Denis Miller: Thanks Bill, glad to be back.
Lou George: Thanks Bill.
Bill Zortman: One of the key areas that I know that you have spent a lot of time looking at demographics and actually doing some work is the dental implants. What’s happened in ’17? What’s going to happen in the future? And what should our listeners kind of pay attention to?
Denis Miller: Well, dental implants historically have been around since the 70s in various forms, shapes, and sizes, and as the patents came off different implants, more and more companies entered into the market, and I think at last count, and I’m certainly not an expert at how many implant companies there are out there, but it’s well into 300s/400s, and that’s just in North America. So, some of the things that are up and coming in ’18, ’19, ’20, moving forward is when you get dental implants, it’s important to stick with the leaders in the field, and there’s only about three different companies that will take care of 80% of the market share, and we’ve chosen to go with Nobel Biocare, which is the leader in the field — they have the greatest market share, and they’ve been at it the longest. They’re the ones that invented dental implants, so you can trust the science that they have. Any of the literature that you see where other people have tested their science against other implants and other studies, it holds up really, really well all the way through. The danger, I think, moving forward is you have a lot of other little companies that sometimes the dentist themselves have a proprietary interest in, and having met some of these companies and some of these people, their main goal is to make it enough of a pain in the rear for the big companies that their little company will be sold and bought out, and then that implant line will be gone. So, moving forward, you might get discounted implants, but they’re discounted for a reason.
Lou George: That’s right.
Denis Miller: And so, I think sticking with more reputable companies with longer track records, which is what we do, that’s part of what the listeners should ask their oral surgeon: what implant company are they using, and why are they using it. So, that’s part of it. A lot of these companies don’t bring things to market unless there’s a lot of research behind it. Again, using Nobel is . . . the key for that is they came out with an implant that was actually manufactured in Israel to begin with, and it took them 10 years to bring it to the American market because they wanted to test it, and it’s got probably the best holding power of any implant out there. It changed the game through something called platform switching, and now they’re using it in different ways to anchor dentures in this new type of design called the Trefoil Technique, which we talked about in a different sitting. So, those are some of the things that are evolving, and I think that you’re moving into 2018 and ’19, you’re really going to need a specialist in dental implants to kind of get all the information that you need to make a proper decision. We’ve talked about this before: if all you have is a hammer, everything is a nail. Whereas, as board-certified oral surgeons, we know all the different parts of surgery and all the different parts of grafting, so we can give our patients a good amount of information to make a decision on what kind of implant setup they want, what kind of bone grafting can they or should they or should not have. That’s all part of the informed consent process, so that’s the things I think people have to think about in 2018, 2019, 2020, moving forward. They just can’t take everyone’s word for it, like “Oh, I’m going to get implants,” and then just do whatever so-and-so says. You have to be able to do your research, and I think Dr. George and I do a great job of being able to educate people on the website, through our links. And, of course, if they come for a consult, the CT and the consult’s free. Come on in; pick our brain. We’ll be glad to give you an opinion.
Lou George: And one of the things we always tell our patients when they’re there and we have their attention talking to them, the products that we’re going to be providing to them are all products that we use on our own family, we have used on our own family, we’ve used on each other to restore teeth. So, this comes down to it quite honestly, and I say this in all of my consults is that, first of all, we’re never going to give a patient more than they need. They’re there for a certain purpose. We’re not looking to sell them a home in Florida at the same time. It’s not about that. On the other hand, we’re not going to sign off on garbage either. We never take the shortcut or kind of under treat just to patch something up or get something by. Both Dr. Miller and I are placing these implants or bone grafting these areas for the long haul, meaning we expect them to live up to what the implant companies say, which in a lot of cases is indefinite, so we really pride ourselves on that. And like Dr. Miller said, the consult and CT scan are free, our time is free. That’s when you get to come in and sit and talk, and like he said, anything you wanted to know about dental implants, we’ll be happy to provide you the information with. Whether you choose to go that route or not, you’ll definitely leave with a much better comprehensive and practical understanding of it.
Bill Zortman: I think when I hear that the average age for dental implants is around 43 here in the Sioux Falls office, that’s breaking news — breaking news in a way that would surprise me a little bit. But we start hearing about 12-, 14-, 15-years-olds that are maybe involved; is that the changing trend?
Denis Miller: Well, you have to be very careful on putting dental implants in kids — teenagers in specific — because facial growth continues into 18, 19, 20. It’s very minimal, but it does occur, and in a small subset of the population, it’s significant enough that, if you put in an implant way too early — 12, 13, 14, 15, somewhere right around there — the amount of facial growth that occurs leaves the implant behind. The implant doesn’t grow with the face like teeth. It’s not biological, so it doesn’t quite follow the same pathway as teeth do. And then, all of a sudden, you’re 25, and the implant crown that you had is now way too short, and to pick on the maxilla, if it was placed at 15 or 14, not only is it too short, now it’s partway in your palate. It’s just really tough to get a prosthetic that will work, and a lot of times, you just have to take it out. Now, there is a subset population of patients that are born with almost no teeth. Now, in that population, for psychosocial reasons and for mastication, yeah, you’ll put implants in at 8, 9, 10, but in 20 years, I’ve probably seen maybe about 3 or 4 of those that are complete anodontia cases and needed something like that, so it’s a very limited set. The vast majority of the kids, right around 17 you’re pretty safe, and a lot of times what we’ll do is, we’ll take a CT scan one year, and then we’ll take one another year, and because there’s no distortion in the CT scans, you can superimpose them, and if there’s no facial growth, then you know you can place them in with a fair degree of confidence that, in the future, the prosthetics are still going to be viable, and so that’s one patient population. The rest of it is people that, for a variety of reasons, their teeth have succumbed to use over the years, whether that be cavities or root canals or fractures, and a lot of people we’re seeing right now would like to have, let’s say, a front tooth that’s failed on them removed and an immediate implant placed. That can certainly be done for a vast majority of people. Posterior teeth, it’s a little bit harder. I would say that’s about 70% of the time we can do it, 30% we can’t. And in the other patient population we tend to see is the elderly that are in good health that would like to have either partial dentures stabilized with dental implants or their dentures stabilized with implants, or they’d like to go for full fixed prosthetics. But we talked about it in an earlier segment: you have to keep an eye to how well people can take care of these things because if you can’t take care of them, you can put in all this beautiful work and all kinds of implants and all kinds of bridges, and if you can’t take care of them, they’re going to fail in five years, and then you’ve spent pretty well, like Dr. George said, the mortgage, and you’re not going to get use of them. So, part of what we talk about is what are the different types of treatments that are available, what can we do, what do we think is reasonable, and what’s the risk versus benefit ratio, and what economically makes sense.
Bill Zortman: Better quality of life seems to be the center of this, and make sure that you come in and be consulted. Know your options, because you don’t want to have something that happens a year from now, five years from now, twenty years from now.
Denis Miller: Yeah, we place a lot of implants, and we see a lot of people, been through it for 20 years, so we see people going through some of the different stages of their life, and one of the things that we’ve seen is a lot of people do clench and grind, and if nobody is really watching about the clenching and grinding, either by adjusting the occlusion or getting people into night guards, that’ll overload the implants. So, I guess one of the take-homes from this segment for the listeners are is if you’re getting a full-mouth reconstruction or even just the back teeth reconstructed, if no one is watching the way the teeth come together and putting you in a night guard, especially if you know you clench and grind — if nobody’s looking, nobody knows — then you’ll blow out those implants and cause significant damage to them in about five years, and you just spent a boatload of money, and that would just be a shame. And when you lose bone, then putting a new set of implants in later is a lot harder.
Bill Zortman: So, how do they get started?
Denis Miller: Well, the first thing is either talk to your dentist or give us a call directly, and our policy is, for dental implants, it’s a free consult and a free CT, and we can certainly get you the information and discuss your case with you, and then you can go back to your dentist, or if you don’t have a dentist, we can find one for you that’s either close to home or close to work and get you on that path if you’re interested in it and if you’re a candidate.
Bill Zortman: Dr. Lou George, Dr. Denis Miller — Siouxland Oral Surgery. Sioux Falls, Mitchell, Brookings, Yankton. Thanks for the visit.
Denis Miller: Thanks Bill.
Lou George: Thanks Bill, have a great day.