Jaw Surgery and Dental Implants in Singapore Blog

Cost is probably one of the biggest factor when a patient considers having dental implants. Indeed implant dentistry is arguably the most expensive dental procedure. However, it is also fast becoming the treatment option of choice amongst most patients who lose their teeth. What was once a “luxury” has become a necessity, at least relatively speaking.This is probably due to our high standard of living in SIngapore and hence rising expectations of the people. Along with the increase in demand, dental implant manufacturers and dentists find ways to lower the cost of implant dentistry so that the majority of patients can afford. How cheap is the cheapest implant in Singapore today?

As dental implants becomes increasingly popular as teeth replacement, more and more people are having dental implants in their jaws. Today, it is has become a mainstream treatment in many clinics. Along with it widespread adoption, the incidence of complications arising from dental implants is also rising. Countries that have an earlier adoption of dental implants on a widespread scale are beginning to see many complications surfacing. This trend is also beginning to appear in Singapore.

Dental implant treatment is arguably the most expensive treatment in dentistry. Over the years, the feedback that I got from patients included descriptions such as “more expensive than open heart surgery” and “stuffing a BMW into the mouth”. So, let’s get it upfront, it is expensive. However, most times, it is cheaper than heart surgery and the good news is that while heart surgery is often mandatory if you don’t want to die, dental implants are elective. So, as much as I hate to admit it, the car analogy is probably closer. But you don’t have to buy a BMW. You can choose to get a Hyundai or you can even choose to walk. Let’s look at the difference between a “BMW” implant and the “Hyundai” implant. And it’s not the country where they are made.

A colleague once told me this story about a patient of his. An elderly gentleman came in with several badly decayed front teeth. The teeth were quite rotten, discolored and malaligned. He thought to himself that he could be a hero to this patient because no matter what he did, he would have vastly improved the function and aesthetics of his teeth. However, as he commence the restorative work, he discovered that restoring function was the easy part but aesthetics is a different ball game, the profile of the patient notwithstanding. The patient was exacting in his demand for aesthetics, no different from a younger patient. A mutual friend who was in the car industry then said that the guy who drives an old beat up car to a car dealership to collect his new car will not accept a single scratch on the new car. How true.

Dental implant as replacement for missing teeth is currently the preferred choice of most dentists and patients. However, for some patients, the bone in the jaw is insufficient to support an implant and requires bone grafting, a method of augmenting the deficiency with bone either taken from another part of the patient’s body or from an alternative source, such as human cadavers, animals or synthetic. The question of how long to wait after bone grafting before dental implant surgery can be done was a subject of intense debate in Singapore recently after a dentist was charged with placing an implant seven weeks after bone grafting.

I was at a dental implant conference last Saturday afternoon moderating a session where the speakers were presenting their respective protocol. Listening to a lecture after lunch was always a challenge regardless of who the speaker was. As such, with the consent of the speaker, I told the audience to put their hand up at any point during the presentation if they want to ask any question or make a statement. Hopefully, with audience feedback, the session can be more lively and engaging. It was indeed but the downside was that we digressed a lot. At one point, someone mentioned the term “All-on-6” which drew a sharp retort from another member in the audience that there is no such thing as “all-on-6” and there was only “all-on-4”. So, who is right?

Many years ago, a patient for whom I was planning a full mouth dental implant treatment in Singapore commented that it cost more than his double by-pass surgery which he had just undergone the year before. Another full mouth implant patient put it in a lighter tone, saying it is like stuffing a BMW into his mouth. Yes, dental implant treatment is expensive. As such, dentists and implant manufacturers alike have been trying different approaches to bring down the cost. However, it is a tough balancing act, trying to bring cost down and maintaining high standards. The All-on-four protocol is one such approach and up to this point, it is proving to be rather successful. Can it replace the conventional approach altogether? Probably not. 

Many patients who need dental implants to replace their missing molars do not have sufficient bone and hence need sinus bone grafting to augment the bone mass to house the implants. Although sinus bone grafting has already evolved to be a commonly done procedure with good results, many patients are understandably concern and would like to avoid it if possible. Some may have a history of sinus disease and entering the sinus for bone grafting may cause a relapse of the disease. In others, there may be ongoing sinusitis which contraindicate the procedure altogether. For these patients, what are the alternatives?

I first heard about sinus lift almost thirty years ago when I was student. It was during a conference on dental implants and one of the surgeons present was advocating that all sinus bone grafting operations for dental implants should be done in a hospital operating room. It was a relatively new procedure back then and there were not a lot of long term studies on the potential complications and doing it in the milieu of an operating theatre provided more protection against adverse outcomes. Well, that was thirty years ago. A lot of research have gone into this procedure and much of what works and what does not are well published in the scientific literature. Today, the procedure is routinely done in dental clinics all over the world. However, this does not mean that complications do not happen anymore. As with all surgeries, complications can and will happen.

Replacement of missing molars and premolars in the upper jaw with dental implants is often challenging due to a lack of bone. Above the roots of the molars and premolars is the maxillary sinus, which is an empty space within bone that is lined by a layer of tissue which secretes mucous. The mucous helps to humidify the air as it enters through the nose on the way to the lungs. These cells lining also contain hairlike structures that function like a broom, sweeping the mucous and any foreign particles that is trapped in the mucous, out of the sinus and into the nose where they are discharged. There are three other pairs of sinuses in the human skull, serving the same function. In Oriental patients, the maxillary sinus tends to expand quite rapidly with age. In adults, it is not uncommon to have the sinus dipping down between the roots of the molars and premolars.