Are you in need of a tooth replacement? Thinking implants or dentures? We recently spoke with Dr. Michel Raad, prosthodontist at Luxor Dental in Pleasanton, California, about the practice of prosthodontics. Dr. Raad graciously shared the ins-and-outs of dental replacement procedures and more in our recent interview.
What is prosthodontics?
Prosthodontics is one of nine dental specialties recognized by the American Dental Association. In short, prosthodontists are masters of complete oral rehabilitation, including restorations and replacement of teeth. Graduate programs in prosthodontics are three years in length, in addition to the four years required to graduate from dental school. In their graduate programs, prosthodondists receive additional laboratory and clinical training in esthetics/cosmetics, crowns, bridges, veneers, inlays, complete and removable partial dentures, dental implants, TMD-jaw joint problems, traumatic injuries to the mouth’s structures, congenital or birth anomalies to teeth, snoring, sleep disorders, and oral cancer reconstruction and continuing care.
What is the difference between a prosthodontist and a cosmetic dentist?
The term “cosmetic dentist” is a bit of a misnomer. In truth, any dentist can label his or herself a cosmetic dentist straight out of dental school without any additional graduate training. Unfortunately, the title “cosmetic dentist” gives off the impression that such dentists went through additional graduate training in order to gain this title. While some cosmetic dentists are very talented dentists, others can cause more harm than good when they try to perform procedures beyond their training. If you are looking for a qualified cosmetic dentist to restore your smile, the answer is to go to a prosthodontist.
What made you decide to become a prosthodontist?
I was drawn to dentistry in general because of the great impact a dentist can have on his patients. By improving a patient’s smile, a dentist can help improve the patient’s attitude, self-esteem and confidence. When I finished dental school, I realized that additional graduate training in prosthodontics was best for me because prosthodontics is the only specialty that deals with cosmetics as well as complete rehabilitation. I was further drawn to prosthodontists by the fact that prosthodontists are frequently the head of most dental teams since they are in charge of drafting the blueprint of any treatment plan.
Can you tell us about your work with computer-assisted implant surgeries?
My work with computer-assisted surgery started in 2007 when the first systems were developed. One of these cases is featured on my website. Back then, technological advances in digital dentistry were going at a very fast pace. Some companies had the idea of applying this technology to surgery. It starts by taking a CAT scan and superimposing the implants and bone grafting surgeries on that scan. After doing so, the system will help you mill a guide for your surgery and the software will give you an exact list of drills to use and the order in which they need to be used. This surgery is very safe and it limits the amount of time spent in a surgery room by planning every single step on a computer. This is very essential to the patient and surgeon alike. The patient doesn’t want to spend an extra hour in the surgery room and the surgeon wants a surgery with no hiccups.
You earned your Master’s degree for your research in ceramics. Can you tell us a little bit about that research?
My main work was on zirconia which is the material used to construct the infrastructure of all-ceramic crowns replacing metal. This infrastructure is cut digitally by burs mounted on a robot out of blocks of Zirconia. My research had to do with comparing different types of zirconia, including one that I fabricated myself in the lab. Also, it compared whether an infrastructure coming from the middle of the block was stronger than one coming from the periphery. The results were that the technique to fabricate such blocks is easy to reproduce by an unskilled technician similar to myself with no previous training. The results also showed that blocks coming from the inner core of the block were stronger. That meant that laboratories had to cut one infrastructure out of the center of the block rather than multiple infrastructures trying to maximize the use of each block.
What is the most common procedure you perform? How does it work?
The procedure I perform the most is implant surgery and implant-supported restoration. More information is included on my website but to be brief, for a single tooth, it works by placing an implant in the bone and allowing it to heal. After a couple of months, once the implant is completely anchored in the bone, we put a crown on top. For full arches, it includes placing 4 implants for dentures or 6 to 8 implants for fixed bridges. Dentures can be connected to the implants via a gold or titanium bar or small ball attachments giving the patient very good retention. This is a giant leap in patient satisfaction from the days where dentures had to cover the palate and glue was the standard of care.
When should a patient be referred to a prosthodontist?
A patient should be referred to a prosthodontist for a second opinion on any large treatment plan, even if the general dentist is going to do the work himself:
1) Denture cases–regular and implant supported. Because of the extensive knowledge of the anatomy of the jaw, a prosthodontist’s dentures cover more surface area of the gums than the general dentist dentures providing more support.
2) Whenever extreme changes are required to restore a dentition. For example, opening a bite that is collapsed or a completely worn out dentition.
3) Aesthetically challenging cases involving a combination of surgeries and restorations
5) Multiple implant placements
6) Patient that requires a full mouth reconstruction
7) Difficult patient with limited opening.
8) TMJ problems and sleep apnea
As someone who sees patients every day who have lost their teeth, what advice can you offer to our readers?
My biggest advice to the readers is that nothing will ever replace your own teeth. Prevention is the key to good oral health. Regular cleaning and following the recommendations of your dentist is key. Most of the problems we see are due to miscommunication between the dental team and the patient, which result in the patient not understanding the value or necessity of the treatment recommended. I recommend that when in doubt patients seek a second opinion. Be an informed patient and ask questions. Don’t be passive and if your gut feeling is that your situation could be better handled by a specialist, go and talk to one and weigh your options. Don’t say “I can’t afford it” and settle for less. In extreme and large cases, some patients incur the costs twice by making the mistake of going to a general dentist for treatment thinking they are saving money.
Any other comments?
With their extensive knowledge and expertise, prosthodontists are not only the experts in fixing your teeth; they are also good at diagnosing the reasons why your oral health got to this state of disrepair to start with and preventing it from happening again in the future.