Bill Klaproth (host): This is OMS Voices, an AAOMS podcast. I'm Bill Klaproth. And with me is Dr. Michael Block who's here to discuss what is involved in getting dental implants to replace all your missing teeth. Dr. Block, thank you so much for being here.

Michael Block: Thanks, Bill. I appreciate you having me on.

Bill Klaproth (host): It's a pleasure to have you here. So when we talk about this, how is a full mouth restoration different than a single dental implant?

Michael Block: Well, first of all, you need to know what an implant is. It's basically an anchor. It's a screw. And it's made of titanium and the surface has been blasted and etched, so microscopically it's rough. It's like the craters of the moon if you were looking at it. And when it's put in, it has to be put in very gently so that the surgeon is not allowed to hurt the patient. It's a little sequence of preparation. And then, when we're done, the implant and bone interface, in other words, where they're laying next to each other, looks like it's never been touched. So I'm the anchor man, that's what I always tell my patients, and I'm not allowed to hurt you.

So the answer, to get back to your question, to put an implant in somebody, they have to be relatively healthy. They have to be able to heal the wound. We always look at the patient's medical history to make sure that they're a good candidate for it. And then, we look at the bone that's in the place we're going to work. If there's an infection present, we resolve the infection, so we put it in a healthy place. And then, the surgery is relatively uneventful for the patient.

Bill Klaproth (host): So a single implant, one tooth, is that what we're talking?

Michael Block: Single implant, one tooth. Prep the hole, do a little reaming sequence, screw the implant in, let them heal for four months and then put the crown on.

Bill Klaproth (host): So a full mouth restoration is basically every tooth is an implant. Is that correct?

Michael Block: No, not quite. The implant's a screw, and then you have a part on top of it and they have to have room to clean. Now, people lose teeth for a variety of reasons, but one reason is that they haven't necessarily maintained a healthy set of teeth. You have to have enough room between the implants. So rather than having an implant for every tooth, maybe it's every other tooth, every third tooth. And then, you screw on a set of teeth typically onto that.

Bill Klaproth (host): So it's not generally every tooth.

Michael Block: The bridge work will replace almost every tooth. But underneath it, the anchors, they may have six anchors for 12 teeth.

Bill Klaproth (host): So when we talk about full mouth restoration, you're basically removing all the teeth to put the new teeth in. Is that correct?

Michael Block: Yes, all of those teeth will need to be removed because of decay or bone loss, or maybe they shift in position, they're not functional. And so what I do in my patients, I say to them, "At the end of this treatment, I want what?" And they answer the question. Most of them say they want a set of teeth that they could chew with and function that don't hurt and they look good.

Bill Klaproth (host): And then, "I smile."

Michael Block: And then, they want to be able to smile. Smiling is a big deal. And chewing is a big deal. And a lot of times when you get older, you just want to be able to chew without any pain. It's a very realistic way of taking care of somebody.

Bill Klaproth (host): Right. So as people age, we've heard this, people get dentures, right? So, how is full mouth dental implant restoration better than dentures?

Michael Block: The denture is a piece of plastic most of the time that you put in your mouth and it's held in by suction of the saliva, but it's removable. If you chew a certain way, it can dislodge. It's uncomfortable. It covers your palate. It's just not a great solution. Most patients who wear a denture, they don't necessarily chew a barbecue rib or corn on the cob very well. They have to use adhesive, which is not really very, very nice.

Bill Klaproth (host): We've seen the denture cream ads, all of that.

Michael Block: It's horrible. It's horrible.

Bill Klaproth (host): Right. So a full mouth dental implant is like having your own teeth. You don't to have to deal with any of that other stuff, the drawbacks of dentures.

Michael Block: Yeah. So these people come in and they maybe have no teeth, that they can't chew very well. So they want to be made whole again. Or maybe there's somebody that has four or five teeth left, but they're in disrepair. They just don't look good. They're not wearing their partials very well. So we take those teeth out, make sure everything's clean. Sometimes we do it in one step. Sometimes we stage it, depends on what the patient needs. And then, we give them a full set of teeth that they can chew with. We make them back whole.

Bill Klaproth (host): So, somebody that wants a full mouth restoration, basically their teeth are gone or shot. We're not talking to somebody that's got a denture. They're generally not coming in for full mouth restoration. It's people with really bad teeth or a lot of missing teeth?

Michael Block: Most of our patients who come in for this have bad teeth. But there are some that have had their teeth removed, but are having trouble wearing the denture comfortably. So the implants can stabilize the set of teeth. So instead of making a denture, we make them a set of teeth, which doesn't have a palette on it and it's just screwed right in. It's like a third set of teeth.

Bill Klaproth (host): So full mouth dental implant restoration basically means you don't have any restrictions when it comes to chewing or anything like that.

Michael Block: You have less restrictions. I'll give you an example. I have a patient who comes in a long time ago and he wore his natural dentition down, his natural teeth down, so they were sharp-edged. And he could shred a carrot. He loved eating carrots and shredding them with his teeth. Well, we made him a set of full upper and lower, but the teeth, when they're made in the lab, maybe a little rounded edges, they may not be sharp-edged like a knife. And his big complaint was that he could eat anything, but he couldn't shred carrots. So you can eat almost anything you want, but there may be some changes that you just have to be aware of.

Bill Klaproth (host): Right. So if you love to shred carrots, maybe you're going to lose that ability.

Michael Block: That's exactly right. But as far as barbecue, corn on the cob, steak, you're set.

Bill Klaproth (host): Which I could see would really improve many people's quality of life.

Michael Block: Oh, it gets them back to eating a normal-textured diet, the fibers they need. But when they go out to dinner or they're with their family, they can be normal.

Bill Klaproth (host): They don't have to be self-conscious, "Oh, I can't order this. I can't. Oh gosh. And if I take a bite into that, what could possibly happen?" They don't generally have to worry about that anymore.

Michael Block: No, they don't have to worry about the dentures falling out of their mouth or displacing or the adhesive in there. And of course, you got taste problems when your palette's covered, so this allows them to have a much better quality of life.

Bill Klaproth (host): So full mouth restoration, certainly many, many benefits. I imagine though people think, "Man, that's got to be expensive." So, what is the general cost of full mouth dental implants?

Michael Block: Well, it really depends on who you go to. So, that's a question that is impossible to answer. But it's like a car. It depends on what kind of car you want to drive. Some people's cars are expensive. Some people's cars are not expensive. It depends on the materials made, what has to be done. So it could range, but it's like a car. That's the best way. And it really depends on who's doing the procedure, what their experience, where they live. Somebody in New York City, Los Angeles, will be more expensive than somebody in New Orleans, for instance, because the cost of living is different.

Bill Klaproth (host): So when you say it's kind of like a car, this might be a goofy question, for the materials, are there different grades of materials? "This is a better type of tooth. We use better material than another implant." Is that a thing?

Michael Block: The implants are pretty much the same cost across the board. It's just the number of them. But the material on top of them differs. It could be very expensive material. It could be a framework with porcelain. It could be something with plastic. There's some milled materials now that are gorgeous, but they're very inexpensive, but they may have to be replaced over time. So there is a big material difference in cost.

Bill Klaproth (host): Does the patient choose that? Or you do what's right for the patient? "This patient needs this, so that's what we're going to do."

Michael Block: Well, as a surgeon, I do the surgery. And there’s a restorative dentist who makes those. And normally, that dentist would have a discussion with the patient as to, “We can use this material, this material, this material. These are the costs involved with each." And then, the patients choose depending on the advantages and disadvantages that they're told.

Bill Klaproth (host): Right. So, what is the success rate of dental implants? How long do they last?

Michael Block: Well, the dental implants were originally done by a gentleman in Sweden named Brånemark in the early '60s. He waited 15 years to bring it to the North American continent in 1981. So we've been doing implants in the North American continent since really the early '80s. So that we only have basically barely 40 years on this. So you're young, you look like you're in your 30s, let's say.

Bill Klaproth (host): You're very kind.

Michael Block: Okay. So let's say that you're going to live to be 95. So 65 years, I'm not sure if the implants will last 65 years. But we have patients that are out 30 to 40 years and are very successful. And we're in the 95 percent range of success when they’re properly done. So it’s pretty high for success rate.

Bill Klaproth (host): Which I think would be very appealing to somebody, like, "Wow. I'm not going to have to deal with this for a long time. I'm going to be pretty much back to whole”—as you put it—"for a very long time."

Michael Block: They will be back to whole. But there is always the caveat that things wear. So their teeth may wear a little bit. They may have to have some of the teeth replaced. That's why everything's screwed in, because then you can unscrew it, take it out and fix it.

Bill Klaproth (host): Again, maybe this is a silly question. Is there a general maintenance in dental implants like this? You go in every four years for a little tightening, a little...

Michael Block: Well, the first maintenance is that the patient needs to keep it clean, just like they should have kept their teeth clean. So, twice a day, they brush, they floss, they do all those things. They go to the hygienist every four to six months and get cleaned. So they need to be on a maintenance protocol with a dentist. The dentist checks, make sure the screws are tight and things like that. And then, every now and then, some of the materials, depending on if they're plastic or porcelain, may chip or they may have to be replaced. That's hard to say what that protocol is, but that does happen.

Bill Klaproth (host): Absolutely. So you still have to floss with the dental implants?

Michael Block: You got to keep them clean.

Bill Klaproth (host): Well, you don't want the funk in there anyways, but I mean, yeah.

Michael Block: What happens is bacteria glue themselves onto materials, just like the barnacle on a boat. And then, the bacteria, they've learned to glide, like a suction cup themselves on it. So then, when you eat carbohydrate, sugar, that's an example, the bacteria take it in, they have a little food fest. And they spit out, they metabolize the carbohydrate and they excrete acid or they just sit there as plaque. And then, your body reacts to the plaque and causes inflammation and that causes bone loss. So you got to keep them clean.

Bill Klaproth (host): So I didn't even think about that. But eventually, if you don't keep them clean, it will eat away at the materials. Is that true?

Michael Block: The inflammatory response to the plaque will result in bone loss. So, the prosthesis has to be made, the teeth have to be made in such a way that the patient can clean.

Bill Klaproth (host): So this sounds like something you don't want to mess around with. You want a real expert on this. So why choose an OMS to place a dental implant to do this full mouth restoration?

Michael Block: Typically, the patients that need this are not your 20-year-olds. They may be 50, 60, 70, 80-year-olds. So they may have some medical complications or may have some systemic diseases. So the person treating them needs to be surgically competent and experienced in dealing with a patient that may have medical issues. That's number one.

Number two, you are doing something in bones. So the person doing the surgery needs to be an expert in healing of bone and how the surgical wound will heal. They need to know how to select a patient that will heal or how to set the patient up to heal. So an OMS, an oral maxillofacial surgeon has the training to handle all of that much better than somebody who doesn't have that training or who thinks they do because they took a weekend course or a little course over a couple of months or so.

Bill Klaproth (host): Right. So you're definitely in better hands with an OMS. Well, this has been fascinating, talking about full mouth restoration. As we wrap up, Dr. Block, and thank you so much for your time, this has been fascinating, anything else you want to add?

Michael Block: No. I think the main thing is that you want to go to somebody that's got experience in doing this and somebody who knows how to handle the other issues. We tend to focus as a society on one little thing, one little piece in part. But the mouth is connected to the whole body and as a patient underneath our scalpel, so to speak. I know that sounds scary, but it's true. The patient is there. So we have to do whatever's necessary to keep the patient happy and to take care of that patient. And that requires a skillset. And that skillset is why the oral surgeon can do this.

Bill Klaproth (host): Absolutely. Well, you have enlightened us and opened our eyes to this. So thank you again for your time, Dr. Block. This has been great.

Michael Block: My pleasure. And thanks for having me. I appreciate it.

Bill Klaproth (host): Once again, that's Dr. Michael Block. And for more information and the full podcast library, please visit MyOMS.org. And if you found this podcast interesting, please share it on your social media and don't forget to subscribe. Thanks for listening.