Double-time dental

There are dental treatments, such as multiple tooth implants, that can involve a series of procedures with lengthy waiting times between each treatment. But medical tourists may need or prefer to get everything done within a specified time or budget. How do dental tourism providers tackle this issue? By Femke van Iperen

According to Patients Beyond Borders, which connects healthcare consumers with options for medical care worldwide, dental tourism has now become the most popular category of medical tourism. The organisation’s CEO, Josef Woodman, says: “As populations age, the need for restorative and cosmetic dentistry is on the rise, which, coupled with the fact that most health plans do not cover [this type of] dentistry, can put huge and unexpected cost burdens on patients. For these reasons, some 30 to 40 per cent of all medical travellers seek some form of dental care.”
The organisation states that a patient could save some $4,400 by travelling to Costa Rica for implant-supported dentures (upper and lower) compared to treatment in the US; $5,800 by travelling to South Korea; and $6,400 can be saved on average by going to Singapore. However, for certain more complex dental treatments there can be weeks between follow-up visits. For medical tourists, this can mean one or more secondary trips, which can mean problems with fitting around work or family commitments or with applying for visa extensions.
 

Complex treatments 
Similarly to implants, cosmetic or restorative dentistry can require multiple visits, explained Woodman. Howard Siegler, director of patient relations at Meza in Costa Rica, which in 2012 was described by the Costa Rica Star as a leading Costa Rican cosmetic dental clinic, adds that it’s generally the ‘lab work’ (the ‘process of manufacturing crowns, bridges, veneers or prosthesis’) that determines the overall length of the procedures and treatments. For Meza’s dental implants, for example, patients are required to make two trips. “Each trip is five to 10 business days, and they are usually spaced approximately six months apart,” he said. “Patients who require gum or bone grafts or sinus lifts may also require extended stays or multiple trips.”
Plus, there may be a need for osseointegration, and Dr Sumit Dubey, a prosthodontist and oral implantologist in New Delhi, India, says: “Though in the case of [some] dental implants the treatment may be completed in one to two weeks, osseointegration will need time to complete in 10 to 14 weeks.” In fact, for more complex treatments such as upper jaw implants, a minimum of six months is needed to allow osseointegration to take place for the dental implant to be a success, explained assistant professor Nikolaos S. Kouvelas, CEO of Eurodentica Specialised Dental Care in Athens, Greece.

a patient could save some $4,400 by travelling to Costa Rica for implant-supported dentures

The procedure of ‘immediate loading’1 can also be tricky, and clients at the Sacred Heart Dental Center from the Philippines can in this case expect a healing period of eight to 12 weeks. “There are implant systems that claim immediate loading of restoration, but most of them fail in the end, and we find this a better protocol with more predictable results,” said Dr Alexander Eduardo R. Garcia, who is the manager and owner of the clinic. At Eurodentica, immediate loading is rarely used, says Kouvelas: “This technique still carries a high risk which we don’t like to undertake.”

Pre planning
Dental clinics can also help condense the time otherwise needed for some of the more complex treatments by conducting thorough preparations. The Sacred Heart clinic, for example, advises patients to have a pre-treatment consultation – via email, Skype or social media messenger – and for them to send X-rays and any other dental records they have ahead of time: “Scheduling is crucial, especially for the clinics and labs, and to help save time, our focus is on a complete oral status check-up; a proper diagnosis; and on the ‘chief complaint’,” says Garcia.
To determine which patients are eligible to complete their work in a condensed period of time, Siegler explains that patients may require periodontal or other foundation work before their dental restoration can take place: “We typically use X-rays, photos and dental treatment plans completed by our patients’ home country dentists, and clinical examinations once the patient arrives.”

All under one roof
To help save time on treatments, some clinics offer different specialities under one roof. For example, after Eurodentica incorporated an anaesthetist for an in-house service in 1995, all its procedures could be completed in one to two days. Today, the clinic provides dental care in eight different specialisations. The latter allows more complex treatments to be done ‘by the collaboration of four to six specialised dentists’, explained Kouvelas. In a similar way, Dr Dubey’s Dental Clinic works with ‘well-qualified experienced dental experts from various specialities of dentistry all under one roof’. At Meza, it’s thanks to US-trained cosmetic dentists and upscale, accredited facilities that ‘even full-mouth restorations that normally take 10 business days to complete only require the patient in the dental chair a few days total, with appointments of varying lengths’, says Siegler.
Meanwhile, the dedicated dental laboratory that the Sacred Heart Dental Center works with allows for procedures that would normally require multiple visits – for example some porcelain crowns, bridges, root canal treatments, dental implants, tooth extraction and surgery, tooth fillings, and cosmetic dentistry – to be completed in or under five days. “Dentist and laboratory staff in our clinic collaborate in the laboratory and at the chairside, so that treatments are done with precision,” explains Garcia.

Clinic packages
“For more extensive work, a clinic might help arrange travel, airport pick-up and drop off, the shuttle to and from the hotel, passports and visas, and the planning or recommendation of side trips for patients and companions,” says Woodman, highlighting that clinics can also opt to offer inclusive packages. Such packages provide the reason why medical tourists choose Eurodentica for more complex treatments, adds Kouvelas: “Since specialised dental treatment costs in our clinic are half the price from [for example] the US, Europe and Australia, and we are willing to pay for the patient’s travelling expenses and accommodation, we believe it is possible for a dental tourism patient to spend the time for another trip.”

Specialist techniques
Furthermore, there are some specialist dental techniques available and, says Garcia, for those patients that prefer a single-visit implant treatment, the Sacred Heart Dental Center for instance offers a type of mini dental implant by Intra-Lock International (US). This procedure, he explains, involves the use of immediate loading fixtures and has an FDA (US Food and Drug Administration) certification for long-term use for crowns, bridges and removable dentures. He adds: “We have been utilising it and the success rate is promising.”

for more complex treatments such as upper jaw implants, a minimum of six months is needed to allow osseointegration to take place

In some cases of single-piece implants, Dr Dubey’s Dental Clinic is also able to offer a successful immediate loading soon after the tooth extraction. “Most preferably with Nobel Biocare Active implants – bone grafting also helps a lot,” says Dubey. To which Kouvelas adds: “One example for all-ceramic crowns is that we are able to make it in our practice using CAD/CAM technology2. Or, if a patient needs root canal treatment in two molars, the endodologist completes the treatment, and at the same appointment, with CAD/CAM, the prosthodontist can make the all-ceramic crowns in one day. Thus, treatment which usually lasts around 10 days can be completed in one single day.”

Conclusion
Although cutting corners may at first seem attractive, Woodman asserts that it does not pay for patients to seek shortcuts in time and cost at the expense of quality, which is something most would agree on. He says: “It’s important for patients to carefully vet dental clinics and practitioners for accreditation, doctor’s credentials, history of service, and favourable reviews, and whether the clinic has an in-house laboratory.” Dubey agrees: “Patients should take out sufficient time for their dental treatment; as basically their health is also their wealth.” 

REFERENCES AND SOURCES
1. Traditional implants involve placing the implants and providing the tooth restoration after three to six months. This timeframe is needed for bone and gums to attach to the implant. The obvious disadvantage of this procedure is that it leaves the patient with no teeth or with a removable, temporary prosthesis. Immediate loading means a temporary crown is fixed for aesthetic reasons and not for functionality. Source: www.swiss-dentalclinic.com/en/ImmediateLoading.aspx
See also: www.dentalimplantcostguide.com/same-day-immediate-loading/
2. According to the European Society of Cosmetic Dentistry (ESCD), computer-aided design/computer-aided manufacturing (CAD/CAM) has been used extensively in many manufacturing and engineering fields. A little over two decades ago, at the University of Zurich, the technology was used to create the CEREC method, which creates porcelain dental restorations in a matter of minutes instead of days. The technology is so precise that dental restorations made by CAD/CAM often fit better than those made by hand in a dental lab. Patient satisfaction is increased as a tooth can be repaired in a single day, instead of requiring repeat appointments. Source: www.escdonline.eu/cosmetic-dentistry/cadcam-dentistry/