Molar Implant: One graft or two? Autologous plasma or no?
January 8, 2017 8:51 AM   Subscribe

Ms. Wrench (~50F) needs a dental implant to replace a broken molar. We have two estimates: one with lots of plasma culturing and two graft sessions (at extraction and at implantation); and one with one graft at implantation (I think; it's one graft, but not sure of the timing).

One estimate is significantly higher than the other, and we're trying to determine whether it's worth it. So, considering the wide latitude afforded "medical judgment," what should we be thinking about?
  • Are two grafts better than one? (How much better?)
  • Are there any recent studies of this? (At dentist conventions, what papers get mentioned when practitioners are discussing which way they do it, and why?)
posted by spacewrench to Health & Fitness (5 answers total) 4 users marked this as a favorite
Is the situation that your SO is missing bone immediately around the impacted area? Grafts are usually only for these kinds of issues, but I have seen dentists still sell them to unsuspecting patients. Also, where is she getting the graft from? Have they explained scraping bone from her ankle?
posted by parmanparman at 1:29 PM on January 8, 2017

I am heading toward the finish line of a dental implant process (in the US) so my input is anecdotal. Mine is tooth 7.

I had a graft done what would have been six months before the actual implant to ensure that the graft took properly. Although my graft was fine and the bone was growing back around it, I had to have a second graft process done called a ridge augmentation. Another bone graft, but in the front of the gumline as opposed to up the "hole" where my tooth once was. This was to build out the gum, because there was a dent in my gums right above where my tooth used to be. Apparently a lot of the bone had worn away around that bad tooth over the years. My initial estimate didn't include the second graft.

There are tv ads on late at night touting one-day dental implants at a local place. When I asked my doc why my process has taken so long, and this place promises one day, he said it was because he preferred to make sure the graft took and no infection was present, before implanting the hardware. Kind of like making sure that if you're screwing hardware into the wall to hang something important, you want to make sure you're screwing into the stud and not unsupported drywall. I didn't have a 'stud', so to speak, and now I appreciate the time it's taken to do it all right. My implant was 'installed' early last week without incident.

My grafts were from cadaver bone, so there was no scraping of my ankle involved (holy crap that sounds awful!)

Perhaps it is possible to do the graft 6 months before, and she won't need the second?
posted by kimberussell at 1:47 PM on January 8, 2017 [1 favorite]

My husband had two dental implants for his upper front teeth. He had a bone graft before the implant (like kimberussell,) then had to wait several months while the bone grew in. That was the only grafting done, and it worked well.
posted by chocolatetiara at 2:29 PM on January 8, 2017

Thanks everyone! I spent the afternoon Googling and found an NIH paper about Platelet Rich Plasma treatment, which is one of the big-ticket line items appearing twice in the expensive estimate. Looks like that dentist wants to use it on the bone-graft portion and to coat the implant post, and NIH suggests that both uses are legitimate. I don't know whether it's necessary in my wife's case, or excessive caution by the dentist, or just straight-up upsell of an expensive add-on.

So, due diligence completed, but ... ¯\_(ツ)_/¯

Go for it if you can afford it, and if you can't, then hopefully you didn't need it. (I suppose it's more important to make the right decision if you need multiple implants, but in that case, you can try it the cheap way, and switch to the expensive way if it doesn't work acceptably.)
posted by spacewrench at 4:45 PM on January 8, 2017

How much Platelet Rich Plasma treatment cost? I heard price range between $800 and $1200 for a single procedure
posted by christian29 at 9:58 AM on March 7, 2017

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