Hear more from one of Dr. McAndrew's patientsKaren McAndrew, D.M.D., M.S., understands balance in her work. She founded her private practice, The Virginia Center for Prosthodontics and Dental Implants, in 2000. McAndrew dedicates herself both to prosthodontics with the revolutionary technology of dental implants as well as to helping historically underserved patient populations in need of dentures. Into this balancing act, McAndrew also finds time to take a high-profile position with the Academy of Osseointegration where she serves as chair of the membership committee.
Dental 1: Why did you go into dentistry, prosthodontics and implant-related restoration work?
Dr. McAndrew: I was always interested in the healthcare field and explored a variety of things. But I found that dentistry offered a unique blend of science and the didactic portion of medicine combined with the artistic nature of dentistry, and that’s really why I went into prosthodontics. We’re playing with arts and crafts all day long. For me it’s not just a job; it’s really something I enjoy. There’s a lot of sculpting and using waxes, and changing the color and form of the aesthetics – and blending that with function.
Prosthodontists take a whole, comprehensive approach to restoring the dentition (the kind, number and arrangement of teeth collectively in a person) rather than restoring single teeth at a time. We look at the entire occlusion and the status of the other teeth – the complete dental complex. That’s because we can’t separate the front of the mouth from the back of the mouth if we are going to make sure everything is going to function well together.
On my implants interest, I had an incredible group of mentors at the University of Pennsylvania where I graduated from dental school in 1995. Especially in the field of prosthodontics and surgery, I was fortunate enough to be in an institution that was heavily into implant research and education. Even as a dental student back in the 1990s, we were taking implant courses and learning to place implants by assisting. We also were able to gain experience by restoring these cases.
I thought it was such an incredible way to restore the dentition and restore function. Especially in edentulous (having lost teeth) patients who are in essence dental cripples. These are people who are not able to function and sing in their church choirs. So implants and restorations give these patients their lives back. Because I thought dental implant therapy was so wonderful, when I was completing my residency at Chapel Hill at the University of North Carolina, I sought out as many implant patients as I could.
Dental1: It sounds as though you are a believer in implants. Can you talk more about that subject?
Dr. McAndrew: Implants are absolutely revolutionary. They have really added a whole new approach to replacing missing teeth that was formerly unavailable. So dentists are in essence giving the patient back as close as possible to what their natural teeth were like. There is nothing in dentistry that can replicate form and function like a dental implant.
Dental1: Do you do restorations and implants?
Dr. McAndrew: I work very closely with periodontists and oral surgeons, and I focus my practice on the restorative aspect of dentistry. The main issue, though is treatment planning and I’m involved in all phases of that.
Creating harmony between the hard and soft tissue architecture and prosthetics requires treatment planning from the very beginning so we can get optimal results in terms of function and aesthetics.
We need to know what the destination is. It’s like planning a trip. We need to know before surgery where teeth need to be positioned from a functional and aesthetic standpoint – the correct spacing of teeth to each other and the relationship of the upper and lower jaws. If we just see an edentulous space and place implants without considering all those factors, it may not be at the correct depth, angulation and placement to restore the correct aesthetics and function.
Dental1:Do you think the two-member team approach to implants is better than having a single dentist do all the work?
|Hear more from one of Dr. McAndrew's patients:
Janice Orlik has only had her dental implants since April 2006, but she’s already a believer. The road to her dental problems started years ago – the result of the less advanced dental care available in her youth. Coming of age in an era not known for its dental prowess was only part of Orlik’s problem with her teeth, though. Family genetics played a significant role, with a "horseshoe" shaped mouth that makes dental work difficult and a history of mothers and sisters losing teeth.
For years dentists had told Orlik she had little hope but to become a toothless old woman. “The shape of my mouth – there wasn’t a whole lot they could do. I wouldn’t have even been able to hold dentures with the original shape because I had thick bone in the roof of my mouth.”
But one day last year when she was visiting with her regular dentist about what could be done, the clinician said, “I have the perfect person for you to see.”
“It was so great,” said Orlik. “There was none of that referral thing where you take a number and make a call. Instead she walked me right over to Karen McAndrew’s office and asked her to talk to me.
“I liked Karen from the get-go. She was straight forward and up front, and she talked in a soothing voice, giving me various options including the one she suggested: That I was a good candidate for teeth in an hour. I felt very confident going with what she thought was the best approach,” she said. “She really was the sweetest. Nobody likes going to the dentist, but her approach was ‘Why wouldn’t you like to come here?’ Also she treated you more like a friend than a patient. I really appreciated that.”
To read more about Janice's experience getting implants, click here.
Dr. McAndrew: People who are qualified and feel confident to place dental implants should be doing that. I’m fortunate enough that I have several phenomenal surgeons in my area who allow me to spend more time doing what I was trained to do. In my case, there is so much to know and learn on the prosthetics end that my time is best spent there. Similarly, there is so much to know on the surgical and grafting end that specialists with training in that area are in better positions to make those decisions.
I often attend the implant surgeries, however. When we have a large case I like to be at the surgery so I can be sure we’re placing implants accurately. Also, when we load immediately, I’m there to complete that aspect of the treatment.
Dental1: It’s great that you raised the topic of immediate and delayed loading. What are your thoughts about it?
Dr. McAndrew: Every case is different. Certainly if an implant does not have adequate primary stability with high degree of torque at the time of placement, we need to wait to place the restorations. It has to be strong enough in the bone for us to go ahead and load. Also if the implant is placed in more spongy bone, then it shouldn’t be primarily loaded.
The patient population who benefits significantly from immediate loading is the one that we are transitioning from a dentate state to an edentulous one. If we don’t immediately load with the fixed prosthesis, they have to wear a denture. That is uncomfortable as far as function is concerned. Also, we see a lot less discomfort when we immediately load because we don’t have dentures sitting on surgical sites.
But the number one reason why we wouldn’t immediately load is porous bone and the need for significant grafting. Other than that, the new coatings and shape of implants that have been studied and brought to market over the past five years are enabling us to gain primary stabilization in a large number of patients.
Dental1: What’s new in your field?
Dr. McAndrew: One exciting area is the application of newer techniques utilizing 3-D imagery in order to place and make treatment plans for dental implants. We can do virtual surgeries now on the computer. It has its learning curves, but it will make our surgeries more predictable because of the ability to visualize the bone and anatomical structures prior to surgery.
For that reason it can be less invasive. By using a cat scan of the patients jaw, and the computer system, we can actually see the bone and know where all the anatomical structures are without making an incision. That allows us to identify the exact placement site and so we can punch right through gum tissue without an incision.
Another area is fabricating substructures for restorations from titanium and ceramics. The cost of gold is going through the roof, so making frameworks and abutments out of titanium or ceramic makes for less expensive and lighter prostheses. Also, with titanium and ceramics you don’t cast it; you actually mill it instead of having to wax it. That process can give us more accuracy and less expense.
Dental1: Tell us about your volunteer work.
Dr. McAndrew: We started out helping out with Mission of Mercy, which the Virginia Dental Association is very active with. The group provides all types of dental care for the less fortunate in the state of Virginia. Four or five years ago we started out fabricating seven dentures, and this year we will complete 30 sets.
It’s unbelievable the number of folks who are willing to come down and help. I head up the denture team: Dentists, lab technicians, dental assistants, front office folks, hygienists and dental students – quite an array of dental professionals.
We go down twice a year for four days. Some patients are from small mining communities, and folks come from the mountains as well. The community we help is such a wonderful group and very appreciative.