Wednesday, 22 August 2012

Dental Implants demystified

Dental Implants demystified 

When it comes to tooth replacements dental implants are increasingly becoming the treatment of choice, however high treatment costs very often prevent this treatment option in Australia. Hence many customers are looking to south east asia for  lower price alternative.

In this first blog about dental implants I will try to simplify the concept of dental implants and explain some basic features of dental implants.

Dental Implants - A Blueprint

All implant restorations consist of a fixture - this is the part anchored to the bone, an abutment - this is the part penetrating thru the gums and the prosthesis - the tooth.

Sometimes abutment and prosthesis are one combined part

The fixture 

In a nut shell a fixture is just an anchor ( not too dissimilar to a gib-board anchor) which is screwed or tapped into the bone and will after sufficient healing time be able to carry a tooth, bridge or denture.
Obviously this is rather simplified.

Implants come in different materials, most of them are titanium but recently we have seen the rise of ceramic implants as well.

In terms of materials the important aspect is in fact the surface applied to the implant material as this will directly effect the speed and quality the host bone is attaching to it. This is basically the first hurdle in the treatment as many of the simpler or older technology surfaces will only allow for a slow healing which very often translates to less bone to implant contact.

More modern surfaces are generally of the super rough kind which has shown to facilitate fast healing and increases in bone to implant contact.

In fact over the last years we have seen a technology race of the implant leaders in getting their surfaces improved.

The abutment

The abutment is a basically a cylinder or similar shaped tube which can be attached to the fixture, hence penetrating thru the gums and allowing a tooth to be either attached to it or even incorporating a tooth shape. Abutments can be pre made (off-shelf abutments) or custom-made in titanium or zirconia.
Custom abutments are regarded as the up to dat away to go as it will preserve soft-tissue contour and health much better than the former. However this comes at a price.

For ongoing implant health the abutment must a) fit very precisely to the fixture to minimize gaps harboring bacteria and b) of a shape which will allow the connecting screw to stay tight. As screw loosening was a major concern with implants in the past.

Screw loosening - the loose screw - will have a major impact on the tissue surrounding the implant. In fact a loose abutment screw can cause total implant failure, either due to implant fracture or inflammation of the bone surrounding the implant.

Modern implants very often therefore have internal connector representing either tri-lobes or hexagonal shapes of varying angles which will help to keep the abutment in a secure position.

The prosthesis

The prosthesis attached to an Implant can range form a single tooth to a complex bridge. It can be screwed to the implant or glued to the abutment.
Generally speaking specialist prefer to attach the prosthesis using a screw whereas general practitioners often like to glue.
This has often puzzled me. It seems that most general practitioners are using the later technique as they are used to gluing their crowns to teeth and are afraid of the perceived complexity of using a screw.

However gluing a prosthesis to the implant is in my opinion not always a good option, implants are not teeth. Any glue residue left on the implant surface can cause dramatic bone loss around implants. It is not unheard of that an implant can be completely lost within the year if this happens. A screw retained prosthesis has a far lower risk, however as glues to give and screws don't the prosthesis needs to fit better ( which is not necessarily a bad thing anyway)

The fit of the prosthesis must fit excellent, where you might get away with a rather sub-optimal fitting prosthesis on a natural tooth, the implant is unforgiving.

And that is it. Really not more to it.

So why are dental implants so expensive, in fact in Australia and New Zealand most patients who could benefit form dental implants cannot afford them.

Well beside the concept is fairly easy - you still need to know where to put the whole to screw the fixture in. Even if the surgeon is only a fairly small distance of this can have a big impact on the implant success.

Secondly fixtures and abutments are expensive, said that we currently see hordes of cheap implant manufacturers coming to market with cheaper and cheaper components.
But buyer aware lots of these companies are of the backyard workshop type. Done be fooled by fancy names or claims that the implants are produced in countries such as the USA.
Most of this implants are distributed by US companies but produced in countries such as Israel, Brazil, India only to name a few.

These fixture on first glance look such the same as the more expensive manufacturers, but rest production quality and in particular surface technology is not the same.
The same is true for their abutments, with the naked eye everything looks like fitting nicely, but if we were to look at it under magnification the dirty truth comes to light. In fact I have seen abutments which were that bad fitting that magnification was not even required.

And lastly implant companies come and go currently at a phenomenal rate, but you have the fixture for life ( or at least for many years). The prosthesis commonly last not as long as the fixtures, so what happens when you need some spare parts of your implants. We currently see more and more patients coming in with odd ball implants who need some maintenance, but surprise,surprise we cannot get any fitting parts.

If you are unsure if you are getting a fair deal you might want to contact for an alternative quote.

Sunday, 1 July 2012

Cheaper dental treatment - To Thailand or not To Thailand

Following my last post, lets refflect on my earlier post with regards to the fairly expensive dental treament in Australia and New Zealand compared to the same Treatment in Thailand.

Why is it so expensive Down Under ?

Well if you ask your dentist you will most likely get the following answer (or something to this effect:)

"Because we struggle with high overheads to run our business, only a small amount of what you pay actually ends in the dentists pocket, after paying for staff, materials, general business expenses etc."

And of course the dentist himselve would like to have a comfortable life, have a nice house, flash car, good wine etc.

And I do wholeheartedly agree with this, I want a nice house, a good car ( and rest assured I have both). And lets be fair - would you trust a lawyer if he arrives in an old Ford Escort ?

But how is this now working in Thailand or India ( or any other nation in south-east asia).

Well lets look at this a bit closer

- nice apartment in Mumbai -   well if you think Sydney is expensive - think again. 4 Million US will not buy you much in Mumbai or Bangkok.

(sure living on the streets is cheaper - but face it you don't want to go to a backroad dentist !!)

- nice car in Thailand - yor medium size European car will outprice any Holden by the factor of 4-5 (100.000 USD is not uncommon).
- general living expenses - might be slightly less, but if you want the good stuff you need the green, and lots of it.

So there are only two avenues left how our Asian collegues might be able to save some costs

a) staff - and yes there is some saving
b) material - and again yes the same implant which is sold in Australia for 800 AUD will be around 200 USD in India. (so I think our all so nice suppliers Down Under need to wake up - and fast )

But thats about it !! So in fact the costs of dentistry in South East Asia at face value are most likely the same than Down Under.

But how can they offer treatment so cheap than - one may ask.

The only ways dentistry can be bought cheaper is by

a) creating a generic low overhead environment (more efficient workflow)
b) getting the cheapist lab work in possible ( most likley sourced in either China or some back-road shed using unskilled labor)

Option b) is highly dubious as you will compromise the quaility of the crowns are are about to get fitted to your teeth by either workmanship or material or both. ( Gold crowns form China have found to contain all sorts of metalls but gold).

So to safely reduce costs only option a) is valid.

But how do we change the modell we dentist are operating ? Or can we ?

I think we can ! And you certainly do not have to go to Thailand and/or accept third class lab work for it.

It can be done in Down Under.

Have a look at and talk to the guys, as this modell suggest that similar cost safings can be achieved, without the 12 hour travel, uncertainty about warranties and quality. All labwork is done by a reputable in house laboratory.
And the best they do speak english - withsome accent so - but hey the Ozzies have one as well.

Tuesday, 12 June 2012

                       Why is dental treatment so expensive in Australia and New Zealand ?

                                                                          or is it ?

The main reason dentist (or at least so they say) charge the fees they do is ----  Overheads --- of their practices. Plus of course we all know they would like to have a comfortable life, a bach, a porsche etc.

But hey - dentistry has gone global. This might be a weak up call to the profession, a late weak up call.

                                      Patients cannot afford the dental treatment they need.            

And this is happening all over the world.

But wait -- Isn't there Thailand and India. And yes more and more Patient will happily fly to third emerging economies to take advantage of cheaper dental treatments.
And most of these destination will generate 20-30% of savings.
But as flight and accommodation costs add up this only really makes sense if you need a lot of dental treatment.

Often this is called dental tourism or dental holiday. But rest assure having massive dental work done, in particular implants etc is not a holiday.

Sitting on the pool side with a mouth full of temporary crowns on your teeth will not only ruin your ( albeit temporary) smile, but the cold beer just doesn't taste the same.

Maybe its time the local dental community starts to want up and works on their practice models ( and maybe a Golf GTI is a good enough replacement for the Porsche 911 - who knows)

A first of these new concepts is currently emerging in New Zealand -

This company offers Australians and to a lesser degree Kiwis similar savings on their dental work as clinics in Thailand.

So whoever needs their smile fixed --- check it out !!!