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Collaborating to Improve Lives with Oral Surgery

Dr. John Moenning: Collaborating to Improve Lives with Oral Surgery

March 17, 2006

Dr. John E. Moenning received his Doctorate in Dental Surgery from the Indiana University School of Dentistry in 1983. After finishing a General Practice Residency at Indiana University in 1984, he went on to complete a three-year residency in Oral and Maxillofacial Surgery at Indiana University Medical Center and Methodist Hospital. In 1988, he received his Master of Science from the Indiana University School of Dentistry, focusing on orthognathic (jaw) surgery research and also completed a fellowship year at the Baylor University Medical Center in Texas. He has published more than 18 articles about aspects of Oral and Maxillofacial Surgery, served on the American Association of Oral and Maxillofacial Surgeons Committee on Practice Management, and has a patent pending on a nitrous oxide mask for dentistry. His office is in Fishers, Ind. and is part of Indiana Oral and Maxillofacial Surgery Associates. He also works an assistant clinical professor at the Indiana University School of Dentistry.

Dental 1: When did you know you wanted to be a dentist?

Dr. Moenning: I grew up in a medical family. My grandfather was a general surgeon and my father is a general surgeon. So, I’ve always been around the healthcare profession and have always been proud of that heritage. Dentistry is what worked out for me, and eventually oral surgery.

Dental 1: How did you choose your particular area of expertise?

Dr. Moenning: I’ve always been around surgery and when I started dental school, I was exposed to the specialty of Oral and Maxillofacial Surgery. It drew my attention and thus became my goal.

Dental 1: How have you seen the field change in the last 15 years?

Dr. Moenning: I think we have seen a lot of changes in the area of dental implants and bone grafting. Both of these areas have undergone many advancements and developments. All of these have helped us to restore people without using a lot of older procedures.

Dental 1: Is the interest in dental implants growing?

Dr. Moenning: Yes, rapidly, every year. The companies are doing more and more research to develop the implant materials. The field of dentistry is doing more research to evaluate the implants and expand our ability to utilize the implant materials in different situations. It’s a very exciting area of patient care. We place dental implants for individual teeth or for multiple teeth. We can make them so they act as anchors to add a partial or full denture. Multiple implants can be used with a semi-fixed prosthesis, used as an anchor to move teeth, or used in cancer reconstruction. We are even putting them in the ear area for people who don’t have an ear so you can anchor a prosthesis that looks just like a natural ear.

Dental 1: You’ve been part of a team working on an interesting project connected to dental implants.
How did you get involved in treating Jonathan?

Dr. Moenning: Jonathan first came to us as a 15-year-old referred by his family dentist. He was referred to us to see how we could help. Jonathan was born with ectodermal dysplasia. This is an inherited condition where individuals have sparse hair, and because they don’t have sweat glands they can’t tolerate heat changes. They also are missing many or almost all of their teeth. Jonathan had to start wearing dentures at the age of three and continued on through his high school years, which was very difficult. But Jonathan is such a tremendous young man in the face of such adversity and has a great attitude. He is very well liked by his peers.

Dental 1: It sounds like a challenging situation.

Dr. Moenning: This was a chance to bring everything together. My background after dental school involved general dentistry, oral surgery, a fellowship in jaw reconstruction at Baylor Medical Center in Dallas, Texas and working with the same partners for over 17 years. So when Jonathan came to us, there was an opportunity to put all of these experiences to work for one person.

Dental 1: You must have needed to develop a comprehensive treatment plan.

Dr. Moenning: Absolutely. We needed to develop a treatment plan that involved a restorative dentist and our team. We first needed to try and build up some of his bone for the plan. Usually in the area of the jaw you have bone around teeth and have the supporting bone underneath. If you don’t have teeth, you haven't developed that zone of underlying bone. This is what happens with ectodermal dysplasia. Thus, we took him to the hospital and did a procedure known as a Lefort Osteotomy to develop this layer of bone. We had to bring his upper jaw down and forward a bit and take bone from his hip and grafted all that bone into his upper jaw. This was our phase one treatment plan.

Dental 1: So this was a long procedure?

Dr. Moenning: Well that procedure took about four hours, but Jonathan’s overall case started in 2003 and it’s now 2006. His most recent procedure was to place a denture over the implants that were placed in his lower jaw. When Jonathan was healing from his jaw surgery and hip graft, he used the time to contact the National Foundation for Ectodermal Dysplasia. Obviously this is a very expensive procedure and the foundation was able to help. It funds some of the reconstruction for these young kids. The Straumann Company is also very active as a supporter of this foundation. They donated a lot of supplies such as the implants and other supplies to help with the reconstruction.

Dental 1: So this was very much a team effort?

Dr. Moenning:Yes it was. Jonathan had the fortunate support of the Ectodermal Dysplasia Foundation and the Straumann Company donated a large amount of money and supplies and we donated our time. It’s really rewarding. Jonathan’s a great young man. It’s our privilege to help him. We all put our heads together, Straumann, the Foundation, Dr. Todd Kaminski, my partner Dr. Tyler Potter, and myself. Jonathan was born with a challenging problem and a lot of the problems crossed over into all aspects of healthcare.

Dental 1: What did the second phase involve?

Dr. Moenning: Phase two involved placing a large number of implants into the new bone. We placed six in his upper jaw and six in his lower jaw, in the hope that when the implants bonded up to the bone we would be able to attach dentures directly that would not move around.

Dental 1: How was this different from his regular dentures?

Dr. Moenning: Well, as a result of his condition, he didn’t have underlying bone, so he didn’t have enough bone to wear dentures. His dentures had to extend further into this mouth and they would slip around, not being very stable. He also doesn’t produce a lot of saliva, and thus his mouth would often be red and irritated. By placing the implants we were able to build a more stable prosthesis that didn’t have as much acrylic or plastic throughout his mouth. The tissue wasn’t covered up so much and thus the redness and irritation could heal and his dentures would be anchored and not move in his mouth.

Dental 1: How did phase two turn out?

Dr. Moenning: He had his implants placed and Jonathan did extremely well. All the implants have taken, except for one and that won’t be a problem. Healing is such an important part of this procedure and you need to have someone who heals well. We got 11 out of 12 implants to heal. In the near future we are going to be putting his lower prosthesis on the implants and he should be a happy young man because it will be fixed to his lower jaw. He will develop this confidence that you see people develop, particularly at his age. He’s a tremendous young man with a wonderful spirit who was easy to work with.

Dental 1: You mentioned that Straumann donated supplies.

Dr. Moenning: The Straumann Company was just fantastic as well. They were able to provide me with a brand new implant material that we felt was important to use with Jonathan called their SLActive implant. These implants have a surface that provides bonding to the bone within three weeks.

Dental 1: Hasn’t the usual time been up to six months for healing?

Dr. Moenning: Yes it was. It’s down to three weeks with these new implants. During their research, the Straumann Company learned that if you build and process the titanium implants in oxygen free, nitrogen environment, the implants will bond to the body much quicker. The implant surface never touches atmospheric air until it’s opened and put into the mouth where it starts to bond immediately. We are bonding metal to bone in three weeks. This kind of technology is what is so exciting in dentistry.

Dental 1: So can you do everything at once now?

Dr. Moenning: Maybe. I wouldn’t recommend it for Jonathan, but this is something we are moving towards in the future. We will be doing more and more early restorations of implants. That’s what makes it so exciting. Someone loses a tooth and that day you put in an implant, place the crown and that day they have been restored.

Dental 1: What was it like to watch Jonathan’s transformation?

Dr. Moenning: Gratifying. I have gotten to this point in my life with the help of family, friends, and God-given opportunities. To be able to pull all my training together – learning from gifted instructors, having had great training opportunities, and blending all of these past experiences with a great team and a tremendous individual like Jonathan – well that is why this was so gratifying.

Dental 1: After this experience, would you like to take on a similar challenge?

Dr. Moenning: Well, I think we do it every day. The challenge is there every day to make someone a little bit more comfortable with dentistry. That’s the beauty of dentistry in that we can work together as a team for that ultimate goal of making someone proud of what they have. That takes qualified people with great companies behind them.

Find out more about Dr. Moenning at www.iomsa.com

Read Jonathan Davis' Inteview or Dr. Kaminski's Interview to hear more about their restorative teamwork.

Last updated: 17-Mar-06

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