Online Health Chat with Todd Coy, DMD

Wednesday, November 8, 2017


Description

Cleveland Clinic’s Section of Dentistry treats routine dental patients daily, but also handles more complex medical and dental issues. Cleveland Clinic dentists employ the latest techniques and most advanced technologies to solve complex oral and dental problems. More important than the latest technology, however, is the firm belief that the team approach to solving problems provides superior results.

Despite improvements in dental care, millions of Americans suffer tooth loss – mostly due to tooth decay, periodontitis (gum disease) or injury. For many years, the only treatment options available for people with missing teeth were bridges and dentures. But today, dental implants are available.

About the Speaker

Todd Coy, DMD received his dental degree from Case Western Reserve University School of Dental Medicine and completed a general practice residency at Cleveland Clinic. He joined the staff in 2006, served as program director for the general practice residency until 2013 and now serves as section head of dentistry. Dr. Coy provides general restorative dental care, and has special interests in dental care for medically complex patients, treatment of traumatic dental injuries and sleep apnea. He maintains membership in professional societies including the American Association of Hospital Dentists, American Dental Association, Greater Cleveland Dental Society and the Academy of Dental Sleep Medicine.


Let’s Chat About Dental Implants


Discussing Details

heartline: What brand of dental implants do you use? Also, what is the cost of each for the implant, restoration, extraction fee (if needed), cone beam X-ray and consultation?

Todd_Coy,_DMD.: Although there are many quality manufacturers of dental implants, we typically use Straumann implants. The cost can vary depending on individual needs, but typically falls between $3000 and $5000 for a single tooth replacement. The line item costs would have to be addressed by our business office.

bsims: Hello. I already have two dental implants, and I am very pleased with my medical provider. The process from pulling a tooth to placing the implant, healing cap, abutment then crown is a long process due to healing. I see advertisements for implants in a day. How can this be? Am I missing something? Thanks.

Todd_Coy,_DMD.: In the case of a single tooth replacement, certain clinical situations can be suitable for implant placement immediately at the time of tooth extraction. Several patient-specific factors need to be considered to determine whether that is a possibility. Having all remaining teeth extracted and replaced in a day is possible and often means that several implants are placed in positions in which they can be immediately stable and able to support the new teeth. Typically, this is a temporary prosthesis that would be replaced with a more definitive one once the implants complete the healing phase.

bettys: What are the pros and cons of using a custom abutment versus a stock?

Todd_Coy,_DMD.: Custom abutments are often a necessary choice due to angulation and spacing. This allows a dentist to have more control over the final shape and position of the implant crown. Stock abutments are generally less costly and work very well when crown positioning is straightforward. 


Particular Posers

nance: Dear Doctor, I am an 86-year-old woman. I am healthy and have all of my teeth. I had my first and only root canal in July on the back lower molar number 31. However, my dentist would not place a crown on the tooth because it remained sensitive to pressure after a healing time of more than three months. My dentist has sent me back to the endodontist who is doing a second root canal in a week on this same tooth. I have been told if this doesn't work, I must have the tooth extracted. My question is: Am I a good candidate for an implant, even at my age? I'd hate to have the bone loss and sunken-in face if the tooth is not replaced. I have a pacemaker, so I also need to know if the titanium screw would interfere with the pacer. Thank you so much for answering my questions.

Todd_Coy,_DMD.: Thanks for your question. Your age should not prevent you from considering an implant. Our clinic has successfully placed implants in patients into their 90s. You should make your provider aware of the pacemaker, but I would not expect there to be any interaction with the implant.

libertysass: I take Fosamax and am now in the process of getting a dental implant. I’ve had the tooth extracted and am waiting for healing prior to implant placement. Is there anything I should know about osteonecrosis, implants and Fosamax before I finalize this procedure?

Todd_Coy,_DMD.: Generally, the lower doses of Fosamax often used to treat osteoporosis are not felt to be an absolute contraindication to implant placement. I would suggest a consultation with your surgeon during which you can discuss your concerns in more detail.

rj:  I am a 66-year-old female with osteoporosis, and am presently on Prolia. I currently have dentures and would like to get dental implants, but I am concerned as to whether I am a good candidate. My last bone density test was in 2016. I am pasting the results below and would appreciate your opinion. Thank you.
RESULT: Bone mineral density of the lumbar spine from L1 through L4 is 0.833 grams/cm2 consistent with a T score of -1.9. Previous bone mineral density from L1 to L4 was 0.813 consistent with a T score -2.1. Bone mineral density of the left femoral neck is 0.575 grams/cm2 consistent with a T score of -2.5. Previous bone mineral density of the left femoral neck was 0.549 consistent with a T score of -2.7. Bone mineral density of the right femoral neck is 0.582 grams/cm2 consistent with a T score of -2.4. Previous bone mineral density of the right femoral neck was 0.567 consistent with a T score of -2.5. IMPRESSION: Osteoporosis. High risk of a traumatic fracture.

Todd_Coy,_DMD. : Generally, the lower doses of these medications often used to treat osteoporosis are not felt to be an absolute contraindication to implant placement. However, they do come with relative risks that should be considered in conjunction with the overall health history. I would suggest a consultation with a surgeon during which you can discuss these topics in detail.


Beating Bone Loss

Summergirl: Greetings. My son had two congenital missing lateral incisors. After failed attempts at closing the gaps with orthodontics, he had two implants placed at age 17 by a dentist in Fort Washington, PA. They were beautiful and expensive at $6,000 per implant. They were always maintained by that office and later by our family dentist every four months; and now in Florida, where he resides, he is seeing a new dentist who is monitoring him closely. My son has started to lose bone in the areas where the transplants are. My question to you is: What can be done for bone loss? I have heard of grafting, but is there stem cell research on ways to restore lost bone? What does grafting entail, and would it be performed as an outpatient? What are the options if bone loss were to continue and treatment is not successful? Are the implants removed and then a type of bridge placed because I also know that a bridge would stress the remaining teeth?
Thank you, Melanie

Todd_Coy,_DMD.: Hello. Depending on the level of bone loss, grafting can certainly be helpful in this situation. This would typically be completed by a periodontist or oral surgeon in an outpatient setting. If the bone loss continues and becomes severe, then implant removal would be considered. At that point, the common options are a fixed bridge, removable prosthesis or in some cases replacement of the implants.

yless1: Can a tooth that is stable, doesn't rock back and forth, and has a perfectly good root canal be damaging to the jaw bone or gum tissues if left in place? Under what scenario would you advise pulling a tooth such as this? And why would it have a negative effect if there is nothing wrong with the tooth itself?

Todd_Coy,_DMD.: This is difficult to answer without images and a clinical exam. However, there are times when underlying issues might exist, such as infection or root fracture, which over time may affect the bone around the tooth or adjacent teeth.


Condition Complications

liesel: I am a 78-year-old female with heart disease and six stents in my LAD. I also have Factor V Leiden homozygous. My upper left number 16 molar was removed years ago and was not replaced with anything. Now, I most likely have to have the next molar, number 15, pulled. At my age and having very bad bone density, should I be afraid of implants for those two teeth? Two years ago, I had my upper right molar, number two, pulled. Since I still had number one and number three, I chose to have a permanent bridge whereby they put a crown on number one and number three with a false connecting tooth over number two. It works really well. My question is: Since there is no tooth to hook a bridge over, like on the other side, should I be afraid of implants at this point in my life? I don’t heal too well, and I am really afraid of complications. Is there another alternative for me?

Todd_Coy,_DMD.: Generally, I would say that your age should not deter you from considering the implant. Without a tooth behind the space, a bridge like you have on the other side is not an option. Other than an implant, the typical options would be to replace the tooth with something removable or simply not replace it at all. It is important to know that if you do not replace the tooth, then the surrounding and opposing teeth can shift, which may lead to other complications often leading to further loss of teeth. I would also suggest that with any bleeding disorder your hematologist be involved in the plan.

liesel: P.S. I am a 78-year-old female and I posted earlier about implants. I forgot to mention one other concern. A month ago, my dentist sent me to an endodontist for a root canal. The root was already infected. When I told the endodontist I was scheduled for a cardiac catheterization and possible stent the following week, he did not do the procedure after calling my cardiologist. My cardiologist says absolutely no dental procedures for three months following the stent implantation. I was on an antibiotic for seven days.

Do you have any suggestions about what I could do from now until January so that the infection does not spread? At the moment I do not have pain.

Todd_Coy,_DMD.: I think the best suggestion is for your endodontist and cardiologist to discuss with you the relative risks and benefits of delaying the procedure and whether any further antibiotic therapy is indicated in the meantime.


Closing

That is all the time we have for questions today. Thank you, Dr. Coy, for taking time to educate us about Dental Implants.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at my.clevelandclinic.org.

Todd_Coy,_DMD.: I want to take a moment to thank everyone for joining in. I realize that implants and other dental treatment can come with anxiety and concern, and I commend you for sharing those concerns with us today. I hope these answers have been helpful in guiding your next steps. Good luck with your treatment and, as always, please work closely with your providers to guide your specific treatment.


For More Information

About Cleveland Clinic Department of Dentistry & Oral Surgery

We see people from all walks of life and from all parts of the world. We employ the latest techniques and most advanced technologies to solve complex oral and dental problems. More important than the latest technology, however, is our firm belief that the team approach to solving problems provides superior results.

The vast resources of Cleveland Clinic provide us access to advanced twenty-first century technology not available to most private offices because of cost. But the true secret to our success is our effective use of our team. With access to multiple dental, surgical and medical specialties, our patients have only to walk down the hall for a specialty consultation as opposed to traveling to another office across the city or state.

Because of its national and international prominence, Cleveland Clinic attracts exceptional professionals from all over the country and around the world and for whom financial compensation is of less importance than in private practice. Since Cleveland Clinic physicians and dentists are salaried, there is no financial motivation to order any but the most relevant tests or to make unnecessary referrals.

While Cleveland Clinic dentists treat routine dental patients daily, they also handle more complex medical and dental issues. For example, we see patients who are anticipating or have had certain medical treatments, such as radiation treatment involving the head and neck, or cardiac valve surgical procedures, that require special dental screening and possible treatment.

Our dentists work closely with our medical and surgical teams to provide the best overall outcome for the more complicated issues our patients may face.


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