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Oral Surgery/Bone Graft Questions

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Question
Hello Doctor Ryan -

I recently had a bone graft done on 14 and 15. I am hoping to get dental implants put in both. My dentist thinks it's possible (and he does implants) but I can't say I'm all that happy with his dental work. My oral surgeon, who did the bone graft, believes only 14 should get an implant as 15 is not necessary. I am now 4 months in from the graft surgery.

1 - Should I get another opinion on number or implants possible?
2 - Can I get an implant in 14 now, and 15 at a later time?
3 - Is it possible to get an implant in 15 or is it just not necessary?
4 - I hear that it may not be possible to tell if a bone graft was successful until the day of the attempted implant. What does that mean, they cut me open and say sorry? Or do they try another bone graft? And if so, who pays for the seond attempt?
5 - Also my dentist said that if he did the implants and they fail, he will redo them at no additional charge ( he didn't give me a timeframe). My oral surgeon seems to think every bit of work is on my dollar. Which is normal or does it vary? Is my dentist just placing the guarantee to get the work? Or is the oral surgeon the seemingly money hungry one as he would charge me to retry a failed implant?

Answer
Chris, Thank you for your question. You raise many good points and these are great questions.
1- Should I get another opinion on number or implants possible?
You should get another opinion.
2 - Can I get an implant in 14 now, and 15 at a later time?
The implant at site 15 later will depend on the amount of bone that is there. Usually, an implant can be placed but later but you might need bone grafting at that time depending on if and howe much bone is left.
3 - Is it possible to get an implant in 15 or is it just not necessary?
I would need to look at you case (radiographs, photos and possibly models to make that determination).
4 - I hear that it may not be possible to tell if a bone graft was successful until the day of the attempted implant. What does that mean, they cut me open and say sorry? Or do they try another bone graft? And if so, who pays for the seond attempt? If they do not have an imaging device to tell how much bone is there they will have they will not be able to tell. A cone beam CT (CBCT) can be done before any surgery to determine how much bone is there but there is usually a charge for that.
5 - Also my dentist said that if he did the implants and they fail, he will redo them at no additional charge ( he didn't give me a timeframe). My oral surgeon seems to think every bit of work is on my dollar. Which is normal or does it vary? Is my dentist just placing the guarantee to get the work? Or is the oral surgeon the seemingly money hungry one as he would charge me to retry a failed implant? These charges vary by doctor. The stability of an implant depends on a lot of factors including how the patient takes care of the implant. Implants require special cleanings that are different then regular cleanings and not everyone is familiar with this. Once the implant is placed, it can fail for many reasons including fault by the patient, fault by the restoring dentist and possible fault by the oral surgeon and sometime by no ones fault. It is hard to control all these factors. Since all of these factors are sometimes hard to control especially if there is no good follow up, there may be additional charges for replacement and sometimes there is only additional charges if the implant falls after a certain number of years. There is no guarantee of implants and there are charges to the surgeon for materials that can get quite expensive. So, long story short, some will charge you for materials only, some won't charge you in certain time limits and some will always charge you. Just depends. I hope that helps. If anything is not clear just reask the questions and Ill try a different way.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon

Expertise

Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com

Experience

Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

Organizations
American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Publications
Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

Education/Credentials
S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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