the-dental-assistants-assis-blog

[the-dental-assistants-assis-blog]

Implants and why every dentist should consider doing them

Spoiler alert: I’m just an assistant, so what do I really know, right? I’m not one to talk real fancy, but I have seen/ assisted for roughly 1,000 implant procedures or more. So, if nothing else... I have stories.

So, from my angle... implants are easy. Even a slam dunk under the right circumstances. Such as placing one in the socket of an extracted tooth. The hole is already there, where it should be! Put a little Puros (bone growing material) in with it... it’s a masterpiece. I’m sure doctors make it look easy. But I’ll argue that it has more to do with being a “cowboy”. You have to have guts because ideal situations are not at a truly high percentage. You usually have a patient over the age of 30, with bone loss, who smokes. Eek. Also, you have to have marketing skills, or you’ll never place an implant. At $5,000 per implant, John Smith would rather get a $2,000 bridge, and invest the rest. BUT... what if the implant and the bridge were equally priced... or what if the bridge would cost more? I’ve seen “selling” an implant be tough for a dentist, but I’ve also seen it be EASY. Implants sell themselves if you have the right marketing plans in place. Here is an example of how I speak to my patient about the loss of a tooth/ teeth:

“Now don’t fret, Mr. Smith. It’s only a tooth. BUT, when you lose this tooth, other teeth are going to shift to fill in that space. Smile for me, big.... I can see that tooth when you have a good, big smile. You also chew with that tooth, so the pressure will increase to your remaining teeth. Now, you have some fantastic options in this day and age to replace that tooth! I’ll tell you all of them, and you can decide the one that best suits you. Now, there is the option of doing nothing, I don’t recommend that for the reasons I’ve already told you. You can have a removable appliance, which you’ll hate, and it’ll work for weddings and funerals, but don’t go eating any Brazil nuts. You can have a bridge, which you’ll like just fine, but it’ll involve shaving down two perfectly good teeth, and properly cleaning it will be a bear. Lastly, for just a little bit more than the bridge, you can put in an implant, and never worry about that tooth again, and always have it. If you were my brother, I’d suggest the implant. In the end, it’s economical and solves the problem.”     

9 out of 10 take the implant. Tried and true. Then, the same day as the extraction, place the implant. Easy. 

Now, what happens when my “magical world” of implant placement fails? Failure is nothing to be afraid of. I’ve seen oodles of failure. Like candy thrown at a parade... The remedy is usually easy, and permanent. 

Failure 1: You hit a nerve with the implant. Remove the implant immediately. replace with a shorter implant. Cross your fingers the nerve heals. You could also tell the patient that “it should heal within two years, because nerves heal slowly.” I wouldn’t, because I’m too honest, but I’ve seen this tactic work in the real world. Oh malpractice. Oh statutes of limitation....

Moving on, Failure 2: The sinus has swallowed the implant. Dear God, no. Now, this can be a HUGE deal. Hospital surgery, lawsuit, your name in the papers... that’s a little dramatic, but you get the idea... here is what I’ve seen:

Mr. Smith is here for his post op check... Hey, the implant is gone... “Did it come out?” “No?”.....

Step one: X-rays. To really drive that failure home... I’m kidding, it’s for obvious reasons. 

Step two: Under no circumstances do you allow him to leave! Fixing this could take some time. 3 1/2 hours is a fair guesstimate. So... keep him calm, and part of the team.

Step three: open the area through the same area the implant was placed. We are minimalists! In and out the same way, if possible! And it is. unless you lay them back.... which you probably will, right? for access, and visibility. 

BUT.....

That’s how we hang out for 3 1/2 freaking hours, trying to fish that bastard out! The solution.... drum roll, please.......... Have him jump up and down, then don’t lie him back but a few inches. Reach up with a small hemostat.... TRAGEDY AVERTED! It still amazes me how even with all the technology... it’s still common sense and simplicity that end the day.

Final Failure: The implant didn’t take. Eh, this is common, and the answer is simple, easy, and leads me to my final points.... put a thicker implant in. Did you use a 3.7x10? Use a 4.7x10. Wowza.

On to my final point of implant placement, and my humble opinion that most, if not all dentists should place them: 80% of the time it’s a 3.7x10! 

Ok, so you have a good patient, no real bad bone loss, and you’re placing all implants on the top. Typically that will consist of: 3 3.7x10 on either side for molars. one 4.7x13 on either side for canines, and 2 more 3.7x10 for the incisors. It can vary, maybe the last molars will be 3.7x8, but this formula works.   

Ok, I’ve made this post long enough, and probably upset someone out there who reads it. My point here is discussion and learning, not arguing and playing “Ms. Right”. All I’ve mentioned, I’ve seen and lived through. It will differ from others. My opinions (which are not unlike a$$ holes) are not scientific fact, and I don’t claim them to be. Don’t do this at home, I’m a trained poodle (professional), yadda, yadda. If you didn’t find this helpful, I hope you at least found it amusing. 

Don’t forget to floss.

[the-dental-assistants-assis-blog]

“I’m your huckleberry”

I’ve been a dental assistant for 16 years, and I’ve been a dental assisting instructor for almost a year. I enjoy dental temp work and have been a temp for four years. For my first eleven years, I worked with a general dentist who mostly did implants, gingival grafts, bone grafts, and other surgeries, as well as fillings, fixed prosthodontics, and esthetic procedures. I consider myself well rounded and cross-trained. 

Now that all that peacocking is said, I’m far from those assistants you see online. I’m much more your 90′s, tattooed chick, who has been hosed down with blood all in the name of someone else’s smile. So, I’m not some stuck up priss making YouTube videos about how to “properly close your mouth around the suction”. Here’s a hint: You DON’T. It BACKWASHES, and sends microbes from down in the suction, up the suction, and to the patient’s mouth. It’s more disgusting than how that video makes patients even more uncomfortable in the dental chair. 

That being said, as long as a patient doesn’t hit me, or fight too hard in the chair, I am hap-hap-happy! I’ve got a star in my chair. This isn’t Disney Land, so no patron is going to “have fun”, as I say. But I always tell them, “we are going to take great care of you, we are going to get through this as fast as we can, and you'll be glad you did this once it’s all over.” 

So, why a blog? Well, I’d like to network, spread more knowledge, and experiences and hear more from others in my field. I LOVE dental assisting, it’s active, keeps you thinking, requires skill and focus... it’s a challenge. It’s also a job that is giving to the public, and I am all about helping people. The job that puts me in the position to help make a real difference for a person, is the job for me. I avidly volunteer for a local free dental clinic held every year, as well. It’s a calling. That, tattoos, and Tom Petty.

Til next time ;)