointment with the "oral surgeon" in the office(who I found out owns the practice of six dentists) to discuss an implant, as well as my torus, and was told that the doctor I went to, does all the implants now, and he uses a laser. The oral surgeon (who owns the office) transferred all implant patients to this other dentist. I asked for the office manager, and spoke with her for almost a half an hour, and was pleased with her responses. I don't know what to do now. I will probably let him do the implant, depending on how the torus heals up. Hell, he would have done the torus at the same time as the implant - I said no way. If I go for another opinion it will be another 200 dollars for the damn consultation, and I would still have no way of knowing if the second guy would do any better job, other than he may be more certified so to speak. I have been to approx 75 doctors in my life (mostly MD's), and I don't have a lot to show for it, and don't want to make a big deal out of getting a dental implant, which I thought was a common dental procedure (although I don't like some of the bad stories I read in here, like I said). The owner of the dental practice is an oral surgeon and apparently must trust this guy if he has let him do all the implant work. I picked his (the dentist who does the laser implants and did my torus) brain real good, and he answered all my questions to my satisfaction - the office manager kind of broke us up because I was taking up too much of his time. I can see he is kinda like the main cog in the office, by talking to the other ladies in the office. I also asked him about the certification stuff (because I thought you had to be a licensed oral surgeon or periodontist to do implants) and that is not true, at least in Maryland. He basically said he can do it all, from fillings and extraction's, to implants - I am sure he can not do certain maxillofacial stuff. Perhaps the laws have changed in the last several years. He said he has been doing the laser implants for six years (four years in another city) and has done over a hundred. I asked him this because you always want an experienced surgeon for any kind of surgery, and it is best to not be one of the guinea pigs. Thanks again for your time Steve...Pete I have a Waterlase in the office, and I agree with Dr. Bornfeld. :-) Steve > Thanks again for your time Steve...Pete > I have a Waterlase in the office, and I agree with > Dr. Bornfeld. > > :-) > Steve You're armed...and dangerous... Steve >> Thanks again for your time Steve...Pete > I have a Waterlase in the office, and I agree with > Dr. Bornfeld. > > :-) > Steve I am sorry Steve...forgive my ignorance. This may be an inside joke - I told you I just joined here today. If you don't like Waterlase, then why did you buy (or rent) one. Please explain...Pete Pete, I have been following this thread and I would like to add my $.02. Sometimes, when the 2nd or 3rd molars are extracted, what was previously an undisturbed smooth transition between the bone holding the tooth and the tooth, becomes a very prominent lingual ridge. Most of the time, the bone re-shapes itself as part of the healing process. However, infrequently, the prominent lingual ridge remains sharp. The soft tissue on the tongue side of this bone can be VERY thin and easily becomes perforated by this ridge of bone. Many times, because the outer-most part of this bone does not have a good blood supply, it dies and is picked out by the dentist with tweezers. Other times the bone remains sharp, and 1 - 2 months later, creates a sore spot. In my experience, perhaps an OMFS could jump in here, the dentist who removes the tooth will have the patient back, and at no charge, perform a minor lingual flap and reshape the bony prominence with drill and /or bone files to make a smooth, rounded transition of the occlusal and lingual bony aspects. This is NOT a torus reduction/removal, but treatment of a sequela or complication of the extraction(s). (In hindsight, we probably should have fixed it at the time of extraction.) Since the mucosa in this area is very thin, it can easily be torn in doing this repair procedure. Because of the delicate nature of the tissue in this area, usually natural gut or chromic gut, which can dissolve/loosen or fall-out in 3 - 7 days are used in order to obviate the need to traumatize the area during suture removal of what is usually black silk sutures. Most dentists do not use synthetic sutures such as Vicryl which are slowly dissolving in 3 - 4 weeks. So...what you are probably seeing is a sloughing of the mucosa and exposure of the bone with early granulation tissue as well as the dissolution of the suture material. The laser dentist probably wants to monitor the healing and make sure that it is not infected. Now, as far as laser use in bony surgery, I have never done it or seen it done. It hasn't become mainstream. I also don't understand how an osteotomy for implant placement can be done with a laser, in that the bone drilling and drills are precisionly sized for the corresponding implant. Also, why did you leave your previous dentist? As I said, fixing the prominent lingual ridge is his/her responsibility or his to refer out to a clinician that will do it, at the referring dentists expense. It should not be something you have to pay for (at least in my practice). If you can't manage the complications you probably shouldn't be doing the procedure. Lastly, I have been watching the postings in this NG and have not seen any war stories about implants. They are 95% successful if treatment planned properly. BTW, what is your immuno-compromise condition called? > Pete, I have been following this thread and I would like to add my > $.02. [quoted text clipped - 46 lines] > > BTW, what is your immuno-compromise condition called? Le huart - Thank for the detailed explanation...But, I just wanted to let you know that I am quite aware as to what has transpired. - I went to my dentist 3 times (which I considered enough) , and it was going nowhere, and I knew he does not remove tori, and I didn't go back to him a 4th time because I was sure the torus behind the molar he removed needed to be worked on, and I wanted a second opinion, since I had been having problems for almost two months after his extraction of the number 18 molar, plus I wanted to talk about getting an implant. The torus immediately adjacent to the tooth he removed was the initial problem, and I had pus coming out of it shortly after he said everything looked okay on my second visit, and I did get relieve when he picked out the loose bone chunk on my third visit after a round of pen-vee k failed (and I already went through a round of amoxicillin prior to that). - The number 18 torus did kind of collapse, or cave in, after he picked out the bone chunk (it popped out and fell on the floor). BTW, I have had Tori on both sides of my lower jaw from front to back for many years, as I explained previously in this thread, so when I say torus, I mean torus, not some prominent ridge that was a result of a tooth extraction (hell, I went to a knife happy oral surgeon many years ago for a pizza burn that wouldn't heal, and he wanted to chisel both sides of my lower jaw (front to back) because of all the tori I had - I said no way - that was major surgery). Quack quack quack :-) . - After my regular dentist picked out the bone chunk at position 18, the torus behind it (at position 17) was now more pronounced in a relative sense since the one before it was caved in after a couple more weeks of healing (and it was now getting rubbed more by my tongue, food etc). And then I could see bone, or spicules, or whatever you want to call it (as white), but it was more solid bone and could not be picked out in my opinion. Perhaps it was starting to manifest itself like the first torus at position 18, as a result of the rocking or racking effect when he pulled the tooth. I felt it need to be chiseled or pared down somehow because it was bothering me and I doubted it would improve on its own, and I was fairly certain my dentist didn't do that sort of thing (since he is not an oral surgeon). - Anyway I had a consultation with the new dentist, who is the laser guy, who does implants and other things that oral surgeons do (but he is not an oral surgeon), and his boss is an oral surgeon who transferred the implant patients to him - I have already explained all this. I considered him competent and experienced and felt confident after our talk. He agreed to remove or pare down the torus and do an implant later. Like I said he would have done both at the same time and I said no way. - When I said osteotomy, I meant using a drill - he used the laser more for the tissue opening and then used the drill to knock down my boney projection - which is what a torus (or exostosis) is. He told me the laser will not cut bone, and I understand what you said about the drill size for the implant. So when I have an implant (don't know if I will now), he will do the same kind of thing (call it laser assisted if you will) - he will still have to use an osteotomy drill to create the female whole for the male implant post - I told him I wanted a Zimmer since my dentist recommended that one, and he agreed it was very good (and the one he uses the most), except the abutment screws into the implant, whereas another version has a force fit abutment which can't work lose - I am an engineer and I understand all this stuff quite well, but I am not a dental surgeon - lol . He explained all this too me as I kept asking him more questions. I could tell he knew what he was talking about. He was a nice guy and I could "shoot the sh.t" with him, and he could tell I was a technical person. I hope he didn't mess up the torus surgery - I was happy when I got home and thought it looked good to see that bulge gone - but it still pains and is kind or raw around the white crap. And the stitches have disappeared like I said, which worries me, and there is no doubt in my mind he will not be able to pull any stitches out if he can not see them. I hope they are not buried and they all came lose from the outer surface - lets not get back into that. - I beg to differ with you about the torus reduction/removal. He did remove (or reduce) the torus, and I got charged $805 for it which my insurance is supposed to cover under the "oral/maxillofacial surgery" section (I would have to pay for the implant (if I have it) totally out of my pocket). Here is what was on the bill - "Removal of lateral exostosis". I told him to make sure to code it accordingly and I zeroxed my insurance brochure and showed him that my insurance covered excision of exostoses (the word removal is close enough). - I serious doubt my regular dentist would do the surgery I had done on the torus. I am not even sure he would do the things you mentioned above ("perform a minor lingual flap and reshape the bony prominence with drill and /or bone files to make a smooth, rounded transition of the occlusal and lingual bony aspects"). The torus was bothering me, and I felt it needed to be reduced or removed. If he didn't agree, than he shouldn't have done it. - I am running out of steam. Pertaining to my immune deficiency, I didn't mention what it is because I get sick of explaining it so people don't misinterpret. I have a serious T-4 cell deficiency and I do not have HIV and the cause is unknown, and I suspect I have had it for many years but didn't find out till 2002 via a CD4 count. As soon as you say T-4 cell people (especially doctors) immediately think you have HIV, and that pisses me off since I am not a homosexual or a drug/needle user. I am surprised you asked because my dentist (and the new dentist) don't even care - it goes in one ear and out the other. I asked my dentist for all the antibiotics and this new guy didn't even offer me any after the torus surgery. I had a Z-pack and I started it yesterday (as a prophylactic at best), because I am having malaise as a result of the surgery. The surgery looks okay no drainage or bad swelling, but it still hurts and is sore. Naturally I have been chewing on the other side. I have several medical surgeries and I know it takes a long time to heal, but I hope the torus heals quickly. I will see the dentist Thursday to remove the stitches that are not there. I was going to call tomorrow (forgot it is a holiday) so I will call Tuesday I guess, to report that the stitches are gone and is that okay, etc. I don't think it is. - I don't know what you mean by "If you can't manage the complications you probably shouldn't be doing the procedure". I needed to have my tooth pulled, and I needed to have the torus worked on. What do you want me to do, die of an ultimate infection (and suffer from constant pain). And I did not leave my regular dentist - I went to the new dentist to talk about an implant and a torus reduction, neither of which my dentist does. - Pertaining to your reference that you have not seen any war stories about implants. Try the post dated 5/12/07 (4 new implants...). I am not saying that is a war story, but it certainly makes me want to think twice. But I am too smart to ignore the complications that will take place if I chew off center for the rest of my life. I would only have one implant at position 19 just behind the second premolar - that will take most of the load (these things cost a lot of money you know :-)). I was told once that studies have revealed that the premolars (esp the second one) do 80% of the chewing (I used chewing as a general term). I understand that the molars are more for grinding (ie it is kind of hard to chew hard items with the premolars). But I tend to agree with the premolars doing 80% (ie they have a nice tearing and partial grinding effect). I will have to study that more. Anyway, If I don't get the implant, it won't be long before I chip or crack the number 20 premolar, especially since it has a point on it that could go at any time :-) . - Le huart, I apologize for the length of this and I hope you read it since it took me hours to write it. I appreciate you taking the time to write me, and I wanted you to know that I am not ignorant about medicine, and now I will have to start studying dentistry - lol . Are you a regular family type dentist or an oral surgeon. Thanks again...Pete PS - I tend to agree with you guys about the concept of all the laser hype. I used to know an ENT back in the 90's who was big on that crap (he was the first to do whatever, and he had only one of two machines in the country - da da da da). I don't particularly care one way or the other, but if the laser may result in a less inflammatory effect (less invasive so to speak) than the better for my immune deficiency :-) . Sorry I didn't make myself clear. If the "dentist" who removes cannot manage the complications that might occur, then I don't feel that that dentist should be removing teeth. BTW, if #19 area has enough keratinized tissue on the buccal and ligual of the ridge, implant surgery can be flapless. We punch a hole in the tissue and drill the osteotomy through the punched hole. Usually no pain. The patient who posted about implant problems, was unhappy with the prosthodontic result. Assuming the implants were correctly positioned (he had all sorts of preliminary Tx planning with a supervising dentist) then the problem may be idiosyncratic to him if the pros TX is correctly done. > Sorry I didn't make myself clear. If the "dentist" who removes cannot > manage the complications that might occur, then I don't feel that that > dentist should be removing teeth. Gotcha...there is no way the dentist would have said he was responsible for the problem with the # 17 torus (I didn't go back to ask - but I know). I believe it was related to him pulling the tooth (ie the rocking and racking forces may have aggravated the torus but he can't be responsible for the torus which was one space back, I don't feel). Hell he only charged me $100 to pull the tooth and no charge for the two follow visits. The laser guy charged me $800 for the torus removal. Do you agree that my regular dentist would not (ie not within his scope) remove the torus because he is not an oral surgeon - and that he could not be responsible for the $800 torus surgery (ie there is a big difference between a simple 100 extraction and the $800 torus surgery - although the $800 was way too much in my opinion - hell if its for paying for the laser, I would have rather he used a knife - lol). He could just say it was coincidental that I had trouble with the other torus and it was unrelated to his extraction. > BTW, if #19 area has enough keratinized tissue on the buccal and > ligual of the ridge, implant surgery can be flapless. We punch a hole > in the tissue and drill the osteotomy through the punched hole. Please explain more...the laser dentist will punch a hole in the tissue with a laser and drill the osteotomy also - so what is the difference. What do you mean by flapless, so I can ask him. I thought they sew a flap over the temporary cap that goes on the implant while it takes four months to knit. > Usually no pain. The patient who posted about implant problems, was > unhappy with the prosthodontic result. Assuming the implants were > correctly positioned (he had all sorts of preliminary Tx planning > with a supervising dentist) then the problem may be idiosyncratic to > him if the pros TX is correctly done. I didn't read all the thread, but his basic complaint was food getting trapped under the crowns as I recall, but he said his bite was fine. Do you agree that I should have the one implant to avoid possible complications with my jaw and the teeth on the other side, that will surely result if I chew off center for the rest of my life. I think the person said he had a big gap for 36 years without the implants - lol . I will not live that long :-) . I told you all I am sixty years old now. The difference with the laser and the tissue punch? Maybe $20,000? Most patients say they were sorry that they didn't do the implant sooner. I have been using 1 stage implants since 1990 with no problems. They are made by Straumann. No second surgery. They have essentially same results as the 2 step implants. AAMOF, Nobel Biocare is pushing their 2 stage, bone level implant, as a 1 step implant - just have to use a thicker healing screw. And lastly, some implant dentists are doing immediate placement of an abutment and a temporary crown, waiting the 4 months to torque the abutment and make a final crown. > The difference with the laser and the tissue punch? Maybe $20,000? He just got a new laser the night before my torus removal. They were working on the old one while I was talking to him during my consult - we had to move for the repair tech. I could tell the guy wasn't going to be able to fix it - lol . Anyway I asked him how much the new machine cost the next day, and he said $55,000 if I recall. Was he bullshitting me, do you think. > Most patients say they were sorry that they didn't do the implant > sooner. I have been using 1 stage implants since 1990 with no [quoted text clipped - 5 lines] > crown, waiting the 4 months to torque the abutment and make a final > crown. He told me you can't do one stage implants on the molars, only the forward teeth (obviously they are better since they are one piece and can't come apart) due to the pressure when chewing while you are waiting the 4 months. I don't quite understand the one step (I know it is an implant and abutment combined into one piece. If you do a one step, then how would you chew with the damn abutment sticking up and wouldn't that mess up the healing and knitting of tissue with the implant for the next four months. What tooth numbers do you do with the one step (ie how far back do you go). In other words why were (and still are, I believe) most implants of the two stage type (especially for the back teeth). It makes sense to me, although I recognize the single piece is better because it can't separate or work loose, like a screwed abutment could. And the force fit abutments are stronger and less likely to come apart but Zimmer doesn't make them. Do you also recommend going with the Zimmer. Thanks le huart - do you have a nickname or first name I can use...Pete I'm sorry, Pete. I didn't explain it correctly. One stage means only one surgery. Instead of placing the implant flush with the bone, then covering it with the gum, then reopening it to place a healing screw or abutment, a 1 stage implant is placed to be flush with the gum, exposed to the oral environment, but no abutment is placed, unless an immediate load crown is the Tx plan. In the front, they can be placed subgingivally with a thicker healing screw that allows access to the implant platform for abutment placement. In the molar area, we use an implant with a 4.8mm body and a 6.5mm platform that allows for a more molar-like final crown. Zimmer has a very good success rate and an excellent reputation. It is the dentist's clinical judgement and clinical experience as to what system is used. I'm sure that you will be very happy with your implant and final restoration. I hope that I clarified things for you. > I'm sorry, Pete. I didn't explain it correctly. One stage means only > one surgery. Instead of placing the implant flush with the bone, then [quoted text clipped - 6 lines] > implant with a 4.8mm body and a 6.5mm platform that allows for a more > molar-like final crown. Huart...I didn't misunderstand you that bad. I think the misunderstanding is in the healing screw (or cap), which I will address in the next paragraph. Perhaps I should have used the word one piece or one step. The way he explained it to me is (and he showed my pictures) - the one piece consists of the implant post and the abutment in one solid piece, and there is no healing cap or healing screw (I believe he called it a healing cap). In the two piece or two step, the first piece is the implant post and the second piece is the abutment that the crown fits over (the abutment doesn't go on until after the four months waiting period). And I thought he said that when he puts the implant post in, he immediately puts the healing cap in the hole (the hole that is for the future abutment to screw into). I understand the healing cap to be nothing more than a plug to keep stuff out of the hole in the implant, that the abutment will be screwed into later. And I thought he said he would stitch the skin over the healing cap the same day as the implant. Then four months later, he would cut the skin (or flap) again and remove the healing cap, and screw in the abutment, then take an impression for the crown. Is this close enough, and we are on the same track. Thanks again. You are a kind person...Pete PS - you didn't address my question about him saying you can't use the single piece implants on the back teeth. I explained it in detail in my last post and asked you how far back you go with the single piece. Could you please take another look and give me your opinion on this. I would appreciate it. Thanks. > Zimmer has a very good success rate and an excellent reputation. It is > the dentist's clinical judgement and clinical experience as to what > system is used. I'm sure that you will be very happy with your implant > and final restoration. > > I hope that I clarified things for you. I have never used a 1 piece combination abutment/implant. Nobel Biocare makes one and it is supposed to be used for areas like the lower incisors. Your dentist talked about 1 piece implants he did not talk about 1 stage (i.e. 1 surgery visit) implants. Go to Straumann.com and Zimmer.com and compare the implants. > I have never used a 1 piece combination abutment/implant. Nobel > Biocare makes one and it is supposed to be used for areas like the > lower incisors. > Your dentist talked about 1 piece implants he did not talk about 1 > stage (i.e. 1 surgery visit) implants. Go to Straumann.com and > Zimmer.com and compare the implants. Thanks Huart...I went to both sites and couldn't find anything specific (by searching "single stage" and "one stage". No need to respond anymore. I think the one piece combination is also a 1 surgery visit (its obvious by what I wrote before). I will ask the dentist about one piece versus one stage when I see him. I think they are kind of the same thing. I will post a new post about all this when everything shakes down. If the damn torus doesn't get better, there will be no implant. I can't wait to hear what he has to say about the stitches, that he will not be able to remove because they are gone :-) . You have been very kind, and I thank you again...Pete > > I have never used a 1 piece combination abutment/implant. Nobel > > Biocare makes one and it is supposed to be used for areas like the [quoted text clipped - 15 lines] > > You have been very kind, and I thank you again...Pete Pete: Le Huart and both Dr. Steve have given you great info......Here is the Bony spurs phtos you can look at after lower molar extraction............ http://www.docere.com/MessageBoard/thread.aspx?s=2&f=173&t=81886&r=1229691#Post1 229691 I think implants are great.......You must get an experience restorative dentist to plan and design the case....Then an experience and skillful surgeon to place the implant at where the implant need to be at......Restorative and surgical goes hand in hand..........Implant is now restorative driven, not surgical. There are plenty of GP can can place and restore implants. But few can truely replace the success of team approach implant dentistry. Best wishes...........Albert >>> I have never used a 1 piece combination abutment/implant. Nobel >>> Biocare makes one and it is supposed to be used for areas like the [quoted text clipped - 30 lines] > of team approach implant dentistry. > Best wishes...........Albert Thanks Albert...I already have enough usernames and passwords, and I don't want to go through another registration process right now, but I would have loved to see the photo. I do not understand what you mean by I must get a "restorative dentist" to plan and design the case. That is the first mention of that I have received in here (you are the fourth dentist to reply I believe). With all due respect that sounds like total overkill and just kind of further makes me want to forget the implant. Hell my regular dentist is an experienced restorative dentist (and so is the laser dentist I am going to now, who also does implants and torus surgery- he better be, he is 53 years old). I thought all dentists were restorative dentists - ie that is what they do for a living. Do you mean a restorative dentist just for implants - if you do, then I am sorry but that is overkill. I have been to approx 75 doctors in my life (with not much to show for it), and I can not make a big deal out of this. I will either let this guy do the job or forget it. Hell I could spend $200 a clip getting a bunch of consultations and I would still never know who would do the best job. The best referral is by word of mouth and I don't know anybody like that, and this doctor is the only "quasi" oral surgeon (I told you his boss is an oral surgeon) that takes my insurance (my insurance at least covered the $800 torus surgery). He has been doing laser assisted implants for six years now - that is good enough for me. I know my insurance will not cover the implant, and I will have to pay for that in full - approx $2,600 for implant, abutment and crown. But I certainly appreciate your comments. This is a great group and all of you are very kind to volunteer your time, and I appreciate it very much. Thank you again...Pete > ahuangd...@gmail.com wrote: > >>> I have never used a 1 piece combination abutment/implant. Nobel [quoted text clipped - 62 lines] > > - Show quoted text - Pete: The most important thing in dentist/patient relationship is trust, and this trust is difficult to built and maintain. Your investment in a dental implant replacement take a lots of your time and money. In addition your relationship with your dentist doesn't stop after he place the implant and restore the crown. Implant require regular recalls to maintain. So this relationship is like a marriage once implant is involved. From reading your last post......You trust your dentist because of his experience, skill, and reputation........So why worry and second doubt him..........He should be the one to answer all your questions............Good luck Sincerely.......Albert > > I have never used a 1 piece combination abutment/implant. Nobel > > Biocare makes one and it is supposed to be used for areas like the [quoted text clipped - 15 lines] > > You have been very kind, and I thank you again...Pete Sorry...I forget you may need to sign up into dental town in order to view that thread.............. I bought a Waterlase about 3 years ago. I use it almost every day for something. I didn't say that I did not like the machine. It is great for anterior cavity preps and gumline fillings. I use it a lot on kids' teeth too. Nice clean preps with less soft tissue bleeding. IME, it does not live up to the promise of 'needle free' dentistry. It is less painful than a 'drill' for most work, but it is not 'pain free' for most treatment unless I add anesthetic. Soft tissue work is pretty good too, but not without anesthetic. Most people who spend $50K for a laser fall for all of the hype, or get rid of the machine. The truth is somewhere in the middle. JMO, Steve >>I have a Waterlase in the office, and I agree with >>Dr. Bornfeld. [quoted text clipped - 5 lines] > told you I just joined here today. If you don't like Waterlase, then why > did you buy (or rent) one. Please explain...Pete > I bought a Waterlase about 3 years ago. I use it almost every > day for something. [quoted text clipped - 27 lines] > > - Show quoted text - The only laser I have is a periolase......It does not do hard tissue...It does not even remove soft tissue effectively like electrosurge.......But I love the result of LANAP and biostimulation. Many dentist buy into waterlase MD and using waterlase to remove decay, treating gum disease, doing crown lengthening..........and expose implant. I don't think waterlase MD can treat gum disease as well as periolase because the different in wavelength. The cost of periolase is $68K with periolase trainning. My service for LANAP is $5500 full mouth..........In my humble opinion the result is better than traditional flap surgery to treat periodontal pockets. I average about 3-4 full lanap cases per month. I use the periolase daily on Biostimulation and crown impression......... So Dr. Steve check out the periolase.......You can find used waterlase for sell on ebay or by other dentist.....But you will not find any used periolase on the market.........There is only 4-500 out there now........ Albert > I bought a Waterlase about 3 years ago. I use it almost every > day for something. [quoted text clipped - 15 lines] > JMO, > Steve Thanks for the balanced and concise critique. Steve >>> I have a Waterlase in the office, and I agree with >>> Dr. Bornfeld. [quoted text clipped - 5 lines] >> I told you I just joined here today. If you don't like Waterlase, >> then why did you buy (or rent) one. Please explain...Pete > I bought a Waterlase about 3 years ago. I use it almost every > day for something. [quoted text clipped - 15 lines] > JMO, > Steve Thanks for the info Steve...Pete ve a Waterlase in the office, and I agree with >>> Dr. Bornfeld. >>> [quoted text clipped - 4 lines] >> - I told you I just joined here today. If you don't like Waterlase, >> then why did you buy (or rent) one. Please explain...Pete |
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