Are you in need of a tooth replacement? Thinking implants or dentures? We recently spoke with Dr. Michel Raad, prosthodontist at Luxor Dental in Pleasanton, California, about the practice of prosthodontics. Dr. Raad graciously shared the ins-and-outs of dental replacement procedures and more in our recent interview.
What is prosthodontics?
Prosthodontics is one of nine dental specialties recognized by the American Dental Association. In short, prosthodontists are masters of complete oral rehabilitation, including restorations and replacement of teeth. Graduate programs in prosthodontics are three years in length, in addition to the four years required to graduate from dental school. In their graduate programs, prosthodondists receive additional laboratory and clinical training in esthetics/cosmetics, crowns, bridges, veneers, inlays, complete and removable partial dentures, dental implants, TMD-jaw joint problems, traumatic injuries to the mouth’s structures, congenital or birth anomalies to teeth, snoring, sleep disorders, and oral cancer reconstruction and continuing care.
What is the difference between a prosthodontist and a cosmetic dentist?
The term “cosmetic dentist” is a bit of a misnomer. In truth, any dentist can label his or herself a cosmetic dentist straight out of dental school without any additional graduate training. Unfortunately, the title “cosmetic dentist” gives off the impression that such dentists went through additional graduate training in order to gain this title. While some cosmetic dentists are very talented dentists, others can cause more harm than good when they try to perform procedures beyond their training. If you are looking for a qualified cosmetic dentist to restore your smile, the answer is to go to a prosthodontist.
What made you decide to become a prosthodontist?
I was drawn to dentistry in general because of the great impact a dentist can have on his patients. By improving a patient’s smile, a dentist can help improve the patient’s attitude, self-esteem and confidence. When I finished dental school, I realized that additional graduate training in prosthodontics was best for me because prosthodontics is the only specialty that deals with cosmetics as well as complete rehabilitation. I was further drawn to prosthodontists by the fact that prosthodontists are frequently the head of most dental teams since they are in charge of drafting the blueprint of any treatment plan.
Can you tell us about your work with computer-assisted implant surgeries?
My work with computer-assisted surgery started in 2007 when the first systems were developed. One of these cases is featured on my website. Back then, technological advances in digital dentistry were going at a very fast pace. Some companies had the idea of applying this technology to surgery. It starts by taking a CAT scan and superimposing the implants and bone grafting surgeries on that scan. After doing so, the system will help you mill a guide for your surgery and the software will give you an exact list of drills to use and the order in which they need to be used. This surgery is very safe and it limits the amount of time spent in a surgery room by planning every single step on a computer. This is very essential to the patient and surgeon alike. The patient doesn’t want to spend an extra hour in the surgery room and the surgeon wants a surgery with no hiccups.
You earned your Master’s degree for your research in ceramics. Can you tell us a little bit about that research?
My main work was on zirconia which is the material used to construct the infrastructure of all-ceramic crowns replacing metal. This infrastructure is cut digitally by burs mounted on a robot out of blocks of Zirconia. My research had to do with comparing different types of zirconia, including one that I fabricated myself in the lab. Also, it compared whether an infrastructure coming from the middle of the block was stronger than one coming from the periphery. The results were that the technique to fabricate such blocks is easy to reproduce by an unskilled technician similar to myself with no previous training. The results also showed that blocks coming from the inner core of the block were stronger. That meant that laboratories had to cut one infrastructure out of the center of the block rather than multiple infrastructures trying to maximize the use of each block.
What is the most common procedure you perform? How does it work?
The procedure I perform the most is implant surgery and implant-supported restoration. More information is included on my website but to be brief, for a single tooth, it works by placing an implant in the bone and allowing it to heal. After a couple of months, once the implant is completely anchored in the bone, we put a crown on top. For full arches, it includes placing 4 implants for dentures or 6 to 8 implants for fixed bridges. Dentures can be connected to the implants via a gold or titanium bar or small ball attachments giving the patient very good retention. This is a giant leap in patient satisfaction from the days where dentures had to cover the palate and glue was the standard of care.
When should a patient be referred to a prosthodontist?
A patient should be referred to a prosthodontist for a second opinion on any large treatment plan, even if the general dentist is going to do the work himself:
1) Denture cases–regular and implant supported. Because of the extensive knowledge of the anatomy of the jaw, a prosthodontist’s dentures cover more surface area of the gums than the general dentist dentures providing more support.
2) Whenever extreme changes are required to restore a dentition. For example, opening a bite that is collapsed or a completely worn out dentition.
3) Aesthetically challenging cases involving a combination of surgeries and restorations
5) Multiple implant placements
6) Patient that requires a full mouth reconstruction
7) Difficult patient with limited opening.
8) TMJ problems and sleep apnea
As someone who sees patients every day who have lost their teeth, what advice can you offer to our readers?
My biggest advice to the readers is that nothing will ever replace your own teeth. Prevention is the key to good oral health. Regular cleaning and following the recommendations of your dentist is key. Most of the problems we see are due to miscommunication between the dental team and the patient, which result in the patient not understanding the value or necessity of the treatment recommended. I recommend that when in doubt patients seek a second opinion. Be an informed patient and ask questions. Don’t be passive and if your gut feeling is that your situation could be better handled by a specialist, go and talk to one and weigh your options. Don’t say “I can’t afford it” and settle for less. In extreme and large cases, some patients incur the costs twice by making the mistake of going to a general dentist for treatment thinking they are saving money.
Any other comments?
With their extensive knowledge and expertise, prosthodontists are not only the experts in fixing your teeth; they are also good at diagnosing the reasons why your oral health got to this state of disrepair to start with and preventing it from happening again in the future.
I had no idea that prosthodontists focus on restoration and replacements of teeth. My mom has a few missing teeth and she is thinking about getting some dental implants, so I appreciate that you say they have an extensive understanding of the anatomy of the jaw and will be able to put in implants that will give the best support. I will definitely tell my mom about the option of visiting a prosthodontist because it gives me peace of mind that they have the specialized and extensive knowledge to give my mom the best implants.
I already received (and paid for in the USA) my 4 implants and bone crafting. I have waited 4 months and now still need the special abutments and crowns that here cost $1200.00 EACH. I will go to Beijing for a convention and want to have all this final work done there. Is it possible to have this work done by another dentist; in the case, in Beijing. It will cost a lot less, and I ha a wonderful crown done in Shanghai some yrs ago ($60.00 US dollars) It is still very good.
Please advise asap, if you think I can get a dentist who did not do the initial work to do a good job. I wrote to the ex-pat information site but have not heard back.Thank you.Please send response to my e-mail
Dental tourism is becoming quite popular, and many are seeking cosmetic and restorative dental work outside the U.S. in order to save money. While there are some highly trained and experienced foreign dentists, many are not qualified to perform advanced dentistry. As a prosthodontist practicing in the United States, I have seen many patients with botched or shoddy dental work done abroad, especially with regard to dental implant procedures. My advice is to stick to the U.S. dentist or prosthodontist that originally placed your implants.
Great informational website! I am always interested in learning more about dental procedures. Unfortunately I have been plagued with dental problems since my early 20’s…currently 63 and needing 4 more implants (already
have 3). I do not have dental insurance and you know the cost of implants.
Could you provide a listing of Dental insurance companies who cover implants? My research has identified denture providers but implants are excluded. Any help you can provide would be greatly appreciated.
Our discount dental plan can get you up to a 20% discount off implants. You can see a full fee schedule specific to your area at https://www.1dental.com/.
I am 33 yrs old and have spent the last year getting dental work done with zero satisfaction of fixing what I went for. It only opened up a huge can of worms. The dentist had knowledge of my tmj. I started to go because I was missing a lot of teeth, which caused my tmj. I knew I had to do something because I started grinding & chipping my teeth at night. The dentist first advised a plan to pull my wisdom tooth and another molar…worst mistake of my life. I don’t understand why the dentist would do this, and the cost is outrageous. I can’t even wear a nightguard now to correct it. All the work he started, he never finished anything because my bite kept collapsing and changing for the worse every time he did a filling/route canal (without caping it right away). I wanna sue him or get my money back. A year later I’ve got a temporary tooth that SHOULD be permanent!!! Don’t let regular or cosmetic dentists work on you if you have any issues with your bite or jaw. I HAVE not been able to find dentists in my area that can correct this or give me hope to lead a normal life…..
I FEEL LIKE A LOST CAUSE and have NO MEANS to pay to correct it.
Hi, Tracy. I’m so sorry to hear that. It’s definitely discouraging not being able to lead a normal life because of your dental issues. And I’m sorry to hear that your dentist was more harmful than he was helpful. The one solution I can offer you is to consider our discount dental plan. You can find out more information at https://www.1dental.com/ or call us at 800-372-7615. These plans can save you anywhere from 20 to 60% off your dental work when you go to one of the dentists in our network. You can check to see how many dentists we have in your area on our website by typing in your zip code. If you need assistance, feel free to call in and one of our representatives will be able to help you. When you go to a regular dentist, you are going to receive greater discounts; however, we can still save you between 15 and 20 percent off your dental work at a specialist. When you speak with one of your representatives and let them know what’s going on, they will be able to better assist you and tell you which plan is going to be the right fit for you. I hope you find the help you need to take care of your dental needs.
I’m a 56 year old woman with 44 years of ongoing dental work. Awesome website. I only wish I read it 3 years ago. Knowledge is power and success. I can offer so much advice after the fact. To our Prosthodontist; total truth. Why would there be a specialist if the job was so simple. It’s very complex and presice. What state do you work in?
Hi Kathy, thanks for reading! Dr. Raad is a prosthodontist in Pleasanton, California.
In 2006, I saw a Prosto for 6 implants. 3 on top and 3 on the bottom. This proved to be a nightmare as they would slide and the abutments would come off and then solid teeth would break off and I am now down to 6 teeth left on the bottom left and 2 left on the top. 2, Implants #30 and 13 had to be removed due to infection. Saw another Prosto and he wanted another 25K to clean up the mess from the other Prosto. Did not feel comfortable with his ego/cocky ways. (Paid him 1300.00 for a consult and placing another abutment in an upper implant tooth.
I am 75 years old now and am gumming it every day. My GP made me an upper acrylic flipper and a right lower flipper that I use PolyGrip to hold on. (not all that comfortable) I have two implants that have no crowns that cut into the gums when the flippers are not on. It seems there is no one in Houston who can help me to simplify my mouth for comfort now. They all want another 25-30K and I am broke now and just need something simple until I die. I have heart problems and am on blood thinners.
My teeth did not become this way from not seeing DDS all my life. It was from bad dentistry. My GP DDS does not specialize in restorative work except for a crown here and there on good teeth. I feel like I should be on a comic strip cover. Very good article, above.
Thanks for stopping by, Nana!
Thanks for all of your work on this web page. I am looking forward to reading more of your posts in the
Thanks for sharing this great and informative blog. This blog gives a very usefull infomation .
Thanks for reading!
Very good article about what a prosthodontist is, and when a patient should be referred to one. I am amazed by the number of general dentists who claim to be experts in the field of cosmetic and implant dentistry. Many of them receive little more than a weekend course before attempting to perform advanced dental procedures like implants and porcelain veneers. We prosthodontists are frequently needed to fix the shoddy dental work that other, less qualified dentists have attempted to do. Thank you 1Dental.com for publishing this.
We’re glad to be able to educate everyone on the various dental procedures and specialists! Thanks for stopping by, Dr. Howard.
Really very interesting post . It really prove useful for all to get know about the dentist and prosthodontist and to whom he has to report . Thanks.
Glad you enjoyed it, Dr. Frith! Thanks for stopping by.
The information shared here was very informative, thankyou
David, thank you for reading!