Dr. Steven M. Moss DMD was recently a guest on the Wellness Hour with Randy Alvarez. In his interview, Dr. Moss discussed the evolution of dental implants, specifically full mouth restoration using the innovative All-On-4™ dental implant procedure which was invented and pioneered by Dr. Paulo Malo.
For those that have failing or missing teeth, your hope for a beautiful smile and healthy eating habits are no longer a thing of the past. With the help of our team, we can have you back in the game, eating healthy and smiling in just one day. Watch the video below for more information and see the results from pictures and videos of real patients of MALO SMILES.
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You are watching the Wellness Hour, the leader in medical news and information. I am Randy Alvarez. Today’s topic: Replacing missing teeth with dental implants. In fact, according to my first guest, he says “No more dentures!” Nobody should be wearing a loose fitting denture and people who are headed for dentures he has good news. With us we have board certified oral surgeon Dr. Moss. Dr. Moss, welcome to the program. Thank you Randy, thanks for having me. I have lots of questions by the way about the process. But for people who don’t know about your center, you have one of the largest centers where you are, who is the typical patient and what the different services that you offer?
We offer a lot of different services. A Lot of them are dental implant related. We focus on patients that need all of their teeth replaced, so your typical denture wearer that are looking to get out of wearing dentures or the person about to loose their teeth and that’s more typical. So that’s the person that’s 60 years old, they’re still working, they suffered their whole lives with periodontal disease and now their teeth are on their last legs, so to speak and they are being told you are going to lose these teeth and they are so fearful. What am I going to do? How am I going to show up to work Monday with dentures in my mouth.
So they don’t want false teeth obviously.
Absolutely not Randy, nobody wants false teeth, that’s an archaic technology.
You hate, not to put words in your mouth, but you do not like dentures.
You know me. I do not like dentures at all. To me dentures are archaic. George Washington had dentures. I doubt very much they were made out of wood. We know what happens to wood when it gets wet, right? But dentures haven’t really evolved much since then. We are still putting these plastic pucks with teeth on them in patient’s mouths and expect them to function and chew. Dentures, to me, you know Randy, today we have such sophisticated prosthetics. We’ve got hands and limbs that are lifelike and move, can be attached to muscles and can pick up glass and drink and we are still giving patients dentures. That’s like somebody who, lets say a diabetic needs a below the knee amputation and they are going to get a false leg and the doctor says “well we are going to give you a peg leg.” A peg leg. Yeah. Or you need your hand replaced and they are going to give you a hook. You might as well put a parrot on their shoulder and a patch on their eye because they are going to stick out like a sore thumb. Dentures to me are old technology.
So according to you, I mean people come in with bad gums, bad teeth that need to be replaced and you on the day of procedure, i want to get this straight, they come out with a fake set of teeth and don’t come in and out.
Is that right?
Yes. You sound a little skeptical. I was too when I first heard about it. You have to realize that implants have evolved since they were first discovered or first introduced to this country since the early 80’s. Most of the implant technology was pioneered in europe. All of the greatest innovations with implants come from Europe. We struggled for decades here with particularly these patients that need all of their teeth replaced. They don’t have enough bone. We thought that implants need to be strait up and down. Why? Because god or mother nature gave us roots that are strait up and down and we just assimilated from that. Turns out that we’re not right. Implants bond to the bone so strongly. They can be placed on angles and we don’t need every single tooth we are replacing.
And we should mention, by the way, you teach doctors, oral surgeon, all over the world. What we are talking about today, is that correct?
That is correct.
You have a big training facility but you lecture all over the country.
Now I do.
Yes and I can tell you how that came about and it’s part of the story I was just telling. In 2008 we do a lot of implants in my practice, thousands and thousands and very complex cases. But we are frustrated by these cases where patients need all of their teeth replaced and they don’t have enough bone. Again, we’re taught, in our residency programs and these gurus that run these programs, that we need 6 or 8 or sometimes 10 implants to support a full set of teeth. It took a guy, a fellow that I am now partnered with, Dr. Malo, who pioneered this procedure called “All on four” and that simply means all of your teeth placed on only four dental implants. Well, that’s been a revolution. Why? Because we thought we needed a 6 or 8. We thought they needed to be strait up and down.
So it’s less expensive, by the way, with less implants.
Of course it’s less expensive.
It’s half of expensive than if you had 8 implants.
They’re strong? I mean you can eat whatever you want?
They are very strong, you can, they physically fuse to the bone. But once they are inserted and they have that biological bond, you couldn’t unscrew it if you wanted to. Of course you wouldn’t do that. So we now know, decades later, since implants have been introduced, that we only need four.
So these people we were to come in, you know they have a mouth that’s a mess, broken down, or whatever and they are taken out and you give them a new set of teeth and they go home. How soon can they eat?
I said it. That night. Another one of the innovations that come along with this “All on four” procedure, Dr. Malo and the company he was working with, Nobel Biocare, they were able to taper the tip of the implant so now we can prepare in bone that’s soft, a small hole and drive a wide implant into it. It’s like a molly that expands into bone.
Does it hurt though? It seems like it would hurt.
Because we are preparing a site under irrigation thats cooling and the bones not being heated up, we don’t see big inflamatory spots of which pain and swelling are part of. So it’s a little bit counterintuitive. Oh they’re going to drill into my jaw and put a screw in there. It’s got to hurt. It doesn’t. Most people don’t take the pain pills we write for them. They use advil or tylenol.
Is that right?
That is exactly right.
The next day they can eat. If they want.
That night they can eat.
Well what can they eat?
Now you can’t snap into a SlimJim the first night, we don’t have that biologic bond, but they can eat regular foods that are not too chewy, well cooked vegetables, tender meats, things along that nature. They are not stuck to mush like denture wearers or pudding, Jell-o or applesauce. No. Regular foods.
Ok so now by the way, where you are, is there a lot of denture wearers?
Well, I’m in one of the densest, let’s put this into perspective, let’s talk about the whole country. There’s roughly about 40 million americans without any teeth in either the upper or lower jaw. So there are 40 million denture wearers out there. It’s estimated that New York City has about 8 million inhabitants so that’s right on my doorstep, Manhattan, 8 million people. 40 million out of the country is about 12 and half percent. Even if we are conservative and we say 10 percent in Manhattan, that’s 800 thousand just in Manhattan alone-
That have an upper or lower denture?
That can fill Giants stadium, Metlife Stadium where the Jet’s and Giants play ten times! Now that’s just the people without teeth. What about the tens of thousand, hundreds of thousands more, in that city also, who are about to lose their teeth. We can fill that stadium again and again and again. That’s how many people there are.
Okay well if the implants are so good then why aren’t they all doing it?
That’s a good question and there are many several reasons. Let’s start with the denture wearer again. Denture wearers, they’ve essentially had all of their teeth already removed. They are out of the system now. They don’t see the dentist anymore. Typically they are relieved about it. They are happy they don’t see the dentist. Why Randy? They remember their life when they had their teeth. It was frequent trips to the dentist. Back and forth. Patchwork here, fix this up, now they need a root canal on a crown and that fails and they need extractions. Take the crowns off, throw them away, waste the money, put bridges on and eventually those fail. Crowns and bridges usually have a lifespan of 10 to 15 years. After a while they feel like they are and annuity to the profession. Constantly spending and spending and they are loosing-
Did they tell you this?
All the time Randy, all the time. So they are fed up, they are frustrated. They’ve had enough, they want to be done and when they finally lose their last teeth and they get their dentures they feel relief. they fell like they are done.
So the last thing they want to do is see you?
Those patients are typically out of the system. No you have the one’s that are in jeopardy of losing their teeth. Their teeth are on their last legs. Right? Terminal dentition, that’s what we call that. Those patients now, they’re being told that they have very few in the way of options. That they are headed for dentures and they don’t want to go there because there is this lack of knowledge of what can be done with implants, generally speaking. So they don’t know. They’re not told. Then you have the fear of pain, the anxiety of pain, which we just mentioned dental implant surgery is not terribly uncomfortable. Many people look in their mouths, the count, oh my god, I’m going to need all of these teeth replaced. They think they are going to need one implant for every single tooth and they say I can never afford that. So they self diagnose. That’s a big one.
How old can you be?
I was going to get to that. That’s next. They self diagnose and they say to themselves, I’m too old for this. I’m 80 years old. I can’t have implants. Well that’s not true. You ask me how old you should be. I have many many patients that are in their 90’s. I’ve heard stories of patients in their hundreds
Why would people want to do this? A 90 year old. Why would a 90 year old want to do this?
Randy, it’s the same reason you would want to do it. Because they want to look good, they want to feel good and they want to eat and chew the things they used to love. Just like you or I.
80 is the new 70. Haven’t you heard? 70 is the new 60! So 80 years old that’s nothing to them.
So aren’t they more likely to fall out when you’re 80 years old? Scientifically I mean the data.
It’s not really an age issue, it’s a health issue. So s long as you’re reasonably healthy. Rule of thumb, if you get to my facility, walk down the hall, climb into the chair without being out of breath youre likely an implant candidate. It doesn’t matter how old you are. Who’s a poor candidate? There are a few. Poorly controlled diabetics, people on drugs for osteoporosis, where they get infusions, which causes the bones to not heal so well. Of course anybody on immunosuppressive drugs. Heavy smokers don’t do so well. Not that we don’t put implants in those patients, sometimes we do, but they are more likely to have a failure, so you need to discuss that ahead of time.
Isn’t it true that if you’ve been 30 years in a denture, you don’t have enough bone to do this?
It’s true particularly, the way we used to think and how we are trained here in this country. Again we are trained that implants need to be strait up and down. We’ve got some anatomical structures in the back or our jaw that are often in the way. The nerve in the lower jaw and many of your listeners have probably been told this. The sinuses in the upper jaw. What we didn’t understand just a couple of decades ago is that we can angle implants. We can place them where you still have bone. Most patients don’t loose the bone in the front of their jaws, they lose bone more in the back of their jaws. We just realized that we could angle implants and connect teeth and they’re just as strong and just as successful as if implants were straight up and down. So that means no more bone grafting, which is another expense.
So it’s not true then?
It’s not true.
Even in 40 years?
It’s simply not true with this all on four technique
Now it depends on your dentist. It might be true in your dentist if that’s his level of education, if that’s his experience. He may tell you, you can’t get implants. I would tell you go get another opinion. Do some research.
You say you’re changing and transforming people’s lives. You believe that?
Everyday, of course i believe it. I see it everyday. I see the response from patients everyday. I hear the stories when they come back. How happy they are. How people can’t believe how good they look. All the time. He’s a gentleman here. He’s a voice actor and also a radio show host. Okay? For about a decade he’s had some failing teeth, he’s wearing partial upper and lower dentures and it was driving him nuts. Because when he’s recording his show he’s spending hours and hours everyday in the studio editing. What is he editing? His dentures. His partial dentures are clicking and clicking and he can hear it. Now e goes to the dentist and he says I’m sorry man you need those teeth removed and there is nothing but for us to give you dentures. That’s his lifeline. That’s his livelihood. This guy cannot be in dentures. He speaks, just like you do, in front of an audience. Well he heard about us, he came down, he was a little skeptical as well. He came down and I said Van –
When he says skeptical, what does he say to you?
He says, look doc i came because I heard your ad. But i’ve told by more than one person, 5 or 6 times –
Person meaning another dentist?
Another dentist. That I am not a candidate for implants. I said Van let’s take a look. We did a CT scan on him and I said not only can I help you, we can replace your upper and lower teeth in the same day. In the same day. So he comes in , little, little nervous, comes in same day we do his upper and lower jaws. Here he is now.
Same day. Upper and lower. 4 implants in the top, 4 implants on the bottom. Fixed teeth attached. Permanent teeth attached. Non removable teeth that do not come in and out. He looks in the mirror. He cannot believe it. A tear wells up in his eye. Now that’s common Randy. common. Tears of joy of course because they are overwhelmed. You know he has his life back again. Story after story after story. So that this gentleman is spending way less time editing, he’s out on the ski slopes in the winter, he’s playing golf in the summer and he’s loving life
But can he eat a chewy steak or-
Or like a carrot?
Let’s talk about your average denture patient again versus him. They can’t eat any of those things you just mentioned. Steaks, chewy foods, raw vegetables, raw fruits, apples, carrots, nuts, he’s eating all those things again. Salads with cucumbers and croutons, which he loved and was missing. Again, so corn on the cob right off the cob.
Popcorn, could they eat popcorn?
Popcorn, biting through an apple, nuts, nuts! We ask people to avoid almonds. That’s a hard nut, which is sometimes hard on the teeth. More so on the crowns and the bridges but nuts! And there’s a lot of people that miss them. Denture wearers can’t – they grind side to side with those dentures, they can’t really chew effectively. Actually there are very good studies done about the efficiently of the lower denture. If you have all your teeth you have 100% chewing efficiency, right? Denture, lower denture, 10%, just by adding two implants, to secure that denture, still removable – it’s called an over denture but just by adding two implants we increase from 10% to 20 to 30%
So you can have salads, things like that?
Absolutely, but they are still coming out at night and the back lifts up just a little bit.
So you like fixed. You don’t like teeth that don’t come in and out.
Especially because we only 2 more, only 2 more we go from an over denture case to a fixed case, teeth that don’t come in and out overnight. No more embarrassing teeth in the jar at night or hiding from your spouse. You wouldn’t believe how many denture wearers hide the fact they wear dentures. Women particularly are very good at this. I’m amazed, amazed, amazed with how many women can get away with my husband doesn’t know I wear dentures. Amazing.
We are going to take a quick break. We’ll come back – more about the dental implant process – what they can expect on day 1. You’re watching the wellness hour, I’m Randy Alvarez, we’ll be right back.
Before I had a partial upper and a partial lower and when I spoke especially when I’d be doing a voice over, a narration, whatever the case may be they would move . People ask me if I’m happy. My reaction is very simple. I could not be happier than what I am. As I said, this is probably the single best thing I’ve ever done for myself. And there’s just no looking back. You know it’s looking forward at this time. I feel a lot better about myself and I definitely feel a lot better about my smile. I’m not afraid to look at people and just give them a nice, nice big smile and I can’t tell you honestly, I’m not kidding, how many compliments I’ve received. What did you do/ You know from people who don’t know what I did. Okay. You look different. It’s my teeth. See. [laughter] I look at myself and I start smiling. It’s like uh oh what are you smiling for? I like the way I look when I smile now. That’s basically it.
You’re watching the Wellness Hour, I’m randy Alvarez, today’s topic, no more dentures according to my first guest that if you’ve been told that your teeth need to be extracted and your only option is dentures, he says you need a second opinion. Because just about everybody is a candidate for dental implants. Is that right?
It’s true when you are replacing all of the teeth. Maybe not the case when you are replacing one or two. Those cases still sometimes need grafting. But we are focusing really In our practice about all of the teeth being replaced. And today we are talking about all on four. All of your teeth, on only 4 dental implants. So yes, that is true because we can angle the implants as we said and take advantage of the bone you haven’t lost.
So the people that are doing this- is it more men or more women?
Yeah it’s a 50/50 mix Randy and that’s very simple. Tooth loss knows no boundaries. Men, women, old, young, white, black – it knows no boundaries race or religion. It affects everybody. Tell you about a woman that we recently had. She came in, her husband dragged her in against her will, very depressed, hardly ever smiled, was really difficult. Her son would come, he had a baby with him, she wouldn’t even hold the baby, she was embarrassed to smile, her teeth would fall out when she kissed the baby. She was a miserable, miserable person. She was very skeptical as well, like most depressed people are, they just don’t believe. Well, let me tell you, two months after her surgery, she comes in, her hair is done, she gained weight, she looks fantastic. Her husband is so happy because now he’s no longer dragged down by this depressed person and he’s got his spouse back, the woman he fell in love with again. So yes its men its women its sometimes young adults too. Young adults lose their teeth for many reasons. Trauma, accidents, those drugs that they are on,
So what you showed me so far. These look like real teeth.
Absolutely they look real.
So it’s more of a cosmetic component to this.
It’s very- look at the picture Randy , look at the way the lip is following the outline of the teeth. The teeth are filling up the smile right? You see gum tissue between each one of those teeth. That’s what make these bridges so lifelike, so real. Nobody would ever guess that these patients have teeth that are prosthetics. They look and act like real teeth and gums.
Now with your center you kind of have this team approach you do it all right there. Is that right?
It’s true but we also have referrals that send patients in and then they do the prosthetics side.
You can work with their dentist?
Absolutely, even if their dentist hasn’t done one of these cases because we have a training facility.
Now, for the sake of time, I know you have more photos.
So what else do you have?
Here’s another women Randy. Look at her Look how she comes in. Right. She’s got a gappy smile, she doesn’t feel very good about herself. Is a woman who suffered with periodontal disease her whole life. She’s out of the dating scene . She refuses to date anymore. She doesn’t think she can get a date anymore. She suffered from periodontal disease her whole life, her whole family suffered with periodontal disease. So loose teeth, bad breath, the whole 9 yards. Really, really reclusive person. Now she comes to us, we say of course we can help. So what we did for her, she could have had a denture as well, but instead, we put the four implants in the top and four implants in the bottom draw and the same day attached fixed teeth. She walked out and could not believe how she looked. She came back the next time and looked like this. She looks like a different person.
Again, look at the smile. Look how lifelike that is. Now she is happy, confident, and feeling better about herself. She is out there, out there dating again. She has a boyfriend now. So, it’s a lifechanger for these patients. We can go on and on with stories like that. So look at the before and afters side by side Randy, she looks like a different person. Look at the detail – look how they follow the line of the lip. You can see the pink gum triangles coming down between each tooth. That is what makes the smile so lifelike. These teeth are no long and square like chicklets like we normally see – some people smiles and it looks like a row of piano keys – not with these bridges because there is a gum component, a cosmetic benefit from this procedure.
There is no adhesive. This doesn’t come in and out at night. No glue or paste. They are fixed to the implants and secured.
So there teeth can be a total mess – gum disease, bleeding, all that stuff, loose. Those teeth are extracted and they get a new set of teeth.
Absolutely. Teeth come out. Clean out all of the chronic infections in the jaw, clean everything out. Get rid of that bacteria that can no longer colonize the mouth once the teeth are out. It’s a fresh start. It’s a fresh start for these patients. They have no pathology anymore. Sure if they never pick up a toothbrush again odds are they are going to lose their dental implants at some point. But, more patients are reinvigorated and motivated because they just can’t believe how good they look and they don’t want to loose that once they got it. We touched on a point earlier where lack of bone sometimes can preclude a patient in some dentists eyes. Well let me tell you a story about a gentleman I had.
He was 77 years old. As I am finishing up his case, and we did upper and lower on him as well and he was a denture wearer, I said to him: George, how long has it been since you had fixed teeth? I thought he said 15 years. He says Doc, as he grabs me by the shirt and pulls me closer, it’s been 50 years! 50 years? How is that even possible? Well, he was in the army and at 27 they took out the last of his teeth which is common in the army because they don’t want to deal with bad teeth. They gave him dentures and for 50 years he wore dentures. Why? Because everyone he went to see told him he was not an implant candidate. Then, he found us and we changed his life.
Is that right?
Now, he is eating foods he has been missing for 50 years. Meats, nuts, fruits, vegetables, corn on the cob. All of those nice things in life. There are benefits to that – a well balanced diet. We have better nutrition, better health. Denture wearers can not masticate certain foods. There is malnutrition in the elderly denture wearers all of the time.
No fiber. There is no teeth in the stomach we like to..
So 50 years with this guy. Did he ever get frustrated? Like you said he’s been told elsewhere that it can’t be done. Did he ever say: I should have done this years ago?
The problem is in this country we are lagging behind in technology. All-on-4 is now just sweeping the nation here.
All-on-4 – that’s a full arch of teeth.
A full arch of teeth on only 4 implants that are strategically positioned usually in the bone that has not absorbed away.
I know you have another photo you want to show.
Yes, because I want to show you that this is not just a problem with the elderly. I mentioned earlier that people lose their teeth for all types of reasons. This one is a bit unfortunate.
So, here is a guy that was on some medications that just rotted his teeth. He is not even 35 years old. All of his teeth were rotten. He had them all but they were rotten down to rubs.
So, they had to come out?
All of them had to come out. Not one tooth could be saved. So they all came out on the same day. 4 implants on the top and 4 implants on the bottom. Look at him now. Look at his grin in the picture. Look how happy he is and these teeth are built to last. These are materials that are biocompatible and will last for decades and decades and decades.
He can check whatever he wants?
Virtually anything he wants. Yes.
Steak, corn on the cob…
Absolutely. Steak and corn on the cob.
Can he bite an apple?
He can bite into an apple typically the same day he gets his front teeth.
Now, we don’t advoate everybody going around and biting apples the first day because we have not had the biological bond form but many people can. That’s how secure these implants go in.
If there was a try in or try out period – you said half a million people with an upper lower denture – if they knew how good this was, you guys couldn’t even service the people.
It would be impossible. We would need hundreds of dentists. There are so many patients that are in need.
There is one more I’d like to show you. There is one more I’d like to show you. Another woman that suffered with periodontal disease her whole life. Not an old woman but she does look a little older than her real age in that picture. So, her general dentist told her all these teeth have to go. She said what are my options? He said dentures and she said no way. Absolutely not. I need to find a better solution. She did some internet research and found us – MALO SMILES. Here is what we did: We gave her a fixed set of teeth on the top and a fixed set of teeth on the bottom. Now she is out enjoying herself. She feels good about herself. Actually, this is a woman that had a hard time getting a job. Look at her picture now. She looks younger in this picture. Look how broad her smile is now.
That is a beautiful smile.
That is an amazing, dramatic difference in this person’s life. So it’s a self confidence boosters. Its not all about being able to eat and chew and smiles. It’s about what it does to you on the inside. It builds your confidence. Let’s talk about life right now Randy.
If you are a person that’s just not happy, overweight, you don’t like your smile. Those things hold you back. They hold you back from dating, from going out and being visible with your friends. It’s difficult. Now, if you change someone’s smile and they see the difference it makes and their friends and relatives are telling them – wow, you look fantastic – that’s an ego booster. THey go to that job interview and they are smiling. When I hire people, I hire people that smile because I want positivity in the office. I don’t want negative people. I want my patients to have a positive vibe when they come to the office. Smiling patients give off that vibe. They give that sense to people that they are a happy, well adjusted person to be around.
For denture wearers? What are their options when it comes to dental implants.
The simplest, least expensive options is what’s called an overdenture. Two implants with clips on them that attach to a little ring in the denture that snap in and snap out. There are different tensions based on your dexterity. That is option one.
Option two. We can give you a couple more implants and give you fixed teeth. Teeth that are not removeable. Sure we can do six or eight but it’s not necessary. People don’t need more than four.
So your options are removable denture onto implants or fixed teeth that no longer come in and out and that’s the world of difference in patient’s lives.
A final message to somebody who hasn’t been to the dentist in ten or fifteen years. There teeth are lose. Okay, and the denture wearer. They are watching this are still skeptical or they are worrying about pain or whatever.. what is your message to them?
Do some research. Find out about this procedure we’ve been talking about or dental implants in general. We can do a lot of things: one tooth, two teeth, snap on dentures, all of your teeth. Get options and get second opinions and third opinions if you are not getting the answers that you want to hear because odds are you are a candidate.
And, you think they should go to an oral surgeon?
I think they should go to a specialist. Whoever is in there area and doing a lot of these procedures. You want someone that is doing high volume. Not someone that dabbles.
And I guess oral surgeons, dentists, specialists from all of the world learn this from you.
Absolutely. They come to our facility. Twice a year we have these programs. They come from South America, Asia, Europe, and all over the world like you said.
So, no one should be wearing a denture?
You think you are going to wipe it out in New York?
That would be nice.
Is that the future?
Oh, for sure.
I’m sure we’ll be growing teeth in a petri dish in fifty years but right now that technology is not there so same day is the way to go.
Thank you for coming on the show.
It’s my pleasure.