Tooth implant

Author
Discussion

Halb

Original Poster:

53,012 posts

183 months

Wednesday 20th December 2017
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I have a tooth that requires removal, so this is going to happen, it's my first tooth extraction. I had fillings wayback in sixth form and a gold tooth but that's it.

Looking at options, there are; bridge, denture, leave it or implant.
I think best for long term jaw health is an implant, but clearly the cost is prohibitive.
A friend suggested a dental plan or a dental school which might do it at a more reasonable rate.
What are the thoughts of dentists of PH?

Driller

8,310 posts

278 months

Saturday 23rd December 2017
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Halb said:
I have a tooth that requires removal, so this is going to happen, it's my first tooth extraction. I had fillings wayback in sixth form and a gold tooth but that's it.

Looking at options, there are; bridge, denture, leave it or implant.
I think best for long term jaw health is an implant, but clearly the cost is prohibitive.
A friend suggested a dental plan or a dental school which might do it at a more reasonable rate.
What are the thoughts of dentists of PH?
Hi Halb,

I couldn't not answer to this as this is my speciality.

First thing to say is that the person who takes the tooth out must do it very carefully so as not to break off any small pieces of bone on the cheek side.

Next thing is depending on where the tooth is and how your teeth line up, it'll almost certainly need replacing but possibly not. Which tooth is it?

You are very well informed with the 4 options you give. No one wants a denture if they can avoid it. They are uncomfortable and bad for the mouth in the long term.

A bridge works but it means mutilating the two teeth next to the gap to hang the new tooth on. If there's no tooth on one side of the space then you can't do a bridge anyway. Also it means joining teeth up together which makes it more difficult to clean between then and makes it more likely to get decay in these teeth. You don't want to start with 1 gap and end up with 3!

If tooth replacement is indicated and a few conditions are met then an implant is by far the best solution as it's vey reliable and doesn't involve any other teeth. It's like having a brand new tooth.

Yes the downside is that it's relatively pricey but you have to think of it as an investment. If you take care of it, it will last a lifetime.

If you do go the implant route make sure to check which system the dentist uses as, like everything, there are different qualities.

I use a system called Straumann, it's Swiss-German and is considered with Nobel Biocare and a couple of others to be the best. The implants contain Type 4 titanium which is pure and inert. Other companies use Type 5 which contains Vanadium and Aluminium which can react with your body and get released.

Sorry for any typos, off to work!

Depthhoar

674 posts

128 months

Saturday 23rd December 2017
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Not a dentist but had an implant a few years ago and am considering another one to replace a molar. First implant was for an upper front tooth (old rugby injury; implant to replace an old crown). Delighted with the result but the placement of the titanium foundation felt like GBH; wasn't offered any form of sedation as I was considered a 'good patient' by the local dentist who referred me to the implant specialist. Looking back would have opted for temazepam. Cost was £1800 seven years ago.

New quote for a rear upper molar is £3500 at what I am told is a leading implant specialist down in Perthshire - a 200 mile round trip away. (My proposed treatment involves 'panoramic' X-rays and CT scans + the nitty gritty stuff actually in the mouth and nil/minimal bone graft - sinus lift procedure not necessary).

The Perthshire place is a much plate glass establishment with many, many receptionist type people + posh coffee machines, leather sofas, wifi etc etc. Reminded me of my local new BMW dealership premises! The implant specialist has won many awards and lectures on the subject and is apparently the 'go-to' person for this sort of dental work, but is not cheap for this neck of the woods. He too uses the Straumann system. This particular implant isn't absolutely essential for me so I am considering my options. If money wasn't an issue I'd probably just do it since I'm delighted with my first implant. I'm told that placing this implant won't involve as much GBH...



Edited by Depthhoar on Saturday 23 December 22:06

Halb

Original Poster:

53,012 posts

183 months

Saturday 23rd December 2017
quotequote all
Driller said:
Hi Halb,
I couldn't not answer to this as this is my speciality.
First thing to say is that the person who takes the tooth out must do it very carefully so as not to break off any small pieces of bone on the cheek side.
Next thing is depending on where the tooth is and how your teeth line up, it'll almost certainly need replacing but possibly not. Which tooth is it?
You are very well informed with the 4 options you give. No one wants a denture if they can avoid it. They are uncomfortable and bad for the mouth in the long term.
A bridge works but it means mutilating the two teeth next to the gap to hang the new tooth on. If there's no tooth on one side of the space then you can't do a bridge anyway. Also it means joining teeth up together which makes it more difficult to clean between then and makes it more likely to get decay in these teeth. You don't want to start with 1 gap and end up with 3!
If tooth replacement is indicated and a few conditions are met then an implant is by far the best solution as it's vey reliable and doesn't involve any other teeth. It's like having a brand new tooth.
Yes the downside is that it's relatively pricey but you have to think of it as an investment. If you take care of it, it will last a lifetime.
If you do go the implant route make sure to check which system the dentist uses as, like everything, there are different qualities.
use a system called Straumann, it's Swiss-German and is considered with Nobel Biocare and a couple of others to be the best. The implants contain Type 4 titanium which is pure and inert. Other companies use Type 5 which contains Vanadium and Aluminium which can react with your body and get released.
Sorry for any typos, off to work!
THank you for a most informative answer.
Well the situation is a might worrisome for me as I don't like thr thought of it at all. I am fairly sure thge dentist at my practice, Padgate in Warrington explained the possible options, I then spent the next day looking on the web. I look after my teeth and feel I've been a tad unfortunate. It was my gold tooth/crown, it fell out with an opal fruit, I guess since there was weakness below, it's been in for over 20 years. The dentists took a look but said the crown can't just go back in as the tooth is not in a good enough condition to take it, and should come out. I don't know if a second opinion is worthwhile here?
Looking at this graphic the tooth is the first molar on my lower right side.

cringle

397 posts

186 months

Saturday 23rd December 2017
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Halb, chances are the tooth is not restorable if it’s had decay beneath the crown and the dentist has already stated it needs extraction. 20 years service is a pretty successful treatment?! And to be fair and frank, it sounds as though the tooth has been lost due to ineffective cleaning, the crown on top was/is probably intact. Like Driller, I place Straumann implants; probably the best on the market and very high success rates, although probably the most expensive implant out there. It’s what I would want in my mouth. Dental schools won’t touch this as they only provide implants for teeth lost due to diseases like cancer or trauma like RTA’s. They won’t do it for a tooth lost to decay as this is seen as neglect. Ballpark figure around the Northwest for a decent job is £2000-2500. Ensure any treating dentist does a full protocol i.e. pre treatment models of the teeth, a CT scan etc. Avoid the Groupon offers as many corners are cut and cheapo implants are used. Good luck

Driller

8,310 posts

278 months

Saturday 23rd December 2017
quotequote all
Halb said:
THank you for a most informative answer.
Well the situation is a might worrisome for me as I don't like thr thought of it at all. I am fairly sure thge dentist at my practice, Padgate in Warrington explained the possible options, I then spent the next day looking on the web. I look after my teeth and feel I've been a tad unfortunate. It was my gold tooth/crown, it fell out with an opal fruit, I guess since there was weakness below, it's been in for over 20 years. The dentists took a look but said the crown can't just go back in as the tooth is not in a good enough condition to take it, and should come out. I don't know if a second opinion is worthwhile here?
Looking at this graphic the tooth is the first molar on my lower right side.
If it's the 1st lower right molar then yes that really should be replaced. It's a large tooth which provides a lot of chewing surface/power not to mention the question of the stability of the surrounding teeth.

I agree with Cringle that by the sound of it the root is too knackered to be able to hold onto the crown. The root substance is probably soft and broken down-a bit like trying to get a nail to stay in a piece of spoiled wood. Still, if you have time and the chance to get another opinion, why not?

As far as the procedure goes, frankly for 1 tooth with good bone volume after sympathetic dentist has removed the tooth (this is the reason I mentioned this before), you're looking at 30 minutes from the time you're in the chair to the last stitch being put in. There aren't really any nerves in bone so after the gum has been numbed up you'll be perfectly comfortable for the whole time.

The actual working time is 5-10 minutes for preparing and placing the implant so you're not sitting there the whole time with the dentist banging away. (NB there is no banging involved!). Leave it to heal for 2 months (can be less) then impressions and a week later you should have your new tooth smile





Armitage.Shanks

2,276 posts

85 months

Saturday 30th December 2017
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How come you see all these adverts for c£650 all in?

cringle

397 posts

186 months

Sunday 31st December 2017
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How come you see some new cars for £7k and some for £700k? The processes, R&D, materials and manufacturing processes are completely different. Dental practices and dental practitioners also vary widely, as do the training they’ve undertaken and the materials they use. The £650 implants are cheap pieces of metal stuck in usually without a CT scan or presurgical models, so lack of planning, and the crown to go on top will be made by the cheapest(worst) dental lab around. The dentist probably doesnt care too much either.

To give you an idea of my costs, the CT scan is £140, study models £70, surgical drill guide £165(if required), actual titanium implant £265, single use surgical equipment £100, porcelain crown and components to go on the implant £430. If grafting is required the materials are around £140. So hard costs can be as much as £1310. Then my time and that of my staff needs to be paid for, my investment into my implant training alone was around 35k, with ongoing courses and a hell of a lot of reading and learning in my own time. Extra insurance is also required and lastly software licenses for the dedicated implant planning software needs to be paid for too

Halb

Original Poster:

53,012 posts

183 months

Sunday 31st December 2017
quotequote all
Well it came out on Thursday, the dentists had to work hard, it didn't wanna come out, eventually after some time it did.

ON FB I saw
The Dental Academy - Daresbury/Smiles & More, my sister tagged me in them, I enquired about Straumann, The Dental Academy replied that their systems are biomet and Neodent, Neodent being owned by Straumann. They said there is no 'best' system as such, just different ones that different dentists prefer.
I guess I've got a wait of at least a month before I can have one in?

Yipper

5,964 posts

90 months

Sunday 31st December 2017
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You should have gotten a 2nd dentist opinion. You should always try and save a tooth and never pull them out. They aren't making any more of them. Nothing beats Mother Nature. Dentists like to pull teeth because it is easier and requires less skill.

Be aware -- implants are not a permanent solution. A surprisingly large number of them go wrong. You could be left with a hole in your face for up to 2 years and all the bone-withering and face-structure-shrinking that goes with it. Some people get facial nerve damage from the process.

Mr Pointy

11,225 posts

159 months

Sunday 31st December 2017
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Driller said:
As far as the procedure goes, frankly for 1 tooth with good bone volume after sympathetic dentist has removed the tooth (this is the reason I mentioned this before), you're looking at 30 minutes from the time you're in the chair to the last stitch being put in. There aren't really any nerves in bone so after the gum has been numbed up you'll be perfectly comfortable for the whole time.

The actual working time is 5-10 minutes for preparing and placing the implant so you're not sitting there the whole time with the dentist banging away. (NB there is no banging involved!). Leave it to heal for 2 months (can be less) then impressions and a week later you should have your new tooth smile
If it's 30 minutes work why are patients being quoted £2500-£4000 for one implant? That sounds like a rip-off to me & maybe it's time charges were regulated.

craig1912

3,301 posts

112 months

Sunday 31st December 2017
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I’ve had two- one 15 years ago (a Branemark?) and one this year (Straumann).

Just feel like normal teeth- no pain. The latest one involved a CT scan (at a specialist centre) impressions, visit to dental lab to match colour, bone graft, about 5 mths with denture whilst the implant took, abutment fitted and two weeks later crown fitted. About 6 mths, spent about two hours in chair (inc extraction) and about £4k. Both lateral incisors.

Definitely worth it and as said above an investment in your appearance and health.

Edited by craig1912 on Sunday 31st December 12:02

CharlesdeGaulle

26,267 posts

180 months

Sunday 31st December 2017
quotequote all
Mr Pointy said:
If it's 30 minutes work why are patients being quoted £2500-£4000 for one implant? That sounds like a rip-off to me & maybe it's time charges were regulated.
Read cringle's post 3 or 4 above yours.

DocJock

8,357 posts

240 months

Sunday 31st December 2017
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Yipper said:
You should have gotten a 2nd dentist opinion. You should always try and save a tooth and never pull them out. They aren't making any more of them. Nothing beats Mother Nature. Dentists like to pull teeth because it is easier and requires less skill.

Be aware -- implants are not a permanent solution. A surprisingly large number of them go wrong. You could be left with a hole in your face for up to 2 years and all the bone-withering and face-structure-shrinking that goes with it. Some people get facial nerve damage from the process.
Why don't you stick to subjects you know something about?

Driller

8,310 posts

278 months

Sunday 31st December 2017
quotequote all
Halb said:
Well it came out on Thursday, the dentists had to work hard, it didn't wanna come out, eventually after some time it did.

ON FB I saw
The Dental Academy - Daresbury/Smiles & More, my sister tagged me in them, I enquired about Straumann, The Dental Academy replied that their systems are biomet and Neodent, Neodent being owned by Straumann. They said there is no 'best' system as such, just different ones that different dentists prefer.
I guess I've got a wait of at least a month before I can have one in?
Hi Halb, glad it came out ok and hopefully the bone is in good shape. You need to wait 2 months for it to heal up and then have a scan before they can plan the implant placement.

I have looked and can’t find any specific info on the titanium type of the Biomet (Zimmer) implants and I’m pretty sure they and the Neodents are classV titanium so with Vanadium and Aluminium impurities. Having said that, Zimmer is an established system and Neodent now has been bought by Straumann.

It’s rather more complicated than just saying that the systems are “just different”. Personally if I needed an implant I wouldn’t have anything except Straumann or Nobel Biocare.

How much have they quoted you? I would class the Zimmer as a mid range implant and the Neodent as a low-cost one which probably costs less than £100 per implant for a lot of the range.


Mr Pointy said:
Driller said:
As far as the procedure goes, frankly for 1 tooth with good bone volume after sympathetic dentist has removed the tooth (this is the reason I mentioned this before), you're looking at 30 minutes from the time you're in the chair to the last stitch being put in. There aren't really any nerves in bone so after the gum has been numbed up you'll be perfectly comfortable for the whole time.

The actual working time is 5-10 minutes for preparing and placing the implant so you're not sitting there the whole time with the dentist banging away. (NB there is no banging involved!). Leave it to heal for 2 months (can be less) then impressions and a week later you should have your new tooth smile
If it's 30 minutes work why are patients being quoted £2500-£4000 for one implant? That sounds like a rip-off to me & maybe it's time charges were regulated.
Well you’re reply seems rather disingenuous Mr Pointy. I was reassuring Halb that from his perspective and with the condition of good bone volume after a completely atraumatic extraction, the clinical time is about thirty minutes.

This doesn’t include time or cost for any of the other things that Cringle mentioned including planning, the scan and preparation of the surgery room, just the actual placement of the implant.

If you’d like to tell me what you do for a living and how much you’re paid perhaps I could then make a judgement as to whether your salary should be regulated?




Edited by Driller on Sunday 31st December 13:32

4Q

3,362 posts

144 months

Sunday 31st December 2017
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I’m in need of a couple of front teeth, one of which is on a bridge and one denture which I need to have replaced with implants. How would I go about finding a dentist to do this as my dentist doesn’t do them? I’m based in north Derbyshire but happy to travel if anyone has a recommendation.

Mr Pointy

11,225 posts

159 months

Sunday 31st December 2017
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Driller said:
If you’d like to tell me what you do for a living and how much you’re paid perhaps I could then make a judgement as to whether your salary should be regulated?
I'm currently singularly unimpressed by the dental profession (as you can probably tell) given my recent experiences. I've just spunked out £650 for a root canal filling to replace a failed one & was warned that sucess wasn't guaranteed & I might need an even more expensive apiciectomy if it didn't. That was for less than an hour in the chair with just two X-rays, no complex CT or other costs.

On my last visit the dentist discovered decay below a filling for which he recommended a Cerac onlay costing a mere £600.

This isn't even with the dentist I've been seeing for 20 years now: he makes so much money from doing more advanced treatments such as implants that he no longer bothers with performing standard treatments & has palmed those off onto more junior collegues in the practice.

As for what I do? Well the last job was managing a £4million project with around 20 contactors under me for the princely sum of £400 a day, out of which I have to pay all my own expenses from PCs to CAD software & PI insurance.

Driller

8,310 posts

278 months

Sunday 31st December 2017
quotequote all
Make sure you read to the end.

Mr Pointy said:
Driller said:
If you’d like to tell me what you do for a living and how much you’re paid perhaps I could then make a judgement as to whether your salary should be regulated?
I'm currently singularly unimpressed by the dental profession (as you can probably tell) given my recent experiences. I've just spunked out £650 for a root canal filling to replace a failed one & was warned that sucess wasn't guaranteed & I might need an even more expensive apiciectomy if it didn't. That was for less than an hour in the chair with just two X-rays, no complex CT or other costs.

On my last visit the dentist discovered decay below a filling for which he recommended a Cerac onlay costing a mere £600.
Well yes I definitely got the impression that you had something against the profession hehe

You seem to have had some bad luck with your teeth but that's not of course the dentist's fault is it? I know it can seem expensive but those prices are based on all sorts of overheads most of which you couldn't even imagine. And if you've had a bad experience it's not fair to tar us all with the same brush.

It's true that if you're going to a private practice in the UK then the dentist is free to choose his prices according to his overheads which is good for him. Here in France it's not the same system and a lot of the conservative treatment (fillings, root canals and extractions) is capped. That root canal filling would have cost you €80 at most over here and half of that if it was an incisor which is really good in a way for the patients but on the other hand because it's so stupidly cheap some dentists just bodge it because they actually like to have a salary at the end of the month.

So you pay your money and take your choice. A common reply on PH (which rather annoys me to tell the truth) is "If you don't want to pay for it, don't buy it then".


Mr Pointy said:
This isn't even with the dentist I've been seeing for 20 years now: he makes so much money from doing more advanced treatments such as implants that he no longer bothers with performing standard treatments & has palmed those off onto more junior collegues in the practice.
Well that's not really fair is it? Have you not progressed and been promoted in your career? Would you like to still be doing the same thing you were doing when you were 23?

Would you expect a neurosurgeon or a cardiologist to be taking people's temperature and handing out prescriptions for cough medicine?



Mr Pointy said:
As for what I do? Well the last job was managing a £4million project with around 20 contactors under me for the princely sum of £400 a day, out of which I have to pay all my own expenses from PCs to CAD software & PI insurance.
Well how ironic. You earn more money than I do then and some months twice as much and I'm booked up 4 months in advance.



Edited by Driller on Sunday 31st December 14:02

Armitage.Shanks

2,276 posts

85 months

Sunday 31st December 2017
quotequote all
cringle said:
How come you see some new cars for £7k and some for £700k? The processes, R&D, materials and manufacturing processes are completely different. Dental practices and dental practitioners also vary widely, as do the training they’ve undertaken and the materials they use. The £650 implants are cheap pieces of metal stuck in usually without a CT scan or presurgical models, so lack of planning, and the crown to go on top will be made by the cheapest(worst) dental lab around. The dentist probably doesnt care too much either.

To give you an idea of my costs, the CT scan is £140, study models £70, surgical drill guide £165(if required), actual titanium implant £265, single use surgical equipment £100, porcelain crown and components to go on the implant £430. If grafting is required the materials are around £140. So hard costs can be as much as £1310. Then my time and that of my staff needs to be paid for, my investment into my implant training alone was around 35k, with ongoing courses and a hell of a lot of reading and learning in my own time. Extra insurance is also required and lastly software licenses for the dedicated implant planning software needs to be paid for too
Ah so that's why the chap who owns Kiss Dental in Manchester can afford a new Ferrari and various other exotica every few months?

cringle

397 posts

186 months

Monday 1st January 2018
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Armitage shanks I hope you haven’t named yourself after the shade of your teeth?! smile

Driller you are too nice my man.

Decay is avoidable. This is not up for discussion. It is caused by sugar and plaque .. which means you are NOT cleaning away all the plaque like you should be doing, and having sugar TOO FREQUENTLY. So if you bring your self inflicted, avoidable problems to a dentist, be prepared to spend a bit of cash for a decent job to be done.

If you kept driving your car into a wall over and over would you walk into your local dealer and act like the damage was their fault? Would you walk into their dealership and declare you hated them? (“I hate the dentist” is what we hear a lot of the time when new patients attend) Would you accept the fee of a few hundred or a few thousand quid to fix your self inflicted situation as reasonable??

Dental practices cost around £100/hour to run in the UK, before the dentist takes a penny home. As for mr smarty pants above who said why are we charging 2500-4000 for “30 minutes work”. Well its not 30 minutes work, it’s around 4 hours of surgery time as well as the costs detailed in my previous post, and a 12 month guarantee too. If YOUR body rejects the implant, through no fault of the dentist’s, the same way a kidney could be rejected after a transplant, guess who has to do 4 hours work all over again for free? And yes this does happen. To be fair, patients in the UK are bloody hard to treat as the NHS has spoilt them and a lot of them do not appreciate the costs and expertise involved.

I’m not looking for sympathy for dentists. I just hope anybody reading this takes responsibility for their teeth and problems and appreciates how hard a job being a dentist is.