Dental Implant Interview 1

Dr. Eberts: We would like to welcome you to our discussion on dental implants and I would like to introduce you to Dr. Gene Sambataro.

I am wondering what got you interested in dental implants. I mean, you are a general dentist so what attracted you to become involved in that?

Dr. Sambataro: Well I have been practicing dentistry for thirty-five years and on many occasions I considered doing implants. It was another very intricate part of dentistry that was going to require some additional training. I was already busy, I did not need a lot more new patients but it kept coming back. My patients were asking me why I was not doing implants, especially when I generally would do the extraction.

So I would do the extraction and then I would refer them out to a local oral surgeon to do the implant. I finally just thought that this was something patients really wanted, that was one reason. The other reason is that most of the surgeons are not willing to do zirconia implants, which are the newest thing on the market. They have been around for probably ten to fifteen years in Europe and now they have been approved here for the last couple of years.

Our philosophy is ensure that everything is bio compatible. Zirconia is just a better product in terms of bio compatibility than the titanium implant.

So there is a couple things; one- patients ask me to do it, two- I have good surgical skills, three- being able to use zirconia versus titanium. It just all kind of fit in and made sense. I took a course to learn more about it and then became interested in doing the complete comprehensive training.

Dr. Eberts: So your background experience has been mostly in biological dentistry. So there is more of an emphasis there for example to remove root canals. And when you do that there is a blank space left. So either the person goes without a tooth or they get an implant.

Dr. Sambataro: So the options were either we can replace that tooth with something called a removable partial denture or removable partial bridge; which is something the patients take in and out to clean it. Two is a fixed bridge, which is cemented and is permanent, but it can also decay. So these are not the best alternatives - but I thought they were because I did not know how to do implants.

But, now having done the training, I think the most important thing is that we are going to preserve bone. For long term preservation of bone, the only way you can do that is by placing an implant where the tooth was extracted. Otherwise the bone is going to continue to shrink, it is going to reabsorb with either the partial denture, which most people are not comfortable with, or bridge. And then the other disadvantage of the bridge is you have to prepare two other teeth to replace one tooth. There is this one dentist that says a bridge is a three teeth solution to a one tooth problem. Whereas an implant is a one tooth solution to a one tooth problem, so it makes so much more sense.

Dr. Eberts: You mentioned something about bone loss; I understand there is a fairly dramatic bone loss with the removal of a tooth.

Dr. Sambataro: If you take the tooth out and just clean the socket without putting any grafting material, you are going to see dramatic bone loss.

Dr. Eberts: Which is a typical procedure and is what is generally done?

Dr. Sambataro: Yes, quite often you will see about a 40% loss in bone in the first three months.

Dr. Eberts: That is in the jaw?

Dr. Sambataro: In the jaw, so if you at that point did not do an implant you are going to continue to see 10% bone loss over each decade of your lifetime. So there will be a point in time, if you had a tooth taken out when you are thirty, by the time you are eighty you are not going to have enough bone to do an implant.

But that is not horrible because you can rebuild the bone. But what makes most sense and what we are looking at now is - take the tooth out, clean the socket out, disinfect it and place the implant immediately. So you get no bone loss and it preserves the bone for a lifetime.

Dr. Eberts: You mentioned training, what was your training in dental implants?

Dr. Sambataro: That is a good question because I get these marketing pieces all the time that you can come and take a two day weekend course. By Monday you can start placing implants. I just did a pretty intensive training of over a hundred and thirty hours of continued education in implantology. This included live placement of implants in the Dominican Republic.

I actually got live hands-on experience in placing implants, which other courses cannot do. The main reason they cannot do that is that the dentists would have to be in state where they are licensed.

So, if I took the course in Florida, for example, I could not do live patient treatment because I do not have a license in Florida. Going to the Dominican Republic really worked out well because I got live training and it also allowed me to donate my services for free to the people there.

I was part of a group of thirty-one dentists and we did over a million dollars in implant placement in one weekend.

Dr. Eberts: That is impressive. What is the single most important thing you do with dental implants that almost no one knows about?

Dr. Sambataro: You mean from the public...

Dr. Eberts: The public perspective, yes, probably even other dentists.

Dr. Sambataro: I think the bone preservation is a big factor. I did not really understand that fully until I took the course and I have been practicing thirty-five years.

I didn’t know how important it is to preserve that bone. And there is only one way to do that. The purpose of the bone is to hold something in, so with the tooth out, the bone has no function so it starts to reabsorb.

I think probably that is the most important thing. Also the fact that you cannot get decay, implants do not decay. Before I took the training I never really thought about it. Very rarely a small percentage of implant patients get gum inflammation. So with implants you get bone preservation, eliminate cavities and periodontal disease and you get something that is perfectly functioning.

And I will tell you what, I have taken implants out due to infections and they are ridiculously hard to get out. We have some tools now from Germany that are going to simplify that. In fact, I used one yesterday and it made it very simple. The only reason I brought that up is that the level of integration between the implant and the bone is amazing. So you have something in there that is strong, that is preserving bone, does not get decayed and does not get gum disease.

Dr. Eberts: So all around, it is a good thing?

Dr. Sambataro: Yeah, and it is also doing what a bridge or partial will do - teeth are not shifting, they are not moving, and you can function with it. The forces that are generated on the implant are as good if not better than your own teeth.

Dr. Eberts: As I understand it, the vast majority of dentist implant titanium, not zirconia. Why is titanium not the best solution?

Dr. Sambataro: Well I guess like everything else in medicine, we do not find out the bad until later, although some dental procedures are very suspicious such as mercury fillings. We are now finding even with titanium knee replacements and hip replacements that the titanium is reacting to the body's immune system.

Dr. Eberts: It is a metal.

Dr. Sambataro: You might be okay if you are not sensitive to titanium. But in many cases, it is causing some chronic inflammatory problems. So it’s the same thing with titanium implants in the jaw.

Dr. Eberts: So what is used now instead of the titanium?

Dr. Sambataro: Just like we went from metal fillings, we have gone to ceramic fillings, now there have zirconia implants.

Dr. Eberts: Which is a ceramic?

Dr. Sambataro: It is a ceramic material. It is still not perfect, it is not human body tissue but it is much greater bio compatibility. It fits in with our philosophy, which is that we want to restore optimum oral health but also not affect the whole body.

So we can restore function and the bite and stop shifting of the teeth by putting titanium in, but what is the effect of that on the rest of the body? Just as many dentist still believe mercury is safe, you can rest assured that most dentist believe titanium is okay.

And it might be a small number of people that are negatively affected by titanium, but if you have another option why would you consider that. The reason you might is because the old adage “you cannot teach an old dog new tricks.”

So if you have been doing titanium implants for ten, fifteen, twenty years, you are not interested in learning how to do zirconia The resistance of oral surgeons to this new technology (which is what I listed in the beginning of our discussion as the number two reason for my interest in learning to do implants) was an impetus for me to reach out and learn this process.