Everything you’d need to know about Dental Implants

[Eon Engelbrecht E-Radio] (0:05 – 0:43)
Welcome again to Save Your Money, Save Your Teeth. It’s the go-to podcast where curiosity meets dentistry. It is straight from the experts.

The expert joining us is Dr. Clifford Yudelman from OptiSmile. My name is Eon, and we are here, ready to take a deep dive into the world of dental care. It’s from a consumer’s perspective.

So whether you’re looking to brighten your smile or just protect your wallet, we’ve got you covered with practical advice and the latest insights. So do stick around as we uncover the secrets to maintaining both your dental health and also your finances. Once again, a big welcome to you, Dr. Clifford Yudelman. Hope you’re well.

[Dr Clifford Yudelman – OptiSmile] (0:45 – 0:52)
Thanks. Yes, I’m great. Thanks for having me on and looking forward to today’s episode.

Thank you.

[Eon Engelbrecht E-Radio] (0:52 – 1:05)
So it’s the second one in the dental implant series and the question I want to start with, Doc, is what are the different types of dental implant treatments available today?

[Dr Clifford Yudelman – OptiSmile] (1:05 – 2:47)
Basically, there’s single-tooth implants, multiple-teeth implants, full-mouth reconstructions, implant-supported dentures, and zygomatic implants. I’ll explain very briefly what each of these are because we’ll get into that further with some questions later. But basically, single tooth is just that.

You replace individual missing teeth with one implant per tooth. If there are multiple teeth missing, we often will do a bridge. So if you’ve got anywhere from three or four teeth missing, you may only need one implant at one end and another implant at the other end.

Implants are very strong, so you can actually put three or four teeth on two implants. And then full-mouth reconstruction, there’s something known as all-on-four or all-on-six. Sometimes we say all-on-X because it can be any number.

It can be five. Basically, that’s for replacing all the teeth in a single arch, meaning the upper or the lower. Then there are implant-supported dentures, which are removable dentures that clip onto the implants for added stability.

That’s called an overdenture. Zygomatic implants—honestly, in South Africa, I haven’t really seen that, but it is done overseas. That’s for patients who have no bone left on the upper and it’s a very long implant that’s placed all the way up into the back of your jawbone.

As I say, it’s not something that I’m that familiar with, but it does exist.

[Eon Engelbrecht E-Radio] (2:48 – 2:56)
Okay. And how does a single tooth implant procedure differ from multiple implants or full-mouth reconstructions?

[Dr Clifford Yudelman – OptiSmile] (2:56 – 5:00)
Yeah. So the procedures are similar, but not exactly the same. A single-tooth implant is generally less invasive with a shorter treatment time.

For instance, if you’ve lost a lower molar, which is one of the most common teeth to lose because people get a root canal and don’t get an onlay or a crown on it, then split it, and lose it. If the bone is all healed, you do the 3D scans we mentioned before, along with the 3D x-ray, and blend them together. You then create a guide, which is 3D-printed, and it has a little hole to guide the implant placement. The implants are placed in the exact right spot, and the crown is put on top of that.

Multiple implants can also be done guided, and that uses, as we mentioned earlier, two or more implants to support a bridge. Sometimes, you can place two or three implants and have six teeth on them. It’s all designed ahead of time, up to the full mouth.

The complexity and healing time obviously increase with a full-mouth procedure, which can be more complex with a longer healing time. There are cases where you get immediate full-mouth work, such as when someone has four or five or six loose teeth that need to be extracted. If there’s good bone in between, the teeth may be extracted and then implants placed into the good bone, which all gets stitched up.

It can be quite a big job. A prosthodontist or oral surgeon would usually handle that. General dentists can do it, but it usually falls within the realm of dental specialists.

Then, of course, the cost increases with the number of implants and complexity. That’s how they differ.

[Eon Engelbrecht E-Radio] (5:01 – 5:07)
Okay. Doctor, can you explain what an implant-supported bridge is and when will this be recommended?

[Dr Clifford Yudelman – OptiSmile] (5:07 – 6:14)
It reduces the need for an implant for every missing tooth. In other words, if you’ve got six missing upper front teeth, which is sometimes common, you can put two big implants in where the eye teeth are and then do a six-tooth bridge across there. Or if you’re missing from your eye tooth on the bottom and there are no teeth behind, you can put an implant in behind the eye tooth and then one all the way at the back.

You could put some premolars and molars. You can put a whole bunch on there. If you’re missing two lower front teeth, you may just get one lower implant that has two teeth on it.

That’s called a cantilever. Sometimes it’s done in the front as well. It’s always custom planned.

There are a number of different ways to do that. You get enhanced stability, and it preserves the jawbone compared to a traditional bridge, which is where you pull out a tooth and the bone keeps receding afterwards.

[Eon Engelbrecht E-Radio] (6:15 – 6:23)
What factors influence the choice between a single, multiple or full-mouth dental implants for a patient?

[Dr Clifford Yudelman – OptiSmile] (6:25 – 7:52)
The obvious answer is the number of missing teeth, the bone density, and the quality of the bone. Sometimes, the flexibility to place implants necessitates grafting, the overall oral health. If someone has a lot of gum disease and it’s not easily treated, that might be a case where all the remaining teeth are removed and implants placed, so you’re not mixing and matching regular teeth with implants.

That way, all the infection goes away. Patient budget considerations, the financial factors, and the patient’s preference if someone wants something fixed versus removable. For instance, if you’re missing all your lower teeth, you could get two implants with little clips on them and get a denture that clips on there, or you could get four implants with a bar and get a denture that clips onto that metal bar—all the way up to maybe six implants—and then get a custom big bridge, basically all-on-six.

That’s all your teeth and that gets screwed on permanently. The cost and complexity go up dramatically with each of those. That last one I mentioned is very popular for people who can afford it.

[Eon Engelbrecht E-Radio] (7:52 – 8:03)
Okay. Now that you’re talking about affording it, let’s talk about costs. How do the costs vary among the different dental implant options?

[Dr Clifford Yudelman – OptiSmile] (8:04 – 9:30)
Obviously, the single-tooth implant, where there’s bone that doesn’t require bone grafting, is the least expensive option. Sometimes, it can even be the same as a bridge. I don’t want to mention prices because implant prices vary greatly from dentist to dentist, depending on the brand of implant they use, their experience, whether it’s guided or unguided, and other factors such as the quality of the lab they use.

In general, you get what you pay for unless the dentist has very high fees for no apparent reason. Multiple implants and bridges are cost-effective for replacing several teeth, but it obviously costs more to replace three or four teeth with two implants than it does to do a single implant. Full-mouth reconstructions can be very expensive, reaching hundreds of thousands of rands.

In the long term, though, a higher initial cost can be offset by durability and reduced future expenses. Then, there’s medical aid cover. Different medical aids cover things differently.

Some people get implants placed in hospital because they have hospital cover. It depends on the medical aid.

[Eon Engelbrecht E-Radio] (9:31 – 9:40)
And now, we get to after the procedure. What is a typical healing time for each type of implant procedure, doctor?

[Dr Clifford Yudelman – OptiSmile] (9:40 – 11:00)
So, single implants and multiple implants are around the same. We mentioned three to six months. Sometimes, you can get immediate placement where the implant is placed and the bone is solid enough to screw a temporary crown on right away.

Or, you might just have a healing cap, a little screw that sticks through the gum. We used to do a lot of two-phase surgery, where the implant is completely buried, the gum is stitched up over it, and then three or six months later, there’s another surgery. That’s not as common these days. Full-mouth reconstruction can take four to eight months.

A lot of the time with a full mouth, you can get immediate load because you’re joining multiple implants together. You’ve got six or so that are bridged together, making it quite resilient to movement. If there’s bone grafting involved, the treatment can be quite dramatic. Some patients might have several surgeries over the course of a year before they can get their tooth.

It varies from patient to patient depending on their age and health.

[Eon Engelbrecht E-Radio] (11:01 – 11:05)
Do you also find that patients lose a lot of weight during this process, during the recovery?

[Dr Clifford Yudelman – OptiSmile] (11:06 – 11:40)
No, not at all. Not with implants. When we say healing, that’s just waiting for the bone to heal around the implant.

Even with extensive treatment—say, a patient gets all their teeth removed and implants placed—if they get immediate placement of a temporary bridge, they can usually eat better by day two or day three than they could before. No, I think people put on weight. That’s a good question.

[Eon Engelbrecht E-Radio] (11:40 – 11:44)
Okay. What else can patients expect during this recovery process?

[Dr Clifford Yudelman – OptiSmile] (11:45 – 12:55)
Well, as I said, just mild swelling. If you’re getting extensive work done, like upper and lower teeth pulled out and twelve implants placed, you’re obviously going to feel a bit beat up after that. It’s not that common in South Africa because it’s an expensive treatment.

Often, patients whose teeth have reached that point usually couldn’t afford dental care in the first place. In other countries, like the UK, maybe it’s different with the NHS or other systems. Socioeconomic factors play a big role.

For a single implant, you usually see very mild swelling, hardly any discomfort, maybe just some Panado. We do tell people to eat softer foods. Avoid chips, crisps, and very crunchy things.

Keep it clean—we give you mouthwash and a soft toothbrush—and there are follow-up appointments. Most people can get back to their normal activities within a few days.

[Eon Engelbrecht E-Radio] (12:56 – 13:04)
That’s fantastic. I know we touched on it briefly earlier, but how does the condition of a patient’s jawbone affect their implant options?

[Dr Clifford Yudelman – OptiSmile] (13:04 – 15:54)
You need adequate bone density for implant success. If there’s bone loss, we might need to do bone grafting. There are different ways bone grafting can be done.

Sometimes, we take bone from the back of your jaw and transplant it to the front. Other times, we use what’s called “bottle bone”—bone chips, either synthetic or freeze-dried. There are many ways to do bone grafts.

In the upper jaw, if the sinus is too low and there’s not enough space for an implant, we might need to do a sinus lift. That can range from a minor sinus push to a full-blown sinus lift, which is a big surgery. Usually, periodontists or oral surgeons handle those cases.

If it were me, I’d prefer to be sedated for something like that. But for a simple lower implant, the procedure is quicker than getting a filling.

There are alternative implants if there’s not enough bone. We mentioned zygomatic implants earlier, but they aren’t that common. We use CBCT scans for diagnostics to know exactly where the bone is and its quality.

It’s an advanced procedure. Our dentists here attend ITI (International Team for Implantology) conferences. Our prosthodontist has been teaching implant surgery and has many years of experience.

[Eon Engelbrecht E-Radio] (15:55 – 16:03)
Doctor, have you noticed any advancements in implant dentistry that have improved recovery times or outcomes?

[Dr Clifford Yudelman – OptiSmile] (16:04 – 18:08)
Oh, yeah. We mentioned guided surgery earlier. Before 3D scanners and x-rays, implant placement was more of an art form, requiring the dentist to peel back the gum, take a good look at the bone, and figure it out.

Now, guided surgery is very precise, like assembling Lego. You place one piece, then the next, and it’s straightforward if you’ve had the training.

There’s immediate loading, where we can place temporary crowns on the same day, or for full mouths, screw in an entire bridge or denture. Implants themselves have improved too, with better thread designs and purer titanium.

Minimally invasive techniques, like guided techniques, have come a long way. We also use PRP (platelet-rich plasma), where we take the patient’s own blood, spin it in a centrifuge, and use the platelets to help the bone heal faster. It acts as a scaffold for bone growth.

[Eon Engelbrecht E-Radio] (18:09 – 18:23)
Wow, that’s fascinating. Finally, doctor, what advice would you give to someone unsure about which dental implant option is right for them?

[Dr Clifford Yudelman – OptiSmile] (18:24 – 20:25)
I’d say see a specialist, but many dentists are highly trained in dental implants these days. Sometimes, oral surgeons will place the implants and tell the patient to see their dentist for crowns. But the planning should always be done by the dentist or prosthodontist.

You want the person placing the crowns to plan it all in 3D with input from the lab technician. It’s a team effort. You don’t go straight to an oral surgeon or periodontist—you go to the dentist specialising in restoring implants.

Ask questions, weigh the pros and cons, and consider your long-term goals, durability, and aesthetics. Think about financing options too.

Choose something that aligns with your lifestyle and budget. Even just two implants to secure a denture can make a huge difference in your quality of life.

[Eon Engelbrecht E-Radio] (20:26 – 20:31)
Dr. Yudelman, thank you so much. Once again, very insightful. We appreciate it.

[Dr Clifford Yudelman – OptiSmile] (20:32 – 20:43)
My pleasure. Thanks for having me on. I look forward to next week’s episode.

It will be our final one about implants.

[Eon Engelbrecht E-Radio] (20:45 – 21:19)
Thank you so much. Here’s a quick disclaimer—while we strive to provide valuable insights, always consult your dental professional for advice tailored to your personal health.

Do subscribe for more discussions on Save Your Money, Save Your Teeth. Until next time, keep smiling and take great care of your teeth.

[Narrator] (21:40 – 22:24)
Discover the world of dental excellence with OptiSmile. Join us weekly for podcasts featuring Dr. Clifford Yudelman, a seasoned expert with 40 years of dental experience across four continents. Gain unique insights and expert dental advice by visiting optismile.co.za. If you’re seeking unparalleled dental care in Cape Town, get in touch with OptiSmile or book online at optismile.co.za. OptiSmile—where global expertise meets local care.