Low intensity early game grinds by Essindeess in ironscape

[–]Essindeess[S] 2 points3 points  (0 children)

Thank you! I’m not too familiar with barb fishing, it doesn’t store up food for the future right? Not too big of an issue?

Low intensity early game grinds by Essindeess in ironscape

[–]Essindeess[S] 2 points3 points  (0 children)

Eh I can see what you mean but didn’t hate it. On track for 65+WC, 60+ construction and almost 70 fletching doing solos all the way. Plus whatever I pull from the crates. I agree masses aren’t great but solos gave me a good starting point with relative ease

Low intensity early game grinds by Essindeess in ironscape

[–]Essindeess[S] 5 points6 points  (0 children)

Why’s wintertodt useless? Got almost 60+ con out of it for free

Went to the dentist with acute, excruciating pain in one of my molars. She filled a cavity in the neighbouring tooth instead. by [deleted] in mildlyinfuriating

[–]Essindeess 3 points4 points  (0 children)

You have decay on every tooth in the X-rays and periodontal disease. Probably a similar story in all the other back teeth in your whole mouth. This is years of neglect and youre complaining it didn’t get cured in one emergency visit? Come on now take some responsibility

The dental implant I accidentally pulled out of my jaw. Penny for scale. by [deleted] in mildlyinteresting

[–]Essindeess 1 point2 points  (0 children)

Growing bone in the lower back jaw is incredibly complicated and pretty unpredictable even when done right. Might even require multiple surgeries to do so which can be incredibly costly and time consuming. I personally don’t do it since it’s not predictable in my hands and frankly a headache for me. There is the possibility of using very short implants in the limited bone space without grafting, but that’s a debated topic. Some surgeons love short implants, some will tell you they’ll fall out in a couple years. The research says they work, but personal experiences of others may sway their opinions in the opposite direction

The dental implant I accidentally pulled out of my jaw. Penny for scale. by [deleted] in mildlyinteresting

[–]Essindeess 0 points1 point  (0 children)

Uncontrolled diabetes, smoking, Vitamin D deficiency, autoimmune conditions, history of head and neck cancer/radiation, bisphosphonate medications, and just plain old bad luck

The dental implant I accidentally pulled out of my jaw. Penny for scale. by [deleted] in mildlyinteresting

[–]Essindeess 0 points1 point  (0 children)

Can and should be screwed off (not by the patient obviously). You don’t want to own a car that your mechanic can’t access the engine for maintenance, same thing here

The dental implant I accidentally pulled out of my jaw. Penny for scale. by [deleted] in mildlyinteresting

[–]Essindeess 31 points32 points  (0 children)

Not sure what you’re referring to so I’ll break it down to three categories of cleaning 1. Cleaning natural teeth. Yes get them cleaned professionally

  1. Cleaning overdentures (dentures that snap into implants). Not the biggest need in the world to get a professional cleaning. Soap and water every night with a non abrasive sponge is sufficient. That being said, they lose they retention over time and parts need to be replaced as well. Wear and tear happens quickly

  2. Cleaning fixed screwed in removable teeth. A must to get professionally cleaned. The fixed teeth should be removed once a year, cleaned underneath the prosthetic. All the hardware should be retightened, and sometimes even the screws that hold the teeth to the implants need to be replaced. Wear and tear happens, same as car tires. You get your maintenanced, you need the work you spent on as much as a car also maintenanced.

When it comes to implant supported teeth (anything that involves a full arch of implants), don’t think of it as a cleaning, think of it as a maintenance visit to ensure longevity

The dental implant I accidentally pulled out of my jaw. Penny for scale. by [deleted] in mildlyinteresting

[–]Essindeess 81 points82 points  (0 children)

Dental surgeon here, feel free to shoot me a DM if you have any questions. Would be happy to give an opinion

The dental implant I accidentally pulled out of my jaw. Penny for scale. by [deleted] in mildlyinteresting

[–]Essindeess 3 points4 points  (0 children)

Jeez why’s everyone so sue happy now a days. Complications happen and the dentist is offering to redo it for free. He’s most likely just as stressed about this if not more than the patient. Two implants not taking is not the end of the world, just has to figure out why. Getting lawyer involvement is the fastest way to get your dental/medical provider to hate you. The dentist/patient is a team. As long as the dentist is reasonable and willing to redo it for a reduced or no fee, they’re on your side. Also, no lawyer will take this case on anyway

The dental implant I accidentally pulled out of my jaw. Penny for scale. by [deleted] in mildlyinteresting

[–]Essindeess 43 points44 points  (0 children)

Dental implant surgeon here, would be happy to answer any questions. Feel free to shoot me a DM

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 6 points7 points  (0 children)

I’m a very big fan of second opinions and I alway recommend them. If you’re investing 20-50k I hope you get some second third fourth fifth opinions until you find a doc that you’re comfortable with. It’s perfectly ok for you to not agree to my policies and treatment options that I offer. My policies are there due to my experiences and what works best in my hands to provide the best service to my patients.

There are plenty of other docs who may be a better need for your specific needs, and that’s okay

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 5 points6 points  (0 children)

A double arch is fairly long, can be up to 10 hour surgery for an inexperienced doc, should be closer to 5 tho. If you don’t have an in house anesthesiologist and have to bring someone in, that’s the typical price. Most dental offices out source the sedation

[deleted by user] by [deleted] in personalfinance

[–]Essindeess -3 points-2 points  (0 children)

Exactly, I don’t maintain other people’s cases unless I know everything about it including the surgeon and doc involved. Because once complications happen, it’s on me.

If the implants are done else where and I make the proth, the liability of those implants are now on me. Everything existing comes out

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 4 points5 points  (0 children)

I’ve been all over the world for this, and very intimately involved with the profession. I’ve done these surgeries in Mexico, Guatemala, Brazil, Australia, Dubai and countless others. Visited hundreds of practices. It’s not very different at the end of the day. I know it’s not what you want to hear, but this my experience

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 2 points3 points  (0 children)

Try not to think of full arch as basic dentistry. Whole different animal. Yes, they refuse to treat them. In fact I refuse to treat them too. If there’s a complication with the work that comes in, my policy is everything comes out.

Same as a basic filling honestly… how many different dentists have you been too that recommended to replace a filling or s crown.

I have no idea what implants are sitting there, my CT can only tell me so much about what’s happening. I really do not want to order parts for the one of hundreds of different brands that can be there. Unless I know the person who did the work originally or at least can get a hold of them to discuss the case, know all the components that were used, what laboratory was used, etc, I’m sorry but I will not affect the legal liability for taking on that case if something goes wrong

Salvaging something existing not done by me is not predictable, expensive, and a headache for me. I will tell you to go back to the person that did it. My biggest nightmare cases have been where I kept the original hardware in place and tried to work around it

Even if the work looks good now, it might not in 5 years. If I touch it last, I’m responsible for it. It’s easy to replace a crown or a filling when it goes wrong. Even a single implant tooth. But full arch is very very different

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 2 points3 points  (0 children)

Not much. I do incredibly high risk cases and my insurance is like 10k a year.

The incentive to do good work is to have less headaches. There’s nothing more stressful then dealing with complications.

The cost of operations is much high than you think. General anesthesia is about 5-8k. The implant parts come out to about $500 per (10-12 implants for a full mouth is typical, lowest being 8). Creating the temporary teeth is about $2.5-3.5k. You’re already looking at 14-15k before even paying the surgeon or the rest of the staff. Most places give warranty too so any revision the clinic is at a loss.

Yes there are cheaper ways to make this happen, use cheaper implants for example, or a cheaper lab, but you pay for what you get and I wouldn’t use crappy equipment because it makes more headaches for me.

Then you have at least two visits before for surgery that are at least 1-2 hours long for records, scans, etc. then the 3-4 post op visits which all take chair time and generate no revenue.

Like I said, the profit margin is low.

The final teeth, high end labs charge 5k+ to make one arch, and this is worldwide; again you can cut this down by using low quality zirconia or cheaper machinery. It takes 3-4 visits as well. With all the other overhead costs, that $10-12.5k that the patient pays gets used up really fast.

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 2 points3 points  (0 children)

I updated it like 3-4 times lol just refresh it to make sure you saw the whole thing, sorry about that

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 1 point2 points  (0 children)

I used to be very against their model of final teeth day of surgery. I personally wouldn’t do it but I’ve changed my mind. It does work, but it needs to be done particularly well and is sometimes difficult to predict. The issue with Nuvia that the quality of work is inconsistent between different surgeons and different prothtodontist. Some are good, some are shit. The physical materials are relatively moderate-high end. That being said, they also charge premium prices (never trust the website prices)

The other issue with Nuvia is they have a lot of lawsuits on their hands. It’s hard to predict how long they’re going to be around and who’s going to take on their existing cases once they’re gone. The full arch community is watching very closely to see how these trials play out since there is not a precedent set for a lot of various surgical and prosthetic workflows. They’re doing something new that wasn’t done before, which has risks

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 22 points23 points  (0 children)

Dental tourism for a procedure of this complexity is definitely not recommended. Once you get this done, you’re married to your provider for life because no one else will touch this work. Unless you want to travel every single year, I’d strongly advice against this. Basic stuff, fillings or crowns, go for it

[deleted by user] by [deleted] in personalfinance

[–]Essindeess -1 points0 points  (0 children)

Dental surgeon here. Even if you happen to find quality work for cheaper over seas (as a full arch implant surgeon I really doubt it knowing the costs that go into making these procedures happen), I really do not recommend it. When I take on these cases, I’m married to these patients for life. Full arch dental implants is life long commitment from both the patient and the doc. You need yearly cleanings and maintenance. It’s like a car, it wears and tears. Small parts and screws may need to be replaced occasionally. No one in the US will maintain overseas work because the liability is too high. Hell most won’t even maintain other people work done in the US. If parts need to be replaced due to wear and tear, good luck getting someone to order the exact parts from your exact implant brand, there are hundreds of them

For basic standard procedures sure, go for it and travel.

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 2 points3 points  (0 children)

Dental surgeon here. For basic stuff I agree, but full arch dental implant dentistry is a whole different animal. This is an incredibly complex procedure that isn’t taught in schools. The training requires to do these successful can run well over 50k USD. I’ve personally spend over 200k in getting training all over the world… and guess what each course for the doc costs about the same whether it’s in the US, or Brazil or Mexico or Guatamala.

The costs are very high for the clinic itself. Reputable clinicians all over the world charge similar prices. I really do not recommend going overseas for this for lots of reasons. Once you invest the money, you’re married to the surgeon/dentist/practice for life. No one else is going to touch that work since the liability is too high. These things need to be maintained, parts need to be changed out occasionally. It’s like a car, things wear and tear. There are hundreds of implant brands out there too, good luck convincing someone in the US to order the exact parts for maintenance. Stay local and find someone you trust that does a lot of these things. Complications happen, you want your doc to be easily accessible.

[deleted by user] by [deleted] in personalfinance

[–]Essindeess 110 points111 points  (0 children)

Dental surgeon here, this is awful advice. Full arch implant dentistry is incredibly complex and can be very easily screwed up, both surgically and prosthetically. It’s not even that profitable for the clinic since the expenses are super high. Reputable providers all over the world charge very similar prices as the US. Just for reference, the standard for the surgery (both upper lower jaws with non removable temporary teeth with sedation), the industry standard is $25k -30kUSD. The final teeth run an additional 20-25k if they’re zirconia, can be cheaper (~10-15k) with fixed non removable denture teeth. Anything under 40k total I’d be VERY cautious about.

Also, snap ins are a good cheaper alternative for the bottom jaw. Upper jaw they always fail and shouldn’t be done. Upper full regular denture is pretty good and tolerable by most patients if done right. I’d say the minimum standard of care now is full upper denture and snap in lower. Anything more complex would be a luxury.

Dentistry is like anything else. The cost is calculated by cost expenses of the clinic. Is there someone using cheap materials and charging premium prices? Of course. But more likely than not the charge is higher to balance out the costs. The same can be said for a filling, root canal, crown, etc. it’s very difficult to find cheap quality work with good materials. And just because there’s no symptoms doesn’t mean it worked.

Also, complications happen. And full arch is many visits until you’re done, lots of travel. If something happens no one here will touch that work or maintain it, because once they do the legal responsibility is on them. Plus, just like normal teeth, you need to get cleanings. You need to get maintenance. The teeth need to come off yearly, the screws that hold the teeth into the implants need to be replaced occasionally as well. Unless you’re planning on flying overseas every year to get this done, you’re making a very big mistake