Dental Interview with Our Expert At Julian Center

Dr. Eberts Gene, what are some of the major sticking points that people have about getting dental implants? And how would you advise they overcome them?

Dr. Sambataro: Well I think most people think they are expensive. They ask questions like “What is the cost? Is my insurance going to cover it? Why go through this? I am okay without a tooth there.” So it comes down to educating the patient about the importance of replacing the tooth and the negative effects if you do not replace it.

Dr. Eberts Could you go into the effects just a little bit, so we understand better what are the advantages or disadvantages of replacing a tooth.

Dr. Sambataro: Well if you do not replace the tooth, the forces that are generated when you bite have to now be distributed among fewer teeth. Regardless, the force is 100%, so if you take a tooth out it is still 100%. Where does that other 10 or 15% of the force of that tooth go…

Dr. Eberts On the other teeth.

Dr. Sambataro: On the other teeth. So you get a domino effect. You lose one tooth, then you lose two teeth, then you lose three teeth. It certainly decreases your ability to chew; it causes teeth to shift so it can throw your bite off.

Those are all reasons why you would want to replace the tooth. Then the question is “well what are the options?” We talked a little bit about a partial denture, that is the least expensive, least invasive, but probably the most bothersome and the one that the compliance is very low.

If I got $1 for every partial that is sitting in somebodies drawer, I would be a very wealthy man. I mean they are just not comfortable. The second option, and not in any preferable order, is the bridge. You have to cut adjacent teeth down.

Dr. Eberts Probably healthy teeth too?

Dr. Sambataro: A lot of the times it is healthy teeth. And both option one and two do not preserve the bone. So if you look at cost, the cost of a bridge, a three unit bridge replacing one tooth, is going to be the same as about an implant. So there is not really a cost factor, when you consider that it is probably double what it would be for a partial denture. But, if you are going to put a bridge in, so if cost was your issue why wouldn’t you do that? You are going to save cutting down the other teeth. Plus, long term it is actually cheaper, because if you do a bridge, I can guarantee you that at some point in your life time it is going to need to be replaced.

Dr. Eberts It is going to fail.

Dr. Sambataro: So if you are fifty years old and you live to ninety it might need to be replaced two more times. It just does not make sense. With the implants, as I said earlier in our discussion, they cannot get decay, they cannot get gum disease. So cost should not be a factor, unless you are going to go with the partial.

Dr. Eberts In fact you could probably argue that it is the least expensive other than the partial, the denture.

Dr. Sambataro: But you can also do the same thing with the partial. Guess what, they do not last. They only last as long as the bridge. So they are uncomfortable, I can’t tell you how many patients I have with partials that they lose them.

They are at a restaurant and they do not want to take it out while they are there, so they go in the bathroom, take it out, clean it, put it in a napkin and they leave it somewhere. It gets lost, they cannot find it.

I have seen a number of patients who spend whatever it was for the partial and within a year they lost it, they had to buy another one. So now they are up to the cost of an implant.

Price can be a concern if you are missing multiple teeth. Let us say you are missing eight teeth on the top. Obviously a denture is going to be a lot less expensive. But you are going to have all the problems with chewing, with the denture falling out, with having to replace the lost or broken denture, with not being able to taste your food because it is covering the palate.

These are some of the factors that will still favour the implant. And there are other options you can do, for example a hybrid type thing. You can put two implants here and two implants here and then put a denture in there so it pops in place, so it stays. Or you can do a bridge with implants. So there are a lot of other options.

The other objection I guess is that there is a surgical procedure involved in the implant. But I can tell you, it is not that big a deal. I am saying that from the surgeon’s perspective. I know it looks like a big deal from the patient’s perspective, but to ease their mind, in order to place an implant it means a tooth was taken out. And I can tell you having a tooth extracted is much more traumatic.

And the analogy that I use is think about a time when you went out in the front yard and you dug a hole and put a plant in it. So you dig a nice hole, move the dirt around, put the plant in, put the dirt over it – that is like doing an implant.

Five years from now that plant dies or you want to put a different plant in there. You have to dig it up. All these roots growing all over the place, so think of the ease of putting that plant in versus the removal. Just like that it is much more difficult to take a tooth out, which you have already experienced so you know what that is like and now they are going to put an implant in.

So think about the implant just like the plant, dig a little hole put the implant in there. So it is still surgery, you have to get anaesthesia, but it is not a big a deal. But I think there is a misunderstanding because people think it is a big deal.

Now there was a time when it was a big deal, but we are not going into the gory details. The implants from the 1970’s and 80’s required quite an extensive amount of surgery. This is now a very simple process.

I cannot think of any other reason why people would object; it would be the cost which we have covered, the surgical procedure, I do not know, are there anti-implant people? Some new movement, some new organization?

If you want to get truly biological anything that is implanted into living tissue is an issue. If we had stem cells, zirconia implants, titanium implants I would do the stem cells. Guess what – we don’t have stem cells available.

Dr. Eberts We grow the new teeth.

Dr. Sambataro: We grow new teeth. Right now June 2015 we don’t have that available.

Dr. Eberts So other than that, what do you see as the future of dental implants? Where do you see dental implants heading in the next months or years?

Dr. Sambataro: Well I would say based on statistics, baby boomers are starting to retire. They have the money to afford these things. Statistics say that at the age of sixty, somewhere like 75% of those people are missing at least one tooth. And then a certain percentage are missing two or three teeth.

So you are going to see a similar thing we saw in our parent’s generation but the option were partial dentures, for the most part that is what I remember. My grandparents they all had dentures. I think with the available discretionary funds, the advantages of an implant over partials, I think people are more prone to do that where they would not do a partial. Because they say “I am not doing a partial now no matter what.” Even if it does provide additional function, prevent the teeth from shifting, they are just not going to do it. I think now that we have something that is more comfortable, more natural I think that it is going to be if it is not already, the growing part of dentistry that was similar to the cosmetic dentistry of the 90’s. When everyone wanted to do veneers and whitening.

Dr. Eberts So what it is going to take however is education. People need to understand these new changes and new technology, the new material that is being used, the ease of it. It is just a matter of getting the word out essentially, which is what this video is about.

Dr. Sambataro: Exactly, people do not do things because they are confused, they don’t understand so they do nothing if they are confused. Also, there is some level of fear because of the unknown., Because they picture in their mind implant…If you think implant and you talk about it like a knee implant, like a hip implant that sounds pretty aggressive, that sounds pretty traumatic but it is not it is not for a tooth implant.

There is a lot of promise there. I think it is really going to change the face of dentistry. The other piece I see is the number of dental implant marketing pieces coming out on a regular basis. And this goes back to, also for me I think is going to be of great concern is a lot of dentist are taking weekend courses and Monday morning they are starting implants. That is not something you should be doing without extensive training and technology.

So if you have that I think general dentist can do this so you do not have to be a surgeon. I know surgeons that I deal with now did the same thing I did, because when they did their residency they were not teaching implants. So they had to take a course. The difference is they obviously have a lot surgical experience, but so do I. I mean I did a residency and I have been doing surgery and I do a lot of extractions mainly because we do not believe in root canals. So it is just a nice fit for me to go from A-Z.

Dr. Eberts Coming from the perspective of the general public how would a person know whether or not a dentist has the kind of background and training that would be required to do this effectively?

Dr. Sambataro: Well I think it is your right to ask.

Dr. Eberts What would they ask though? What would I ask you?

Dr. Sambataro: What degree of training have you had? If they start to waffle – “oh I took a course” or did they take a program that was comprehensive. As I said mine was over 130 credit hours, plus live participation, supervised live training. So that is what you need to do.

If you have taken a weekend course …And for a lot of these weekend courses they are placing implants in pig jaws… that is there experience. Monday morning they bought themselves an implant kit and they are starting to place implants.

I think that some of the material I’ve read is convincing, you really can do this and there are probably some that they can do. Hopefully they are being very selective, but I think it is not adequate. I would ask for some certification from the program that they have taken.

Dr. Eberts Okay, that is all that I pretty much all that I had to ask, but one last question. Is there anything you could think of that could get the audiences heart racing if they just knew about it in terms of dental implants?

Dr. Sambataro: I think now the ease of it, like we talked about. I can get the implant the same day. I can actually get a temporary crown on it. It is funny you asked that question because this Monday we have a patient who is in …I think her son’s wedding is next weekend and she is freaking out because she does not have a front tooth.

So we are going to deliver her front tooth Monday. Whereas before we would say no, what we could do is we could make you this little flipper thing that flips in and out. So that I think is very exciting.

One the procedure is not as traumatic as it use to be, two the delivery is easier and faster. And the cost is really in line with what it cost to get the bridge. And zirconia is more compatible and more aesthetic, that is exciting. Because I have seen a lot of patients who have had titanium and their biggest complaint is that they see this black line up at their gum line.

Dr. Eberts I have seen that.

Dr. Sambataro: So with titanium, you get a nice pretty crown and you go smile and someone says “There is something on your gum.” With the zirconia, even if you get a recession, it is not going to stand out.

Dr. Eberts Well thank you it has been very informative and I hope you folks have learned something good about this. We will be looking forward to talking more.

Dr. Sambataro: Okay, me too.

Ellicott City Dental Interview Three