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Old 12-17-2012, 04:40 AM   #65
Beastly Adventurer
XRman's Avatar
Joined: Dec 2006
Location: SW Victoria Oz
Oddometer: 3,296
Not only Mexico

I am seeing the long term results of dental tourism to Asia in some of my patients. Most of the comments in the previous posting apply.

I had some reservations about three implants being placed in the upper anterior area to replace a failed long standing bridge. I was wondering if the bone loss from the missing middle tooth area of the bridge was repaired with bone grafting material when the implant was placed. you need about 1.5 to 2 mm all around the implant for it to work long term. Most problems don't show up until the final restoration in in place and loaded with biting force. The temporary bridges are left out of contact with the opposing teeth so that the healing bone is not jiggled while the implant-bone interface is trying to heal.

There are probably over 300 or more dental implant comapnies in the world market. They come and go. Many are cheap clones made in third world countries that look just like the original world leading brands, but they are made of different metal and different surface treatments and the tools used for them are all different sizes and shapes. It is a nightmare! Most of the dental tourists have not been provided with any details of the brand or size of the implants used or the connecting abutment details ( the thing the crown is attached to). Maintenance is really hard to arranage if you don't know anything about the system used. ( you will need maintenance at some stage)

I am seeing poor engineering principles being used in cases. For example 2 implants supporting 5 teeth. No sane DIY fish pond bridge builder would build a curved bridge with two supports and then expect it to survive if someone loaded the bridge in the middle of the span. it will eventually fail. Yet I am seeing this done by Asian dentists.The implants will either come loose at the screws or the porcelain will fracture from the metal substructure. The implants might break or just come loose. it is the stress/strain on the implant bone interface that detemrines success or failure. Overloading implants leads to failure.

Why? I think it is that the patient is subcontracting his/her dental reconstruction without sufficient knowledge. Like an owner / builder of a house who has no building skill insisting on the tradesmen doing the job quickly& cheaply. The dentist will do whatever they can in the time available for cash flow. There is no possibility of legal recourse for failure. The clinics open and close and change owners a lot. Try and launch legal action in a foreign country!

Untreated gum disease and implants: the same bugs that infect tooth roots and gum tissues also lead to bone loss around implants. Placing implants in a mouth with gum disease is a recipe for disaster eventually.

The clinic looked clean: It probably is clean too, but is the sterlization process for those plastic bags of instuments verified regularly or at all? I very much doubt it. Infection control in third world situations is hit and miss.

So can I compete on a $ basis with clinics in Thailand.

No. I pay about $450 Au ( 430 US approx) for an implant from the implant company. That is just the basic titanium screw that goes into the bone. On top of that I will have to purchase all the tools for the implant surgery and the gadjets to take impressions and the artificial bone substances (expensive).

My lab fee for an implants case can be close to $800-1000 per tooth. Excellent fit and colour and durable. I can get them done in China for half that, but I have to live in the same town as my patients.

I pay my dental asistants $22 per hour on average. I have 4 of them plus two office staff and a hygenist. My wages bill is about 35% of of my gross income.
I am expected by law to have insurance to cover failures.
I am expected to verify every sterilization cycle.
My total overhead cost is about 80% of my gross income.

Tax takes 50% of my 20% profit so I work for 10%. I still have a nice lifestlye, but I am not rich.

So my point is, you can export our health industries to third world countries just like we have our manufacturing industries, but who will you turn to for assitance when your cheap work turns into a nightmare. Your health is not a consumer item that you can throw away and get another one. Failed implant and dental work have consequences, usually infection and continued bone loss on the way to becoming a dental cripple (full dentures)

Do we have failures: yep. we are dealing with humans in various stages of decline, not ideal physical specimans. Some people have poor bone amounts and quality. Some people have bad habits ( smokers) and tooth grinders.

Some people won't take our advice and seek less than ideal solutions believing in Dr Google and others on forums such as this who are well meaning but poorly informed on the criteria on which to choose good dental professionals to plan and execute their needed reconstructions.
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