[Thad E Ginathom]

Originally Posted by Gansan

Five shot? I heard there are single shot tissue culture vaccines available now?

I don't know. I haven't heard of that.

Three-jab pre-exposure

Three-jab post-exposure --- if your pre-exposure is up to date and with annual boosters.


Implants... professionals, please? What I heard was that you want that implant to be fully accepted into the bone before putting any load on it. No hurry. I'd be suspicious about any dentist offering a quick one (errmmm... if you see what I mean ). It is not like screwing a bracket into a wall and straight away putting the shelf up.

Another thing I thought of: When I had my implants, they came with insurance. You don't want to have to pay twice if, for any reason, it doesn't "take."

[Mortis]

The normal recommended healing period once the implant is err... implanted is around 3 months before the implant is "loaded" with an abutment and crown. A little longer won't hurt though 6 months is a bit long, unless there is some issue noticed by the dentist due to which he has recommended the longer period.
Bone grafts are usually from a refined bovine source so you don't need to worry about another procedure to extract bone and refine it from your own body.
The average cost for good materials and dentists would be in the ballpark of 40-60k not including the bone graft. Obviously pricing is no way judge a dentist, some do poor work and charge a bomb because of their reputation while others do excellent work at reasonable rates. The best way is to go by referrals from someone you know and whose judgement you trust.
You can use their recommendation for a second opinion. Your original dentist seems decent mainly because he has recommended a bone graft and longer healing period whereas a quack would just place the implant in any position where there is barely enough bone to support it and give you the crown and finish off the case a soon as possible.
Can't truly comment on the price though as it depends on several factors.

[Thad E Ginathom]

Wow, thanks! I didn't know the bone could come from another creature! No, ahem, cultural issues with that in India?

I think that when mine was done, if bone graft was needed, they took it from the patient's leg.

[Tejas@perioimpl]

Bone grafts could be bovine, porcine or synthetic fillers. Or best case autogenous from your own body. Cadaver grafts as loosing the race nowadays.

For implants this is what I tell the patients:

You fracture your leg, the doctor puts it in a plaster and tells you not to put weight on it for 1-2 months. He doesn't do a magic surgery and tells you to start playing football.

Same for implants. Whenever an implant is inserted into the osteotomy site, it is technically fracturing the bone and you need for bone to heal around the implant.

Bone takes time to heal. Why? That's how the body works: You fall down and have a scratch, it heals in a few days; a deep cut takes a couple of stitches and a couple of weeks to heal and a fracture a few months. If you start using your fractured hand to lift weights, the two parts of the bone will never be in contact - there will be a slight micro movement - and this would cause the faster healing soft tissue to invade the gap and prevent the bone for healing. Think of araldite: Join two parts and clamp and let set overnight. If you keep checking for strength every hour the join will fail. Same way for anytime you deal with bone. Give it time. 2 months are not a big deal when you want something to last a lifetime. There is no super glue for implants.

Hope this answers and clarifies doubts.

[wildsdi5530]

I'm a Joint replacement surgeon. I use plenty of implants in the body. Prosthesis like hip and knee replacement are implanted to replace a structure in the body. I allow full weight bearing and normal loading on the day of surgery.
Implants in fracture work differently, they are only to maintain alignment and bony contact till the bone heals. Here I allow weight bearing if the whole construct is stable which is in most cases. Some cases where there is joint involvement/ good stability is not achieved, I keep the patients from weight bearing till healing begins, usually 6-8 weeks.
Not sure about dental implants, but I guess once the base is screwed into the bone, it should be stable. the healing time is probably for the soft tissues.

[Thad E Ginathom]

Originally Posted by Tejas@perioimpl

Bone grafts could be bovine, porcine or synthetic fillers. Or best case autogenous from your own body. Cadaver grafts as loosing the race nowadays. ...

That's very interesting. In the case of my implant, the surgeon carefully kept all fragments of bone removed in the procedure, and used them, along with some synthetic material.

It is fascinating stuff. Which is why I did not want to be sedated.

Last time I had a tooth extracted, I asked the surgeon for a running commentary. He said, "Fine: I teach this stuff, so I'm used to doing that." To be honest, once or twice, I did think he was giving me a bit too much detail!

[Torq]

Originally Posted by Tejas@perioimpl

Same for implants. Whenever an implant is inserted into the osteotomy site, it is technically fracturing the bone and you need for bone to heal around the implant.

Originally Posted by wildsdi5530

Not sure about dental implants, but I guess once the base is screwed into the bone, it should be stable. the healing time is probably for the soft tissues.

Dr Tejas has been doing dental implants in his practice for more than a decade now, so I'd trust him. We typically use titanium implants (just like u guys, most biocompatible) which are needed to be fused to the bone properly only after which proper and final crown can be fabricated and cemented onto it. In the mean time, a provisional crown may be given, particularly if its in an esthetic site.

Originally Posted by Thad E Ginathom

.... I asked the surgeon for a running commentary. He said, "Fine: I teach this stuff, so I'm used to doing that." To be honest, once or twice, I did think he was giving me a bit too much detail!

Sir, I am an Orthodontist and routinely explain each and every small step to the patient while working on them. Patients understand more of what is happening. The appointments may not be long but patients do get bored sitting so I help maintain the convo one-sided

[Tejas@perioimpl]

Thanks torq! Placed my first implant in April 2001. Nearing two decades and more than 4000 implants and ten failures

[hondafanboy]

Originally Posted by Eddy

I got an implant done in 2012-13 and it cost me 35k then. Dont quite remember the material but I chose the best one available, IIRC. And was not covered by insurance.

Also, the time to fix the crown was much lesser than 6-7 months for sure.

Also, after two days, you will not feel anything different all so do not worry on that front. In the hands of a good dentist, the procedure is quite painless.

Quite useful and thanks for that. Also the cost seems about right considering what you paid 8-9 years back and general health cost related inflation.

Originally Posted by Thad E Ginathom

I have had two titanium implants supporting a three-tooth bridge, my upper front teeth, since 2004.

1. Yes, the process takes some time and is much more involved than most other dental processes we might experience. I had more than enough local anaesthetic (far more than for an extraction) and never felt a thing. I was offered sedation, but a, wanted to be able to drive myself home, and b, was actually interested in the process.

I was sent home with a prescription for a high dose of Ibuprofen for a couple of days. I'm a baby, and asked for codeine just in case: I never felt the need to take it.

2. I don't think there is any guarantee that they will last until the day we die. Mine: 16 years and going strong.

Bone implant? That would add a whole other other to the experience: surgery to take the bone from other part of your body. Whether you have it or not would not depend on whether it is a luxury implant... But the simple fact of if you have enough jaw bone to support the device. Professionals will need to comment on that.

Implant is a procedure that takes a lot more "fuss" . I was dressed in a surgery gown and great attention was paid to everything being sterile. When I asked why, so much more than having a tooth out, my man explained that putting something in is a lot more critical than taking something out.

I would absolutely recommend it. It is as close to having a natural tooth as it's possible to get. It's expensive, but compare: 16 years ago, in London, my implants were more than 1 lakh rupees equivalent each (about 2,500 GBP for both) but that did include the bridge.

Just make sure that you are getting the right advice to lose the tooth, and that you need to fill the gap. I can't live without front teeth and can't wear a denture due to mybite. On the other hand I have a gap to one side which shows when I smile. It doesn't affect my ability to eat, and is not worth tens of thousands for a slight cosmetic flaw.

Of course, a slight cosmetic flaw matters a lot to some people!

Thanks sir for sharing your experience. Its very helpful and I am strongly considering to get it done. Also its good to know that implant is going strong after 16 years.

[Tejas@perioimpl]

Originally Posted by wildsdi5530

I'm a Joint replacement surgeon. I use plenty of implants in the body. Prosthesis like hip and knee replacement are implanted to replace a structure in the body. I allow full weight bearing and normal loading on the day of surgery.
Implants in fracture work differently, they are only to maintain alignment and bony contact till the bone heals. Here I allow weight bearing if the whole construct is stable which is in most cases. Some cases where there is joint involvement/ good stability is not achieved, I keep the patients from weight bearing till healing begins, usually 6-8 weeks.
Not sure about dental implants, but I guess once the base is screwed into the bone, it should be stable. the healing time is probably for the soft tissues.

Sorry just saw this.

Unfortunately dental implants work a bit differently. They are exposed to approximately 200pounds per square inch of biting force and what really kills implants are lateral forces rather than the vertical forces. And the bone surrounding the implant is just around 2mm thick.

Any micro-movement of the implant causes the gingival tissues to invade the space between the healing bone and implant resulting in a fibrous union rather than an osseous one.

This is compounded by the fact that the maxillary bone is too porous with a lot of vascular spaces (less bone to implant contact) and the mandibular bone is too dense and most of the sites are avascular when we drill.

Thus, unless we get a good cross arch stabilisation with multiple implants we do not immediately load them. But for this a very good lab is required which can give a 100% passive fit.

[wildsdi5530]

Originally Posted by Tejas@perioimpl

what really kills implants are lateral forces rather than the vertical forces.

That explains it. We have axial forces which actually stimulate bone healing. Lateral and rotational forces are bad even for us.
Hence most of out surgery is to convert shearing forces to compression forces.

Incidentally April will be 15 years since I did my first knee. Time flies.

[iVictor]

I wanted to put my recent experience here. In the past 2 months or so, I've been to around a dozen or so expert dentists here (Electronic city/hsr) for my father's dental consultations. His upper teeth are almost finished except the molars, while a lot of lower teeth are still somewhat intact.

After showing the x-rays and physical examination, when we asked for the approach, none of the dentists could think of any structured plan. We were told everything on the fly, from removing all the teeth in a 1-2 sittings and use dentures, to doing RCT for several teeth then putting bridges, to removing all the teeth, putting several dental implants in 1-2 sittings, and using bridge over them. Every single one of them confidently quoted absurd prices.

Most of these have high ratings on practo, and google. Some were even recommended by neighbors & office peers. I guess it's all fake reviews.

In case you have any suggestions or recommendations, do share. Thnx.

[Rama Kumara]

have a question here for Doctors/Polysomnologists. I haven't found a definitive answer to this yet.

I suffer from moderate sleep apnea and also use a reSmed airsense 10 cpap machine in the night.

Despite this, I wake up a lil groggy and simply cannot do without a 90 min nap at noon.
I have put on about 20kgs probably because of inadequate sleep which is also causing extremely poor metabolism.


My concentration is quite poor and my overall zeal for life is not there.

I also need to plan my drives, in such a way that I get some 45 minute sleep in the noon when I undertake long distance driving in my car.

Is there a definite cure for this other than being on the machine all nights?
I am about 35 years old weighing 95kgs. 173 cms in height!

[Jaguar]

Any cardiologist here?

My aunt has been asked to go for a pacemaker and the implant will have to be done in the next couple of days once her condition and sugar levels are stabilized. Needed some opinion on the model of the pacemaker to go for. The hospital has suggested a couple of models and I need help in choosing.

[drsingh]

Originally Posted by Rama Kumara

have a question here for Doctors/Polysomnologists. I haven't found a definitive answer to this yet.


My concentration is quite poor and my overall zeal for life is not there.



Is there a definite cure for this other than being on the machine all nights?
I am about 35 years old weighing 95kgs. 173 cms in height!

Make losing weight a priority as well as increase physical exercise. Breathing exercises. Search for Wim Hoff method breathing exercises. Consult an ENT specialist to make sure you don't have any surgical issues.

Reduce carbohydrates and practice intermittent fasting.

Increasing cardio capacity of your body will go a long way to improve your symptoms.