Friday, May 20, 2016

Dental Implants for Nomads - 5 Lessons Learned

One drawback to nomadic life is the difficulty in maintaining continuity of "in-person" service providers-- be it hair stylists, mechanics, or doctors and dentists.  While most services can be performed same-day or within few days, a few require multiple visits over a much longer time period.  Getting a dental implant is one such example.

As I recently discovered, getting a dental implant as a full-time traveler can be fraught with added "gotcha" complexities.  To help fellow nomads steer clear of these in the future, I share my top 5 Lessons Learned:






#1 - Take charge!  Educate yourself thoroughly before starting the project.


Living in one location year-round and getting all your care from the same dentist or doctor can be WAY easier.  When I lived in Chicago and got my first dental implant a few years ago, I simply relied on my dentist to manage all the nitty-gritty details of what hardware he'd be using for the job and why.  All I had to do was show up for a few appointments with checkbook in hand!

Early last year, now as a full-time RVer, when I started the implant process with a new dentist in Los Algodones, Mexico (next to Yuma, AZ), I fell into the same familiar routine of leaving all the details to my new dentist.

BIG MISTAKE!

Did you know these facts about dental implants?  I sure didn't before I started this journey (....but now know the hard way!):

  • Implant hardware is not interchangeable from one vendor to the next, therefore, it's much more time-consuming (or impossible) for dentists to work with implant brands they don't normally use.
  • There are DOZENS of small "here today/gone tomorrow" manufacturers currently selling their products to North American dentists.  As a result, many don't stay in business that long.
  • Not all implants are installed the same way.  Some require an extra intermediate (and potentially very costly) "uncovering" procedure. 

Had I done a better job of educating myself beforehand, I may have avoided these potential "gotchas."

Taking a few extra days to do the research upfront and interview a few more dentists, would have saved me over $1300 of added dental costs, 8 extra months of time, and many more travel miles.  A big lesson-learned for this nomad!

#2 - Buy all hardware upfront when the implant is installed


A lot can change in 6 months or a year.  Your original implant dentist might close up shop.  The implant manufacturer might go belly-up.  And if you're a nomad, you might be halfway around the world or unable to travel back to your original dentist.  

Meanwhile, you have a brand new titanium implant screwed into your jaw with absolutely no way of mounting that final beautiful crown to it!

Whenever possible (and especially if you're a full-time traveler), ask your original implant dentist if you can buy all the remaining parts on the same day the implant is installed.  Each system is a little different, but in general, the remaining hardware will consist of:

  • Healing Abutment (for one-stage implants, installed immediately then the implant is placed.  For two-stage implants, installed after the uncovering procedure a month or more later).  This screws into the implant and protrudes a bit from the gum line, allowing you to wear a temporary denture tooth during the waiting months for new bone to grow around the implant and gum to heal around the abutment.
  • Impression Coping.  One or more sets of long screws the dentist will use when making your final impression set.  Depending on your situation, the dental lab may also need some implant manufacturer-specific hardware (called a lab analog).
  • Abutment.  The permanent, sturdy post that screws into the implant. This is placed at the final appointment (when the crown is cemented onto it).


Don't accept loose pieces-- these should each still be in their sterile sealed packages as shipped from the manufacturer.

#3 - Get a detailed record of any implanted device at the time it is implanted


This is good advice not only for dental implants, but any type of medical implant.  Manufacturers can have recalls many years later, or a part might fail and need replacement.  You will want to maintain a record of the following information:
  • Implant manufacturer name and model
  • Specific size (diameter, length, etc)
  • Lot number / Date of manufacture from the original packaging if available
  • Invoice showing your purchase/installation date along with the installing provider's name and contact information.
Not knowing the above information can lead to lengthy delays in trying to obtain care from subsequent providers.  When I tried to get crown work in the U.S. for the implant installed in Mexico, it took 2 extra weeks to track down the dentist and obtain this detailed information.

#4 - Whenever possible, get a one-stage implant


I had no idea there was such a thing as a two-stage implant.  I just assumed that because my new Algodones dentist, Dr. Yilka Gomez, said she'd be using a modern titanium implant that it'd be the same process as my first implant in the U.S.  

Since Dr. Gomez never mentioned it (and I never asked beforehand), I unknowingly received a two-stage implant.  I didn't realize that until a full 6 months later when I tried to have a U.S. dentist start the crown work.

To be fair, there are certain clinical reasons why a two-stage implant might be better.  They are shorter than single-stage, so if dealing with upper teeth and not wanting to risk hitting the sinus cavity, my understanding is that a two-stage has historically been the implant of choice.  However, many U.S. dentists have moved to newer techniques that allow them to now use single-stage implants in many more clinical situations than previously.  But some U.S. and Mexican dentists still lag behind (or are more overly conservative than) others.

Know which type of implant you'll be getting (and why) ahead of time.  Here are 2 short animation videos of these two processes:

This video is the one stage process:




and this video is of the two stage implant:



Unless a two-stage implant is absolutely clinically required, the one-stage is far easier for most patients (and far cheaper too).

A two-stage implant "may" be allowed to be uncovered as soon as one month after implantation.  In this scenario, a dentist would be able to do the uncovering procedure-- cutting the top of the gum to expose the top of the implant, and replacing the cover screw with the healing abutment.

If a longer time period elapses before the uncovering procedure, bone will have now grown over the top of the implant.  When this happens, a U.S. dentist will typically refer you to an Endodontist, as they are more skilled with bone removal work.  But this skill comes at a cost-- I had to pay $975 for a U.S. endodontist to perform this step.

Curiously, in Algodones, they don't seem to have this same opinion.  There, they believe that just about any dentist can easily handle this procedure (and charge a minimal fee of only $50-100).

Who is right?  I don't know.  But far better to avoid the whole question in the future and just get a single-stage implant!

#5 - Stick with the most-popular implant systems


If you aren't able to buy all hardware in advance, or have a hardware failure years later, you'll have much great flexibility (and less risk of needing an "orphaned" implant removed due to lack of parts from a long-gone manufacturer), by insisting ONLY on an implant from one of the market leaders.

Because I failed to ask upfront, and failed to buy all hardware beforehand, I didn't learn until well later that the implant Dr. Gomez installed was from a lesser-known manufacturer.  Neither of the 2 subsequent dentists had an existing relationship with this manufacturer, so it added an extra month to obtain needed parts.  Ultimately, when the third dentist could not source an abutment that would fit my implant, I had no choice but return all the way back to Dr. Gomez in Algodones, adding more time and travel expense.

While the market share data is not widely known, I did find multiple references to the top manufacturers listed below.  I will do this research again the next time I need an implant, and will select a dentist who only uses one of the top vendors.

As of 2014, a forum of dental implant sales reps estimated the market to comprise as follows:

  • Top tier (40% market share): Nobel and Straumann
  • Mid-tier (20 market share): Astra, 3I, Zimmer, and Implant Direct
  • Bottom-tier: all the rest (including dozens of "fly-by-night" companies)  

Summary


Dental implants are a modern miracle-- fairly painless to get installed, and once the final crown is in, they function as good or better than an original tooth.  But costs, provider skill levels, and hardware availability can vary widely across the U.S., and in Mexico.

My first dental implant a few years ago (done by a U.S. dentist) took 5 months from beginning to end, for a total cost of $2400.  

This last dental implant (done by 2 Mexican dentists, a U.S. dentist, and U.S. endodontist) took a total of 13 months, for a total cost of $2800!

Some would assume that this tale of woe would sour me from using any Mexican dentist ever again.  But far from it!  

There are a few very good implant dentists in Algodones, who use top-tier single-stage implants, and do excellent work.  Had I used one of them, the total cost would have only been in the $1500 range.

It pays to do your homework!








11 comments:

  1. Good info, Lynne. Sounds like quite a saga, but fortunately it worked out. I just had two crowns on my front teeth due to cracking and chipping. I was surprised as to how the technology has changed in just the last 2 years. New systems let the dentist do 3D CAD imaging and build the new teeth right in their office in a few hours. The dentist and I modeled the new teeth, picked the color, length, and texture all on the computer. No more impressions and waiting. I've been going to the same dentist for 35 years and trust him with everything. Health care providers are one of the reasons as to why I'm still a sometime RVer.

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  2. Fabulous article, I hope I never need this Info, but if I do your post will be invaluable!

    Nina

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  3. I am definitely saving this info. Thanks for doing this.

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  4. Great info Lynne, thanks for taking the time and effort to put this all together. I agree there are many good, even great, dentists across the border. It's the dang TJ border crossing that has been the biggest drawback, guess we could follow your lead and plan an annual trip to Los Algodones, but we're back to using the local talent.

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  5. Wonderful and informative article. Do you have Dr.s in Mexico you recommend?

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  6. Thank you for putting this all together Lynne! My story is a little different. I went to a well known Algodones clinic when my bridges started to deteriorate with one getting badly infected. Two years ago they removed the bridges and did quite a bit of bone grafting to prepare for the implants. We agreed to let everything heal and I would return in 10 months. They gave me a price for the complete job and I made do with only part of my teeth all summer. Returning last November they did more scans and announced that the solution we had agreed to in February would no longer work and I was facing a $14K cost instead of the original $8K ($1.5K of which I had already paid).

    Needless to say, this set me back a little and I left their office to think about it. So far, I have done nothing more. I have no contract or loyalty to them and have since talked to friends who have used a different Algodones implant dentist who I will go and see in November. Luckily I have not had anything actually inserted into my mouth yet.

    Perhaps you could share with us some of the better implant dentists in Algodones. Thanks.

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  7. Appreciate the great explanation; I'm afraid some of this is in my future, and my dentist is nearing retirement...

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  8. Wow! I truly had no idea. I just assumed that they all used the same hardware. Thanks for the info!

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  9. Really appreciate the info. Dental care has been one of our biggest challenges since we went on the road. Thanks so much!!

    TRace

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  10. The one thing about implants that I didn't know was that the hole left in the line of teeth by a missing tooth can really upset the remaining teeth. Once my tooth was removed I put off getting the implant, then the two back teeth began to shift and become loose because they lost their support. The diagrams in your post really explain the process well.

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  11. Well done and nice job ex client work and useful information about the dental community it's nice job.
    dental community

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