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Dana from Florida asks us:
My wife has been undergoing treatment to
place dental implants in her entire upper mouth. She had bone grafts in the back
of her mouth 18 months ago to place bone while she still had front her
front teeth.
8 months ago she had her front upper teeth removed and that
area was grafted also. The periodontist used bovine in both procedures
with a pcp mix (I believe).
However, recent CAT Scan shows total failure of the
graft in the rear and success in the front. The doctor wants to place dental implants
in the front and use a fixed denture. He wants to try grafts in the rear
again at a later date. The doctors blames the failure of the graft on smoking.
We then went to see an eminent prosthodontist in Philadelphia. He says he can
fix this in a day.
The Periodontist in Florida totally disagrees. He says micro movement of the
dental implants (teeth in a day procedure) combined with the failure of the grafts and smoking will not work. The Prosthodontist in Philadelphia says it will work and
Periodontist in Florida is using old techniques and being overly cautious.
What do we do? Who is right here? Thanks for any advice?
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40 Responses to “ Total Graft Failure and Teeth in Day ”
Made a mistake. The bone graft was autogenous mixed with prp.
the “teeth in day” works, and I think very highly of the prosthodontist in phily. i flew out from salt lake city for Dr Balshi to do my dental implant. the key will be to stop smoking! I wouldn’t place implants on a heavy smoker-it just doesn’t work. there are new medications to help in quiting to smole(zyban combined with nicotene patch works pretty good.
sorry about the misspelled words-scott
I am a Maxillofacial surgeon and I do a lot of cases with modified version of “Teeth in an hour” or “All on 4″ concept. We convert the denture or make fixed teeth the same day. We have been doing these procedures since 2004 with great degree of success. Prosthodontist in Philadelphia, Dr. Balshi is a reputable doctor and these procedures do work. We have over 50 successful cases.
Gary wadhwa
Teeth in an hour or litorim was developed in belgium and it is a pretty good system, and is clearly not the not the same as all on four, wich is also pretty good for fixed prosthesis. I think that she needs to stop smkoing before attempting implants, at least that is the way we do things. It is clear that heavy smokers have extra risks in grafts and implants.
Teeth in an hour can be an excellent solution for her , of course is a technique that wont really allow for grafting since is a minimally invasive technique.
I am not a fan of multi time grafting specially in big areas. Both techniques are viable but litorim is faster and probably safer if she quits smoking.
good luck
The smoking is indeed a factor. Smoking has been implicated in early tooth loss, and the inability for bone to heal in the mouth. To expect significant healing to occur in the face of this nasty habit is ill-planned. If she doesn’t stop smoking altogether, don’t put your money and her health at risk. BTW, if you smoke, you need to quit too.
What experience have you had with Novum same day teeth ?
In relation to NOVUM, have doing it for some years now… decent results in terms of function but it pretty much sucks in the cosmetic approach. so i do it no more… well only when the patient asks specifically for it.
In profesional terms, is a simple surgical technique that needs a lot of gear and sacrifices a lot of bone(something i dont like), but in the end it works fine as a glorified total acrilic prosthesis.
Today there are trying some adaptation abutments to convert the special implants into regular ones so they can be attached to other implants by a different type of prosthesis such as an ad modum or others , wich are more cosmetic or can be done with porcelain.
First of all , the patient should stop smoking because it realy affect the success of either the implant and bone graft.
from my point of view, the immediate loaded implant(tooth in a day ) is a wonderful solution for certain selective cases like single missing tooth which you can put the implant out of occlusion for certain time to give chance for osseointegration to occur, the success of dental implant will never be achieved with micromovement of the implant fixture.
my openion for the present case, to put submerged implants and fabricate temporary removable denture to restore function and cosmetics for three months then you can open the implant heads to do your final fixed bridge work.
Dr.Ossama Ghorab
Sounds like the DIEM protocol would be best for your wife. This system would allow for a fixed provisional restoration which gives the implants necessary time to integrate based on the systemic factors in play. Teeth in a Day is a great protocol but NOT in this situation. It’s has been developed as a final restoration and can be VERY expensive for the patient. If it doesn’t work the first time you must start all over again. In this case with the failed bone graft I would avoid it at all cost.
Ok…no challenge on the stop smoking. I totally agree. When I smoke, I can feel the bone in my front teeth tinkle. I get my teeth cleaned now every 3 months. Not an excuse though not to quit smoking. However, my wife refuses to quit. She says she can’t, too addicted, smoking since age 13. It’s the smoking that helps keep you guys (doctors) in business.
However, with that said, please help me understand what you are recomending. some comments seem to believe she needs individual tooth implants. She has no top teeth at all. All top teeth have been removed.
Periodontist in Florida is now reccomending all on four.
Dr. Balshi will be doing teeth in a day with a temp acrylic prosthesis. Then in 3 months replacing temp with a perm porcellan prosthesis. Very expensive. However, even though we will finance this into oblivian, money cannot be an issue when it comes to my wifes well being. I will do whatever is best for her. I will work 24hrs a day to get the funds needed. Therefore, money is not a factor.
One doctors comment is that the prosthesis Dr. Balshi uses “cosmeticaly sucks”. Did I understand this correctly? Also, another comment was that Dr. Balshi’s technique caused a lot of bone loss. Is this correct?
I’ve read on this website that all on 4 maybe high risk because the prosthesis rides on 4 implants instead of 8-10. Thus, placing too much strain on the implants. Causing failure later.
What about SLA Active implants in the rear?
Also, her bottom teeth are capped. They are loose. Dr. Balshi wants to remove them and do teeth in a day on the bottoms. I’m not keen on that idea right now. I see that a new solution has been approved by FDA that restores bone. Should her bottoms be treated with this new stuff? And what about using this where her grafts did not take (upper rear)
I love my wife more than anything in this universe. I appreciate your help very much!
The new FDA appoved medicine is called GEM 2s. Will this repair her bottom teeth so they won’t have to be removed?
And, what about BONE GEN/Calciam Sulfate to repair the rear grafts that failed?
If the back failed because of smoking.
Why didn’t the front?
I don’t know why the back failed and the front took. I have been told that the back failed because the graft was done so long ago (18 mos.) and that implants were not placed in a timely fashion, that maybe the bone was reabsorbed by the body due to no implant and no support. The peridontist in florida says smoking was probably the cause.
However, the cause it not the issue. The cure is. anybody have any answers to my previous posts…GEN2s and SLA Active…bone loss with teeth in a day…cosmetic issues???
Dear patient:
As with any treament…there are several ways to approach it, and there really is no “one correct way.” There is always a price to pay. The research has shown that implant success rates are affected at about 7% less when smoking is involved. When grafting is involved it is much worse! I’m actually surprised that you were not told to quite smoking all together prior to the grafts. Like Dr. Balshi, my practice is a Prosthodontic/implant surgery practice where I place the implants and provide the restorative work. I tend to agree with him, however, I think that all these discussions are pointless! I can sway a patient’s opinion very easily to what I am comfortable doing on a particular case. What you should be deciding is not what type of implants to use or how many. What you should decide is WHO you like as your Prosthodontist! People “push” for what they do best! Their reputation is on the line, and they want to do what they know will work.
So what to do?
1. Pick a Prosthodontist/Surgeon (team or prefferably one person who is cross trained) whom you trust and has a proven track record.
2. Consult and decide with them as to what is more important… the immediacy of an expensive, less esthetic procedure (teeth in a day) or a delayed approach of a staged placement case with proper fixed/removable provisionalization as needed. The staged approach can yeild a higher esthetic result, could be more or less expensive, but is easier to absorb financially as it is done over time.
3. If you are still unsure, come to New York City. We have the largest concentration of Prosthodontists who do implants in the nation, and all within a walking distance. You might find someone with whom you are comfotable easier.
Good Luck!
Dr. Zev Kaufman
Dear Doctors,
Thank You for your help!!!
Please understand my fear & anxiety.
1. We were told prior to the proceedure to stop smoking. However, easier said than done. And, no help to quit. Counseling & medication should be offered at every dental practice. Isn’t this the major reason that teeth are lost?
2. Doctors have egos just like all humans. Most doctors believe there way is the correct way. Probably because they are comfortable with their method (comfort zone). This causes them not to train in newer methods.
3. This being the case, how is a patient to understand what method is the best.
4. The field of Implantology needs to be crossed trained on different methods so they can determine what is the best method for their patients. Instead of me having to go door to door to find out what is best for my wife. Or, at least understand the different proceedures so the Dr. can reccomend the patient to see the right Dr.
4. If i didn’t ask questions on this site I would have never known that teeth in a day is less cometically attractive.STILL DON”T UNDERSTAND WHAT THIS MEANS as opposed to other methods. What’s the difference cosmetically?
5. to this date, still don’t have definitive treatment options, the pluses and the minuses unless we go from doctor to doctor to see who does what, how and why.
The one thing that no one has said is that sometimes things are not fixable, and a compromise has to be done. Smoking plays a part, but so does bone physiology and other factors. Lets face it, some people lose their teeth due to multifactoral problems, and to believe all individuals can be restored to perfection is to take a God like attitude. This lady has lost all upper teeth and has crowned lowers with apparent periodontal disease. While we can graft and improve ridge forms, there are still limitations to what we can do. When we get Star Trek type of technology, perhaps we can be more definitive in making statements. Teeth in a day will not work for all people just as all graft procedures cannot be guaranteed to succeed. Our society is developing to expect perfection without failure. When the evnelope is pushed beyond reality, then more and larger failures occur. While we have maginficant accomplishments, they need to be viewed out of the field of a microscope. The bottom line is pick someone who is realistic in expectaions as to what can be done. This may result in some compromise…ie, a removable appliance vs the fixed appliances….and be prepared that your wife may have factors in her physiology where failure of some or all implants occur in the future. That is reality.
I would have never known that teeth in a day is less cometically attractive.STILL DON”T UNDERSTAND WHAT THIS MEANS as opposed to other methods. What’s the difference cosmetically?
Tissues shrink and change as healing occurs….it is near impossible to get a cosmetic fit due to the changes. The undersurface of the restoration be it fixed or removable play a large part in cosmetics.
Dear Dana,
Whenever we are presented with multiple choices on how to treat our patients the answer lies on the scientific literature review.
You have acess to this information through the internet. Search for Immediate Loading of Dental Implants. You will find Dr. Balshi and Dr. Wolfinger are the leading clinicians and researchers in this field.
They have developed surgical and prosthetic protocals that allow patients such as your wife to be able to be restored in a day with a fixed prosthises avoiding bone grafting in the maxillary sinus by placing implants posterior to the antrum. Dr. Balshi and Dr. Wolfinger published an extensive research in 2003 where over 2500 implants were placed using the teeth in a day protocal, 360 of those implants were placed postierior to the sinuses with a 92% sucess rate.
Do the research and you will see this protocol definitly works. You are in good hands with Dr. Balshi.
Dr.Mongalo
Dear Doctors,
Thank you again for your help.
Dr. balshi will be doing the surgery end of May. I have read the studies that Dr. Mangelo suggested as well as other studies conducted by DR. Balshi. I must commend Dr. Balshi for his lifetime of research. For that reason, I will place my wifes success in his hands.
I will keep you posted on the results.
Thank you all for caring!
Dana
I was only asking, because I don’t smoke.
My back grafts were done first as well.
I lost my front a few months later. Front grafts were 6 months years later than the back
The back needs to be redone.
He didn’t choose to blame me.
He just said the bone loss in the back was worse.
He’s re-doing the back grafts.
No charge.
6 months… not years ..
sorry
Long day.
Peppyone,
I didn’t mean to seem curt. I wasn’t trying to be. Just a poor choice of words to shorten response.
Smoking is a horrible addiction and a disease. It should be treated as such.
I am very sorry you had a problem also! I will pray that your graft takes. I wish you well. Please let me know how it turns out.
By the way, see what kind of response you get about SLA Active or some new kind of stuff or gizmo that may work.
Best wishes,
Dana
Thanks Gizmo for your thoughts and prayers.
I offer you and your wife the same.
I don’t really agree with blaming every ill on smoking.
I don’t smoke. Never have.
Genes usually win.
Both my parents and one side of grandparents also lost their teeth.
None smoked.
Wow! I’m completely intrigued with this forum! Some what of a soap opera.
I just wanted to throw in that as someone who researches dental implants for a living, I find some companies are making leaps and bounds in the area of cross-training and getting the correct info to the patient. We will all see the difference over the next few years. Sorry this doesn’t help you today.
As for my opinion on dental implants, I have my favorites. But, my number one favorite is the only one I’m going to talk about! The wife might have had a different outcome. Astra Tech has done so much research on identifying solutions to grow more bone in a shorter time. Consequently, this could also be a treament possibility in compromised cases as well. ie, smokers, cancer patients, diabetics. Check it out…their research is amazing. Read about it and you’ll understand why it’s my favorite! In fact, MD Anderson uses Astra Tech exclusively for this reason.
And patient…regardless, you’re doing the right thing for your wife! You’re taking care of her.
Over and out!
Mr. Kolodney,
Read your blogs and I sympathize with your situation. Understanding that smoking will likely compromise your wife’s case is important but there are other factors that need to be considered.
Engineering principles must be obeyed in treatment planning and restoring any implant case.
It is unforunate that the grafting was unsuccessful in the posteior region but this can happen. I would recommend block grafting to obtain the desired result at this point. This uses your wife’s own bone to provide the bone width needed to place implants.
I would not recommend placing 4 implants to support a prosthesis that replaces an entire arch - ask a general dentist if he/she would place a full arch fixed bridge on 4 NATURAL teeth….I think you’d be very hard pressed to find anyone who’d do it. Why, because it’s not enough support. In the maxilla, all 16 teeth had at least 28 roots. You want your investment in your wife’s dental health to last for the long term. The implant placement protocols recommended by the company which markets Teeth-in-an-hour (I have the implant system but do not subscribe to their suggested placement protocols) are in my opinion not predictable for the long term. There are many factors which are involved in the success of any implant case. Bone density, occlusion, biting habits, parafunction, etc. All of these need to be taken into consideration in your wife’s case.
I hope this is helpful and you are able to have your wife’s case completed so she achieves good function and health for the long-term.
Hello to post-er who does dental implant research for a living. Your number one choice was Astra Tech - I went to website, but found it greatly lacking in research articles. Am I looking in the wrong place? Tho I am a good researcher and think I followed all their links. I am not being critical. I would like to review Astra’s research. Thanks
There are many techniques driven by patient desire, industry profit-margin, and those that are recommended by dental professionals. We “listen” to your desire for perfect white teeth in a 20 minute appointment, like getting your nails done or something.
There are procedures which are done on a daily basis because they have proven their value with history and in the hands of various dentists, whether they are prosthodontists, periodontists or oral surgeons.
The teeth in an hour, yes its marvelous to get teeth in an hour, but ask your dentist if that’s something they would want to have done to themselves. It’s not a technique that is based of years of experience. Sure there are lots of research publications out there with good results thus far, but not enough to incorporate into my practice.
Every new technique has its risks and complications, and if its that much better than the current “STANDARD OF CARE” why aren’t all the surgeons doing them?
Immediate loading is an advanced and challenging technique that can be highly successful when performed properly. Few dentists, regardless of specialty, have significant experience with full maxillary cases, which are probably the most difficult indications.
There are several dentists scattered around the country that have developed the expertise to accomplish successful results for these kinds of cases. As a board certified periodontist and implant surgeon, my office has been providing immediate loading of all kinds of immediate load cases for over 9 years. We have documented over 1700 immediately loaded implants with a cumulative success rate of over 96%. Our procedure, called TeethToday®, is routine in our office, but would be considered exotic in most other settings. Our experience with smokers has not been significantly different than with non-smokers. Certainly, I prefer to work with a non-smoker and this should be another good reason for your wife to quit.
Immediate loading is neither experimental nor undocumented. It is well supported in scientific literature and clinical practice. But it certainly may be more difficult to achieve successful results as it is significantly more complicated than more conventional procedures. My advice would be to either seek a surgeon/restorative dentist team with meaningful experience in immediate loading cases or stick to a less experienced team with a conventional approach.
Success!!! My wife looks like a movie star. Aesthestics are great. Very little pain. Moderate swelling on day 1. Day 2 minor swelling and no pain. Threw the pain pills in the garbage. No reason to go thru multiple painful proceedures anymore. Procedure done on 5/31 in Philadelphia. Home on 6/1.
This has been a life changing event for my wife. Thank you, Thank you, Thank you! Words cannot express my gratitude enough.
All I can say is that two days is not a success. While in the military, whe had a saying…”that was a military success”. It meant the person was not going to be seen again, so what was not seen again was a success. While I most definitely wish the very best, I still remind you to be prepared for changes in the plan should full success not continue for the next year or two.
Almost one week. Swelling almost gone. Still no pain. Next step in 4 months when she gets her permenant porcellan teeth. I will report back on osseointergration (think I used the correct term) in about 4 months.
Does your wife take Fosamax?
Now Aug.3 2006. Still have temp prosthesis. All is great. Absolutely no problems so far!
it was recommended 2 years ago that the best alternative for me was to have the then Novum procedure with 3 implants, and an off the shelf set of 12 teeth, for implants to my edentulous mandible. i have had every option to save, restore, and to add to my lower jaw with each and everyone eventually failing. no different with the novum….i have the most caring, competent, and above all ethical maxillofacial/oral facial surgeon in the pacific northwest in Dr. Patrick Collins. we have had our days, and even failures, but he has always been willing to drop everything to make sure that what he has done is taken care of with little effort for me, and at his own expense. we had a failure on one of the implants 6 months after the surgery, he removed it and we waited 6 more months for the bone to heal so that he could place another, with that completed, we are having trouble identifying, (presently in the process of this as I write, have an appointment today to determine) failure of another implant. he has stated that if the implant has failed that he is willing to cover all costs and do the “all on four” with a modified procedure that will again try to “fix” the problem. We all have hope that this time that we get the ulitmate result. I am a 57 year old male, have never smoked, and have had my upper teeth with a couple of fillings all my life. I recommend those who are contemplating an implant procedure know who they are dealing with, question the number of procedures performed with the “exact” success rate, and whether or not you can truly depend on your dentist/surgeon to meet unscrupulous ethical standards when the going gets a little tough. It is very important to find the general dentist who is as willing to stand behind their part in the procedure as it is crucial to overall success. I did not have that with my first dentis, who asked for $5000.00 up front with no description of services to be rendered, as well as taking a large payment from my insurance companies. he alluded each time that i had a problem that it must be something “I” was doing to cause the pain, looseness, or whatever I was concerned with…he actually sent me a bill for cleaning and was more concerned with me purchasing a whitening program, and an expensive oral cleaning system that taking care of the teeth. I believe that the system will eventually work, because I have people who are willing to make sure it does…..that is the difference.
has anyone ever heard of zygomatic implants ? i recently was told this procedure will have to be done on the upper surgery because of the amount of bone lost and these implants will be a stronger foundation, i too will be having dr balshi for my implant surgery, how ever i have not read about anyone that has had this procedure using this kind of implant.
To Luis Cin,
As stated above there are a lot of ways! A zygoma implant is one of those options in most times severe cases of resorption of the maxilla. But nowadays there are new procedures for example due to the CBCT scans. So this is I think you hear less about zygoma implants. This isn’t a simple procedure. So you need someone who is very experience. But maybe in your case it is the best option. I hope this is an answer to you question.
Good luck
Luis Cin,
First, I would like to say that we have many differing concepts in the world of implant dentistry and no one way is considered the standard. You have been offered a treatment plan that I happen to be opposed to so I will do my best to explain why.
The zygomatic implant is an incredibly technique sensitive surgery…one that approaches the eye socket in order to achieve stabilization. Without getting into specifics, the zygomatic bone is not the same type of bone found in the upper jaw (maxilla) and is proven to be less ideal for dental related occlusal forces. The risk today to proceed with such a technique, I believe, is too great.
Today, we have procedures that augment your bone so that ideal placement of the implant can be achieved. Some doctors prefer to do “flapless” surgery because it reduces surgery time and is appealing for the patient. Usually, a CT guide is used. I am familiar with Dr Balshi and must state he is a controversial name because of his approach. Not that he is wrong or bad…he is controversial.
My question that I would pose is what would happen if the implant fails? How do you remove a 25+mm implant that is approaching you eye? If all goes well, great, but if a procedure exists that yields a predictable implant then why attempt something so risky?
Either way, I wish you success and a speedy recovery.
Hi Dana
I am very interested if your wife is still problem free 1 1/2 years later. I’m looking into same doctor. Seems as if all of the state of the art technology helps aide in best implant placement and maybe contribute to success.
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