Earned his DDS in 1971 from the University of California, San Francisco and continued post-graduate training at the Harvard Forsyth Training Center for Clinical Scholars in Oral Biology..Read More
Implants Vs. Root Canal, Crown Exposure or Dental Post
Table of Contents
- Who are the best candidates for dental implants?
- What dental services do you provide?
- What are the benefits of having dental implants as opposed to other forms of dental treatment?
- Do dental implants require any additional maintenance post-op?
- How can ADHP help me make the right choice for appropriate dental care?
Affordable Dental Health Providers, (ADHP) was founded by Ron Barbanell, D.D.S., D.M.Sc., in 1976. We at ADHP believe that appropriate dentistry begins with the concept set forth in the age-old adage “if it isn’t broken, don’t fix it." When teeth do need fixing we believe “less is often more,” meaning we like to provide appropriate, conservative and economical care that achieves good long-term outcomes. We accept as common knowledge that the natural integrity of the dental enamel of “virgin” teeth may be irreversibly and detrimentally altered by any invasive cutting, grinding or other forms of abrasion. Such loss of natural protection (by dental “fixing”) begins a process known as the “cycle of restoration” written about extensively over the years by Dr. J. Bader. The concept generally predicts that teeth with small fillings ultimately and repeatedly get fixed with larger fillings overtime until those teeth often require crowns. Later, many of those “fixed” teeth get replaced by bridges as various other previously “fixed” teeth are often lost due to failed root canal therapy, failed posts, progressive periodontal disease, and mechanical failure.
Based upon your accepting and understanding how delicate teeth really are we urge you to never ever replace a single lost tooth by the traditional method of grinding down to stubs adjacent virgin teeth to accomplish replacement with a “so called” traditional permanent bridge. At ADHP our single implant replacement of one lost tooth costs less than two natural tooth supported bridge replacing a single lost tooth. The dental implant approach does not initiate the “cycle of restoration” that would be the case when cutting two teeth to make the stubs that support this type of “permanent replacement.” Appended is a very objective article by Dr. Gordan Christianson regarding his recommendations and usual fees around the country for both approaches. It is noteworthy that Dr. Christianson validates much of what is set forth herein, as well as shows our fees are at least the national average. He also introduces a subject studied at length by Dr. Bader and others (summaries appended) as to why and how dentists often make treatment planning decisions and why recommendations are so often so radically different between dentists. This will be discussed further below and give you (the consumer) a bit more to consider when picking dentists and their plans for you.
Persons reading this editorial (you) are generally the victims of various forms of dental treatment failures related to the culmination of the “cycle of restoration.” That is why you are seeking information about dental implants and might have benefited from implants sooner rather than have alternatively chosen “fixed” tooth or teeth alternatives, if in fact such alternatives were ever mentioned to you. Your personal and professional care plays a role in outcome, but your genetic predisposition to dental disease is a very dominant factor when considering treatment planning where experience with dental diseases are historically progressive.
At ADHP we “fix” diseased or damaged teeth when that alternative is appropriate. We discourage elective invasive treatment of teeth for subtle esthetic changes. We encourage fillings and crowns be “fixed” by repair, rather than replacement when appropriate because new “fixes” (replacements) always involve more and deeper cutting and grinding of affected teeth. Additional removal of tooth structure to replace dental restorations causes increasing cumulative trauma to the tooth nerve. In addition cumulative violation of the natural integrity of teeth makes them increasingly susceptible and permeable to heat generated by drilling, and inflammation due to applied chemicals. Toxins from bacteria leak into tooth root structure and ultimately to the dental nerve through filling and crowns due to micro-leakage and mechanical failure of fillings. Teeth with root canal therapy become increasingly brittle over time, further compromising tooth integrity and resistance to dental diseases. As “fixing” often involves foreign objects (full crowns) being placed for esthetic reasons beneath the gums, promoting progressive periodontal disease may be another negative consequence. Badly broken-down dentitions with multiple missing or decayed teeth, (commonly in the presence of advanced periodontal disease) can be replaced with more and longer invasive “permanent” bridges to avoid the alternative of removable appliances (partial dentures). However, newer, perhaps better, even more affordable long lasting ways to “fix” major partial or complete edentulism are emerging, and are now more commonly available. These include dental implant strategies of various names such as “Same Day Implants” or “All on 4” and other hybrid approaches which can be more affordable and long lasting than traditional “tooth fixing” approaches to restore full upper or lower jaw dentitions where all or most teeth have been lost. Replacing many missing teeth by relying upon complex, technique sensitive “fixes” using disease susceptible teeth as the support for traditional dental appliances makes predictable long term outcomes of those approaches less favorable than implant supported alternatives.
Implant strategies can provide long-term beneficial outcomes without the predictable and frequent consequences of the “cycle of restoration” amongst patients whose natural teeth are highly susceptible to dental diseases. We promote and perform innovative restorative prosthetics and advanced periodontal therapy, (including periodontal grafting techniques) if the expected life of diseased teeth to be treated by these techniques are likely to provide long-term benefit for the patient who has not been historically predisposed to continuous dental disease and such treatment does not cost more than dental implant alternatives which do seem to provide more predictable long-term outcomes. Saving very compromised teeth for 5 or even 10 years with complicated dental “fixes” is not worth the money, time, or suffering. It is noteworthy that dental scientific literature searches about survival rates of root canal therapy, posts, and crowns virtually never go beyond 10 years, commonly 5 years, and in many instances shorter periods of time. There are no studies we can identify, that categorize samples of patients with high susceptibility to dental diseases versus those who have more effective natural resistance. If such studies were available we believe the rate of failure to those who are highly susceptible would be much greater exposing a higher than published rate and frequency of failures of traditional fixes as opposed to studies of pooled population samples which miss small, but important sub-groups of people who differ from average and therefore have a much worse experience (failure) than is published for the population in general. Our personal experience is most of our implants generally seem to last decades and our patients who have been treated for up to 34 years expect to take their implants with them. There have to be a few exceptions to this generalization that we are unaware of, but this outcome certainly is representative of the vast majority of our treated patients (see our testimonial section). Our experience with appliances that were built upon teeth and implants is that the subsequent problems are almost always with the teeth, while implant support is much more stable.
Placing dental implants usually involves little or moderate discomfort. Implants (as opposed to teeth) do not redecay, they do not necessitate root canal therapy which can fail, and they do not require posts that can fracture tooth roots over the long- term. Implants do not get the same perio disease as teeth although sometimes minor surgeries intervention is necessary. Again the need for this intervention is much less for implants than for teeth. This seems to be because implants appear to be more resistant to your systemic changes and often seem to tolerate less than ideal maintenance as compared to “fixed” teeth. The first implants we placed 34 years ago are still functional. Again, this outcome is common. The need to “fix” implant prosthetics does occur, but not very often.
How can we help you? We at ADHP believe every citizen has a moral duty to try to produce a service or product that will improve the quality of life of their fellow citizens. Whether one is an unskilled laborer or a brain surgeon, the opportunity to exercise this moral imperative is always present. As ADHP dentist’s we strive to be skilled surgeons (technically as well as scholarly)(please click here to view my qualifications). Our implant training (which is ongoing) has taken place at Harvard, University of Southern California, Loma Linda University and University of California dental schools. We also want to be good business people who successfully advocate for patients by giving them as much value for their money as possible, while still making a fair living for our families.
Another important way we at ADHP can improve your access to appropriate, affordable dental care is by controlling all related costs, including setting our hourly fees (by far the largest cost) to be within the reach of regular people. We offer affordable, appropriate, traditional or dental implant alternatives without compromising quality of service, quality of materials, or self-sacrifice. We have successfully provided comprehensive dental treatment, including dental implants, to regular people, since 1977. Our philosophy of care is scientifically, and evidence based. No hype, no “bait and switch,” no B.S.
Once again, our ultimate message to you about your search for proper dental care is that “less is more.” The fewer teeth that become cut on for any reason (including for cosmetic purposes) the less likely the “cycle of restoration” will lead to a needless and commonly predictable progression of seemingly endless tooth “fixing” which may (in those with high susceptibility to dental disease) inevitably lead to tooth loss. Heroic complex “fixing” of diseased prone teeth repeatedly repaired over time, is surely a poor alternative to dental implant alternatives. If your teeth are historically susceptible to tooth decay or periodontal disease and they now need a major fix, as Kenny Rogers would sing, “You have to know when to hold them, and when to fold them.”
Also, when thinking about dental implants in particular, don't assume you have to pay large sums of money to obtain such care. Do not assume that by paying more you will ensure a successful or even better outcome, than that which can be obtained by diligently shopping for appropriate, affordable, quality alternatives. Inform yourself about your chosen dentist’s track record, education, fees charged and the materials used to ensure that you find a great fit for you, your wallet and your dental problems. Ask your dentists about the concepts you have learned by reading this material. Ask for the scientific evidence in lay persons language that makes your treatment plan the best for you and not an accommodation to skills of your dentist. At ADHP we do not do certain complex implant procedures which we believe exceed our abilities. We always give our patients referrals to others who we believe are more competent than we are in executing certain procedures. (please click here to learn more about Affordable vs. Expensive Dental Implants)
Do not fall for self-serving rhetorical hype about “best implants,” “best materials” and “best dentists who treat the stars” with no proof other than bragging about pseudo facts or opinions not backed by sound long-term scientific evidence, verifiable experience, and genuine long-term testimonials when available. Slick repetitive radio, TV and other forms of advertising are tempting. When you evaluate these forms of advertising ask yourself “Where’s the Beef.” For younger people who don’t remember that line, it is a metaphor for “where is the substance” or factual basis of your product being better or excellent or in this case of your promises.
In this vein, inform yourself about the justification of the specific care and costs that are recommended to you for your dental problem or problems. Ask if you’re existing dental work that has been diagnosed as defective can be appropriately repaired, rather than replaced, considering your susceptibility to dental disease and the mechanical problems present. Conversely, ask if your disease susceptibility and condition of your teeth justifies more traditional fixing rather than choosing dental implant alternatives or if your dentist considers this at all. Ask what will happen if you don't accept recommended care. What damage will occur over what period of time if you do nothing or you choose repair over replacement or dental implants over continued tooth fixing? If you are told to have functional teeth which have not active disease to be extracted, there must be very good reasons for such a recommendation. Ask each question in the form of what is the reasonable estimate of the probability of various outcomes predicted to justify recommendations that are to occur. Make sure you understand alternatives available, especially when you are being advised to extract good teeth. Finally, ask for written explanations about why your particular treatment plan is best for you and your specific circumstances if you are uncertain about the validity of the explanations you have been provided.
Finally, good luck in your journey to seek out affordable, appropriate, quality, long-term, evidence based dental care which is a custom fit for you. We hope our advice and admonitions have helped you learn more about how to help yourself. We will be happy to further assist you if given the opportunity.
Affordable Dental Health Providers