Dr. Ganeles is a periodontist practicing with the Florida Institute for Periodontics & Dental Implants in Boca Raton, Fla. Currently, he serves as Adjunct Assistant Professor at Nova Southeastern University, College of Dental Medicine, in Ft. Lauderdale, Fla. He has authored or contributed to many publications for professional journals and is also a Diplomate of the American Board of Periodontology; a Fellow of the American College of Dentists and a Fellow of the International Team for Implantology (ITI). He lectures extensively both nationally and internationally and is a consultant and surgeon for several reality television shows including ABC's "Extreme Makeover" and UK Channel 5's "Brand New You." His special areas of interest and expertise are in healing time reduction for dental implants, regenerative procedures in relation to teeth and dental implants; image guided technology for implant surgery.
Dental1: As a dentist, how do you view implants?
Dr. Ganeles: Implants are the best development in dentistry to come along in my generation. They allow dentists to be completely positive and constructive in replacing missing teeth. Patients can enjoy the benefits of dental implants that function like natural teeth and allow them to look and feel whole.
Dental1: What was it like for you to participate in the reality TV show "Extreme Makeover?"
Dr. Ganeles: "Extreme Makeover" was an entirely new experience for me. First of all, I have no formal training in acting, media or how to behave in front of a camera. My first case was actually very difficult. I was sweating physically (I had a camera in my face the whole time) and emotionally because I was convinced I had committed professional suicide on prime time. After a sleepless night, things worked out spectacularly well. The patient loved her results and I really got a huge burst of pride, accomplishment and gratification from it. The other thing I really enjoyed was the comments I got from dentists and patients from all over the country. The show really put implant dentistry on the map and showed people that it is not an exotic or impossible procedure. It demonstrated that ordinary people should expect the opportunity for permanent teeth, even if they are missing them all. The best part of a show like "Extreme Makeover" is that it highlighted what sorts of results are available today for people with certain medical or dental problems. It was a very positive showcase for implant dentistry.
Dental1: Were the participants changed by improving their teeth?
Dr. Ganeles: The participants told me that of all the procedures done, they value the dental procedures the most, particularly the ones who were missing teeth and got them permanently replaced. Teeth are so important. They provide support for the face and if you have lost your teeth and bone structure the soft tissue will collapse underneath and then it doesn't matter what you do to your eyes, nose, or chin because you have this collapsed look. Implants and new teeth provide what we call an "internal facelift." They actually prevent atrophy, stimulating bone to be retained. You can actually change someone's looks by fixing their smile and restoring the lower half of their face.
You can gauge someone's temperament, mood and personality by their smile and people who lose teeth very often don't want to smile. I also participated in a British show called "Brand New You" and those participants also loved their brand-new teeth. They can't stop smiling. I got an e-mail this week from one of the British women I treated and she said to me "I think I'm smiling for all of Britain." I love those kinds of comments.
Dental1: Can any dentist do implants?
Dr. Ganeles: Legally, any dentist can do implants. Realistically, the only dentists that should be doing the surgical portion of implant dentistry (which is what I do) should be specialists who are trained in manipulating gums and bone tissue, and know how to supplement them when there isn't enough. This is typically a specialty of oral and maxillofacial onsperiodontal surgery.
Dental1: Sometimes you see the term "implantology specialist." Is that a new field in dentistry?
Dr. Ganeles: There is no recognized specialty of "implantology." Implant dentistry falls into a number of different specialties and general practice. Anyone advertising themselves as an implantologist is usually a general dentist who has gotten some additional training, which in itself is fine. But, it's not a specialty. That would be misleading. The American Dental Association recognizes nine specialties. There are specialty boards, examinations and training programs centered in academic institutions. Implantology is not one of them.
Dental1: How do you find a qualified practitioner to do the implants?
Dr. Ganeles: The best way to find a qualified practitioner would be to call a dentist and find out where they would go to have this kind of procedure done. [Dental1.org offers a dental professional locator.] It may or may not be easy to get an honest answer. If you think you are not getting proper information check with the American Academy of Periodontology, The Academy of Osseointegration, or the American Academy of Oral and Maxillofacial Surgeons to find out who is listed in your area. There are a lot of resources available online.
Dental1: Who is the best candidate for dental implants? Can everyone have them?
Dr. Ganeles: Virtually anyone can have a tooth permanently replaced with a dental implant. It may be more or less difficult depending on what the particular patient's dental needs are when they come in. One requirement for a successful implant is there must be an adequate amount of bone support for the implant. Many patients who lose teeth also lose bone that support the teeth. If there isn't enough bone, there are all sorts of techniques available to replace the bone and support what is left. That's one of the reasons I like to recommend specialists over general dentists because specialists are generally more skilled in these kinds of regenerative procedures.
Dental1: Could you describe the procedure?
Dr. Ganeles: This is a two-stage procedure. One part is replacing the root portion, which is the implant. The second step is replacing the tooth. Typically, two different types of dentists do these two steps. The first step would be a surgical specialist and the other would be restorative or cosmetic specialist.
Placing the implant into the jaw is actually not a complicated procedure. Putting it in properly is a little trickier. It's done very gently using a slow speed hand piece and a lot of saline irrigation to make sure the bone is not damaged while creating the space. That's very important because if there is trauma or injury to the bone cells, the implant will not heal. So it is a delicate process from that perspective. Historically, implants had to heal from three to six months before the teeth were attached. For some implants, like Straumann, that period has been routinely reduced to six to eight weeks from the time the root portion of the implant is placed to the time a permanent tooth can be placed on top of it. The reason I was selected to be on "Extreme Makeover" and "Brand New You" is because one of my "claims to fame" has been the ability to shorten that time period even more. Using a process called "TeethToday" we can place implants and then the teeth on top immediately without sacrificing any predictability or any long-term ability.
Dental1: How have you been able to shorten the implant process?
Dr. Ganeles: There has been an improvement in the surface texture of the implants or the roughness that allows the implant to bond more quickly to the jaw. "TeethToday" has been able to take the process from six weeks to six minutes because we now know more about the healing process and about the ability to integrate the tooth portion of the dental implant into the surgical process. The teeth placed immediately on top of the implant actually help to protect it, keeping it in place and allowing the implant to be cosmetically useful. The patient can chew on them while still allowing the implant to heal properly.
Dental1: Are the first teeth placed on implants temporary?
Dr. Ganeles: Yes. They are temporary and are usually made out of plastic so that they can be made quickly. They are used while the permanent teeth are being created.
Dental1: Are there any complications from the procedures?
Dr. Ganeles: As with any surgical procedure, there can be complications. There can be infections and pain. In the lower jaw it's possible to injure a nerve that runs through that area which can result in numbness. That is very rare. In the upper jaw the sinuses are often close to implants and it's possible to injure or cause an infection in those areas, which is also very rare. These complications are almost always reversible and happen far less than 1 percent of the time. Again, it's important to see an experienced doctor who does lots of procedures, as this will reduce the incidence of complications and increase the success rate for the procedures.
Dental1: Do implants ever need to be replaced?
Dr. Ganeles: We talk about dental implants as replacing the whole tooth. In reality a dental implant is only a replacement for the root. A cap or a crown is attached to that implant which replaces the functional and esthetic part of the tooth. Those crowned teeth can have problems: The porcelain can chip or break. If that happens the tooth can be replaced without changing the underlying dental implant. The implant, which is the root part of the process, is biologically bonded to the jawbone. Occasionally, you can develop an infection in the gum that can extend into the jawbone. If it does not get controlled or addressed, then the implant can become loose and fall out. It is highly unusual for that to happen. Older implants or implants of lesser quality can have material failure such as fracturing or they can have the surface come off, but that doesn't happen much with high-quality implants.
Dental1: What are the benefits to removable implants where the teeth are cemented onto the dental post and non-removable implants where the teeth are simple attached?
Dr. Ganeles: There are no removable implants. It's only the teeth placed on top of the implants that can be removed. Using removable teeth attached to the implants is an effective way of anchoring dentures without placing too many implants. For instance, if you didn't have any lower teeth and you had a full denture on the lower , you would need about six dental implants for fully fixed permanent teeth. Alternatively, if you just wanted to make your denture better and didn't mind removing it for cleaning, then you could accomplish the same effect by just placing two implants. So, the cost is significantly less. It is also a little bit easier for some patients to clean individual implants if there are removable teeth on top rather than having permanent caps attached to them.
Non-removable teeth attached to the implants are the closest thing to permanent teeth replacement. They are usually made out of porcelain so they look better and feel more like natural teeth. They provide the kind of confidence, comfort, speaking precision and psychological well-being that having your own natural teeth would convey. It's the closest thing we have to re-attaching a severed limb in dentistry. The disadvantage is that they tend to be more expensive.
Dental1: Is this procedure painful at all?
Dr. Ganeles: Surprisingly, dental implant surgery is not painful in most cases. As I said earlier as we prepare the site for the implants, we take great care to make sure the bone has not been damaged or injured so that it will heal properly. One of the benefits for that kind of meticulous preparation is that you also don't get much pain. Sometimes you can get more pain if you have grafting procedures in order to enhance or strengthen the bone or the gums. That can hurt, but not for long. Usually the pain is gone in three to five days and the swelling is also gone in that time. Patients usually go right back to their normal lives and take pain medication only for a few days, if necessary.
Dental1: After implants, is any special dental hygiene routine required or special maintenance?
Dr. Ganeles: Patients who have had implant dentistry need to continue to see their dentist, but it's not for any unusual maintenance procedures. They are typically seen on a three to six month schedule by a hygienist for cleaning. At least once a year, the patient should see their dentist to check the restorations to make sure that everything is seated properly and nothing has moved (i.e. that no damage has occurred). The gums around dental implants are exactly like the gums around natural teeth. It's certainly possible that you can develop inflammation if plaque builds up, which will stick to implants as well as to natural teeth. Implants tend to be a little more resistant to gum disease than natural teeth and it's impossible for an implant to decay.
Dental1: Dental implants are more expensive than traditional bridges and crowns. Do you think the cost will go down as the procedure becomes more a more common practice?
Dr. Ganeles: Dental implants are not necessarily more expensive than root canals, bridges or crowns. Root canals in heavily-damaged teeth often compromise them, requiring follow up periodontal surgery and then some exotic and expensive restoration. They don't always have a very good prognosis. If you look at what is going to be in a person's mouth 10 years later, the implant will still be in there, but the tooth with root canal won't be. If you factor in the cost of failed procedures for root canal, periodontal surgery and bridge work, the implant comes out much less expensive.
I think we will see fees go down as more and more general dentists start doing the surgical aspect of dental implants. I'm not sure that is always a good thing because the complication rate is also going to increase if they start doing advanced or complex cases. So there is going to be a trade-off between the cost of the procedure and the outcomes in some instances. As with any type of medical procedure, the doctors that are doing the greatest number of procedures with the greatest complexity will continue to charge the highest fees and continue to have the highest success rates.
Dental1: When can we expect to see you on TV again?
Dr. Ganeles: I believe my next "Extreme Makeover" will be on Feb. 10. There will also be another new show later this season. The British "Brand New You" is scheduled to air sometime this season as well.