Teething Gains - Progressive Periodontics

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Teething Gains
Dental implants have come a long way,
and can make a big difference.
BY SARA RAE LANCASTER
A
s the song says, you’re never fully
dressed without a smile. But if
you’re among the millions of
Americans who are missing one or more
teeth, you might shy away from smiling.
That need not be the case. Dental
implants are a great option for restoring a
confident smile and proper jaw function.
“It’s a viable option, and probably the first
option that should be presented to people,”
says periodontist Dr. Ahmad Eslami of
Dental Implant & Periodontal Solutions.
And thanks to advances in technology,
patients have even more to smile about.
“Dental implants have been evolving over
a long period of time,” says Dr. Tim McNamara of Progressive Periodontics and
Dental Implants in Greenfield and West
Bend. Now, it’s never been easier or less
cumbersome to get them.
But you still want someone with
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expertise in the procedure, so it’s important to research a practitioner’s qualifications. “Ask how many they have done, but
you also need to know the person’s formal
training,” says Dr. Daniel Domagala of East
Town Dental Group of Milwaukee.
Basically, a dental implant is a prosthetic
root that’s set in the jawbone where there
was once a tooth. The implant consists of a
hollow titanium screw with threads on the
outside and inside. The outside threads
stabilize the implant as the bone heals and
bonds to the new prosthetic root. After a
crown is attached, the completed implant
looks and functions like a natural tooth.
That may sound simple enough, but as
McNamara explains, “the process used
to have a lot of guesswork involved. We
used to have to fabricate the surgical guide
by hand, and that got us close to the right
place for the implant, but not exact.”
The procedure was also invasive and
painful. In order to ensure the best placement, and avoid hitting vital structures
beneath the gums, surgeons would make
deep incisions to examine the underlying
bone structure. Still, says prosthodontist
Dr. Tim Hart, who partners with Dr. Steven Koutnik at Lake Bluff Prosthodontics
and Implant Dentistry, “surgeons couldn’t
see beneath the bone.”
That changed when computed tomography technology (popularly known as
a CT scan) made its way into dentistry,
allowing a more accurate evaluation of a
patient’s anatomy. Hart was one of the first
in the area to use dental CT technology
in 1999. “So although it’s been around for
a while, it was more expensive and not as
readily available as it is now,” he says.
Back then, most dental providers did
not own their own CT machines, so
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patients had to make a separate trip to
a nearby hospital. The inconvenience,
added cost and radiation exposure meant
the procedure didn’t make sense for most
patients, who only needed one or two
implants. Then came cone-beam imaging
and 3-D printing.
Unlike conventional scans that produced flat, two-dimensional images, conebeam computed tomography produced
three-dimensional views of the patient’s
jaw that could be manipulated using
sophisticated computer software.
“But that doesn’t tell me where the gum
tissue is,” Hart says. So an impression of
the patient’s teeth and gums is taken and
scanned into the digital representation.
“So you have one screen showing bone
and teeth,” Hart explains. “Then we merge
the plaster model into the CT scan, and
by clicking a mouse button, I can turn on
and off the soft tissue represented by the
model.” The last step involves scanning
in a representation of the future crown,
either digitally or from a wax model.
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Think of the process like one of those
home-design shows, in which the architect shows homeowners an image of an
existing fixer-upper and, using design software, overlays the envisioned end result.
In the case of dental implants, this digital
representation provides a more accurate
analysis of the patient’s jawbone structure,
tooth orientation and soft tissue, plus the
location of vital nerves and arteries.
The other technological advancement,
3-D printing, takes that detailed digital
representation and prints a more accurate
surgical template, removing the guesswork
that once surrounded implant placement
while reducing the procedure’s discomfort
and increasing its overall success rate.
It means faster, less-invasive surgery,
McNamara says. “In an accessible area of
the mouth, it’s possible to place it in about
five minutes after the patient is numb. And
because it’s less invasive, postoperative
recovery time is also quicker, making it
one of the most predictable procedures in
dentistry with a 97 percent success rate.”
The new technology even offers hope
for patients who were previously told that
dental implants weren’t an option. “Basically, anyone who has lost one or multiple
teeth, or is about to lose any teeth, is a
candidate for dental implants and should
investigate that possibility,” Eslami says.
Some conditions, he cautions, would
limit a person’s eligibility, such as active
chemo or radiation therapy for cancer;
uncontrolled diabetes; or taking certain
medications for osteoporosis. But “those
situations aside, what people need to know
is dental implants are not just for the elite
anymore,” Eslami says.
Implants also offer an alternative to
dentures. “A lot of people think if they lose
their teeth, they have to have dentures,”
Eslami says. “While some people may end
up with that, this is an option that should
be explored for people who want to live
with the full function of their mouth.”
To choose a provider, “first, you need
to interview the person and learn about
that person’s background,” Eslami advises.
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“How many have they done? How often
do they do them? What is their training?”
Performing due diligence is especially
important because implant dentistry
is not recognized as a specialty by the
American Dental Association. “Dental
implants is not a specialty in itself, but
it is part of other specialties,” Domagala
says. As such, he offers additional advice
to help patients connect with the right
implant dentist.
Domagala suggests exploring candidates within periodontistry and prosthodontistry first, as both require extensive
implant training.
Prosthodontists have at least two extra
years of training beyond general dental
school and receive extensive training in
placing artificial teeth on top of dental
implants. But that’s just half of a dental
implant procedure. Only a handful are
also trained in the actual surgical preparation and placement of the implants.
Periodontists are specially trained in
both the surgical prep and placement of
dental implants, as well as how to deal
with any post-implant problems.
“At least 50 percent of their training is
in dental implants,” he adds.
Along with the person’s training, check
into what technology is used. Dentists
interested in modern procedures often
have advanced technology on-site and
the training to operate it. At Domagala’s
practice, you can find the various dental
specialties and advanced technology all
under one roof.
“There aren’t too many practices that
offer a surgical suite, prosthetics suite, everything essentially being made in house,
eliminating the need for patients to walk
office to office,” he says.
Also, patients should ask to see before
and after photos from a case similar to
theirs. An experienced implant dentist
will have plenty of photos to review
(Domagala takes photos of every single
patient during and after the procedure).
Finally, though cost is important,
remember that cheaper isn’t always the
better deal, and more expensive doesn’t
necessarily equate to a more experienced
provider. “Don’t let price be the deciding factor,” Eslami adds. “Rather, when
choosing someone, let experience and
training be your guide.” ◆
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