Dental implants.
- Thread starter nlaruccia
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Sockhopper
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There ARE issues of incompatibility not just with the different hardware but with different methods being used in different countries.
In Canada, dentists in my city will not match how they make the crown to the Argentine method used for implants. The same goes here for implant methods used in Brazil which are also different again from the Argentine method and different from methods used in some European countries.
Labs seem to be the boss here. The lab, not your dentist, determines the method and won’t adapt to the Argentine one. Dentists here pass the impressions they take to the lab and leave everything up to the lab. That's how the system works here. Dentists won’t adapt to a foreign method not because they lack the skill or knowledge to but because their professional liability insurance won’t protect them if they don’t confine themselves to using the method recognized and used here. When this happens, the abutment you’ve carefully brought back from Argentina for your home dentist is useless. The North American method of how the crown is made and the resulting mismatch with the method used for your implant can leave you with two 3cm gaps between the crown made here and your gum. This creates a food trap that increases the risk of your bone and gum becoming infected and your implant then falling out and having to be replaced. Because your dentist is basically a nice person but focuses on your immediate satisfaction, he won’t tell you this unless you remember to ask him about food. Even then, he’ll make light of it perhaps because he just likes you and wants to do whatever he’s permitted to do for you. This qualifies as success here more than how well your implant and crown will hold up over time.
I'm not a dentist but the difference in the methods used from what I’ve as a laymen seen is that implants done the Argentine way fit higher in the gums while the North American method of making an implant crown coincides with the implant being lower in the gum. In the North American method, the crown is attached to the ‘screw’ and appears to fit over the implant. In the Argentine method, the implant is attached to the ‘screw’ and holds the crown. If your knowledge differs from this or is better, please let us know.
Some US dentists do adapt their method for a patient who’s had an implant inserted in BA. The Argentine method is very easy. Any dentist in the world should be capable of doing it. But many North American dentists won’t know the Argentine method until they come to make your crown. Here’s the rub: if you ask your home dentist before you have implant surgery in BA if he’ll make an implant crown for you once your prospective foreign implant heals, he'll say "Yes” (if he likes you and isn’t a money grubber) because he can’t conceive of the North American method not being the only one in the world nor that all methods used in the world wouldn’t be made to be adaptable to the North American method.
Canadian dentists generally tend to see things done differently from here as extremely weird and thereby automatically wrong! When I see a top specialist or ordinary NHS dentist in London UK, or Dr. Pelcman in BA, or someone in France, I don’t encounter this. They’ve all had far greater exposure to a broader range of techniques and implants than Canadian dentists in my experience of dentistry and having lived in a few countries.
To counter this Canadian impasse, there is one way around all this. Dr. Pelcman does this. But first, some background is needed. Implants generally take 3 months to heal before a crown can be placed. I’m told that it takes that long for your bone to integrate by between 65% (minimum acceptable integration) to 75% (optimal integration). But length of time needed to heal can be 6 months and rarely, 9. Only your surgeon can advise you of the time each of your implants needs before it can be crowned and function as a tooth. It’s crucial to abide by what he/she says. Length of time can depend on circumstances existent at each particular implant site, for example upon the quality of the bone right there. Additionally, you must not chew on an implant at all for the first 90 days after surgery. After 90 days, the implant and bone are just strong enough to take gentle chewing. I doubt that any dentist anywhere would let you walk out with a crown fitted right and worn right after implant surgery has been done as someone implied in this thread.
So, back to one way around the incompatibility of methods. Dr. Pelcman recently made a crown for a back molar for me just 2 weeks after implant surgery. His lab made it in about 3 days. He then lightly tried it in my mouth, had the lab make adjustments and finish it, tried it on me again, liked it and made small adjustments beside me while I sat in his chair. He then had me sit 15 minutes with my upper and lower teeth closed on a piece of gauze. Then he fitted the crown in my mouth for seconds and found the fit to be perfect. So did I! I took this crown home, waited for 3 months to pass and then asked my home dentist to cement it. That’s all he would need to do. No abutment. No further lab work. But he didn’t want to use this crown. That a crown could be made while an implant was still fresh is novel to him and his colleagues. He was positive that this crown would never fit my implant although I told him that it had when Dr. Pelcman tested it in BA. He finally agreed to ‘try’ fitting this crown just to cajole me and show me how stupid I was to have dental work done in “South America”.
Of course, this crown fit perfectly once I directed him how to do the gauze thing. When he returned 15 minutes later confident that I’d see how wrong I’d been, he was astounded that a piece of gauze could do what it had. He couldn’t believe his eyes. This crown was so well seated in my gum and solid that it didn’t need any cement or to be touched again by him. I explained that the gauze causes the gums to shrink just enough for the crown to seat itself in the gum while the gauze is present. In an age when our dentists rely upon and put their faith in technology far more than knowledge, hands-on skill and problem-solving, simple methods are too SMALL for them to want to comprehend and to have to charge you less for. And a whole generation of dentists here has never seen a handmade crown. I was happy to not have to spend $CAD 1,800 more for an implant crown made here and have more impressions taken or return to BA so soon.
When I came to pay for the cementing that had not been done, my private dental insurer’s schedule lists no such item as just a cementing of a crown. There is an item for re-cementing a crown that has fallen off. That schedule of procedures doesn’t provide for initial cementing of a crown by a dentist who didn’t also make the crown. So he found another listed procedure that would do. In this way, I again saw how dentistry comes to be so regimented here as to which services our dentists can and can’t provide us. This leaves no room for creative thinking and solutions when insurers’ rules work in one way against dentists and in another way against patients. If this bondage is indicative of more fields than just dentistry, then no wonder my country isn’t keeping pace with competition beyond its borders.
The same kind of thing goes on in the US sometimes when Americans have implants done in BA. US dentists have in at least 3 cases I know told patients that their new implants (once these US dentists found out from their patients which of their implants had been done in BA!) that all THOSE implants were seriously infected and had to be removed and replaced immediately.
If you're ever told this and have no pain, stay calm. Ask your dentist to email you the fresh x-rays he's just taken. Forward these to your Argentine dentists. When they find no infection whatsoever, they are as astounded by this scam on our continent as we are by other types of scams in their country. They can’t understand their colleagues abroad stooping to fraud. This embarrasses them and hurts their pride in their profession. Imagine hearing that the patient you’ve treated has since been told that he has an infection that he clearly does not have, and his being told that he must now suffer a loss of more money, removal surgery, healing time, new implant surgery and more healing time, and going another year unable to eat well and never smiling just because North American dentists won’t kick the myth that we patients ought to have more money than we do and that if we don’t have it, then we don’t deserve the best in dentistry and are cheats to search for it at a price we can afford. And that we should, instead, be content to wear false teeth as our grandparents did 50 years ago.
I've been eating on my new crown for 5 weeks. It feels like I was born with it. It looks better than my crowns made by expensive prosthodontists here. My home dentist who fitted this crown said so as part of his apology to me.
Putting my faith in Dr. Pelcman has been one of my best life decisions.
In Canada, dentists in my city will not match how they make the crown to the Argentine method used for implants. The same goes here for implant methods used in Brazil which are also different again from the Argentine method and different from methods used in some European countries.
Labs seem to be the boss here. The lab, not your dentist, determines the method and won’t adapt to the Argentine one. Dentists here pass the impressions they take to the lab and leave everything up to the lab. That's how the system works here. Dentists won’t adapt to a foreign method not because they lack the skill or knowledge to but because their professional liability insurance won’t protect them if they don’t confine themselves to using the method recognized and used here. When this happens, the abutment you’ve carefully brought back from Argentina for your home dentist is useless. The North American method of how the crown is made and the resulting mismatch with the method used for your implant can leave you with two 3cm gaps between the crown made here and your gum. This creates a food trap that increases the risk of your bone and gum becoming infected and your implant then falling out and having to be replaced. Because your dentist is basically a nice person but focuses on your immediate satisfaction, he won’t tell you this unless you remember to ask him about food. Even then, he’ll make light of it perhaps because he just likes you and wants to do whatever he’s permitted to do for you. This qualifies as success here more than how well your implant and crown will hold up over time.
I'm not a dentist but the difference in the methods used from what I’ve as a laymen seen is that implants done the Argentine way fit higher in the gums while the North American method of making an implant crown coincides with the implant being lower in the gum. In the North American method, the crown is attached to the ‘screw’ and appears to fit over the implant. In the Argentine method, the implant is attached to the ‘screw’ and holds the crown. If your knowledge differs from this or is better, please let us know.
Some US dentists do adapt their method for a patient who’s had an implant inserted in BA. The Argentine method is very easy. Any dentist in the world should be capable of doing it. But many North American dentists won’t know the Argentine method until they come to make your crown. Here’s the rub: if you ask your home dentist before you have implant surgery in BA if he’ll make an implant crown for you once your prospective foreign implant heals, he'll say "Yes” (if he likes you and isn’t a money grubber) because he can’t conceive of the North American method not being the only one in the world nor that all methods used in the world wouldn’t be made to be adaptable to the North American method.
Canadian dentists generally tend to see things done differently from here as extremely weird and thereby automatically wrong! When I see a top specialist or ordinary NHS dentist in London UK, or Dr. Pelcman in BA, or someone in France, I don’t encounter this. They’ve all had far greater exposure to a broader range of techniques and implants than Canadian dentists in my experience of dentistry and having lived in a few countries.
To counter this Canadian impasse, there is one way around all this. Dr. Pelcman does this. But first, some background is needed. Implants generally take 3 months to heal before a crown can be placed. I’m told that it takes that long for your bone to integrate by between 65% (minimum acceptable integration) to 75% (optimal integration). But length of time needed to heal can be 6 months and rarely, 9. Only your surgeon can advise you of the time each of your implants needs before it can be crowned and function as a tooth. It’s crucial to abide by what he/she says. Length of time can depend on circumstances existent at each particular implant site, for example upon the quality of the bone right there. Additionally, you must not chew on an implant at all for the first 90 days after surgery. After 90 days, the implant and bone are just strong enough to take gentle chewing. I doubt that any dentist anywhere would let you walk out with a crown fitted right and worn right after implant surgery has been done as someone implied in this thread.
So, back to one way around the incompatibility of methods. Dr. Pelcman recently made a crown for a back molar for me just 2 weeks after implant surgery. His lab made it in about 3 days. He then lightly tried it in my mouth, had the lab make adjustments and finish it, tried it on me again, liked it and made small adjustments beside me while I sat in his chair. He then had me sit 15 minutes with my upper and lower teeth closed on a piece of gauze. Then he fitted the crown in my mouth for seconds and found the fit to be perfect. So did I! I took this crown home, waited for 3 months to pass and then asked my home dentist to cement it. That’s all he would need to do. No abutment. No further lab work. But he didn’t want to use this crown. That a crown could be made while an implant was still fresh is novel to him and his colleagues. He was positive that this crown would never fit my implant although I told him that it had when Dr. Pelcman tested it in BA. He finally agreed to ‘try’ fitting this crown just to cajole me and show me how stupid I was to have dental work done in “South America”.
Of course, this crown fit perfectly once I directed him how to do the gauze thing. When he returned 15 minutes later confident that I’d see how wrong I’d been, he was astounded that a piece of gauze could do what it had. He couldn’t believe his eyes. This crown was so well seated in my gum and solid that it didn’t need any cement or to be touched again by him. I explained that the gauze causes the gums to shrink just enough for the crown to seat itself in the gum while the gauze is present. In an age when our dentists rely upon and put their faith in technology far more than knowledge, hands-on skill and problem-solving, simple methods are too SMALL for them to want to comprehend and to have to charge you less for. And a whole generation of dentists here has never seen a handmade crown. I was happy to not have to spend $CAD 1,800 more for an implant crown made here and have more impressions taken or return to BA so soon.
When I came to pay for the cementing that had not been done, my private dental insurer’s schedule lists no such item as just a cementing of a crown. There is an item for re-cementing a crown that has fallen off. That schedule of procedures doesn’t provide for initial cementing of a crown by a dentist who didn’t also make the crown. So he found another listed procedure that would do. In this way, I again saw how dentistry comes to be so regimented here as to which services our dentists can and can’t provide us. This leaves no room for creative thinking and solutions when insurers’ rules work in one way against dentists and in another way against patients. If this bondage is indicative of more fields than just dentistry, then no wonder my country isn’t keeping pace with competition beyond its borders.
The same kind of thing goes on in the US sometimes when Americans have implants done in BA. US dentists have in at least 3 cases I know told patients that their new implants (once these US dentists found out from their patients which of their implants had been done in BA!) that all THOSE implants were seriously infected and had to be removed and replaced immediately.
If you're ever told this and have no pain, stay calm. Ask your dentist to email you the fresh x-rays he's just taken. Forward these to your Argentine dentists. When they find no infection whatsoever, they are as astounded by this scam on our continent as we are by other types of scams in their country. They can’t understand their colleagues abroad stooping to fraud. This embarrasses them and hurts their pride in their profession. Imagine hearing that the patient you’ve treated has since been told that he has an infection that he clearly does not have, and his being told that he must now suffer a loss of more money, removal surgery, healing time, new implant surgery and more healing time, and going another year unable to eat well and never smiling just because North American dentists won’t kick the myth that we patients ought to have more money than we do and that if we don’t have it, then we don’t deserve the best in dentistry and are cheats to search for it at a price we can afford. And that we should, instead, be content to wear false teeth as our grandparents did 50 years ago.
I've been eating on my new crown for 5 weeks. It feels like I was born with it. It looks better than my crowns made by expensive prosthodontists here. My home dentist who fitted this crown said so as part of his apology to me.
Putting my faith in Dr. Pelcman has been one of my best life decisions.
jimdepalermo
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A few years ago, a friend visiting from the US was having trouble with some false teeth and asked me to find out about implants, which he might schedule for a return trip. His dentist in Missouri (with no specialization in surgery) had quoted him an estimated price in the tens of thousands of dollars.
Remembering a conversation with my expert dentist in NYC about possible long-term complications from implants, I decided to look for qualified maxilofacial surgeons here, rather than general odontologos. My friend also needed someone who speaks English. I went through the OSDE cartilla for English-speaking maxilofacial surgeons with conveniently-located consultorios.
I spoke with a few surgeons, all but one of whom said "sure - no problem - tell your friend to schedule at least X weeks here, and I'll take care of him."
The exception was a Dr. Ferreria. I couldn't reach him for a couple weeks because he was away presenting research to a dental conference in the US. When we eventually spoke by phone, he explained that he would need to review a number of diagnostics before recommending an approach. He seemed especially capable - and cautious. The signature block on his email read
Remembering a conversation with my expert dentist in NYC about possible long-term complications from implants, I decided to look for qualified maxilofacial surgeons here, rather than general odontologos. My friend also needed someone who speaks English. I went through the OSDE cartilla for English-speaking maxilofacial surgeons with conveniently-located consultorios.
I spoke with a few surgeons, all but one of whom said "sure - no problem - tell your friend to schedule at least X weeks here, and I'll take care of him."
The exception was a Dr. Ferreria. I couldn't reach him for a couple weeks because he was away presenting research to a dental conference in the US. When we eventually spoke by phone, he explained that he would need to review a number of diagnostics before recommending an approach. He seemed especially capable - and cautious. The signature block on his email read
Jose Luis Ferreria, DDS, PhD
IAOMS Past-President
Chairman Oral and Maxillofacial Department
School of Dentistry
Universidad de Buenos Aires
Callao 796
Buenos Aires - ARGENTINA
Phone Fax 54 11 4816 0087
My friend did not pursue this, so I have no direct recommendation to pass along.IAOMS Past-President
Chairman Oral and Maxillofacial Department
School of Dentistry
Universidad de Buenos Aires
Callao 796
Buenos Aires - ARGENTINA
Phone Fax 54 11 4816 0087
Sockhopper
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SamG,
How horrible this happened to your front tooth! I've not lost one there. I understand how you feel but you know, all ages and kinds of people need implants and we just get used to it and try to imagine the day we won't have a space there any longer. People are pretty nice to you but but it can be embarrassing. Believe me, it's worth it! It's better than Christmas to plan a fancy restaurant for supper on the day that crown is inserted,. Doing that at your favourite place for hours on end in BA is a fabulous reward to schedule. And so is ordering any kind of food you want!
When I got down about looking awful and worrying what people thought when they saw the gap, I remembered this true event involving a 27-year year-old very pretty woman who'd been a patient of Dr. Pelcman about 2 years before me and who highly reommended him to me. She even e-mailed me photos detailing the many new aspects of life her after he helped her. She was born without teeth and didn't grow any adult ones. She lived in southern Ontario. She researched for a great dentist who could help her anywhere in the world. She really wanted to change her life. She found Dr. Pelcman, contacted him and learned he'd be visiting NYC very soon. She drove after work overnight from Canada to his hotel room there. He examined her. She drove home. Then she went to BA. He gave her her very first set of teeth, every single one of them, all at once! But all she talks about is her great new life life, not her memory of pain. Surely she must be the world's bravest or most committed dental patient!
I'm not a dentist but I've had so much dental work in my life that new dentists in every country are amazed when they first see my x-rays. What I know is from a patient's perspective. It's general knowledge, not advice.
I've never heard of a temporary crown at an extraction site because there's nothing in that spot to attach one to; and that area needs to breathe and be well cleaned and kept healthy until the crown is fitted.
Where I live, it's not until the surgery is actually being done that my dentists discover that I need other thngs done done as well during surgery- eg.commercial bone added or a sinus lift. Each cost $800 a pop here. Dr. Pelcman has a much better grasp of the state of bone than do dentists here. He doesn't just rely on x-rays. At consultation, he handles the gums in an expert way to test how much bone you have and its characteristics. He knows far more about what's going on in a problem tooth than any of my specialists here who only study x-rays. This way, I'm not shocked at the price when after surgery I get the bill and see that another $1600 has gone on it for extra procedures. I've not yet had a 'price' surprise with Dr. Pelcman.
If only you could have your extraction and implant done right away, you'll save a mint! At home, the extraction alone costs me $500 whether or not I have implant surgery at the same time. Dr. Pelcman doesn't charge for the extraction when both are done together. Another point is this. Let's say you go to your family dentist at home because he'll probably charge less than a periodontist in your city who does extractions and implant surgery. If your family doctor doesn't also do implants, then you'll have to let the extraction heal before you have the implant surgery done by someone else, eg. a specialist.
The good news is that you say you're returning to BA in a year. Generally, an implant needs to be crowned within one year, maybe a bit longer, after surgery. Waiting too long to have a crown allows the bone to grow over the implant. If that happens, the implant can no longer be crowned; it would have to be removed and the whole process begun again.
Best of luck. Please get back to us on whatever you decided to do.
How horrible this happened to your front tooth! I've not lost one there. I understand how you feel but you know, all ages and kinds of people need implants and we just get used to it and try to imagine the day we won't have a space there any longer. People are pretty nice to you but but it can be embarrassing. Believe me, it's worth it! It's better than Christmas to plan a fancy restaurant for supper on the day that crown is inserted,. Doing that at your favourite place for hours on end in BA is a fabulous reward to schedule. And so is ordering any kind of food you want!
When I got down about looking awful and worrying what people thought when they saw the gap, I remembered this true event involving a 27-year year-old very pretty woman who'd been a patient of Dr. Pelcman about 2 years before me and who highly reommended him to me. She even e-mailed me photos detailing the many new aspects of life her after he helped her. She was born without teeth and didn't grow any adult ones. She lived in southern Ontario. She researched for a great dentist who could help her anywhere in the world. She really wanted to change her life. She found Dr. Pelcman, contacted him and learned he'd be visiting NYC very soon. She drove after work overnight from Canada to his hotel room there. He examined her. She drove home. Then she went to BA. He gave her her very first set of teeth, every single one of them, all at once! But all she talks about is her great new life life, not her memory of pain. Surely she must be the world's bravest or most committed dental patient!
I'm not a dentist but I've had so much dental work in my life that new dentists in every country are amazed when they first see my x-rays. What I know is from a patient's perspective. It's general knowledge, not advice.
I've never heard of a temporary crown at an extraction site because there's nothing in that spot to attach one to; and that area needs to breathe and be well cleaned and kept healthy until the crown is fitted.
Where I live, it's not until the surgery is actually being done that my dentists discover that I need other thngs done done as well during surgery- eg.commercial bone added or a sinus lift. Each cost $800 a pop here. Dr. Pelcman has a much better grasp of the state of bone than do dentists here. He doesn't just rely on x-rays. At consultation, he handles the gums in an expert way to test how much bone you have and its characteristics. He knows far more about what's going on in a problem tooth than any of my specialists here who only study x-rays. This way, I'm not shocked at the price when after surgery I get the bill and see that another $1600 has gone on it for extra procedures. I've not yet had a 'price' surprise with Dr. Pelcman.
If only you could have your extraction and implant done right away, you'll save a mint! At home, the extraction alone costs me $500 whether or not I have implant surgery at the same time. Dr. Pelcman doesn't charge for the extraction when both are done together. Another point is this. Let's say you go to your family dentist at home because he'll probably charge less than a periodontist in your city who does extractions and implant surgery. If your family doctor doesn't also do implants, then you'll have to let the extraction heal before you have the implant surgery done by someone else, eg. a specialist.
The good news is that you say you're returning to BA in a year. Generally, an implant needs to be crowned within one year, maybe a bit longer, after surgery. Waiting too long to have a crown allows the bone to grow over the implant. If that happens, the implant can no longer be crowned; it would have to be removed and the whole process begun again.
Best of luck. Please get back to us on whatever you decided to do.
sam3g
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Sockhopper said:
Thank you for all the advice and support! I didn't realize that implants were so common (I'm in my 20's so I don't know anyone that has had them quite yet). After talking with Dr. Pelcman, we decided to do the extraction and implant next week. He is going to try and use a US made implant (and sell me the abutment) as I will be getting the crown done in the US (no plans to come back to BA anytime soon). He seems like he has a lot of experience, and what little English we spoke was commendable. My girlfriend has decided to have a root canal done with him as well next week. I will keep you updated on how it goes!
sam3g
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I had the surgery at Dr. Pelcman's office last week. He charged me U$780 for the following:
-Temporary tooth (until surgery - he put a metal rod in what was left of the root and fastened an acrylic tooth)
-Root extraction
-Implant
-Abutment (Implant and abutment are made in USA)
-Denture with fake front tooth
Overall I am very pleased with Dr. Pelcman. He seems like a straight shooter and although my fiancee feels he was lacking warmth with her root canal, you can't argue with the results.
I'll get a crown put in in the US in a few months. Does anyone have any tips for getting used to dentures? Mine clip on my back teeth to provide me with a front tooth. I find them extremely uncomfortable!
-Temporary tooth (until surgery - he put a metal rod in what was left of the root and fastened an acrylic tooth)
-Root extraction
-Implant
-Abutment (Implant and abutment are made in USA)
-Denture with fake front tooth
Overall I am very pleased with Dr. Pelcman. He seems like a straight shooter and although my fiancee feels he was lacking warmth with her root canal, you can't argue with the results.
I'll get a crown put in in the US in a few months. Does anyone have any tips for getting used to dentures? Mine clip on my back teeth to provide me with a front tooth. I find them extremely uncomfortable!
Sockhopper
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sam3G,
Before you fly to the US, nortify Dr. Pelcman that your finding it uncomfortable and ask him how long it will be until you grow accustomed to it. You must be happy not having to wak around with a gap!
Before you fly to the US, nortify Dr. Pelcman that your finding it uncomfortable and ask him how long it will be until you grow accustomed to it. You must be happy not having to wak around with a gap!
BaltRochGirl
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Sounds like Pelcman is the way to go for crowns, could someone who has been to him please PM me their name for a recommendation?
Muchas Gracias!!
Muchas Gracias!!
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