From the Desk of Dr. Moody

To cement or not to cement, that’s the question
May 14, 2016

I am asked many times what is the best, cement or screw retained restorations? My answer ,without a doubt, is screw retained. The literature on excess/residual cement is clear and the evil of this is the dreaded inflammatory process known as peri-implantitis. When discussing this it is important to remember that the natural angulations of the bone in the esthetic zone will most likely dictate the use of cement restorations. I have found that when the screw access would come out at the incisal edge or facial it is better to cement for long term esthetics survival due to strength of material. All is not lost having to cement restorations, with todays technology and the ability to create hybrid abutments (CAD/CAM zirconia luted to a titanium base) we can now move the finish line closer to the gingival margin so that cement removal is easy and complete. With the hybrid abutment we can also allow for stump shading and more natural emergence profiles than ever possible with a stock abutment. In the posterior the use of screw retained restorations are much easier due to the position of the bone and implant as it relates to the final restoration.

— Dr. Justin Moody, DDS


How to Talk to Our Patients About Dental Implants
April 18, 2016

I had the great fortune of learning this from my dear friend JoAn Majors many years ago. We always make this conversation too technical or too hard, simplify the process. The dental implant is simply a “man made root”, it replaces the root of the tooth or teeth that need to be or have been extracted. Being made of titanium this man made root does not experience many of the problems that real teeth have such as aches, pains, decay and root canals. Be extra careful to not imply that this is a permanent or forever fix as nothing in life is forever. I like to tell my patients that this treatment is like a marriage, I will do my very best while you need to do all the things I ask of you both in the healing phase but for re-care as well. Remember that we only have one chance to educate our patients, if we don’t and they ask us about it than everything from that point on is an excuse!

— Dr. Justin Moody, DDS


Solutions for the Lower Denture
April 12, 2016

We know that no other dental procedure has more patient issues and complaints than the lower mandibular denture. The placement of as little as 2 dental implants may allow the patient to not have to use dental adhesives and increase the quality of life for them.  Be clear that most removable dental prosthesis which employ implants fall under the category of implant retained. Implant retained by definition is a removable appliance that is tissue borne but held in place with dental implants through the use of attachments. In contract to the implant supported prosthesis where the appliance is held in place with the implants and the downward forces are transmitted to the implants alone and not to the tissue. Be sure that you explain this to the patient so that they are informed of what they are getting for a final prosthesis. This conversation often leads to the placement of more implants, remember you can’t do these procedures if you don’t talk to them about it.

— Dr. Justin Moody, DDS


Talking About Bone Loss – Standard of Care
April 4, 2016

It is our moral and ethical duty to inform our patients of the potential for bone loss following extraction of a tooth or teeth. Will everyone listen? NO, but at least we educated them on what will happen and in the end it is up to them to act. Knowing that bone loss is 10X greater the first year after extraction than all the subsequent years makes this conversation necessary.

Failure to inform our patients may cause medico-legal issues in the future as well as cost the patient significant time and money to try and rebuild these sites. Not only in grafting the right thing to do but it is a profit center for the practice that can add significant profit to the bottom line. The grafting of extraction sites at the time of extraction on average adds 5-10 minutes to the procedure while increasing the doctors per hour production. Grafting should be coded and billed per site not per the amount of material used however some full arch cases we may open a larger amount of graft material and charge a per arch fee. I would ask you to consider a reasonable fee for the grafting knowing that these motivated patients will most likely return for dental implant treatment and ultimately the prosthetics as well.

— Dr. Justin Moody, DDS

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