Today we are having a chat with Dr. Tavakoli. We will discuss the current trend of cheap options for dental implants; The associated risks that patients are kept in the dark about; What exactly you should know, before deciding to go for implants and how you would know you have found the dentist you can trust, with changing your life.
It’s no secret that there are dentists who offer dental implants for very attractive and low price; however, the part that’s hidden from the patients is: "what drives these lower prices". One of the reasons these prices are low is because, in some cases, certain health and safety protocols are not followed to the highest levels of standard and/or not managed properly. This has two consequences:
It makes it difficult for patients, because they may not know that they’re putting their lives at risk by choosing a cheaper option.
It also makes it difficult for dentists, especially those with good intentions who want to provide the best available treatment for their patients, but can’t compete with these low prices.
Dr. Ali Tavakoli
This is something that I'm dealing with on a daily basis. Some of the patients who come to my office tell me about “a dentist across the street” who is willing to place and restore implants for $2,000. Then they ask me: “How come my price is higher?” I understand their confusion and point of view. Sometimes, it can be hard to trust the dentist you are speaking to. The reason for these price differences is the way we practice. There are also differences between implant systems. If you Google ‘implant systems’, it will come up with hundreds of different options. Whichever option patients choose, is up to them, but how can a patient decide whom to trust? That’s the real question here.
Abhi: You're absolutely right, I think that is the big question. I am going to ask you that later as well. Here are some questions that I have for you:
Q1: What are the top 3 things that a patient should consider when they are looking for dental implants?
Dr. Ali Tavakoli:
First of all, you need to start searching and find a dentist that you like. The goal here is not to find a dentist, the goal is to find the right dentist. Here comes some of your options: do a google search, go through reviews, ask a friend, word of mouth, etc. When you feel you have found the right dentist, you should have a consultation or a meeting with him/her to see what your gut feeling is about that dentist. You can sense a lot from meeting your dentist in person. Are they trustworthy? Do they sincerely care about their patients or they are mainly business driven? Are they honest with their profession?
For example with me, I'm coming from a generation of dentists. I believe in Generational Dentistry. My grandfather was a dentist. I grew up hearing stories about his deep sense of compassion for his patients and their family members. What did he do and how did he treat his patients that made them remember him long after he was gone? The answer to this question, had a huge impact on me and molded the way I run my practice today by using him as my role model.I am young, 42 years old and will be in practice for another 30 or 40 years, which means instead of seeing my patients for just 3 or 4 years, I can potentially see them coming in generations. My focus is on building a lifelong relationship with my patients. For example: if I see a patient today, I would most probably see their children in 6 or 7 years. I would love to see this family coming to me for the next decades. This is what I call Generational Dentistry and this is the way I see the profession. I don't want to just grab money from patient to patient. I don't look at it this way. I want to provide good service, make my patients happy, become friends with them and create a lifelong relationship with that patient’s family. I see it as a lifetime benefit. Not only for my business, but for the patient.The kind of dentist you pick is the most important factor before moving forward with anything else.
World Class Implants.
Nowadays, implant dentistry has become one the most expensive dental treatments besides orthodontic therapy. That is why the only implant system that I work with, is Nobel Biocare which is actually the very first dental implant system in the history of implant dentistry; in other words, The Original Implant System! There is strong evidence and a long history of success for this implant system. That’s why I stick to this implant which is very well known and recognized globally. When patients tell me "The dentist across the street” uses another implant which is half the price, I tell them: “Maybe they are good implants, but they just came to the market and for that reason I cannot trust them.” I work with Nobel Biocare which has been in the market over 40 years and keeps progressing and coming up with new ideas. All my patients should be getting the absolute best treatment with stable long term results. This may not be achieved by using implant systems which have not yet passed their test-of-time.
In my opinion, a dentist is the intellectual part of the conversation on the subject of oral health. Educating patients is a fundamental phase of any treatment. In our office, we fulfill this by providing educational materials (videos, models, pamphlets) and through as many consult sessions as it might take. We make sure, our patients are given adequate information, so they can make the right decision.Upon obtaining an informed consent, we proceed with the treatment.
Q2: What safety concerns should be considered in implant dentistry?
Dr. Ali Tavakoli:
Not all patients are qualified for implant treatment. We need to check patient’s overall medical condition. Maybe they have some underlying systemic diseases such as uncontrolled diabetes, high blood pressure or are heavy smokers. These conditions can complicate the treatment or increase the risk of failure.So we first do an Overall Systemic Assessment of the patient.Based on the assessment we either choose another (non-surgical) treatment option or seek medical assistance to control the underlying diseases before we move forward to Phase 2 which would be doing the procedure.
We need to actually do all the measures, collect diagnostics: radio-graphics, pictures, impressions and models. Then we do a comprehensive examination to come up with a well-thought treatment plan.
Select the Right Case.
We ensure the patient is qualified for the treatment. It has to be the right case. For example, if the patient has had a missing tooth for several years, it is possible that there’s not enough bone left to support the implant.There are other measures that need to be in place. In case of lack of enough bone, we do bone grafting. In some complex cases when the sinus is close to the crest of the bone, we need a sinus lift surgery. There are so many technical aspects that need to be assessed to ensure the patient is suitable for the treatment;Case selection is very important for the success of the treatment.
In some cases we can't do implant dentistry. We have to find some other treatments like bridge work (fixed) or partial dentures (removable), but those cases are really rare because of so many other ways to improve the quality of the bone like bone grafting and gum surgery. This is a teamwork. Sometimes we need to have a team of oral surgeons or gum specialists to first enhance the quantity and quality of the bone and then we proceed with the implant insertion.
Q3: How can a patient know that they can trust the dentist they are speaking to?
Dr. Ali Tavakoli:
Actually gut feeling is a big thing, I'm not the only person saying that. When we take Continuing Education dental courses, one of the first things they teach us is “Trust your Gut Feeling”.Patient has already done his/her research and gone through the reviews. Let’s say he/she finds a dentist who came on top, but when meeting them in person, the dentist doesn't leave a good impression. So what will the patient do? Even if that dentist is really the best in town, the patient will go and find another one. That’s the gut speaking. That’s what you should trust.
Q4: How did you get into implant dentistry? What was the drive and passion behind it?
Dr. Ali Tavakoli:
It Changes People’s Lives.
There is a huge impact on the patient emotionally and psychologically, if we can enhance their smile. Did you know that not having teeth is considered a disability in technical terms? When you have removable or complete dentures you feel like a grandma or a grandpa. Maybe you are 30 or 40 years old but because of an accident, or a gum disease, you lost all your teeth. Psychologically, that’s a bad feeling, patients often feel helpless. By doing implant dentistry, you can help that patient get teeth that look and feel like their own natural teeth and help the patient feel confident again. It is a very gratifying job. This is the passion when you do restorative dentistry.When you give patients their missing teeth back, teeth that look and feel like their own natural teeth, you see it right away. You can see it right in their eyes that they feel young again. They feel complete again. That’s actually on top of Nobel Biocare’s pamphlets. The motto says: "Complete Yourself". I really like this statement. It’s a short but strong message. It’s all about your feeling, not about how your look. For example: If a patient has missing teeth and nobody can see them, it still matters because it is not about seeing, but feeling them. When you don't have those 2 or 3 teeth, you are not fully functional in your mouth, but when you replace them you feel totally different. Now your teeth are fully functional and you are “complete” again. That feeling is priceless. This is my passion for becoming a dentist. It’s a very rewarding profession.
It Helps People Become Emotionally and Psychologically Healthy
This is something that I mention to all of my patients. Aesthetics and function go together. It’s not just about luxury. I mean, Aesthetics is very important on a psychological and emotional level too. It is very important for regaining confidence and feeling happy about yourself again. These are very important. I was reading this textbook about implant dentistry. The author mentioned something in the introduction that completely changed my mind and the way I see dentistry. It had a huge impact on me. He wrote:
“I love dentistry because I am dealing with the part of the body which is the gate of our temple. You can do so many things that no other organ can do: you smile, you laugh, you kiss, you whisper, you eat, you drink. All your facial impressions happen with the muscles around your mouth, with your teeth.”
Medical Doctors and Dentists often make fun of each other and tease each other. My sister is a Medical Doctor. I always tease her by saying that I am not just dealing with teeth, I deal with the part of the body where you smile, you laugh, you speak and so on. Just like medical doctors who specialize in eyes, lungs, etc., we deal with oral cavity and teeth. We are mouth specialists.
I Was Trained Under A Dental Icon.
This is a fun story actually. I came to Canada as a General Practitioner, but I couldn't work here as a dentist because I had to go back to school. So I was lucky and fortunate enough to come across Dr. Izchak Barzilay. He is a global icon in the world of implant dentistry. I worked for him as a dental assistant for almost 2 years before I actually got admission to UofT. That’s where I got exposed to advanced dentistry. He is one of the most well-known Canadian dentists. I thought when I go to school, I will get my specialty in Prosthodontics - which is mainly involved with implant dentistry. Dr. Barzilay has his own Continuing Education Centre at his office where he holds biweekly courses by himself and other specialists in Toronto. I got to attend these courses during those 2 years.Attending these courses along with shadowing him closely, educated me well enough to do implant dentistry confidently today. Still, there are some very complex, rare cases that we need to refer to specialists, but in 80-90% of cases, a well-trained general dentist can perform the treatment at a very, very high quality. Especially with the help of digital dentistry, you can perform these procedures with pinpoint precision.
Q5: What do you like about implant dentistry?
Dr. Ali Tavakoli:
Seeing That Look In People’s Eyes
The first time patients see themselves with their new teeth and they can’t tell their own teeth apart from the implants, that first smile on the patients’ face is priceless. They have this look of relief, joy, and youth in their eyes. I’m telling you, you can see it right away how happy they are! That’s definitely the best part.
Scientific Impact on Patient’s Health
When a patient loses a tooth for any reason, that part of the bone which was supporting the tooth is not functional anymore and it will shrink with time.When somebody has a missing tooth for quite a while, you can tell the bone is shrinking just by looking at the spot. This has huge negative effects on the neighboring teeth. So it’s not just about losing a tooth at this point. You are actually losing bone, losing foundation, losing support from other teeth. In time, what happens is when the bone is shrinking, the other teeth shift or drift to the missing area. In the long run, those teeth may become prone to fracture. It is an unfavorable condition for the surrounding teeth and bone and can compromise the longevity of those teeth. The whole dentition is a dynamic system, when one part is missing, it affects the other parts of the system. When you get an implant, your mouth goes back to function. By having an implant there, we can actually maintain the bone and maintain the health of the body in that area. It’s very important.One of the questions our patients ask is: Instead of putting an implant, why not replace it with bridgework? Bridgework is a fixed treatment to have a tooth in the missing area in your mouth. So why not choose bridgework over implants? One of the main advantages of having implant is maintaining the bone level and not cutting other teeth, because for making a bridge, we need to actually cut down two perfectly good neighboring teeth to put crowns on top of them.
Q6: What do you think could be improved in implant dentistry?
Dr. Ali Tavakoli:
The Future of Implant Dentistry… is here
I would say new insights come to the market on a monthly basis. Because of digital advancements, we have had so many changes in dentistry just in the past 2 years alone. In some cases we go Free Hand to place the implant. But in other cases where we don't have enough bone or we are dealing with very limited space, we have to make sure we don't violate the neighboring teeth, so we take a 3D image of the bone and the surrounding teeth. This provides us with a Digital Surgical Guide (Implant Guide). It’s like a plastic mask that we put on the teeth. This implant guide has a hole that directs us exactly where to put the implant and tells us what direction to put the implant in, on a 3-Dimensional level, making sure that we are not violating any other teeth, not violating nerves, sinus, nose cavity, etc. This is the Future of Implant Dentistry: going forward with the help of digital advancements. I would say that by improving this technique and process, we can significantly benefit patients and positively impact the success rate of dental implants.
Q7: What sets 123 Dental apart from others in Canada?
Feels Like Home.
The vibe of our office and the way we have designed it makes everyone relax and comfortable. We spend 8-9 hours of our day here, so we made it in a way that it feels like home. For example: warm soothing color of the walls, Persian rug, and the sofas, all remind you of the comfort of your living room. We have a piano here, not only do I play piano but also my patients come in and play. We have books here. We give books to our patients. Some of our patients actually treat us like a library; they borrow books, read them and bring them back. It is not 100% about dentistry. We also spend a lot of time improving our chair-side manner and patient communication skills as well.
This starts even before our patients come to the office. When a patien