Dental implant and sinus lift

paddypaws101

I have found a local dentist offering implants at a really good price and am thinking of having two. First one in lower jaw is routine, but second in upper jaw would require an internal sinus lift.
This procedure worries me somewhat, despite the dentists explanation of it being a 'mini' lift.
Does anyone have any experience or opinions to share?

tonyhamm

Sinus lift looks terrible (see videos on youtube) - but in reality because its cartilage that the drill goes through, its not as bad as it looks. I like shocking people by saying this is what I cannot wait for, and showing them the youtube video of a sinus lift.

The main things for me;
1. The latest technology - Is that they do not irradiate me with CT scans - I have chosen only dentists with the i-Cat x-ray CT machine which cuts down massively on radiation. (A normal CT scan gives a seroius amount of radiation - its not like a normal x-ray, and it is a factor to minimize if you can).
2. Experance of surgery and procedures- and UK based and regulated.
3. Materials - The stuff used for the bone graft and sinus lift filling.
4. Price.

I have been debating about going to a very experienced dentist, or going to one of the new implant chains like http://www.dentalcareplus.org.uk/manchester-clinic.htm




Sinus Lift Lateral Window Method 995
(Atraumatic) Tooth Extraction 70
Guided Bone Regeneration? 295
CT Scan, X-Ray and analysis 195
Single Implant 1,295
Total 2850
So about £3000 for my upper back molar if the lateral Window sinus lift is used. If the Summers Sinus lift is used, then about £2200.

Toothsmith

The one thing I dislike about 'chains' is that you need to know 'who' is doing the procedure,and be able to check them out, and see their qualifications and get recommendations.

Often with chains, there is a high throughput of dentists, with qualifications that aren't always UK based, so not easy to check.

If you can satisfy yourself on those points though, then it should be fine to go there.

tonyhamm

The qualifications and experience of chain surgeons is a big worry. They may big up the fact they have someone on staff from the Royal College of Surgeons with a Masters in Implantology - but you can almost guarantee thats not who is going to be doing your implant, and your to be part of a learning curve. I read that 50% of the first 50 implants placed by a surgeon learning his craft are below quality.

I have the added complication of Periodontal disease, due to tooth loss where a upper molar was lost, and absorbsion took place, meaning the gums of neighbouring teeth became looser and the periodontal attachments were inevitably attacked by periodontal bacteria with bone loss and the adjecent teeth moved. The periondontal disease means I will now lose the tooth, and thus am looking at an implant.

I fear a chain may also be keen to minimise the amount of time they spend on a patient and may do an extraction followed by bone graft in one procedure without giving 8 weeks to make sure the site is cleared of any periondontal infection by the immune system.

brook2jack

The number one contraindication for implants is active periodontal disease.

Implants can be lost as easily or easier than natural teeth to periodontal disease.

It is completely pointless having implants until your gum disease is under control, and periodontal disease has nothing to do with having teeth out and everything to do with having excellent oral hygiene, not smoking , and having no underlying conditions such as diabetes.

Do you see a hygienist regularly and do you understand how meticulous you will have to be with oral hygiene? Most implantologists will want you to see a hygienist every three to six months.

I would also have a word with your dentist/hygienist about how periodontal disease develops, it is not inevitable once a tooth comes out and having a tooth out does not make the gums of the neighbouring tooth looser. It is really important you understand your role in controlling gum disease before spending alot of money on treatment that may be compromised or lost quickly if your gums are not stable.

Did your dentist recommend implants?

tonyhamm

In my case this sort of thing happened to my upper molar.
http://www.youtube.com/watch?v=1FRuOwQ4VEw

So the peridontal disease at this site is only so severe because of the earlier tooth loss, and adjecent tooth movement.
I have been subject to root planing and scaling at this site, by the local Dental Hospital due to the pain and infections, after I demanded a refferal, (which took ages). The disease has stablised in other pockets which were only 4mm or so. However, at this site the pocket in this molar was >7mm. I do not smoke or have any health problems like diabetes.

Even though it was scaled and planed at the hospital, and this 7mm pocket reduced, after about a year the disease reemerged.

I have the normal regular polishing and scale cleaning by my dentist - but its not a periodontal service - and they will not monitor pocket depth, or plane/debride pockets. Such a periodontal service from a local dentist is seemingly impossible to get on the NHS. My teeth are so clean nowadays, with total lack of tartar etc.. the Dental hygienist's normal scaling and polishing efforts are prob. not adding anything.

No matter how careful I have been with my oral hygiene (twice daily ultrasonic toothbrush, tepe brushes, floss, mouthwash) the site with this particular molar tooth (at a odd angle) has been reinfected by periodontal bacteria to a severe degree. I can feel the pressure now. I have even had a few attacks of fever from it.

There is a long waiting list for periodontal treatment at the local hospital - at least 4 months if not longer. When i asked in disbelief about the waiting time, the receptionist said that waiting list is so bad because lawyers have now suddenly caught onto the fact that a patient subject to any delay, or worse - not being referred at all for periodontal treatment by a local dentist means the dentist is liable for all subsequent damage in law. This has meant a recent flurry of referrals has extended the waiting time.

I have been looking at what I can do if I give up on this tooth, and get an extraction and implant instead. From what I have read, if the tooth is extracted and the site is left for 2 months, the periodontal disease will be overcome by the immune system, and the site will then be disease free. Sinus lift and bone grafts can then take place.
See - http://www.osseonews.com/periodontal-disease-a-contraindication-for-dental-implants/

brook2jack

Taking a tooth out cures the gum disease in that area, but putting an implant in when nothing has changed in terms of oral health means the implant will be lost quickly.

Scaling and root planing does not cure gum disease, it reduces the bacteria for a short while until you learn how to clean effectively in the area.

Loosing teeth and teeth moving do not cause gum disease.They may make it more difficult to clean and it's plaque building up that causes gum disease.

Implants are not fit and forget, if you have had gum disease you may need three monthly maintainance visits. Implant maintainance is not available on the nhs.

However no implantologist will place an implant on someone with active gum disease. You may be well advised to seek out a private dentist who will help you control your gum disease and whose hygienist is well versed in implant maintainance.

Have you actually seen anyone or have you just diagnosed yourself as needing implant and sinus graft? Very many people are not suitable for implants, many teeth are not suitable to be replaced by implants.

If you want to invest in your teeth getting the basics right so you can keep your remaining teeth would seem to be a wiser investment. Investing in private gum care to help you look after the rest of your teeth would seem better than planning for an implant you may not be suitable for. Again have you discussed any of this with your dentist?

Toothsmith

You'd be better off, long term, spending your money on a reasonably priced private practice for general maintenance - regular visits to hygienists etc, rather than a big, costly treatment that won't be the 'one off fix' you're probably hoping for.

Implants take as much, if not more maintenance as natural teeth, and if stuff is going wrong with your own teeth, it will also go wrong with your implants.

You will need more than a visit to an average NHS dental practice once or twice a year to look after your implants once fitted, so you might as well get used to paying for a greater level of care before its done, rather than it being a surprise afterwards.

Hopefully, you'll be told all this during your initial consultations anyway.


Edit - I was quite a long time writing that, as I was watching TV too! By the time I hit 'send' Brook had posted something pretty similar!

tonyhamm

I appreciate what you have said about the general oral condition of Periodontal Disease in relation to implants.
I will look into maintaining the tooth more deeply.
Maintenance is certainly food for thought. Regular scaling sessions would not be cheap though.

Before it was looked at, the tooth had lost significant bone, with a pocket of over 7mm + mobility. Its at a odd angle nearly impacting on another tooth. I was warned it would be hard to keep it, and, because of the impact gap trapping food, the adjacent tooth may develop caries. The scaling (maintenance) was somewhat successful though.

And another big point is my general health - if there is any chance of stopping the periodontal fevers and infections, the shaky feeling etc.. which ALL come from this one highly compromised single tooth, by extraction, not maintenance, I can only think thats a good thing. (unless the damm implant creates similar problems)

I believe heart disease and other inflammation caused diseases like dementia are very significantly worsened or even caused by regular periodontal infections in the blood.

Would you suggest that getting a bridge is better than an implant, if periodontal disease is such a contra-indication for implants?

(BTW - I have not really consulted anyone yet - I tried to read up and have sketched out the general costs and what likely may be needed if an extraction and implant replacement would be undertaken. )

I would like to stress that apart from the periodontal disease, my other teeth have NO fillings, are pretty white, smooth and clean, gums pink and are in quite good condition - and I have a full set of teeth minus the one I lost.

brook2jack

No dental work is maintainance free and none lasts forever. You should always budget for the the costs of maintainance and replacement. However with gum disease you should be aware it is never cured, it is merely kept under control .It is a long term battle that you will always have to be aware of.


The only person who can answer if a bridge would be suitable is a dentist who can see you and your x rays.

However keeping the teeth supporting a bridge clean and healthy is even more difficult that keeping your own teeth clean and healthy. You need to use special floss like superfloss and be meticulous in cleaning.

Another option may be to not have the tooth replaced at all and leave a gap. That will be the easiest to keep clean.

However the thing that leaps out is you have to talk to your dentist about what the most appropriate treatment plan is for you, as treat planning yourself from the internet is fraught with difficulties. If the tooth is so infected as to be causing you problems the conversation about taking it out should be happening now.

Toothsmith

tonyhamm wrote: »

Maintenance is certainly food for thought. Regular scaling sessions would not be cheap though.

If you want cheap, then implants are not for you.

If you don't want to be tied in to regular maintenance - then to start with, any money you spend on implants might as well have been flushed down the loo.

Just because dentures have been around for centuries, doesn't mean they do not still have a place in modern dentistry. A well constructed set, whilst you're still young enough to adapt to them and get used to them, could easily be a more appropriate treatment for you if cheap(er) is your priority, and you don't want to faff around with regular care.