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Dental Implants

   

Introduction

Nearly one out of ten (20 million) adult Americans have no teeth and over 100 million are missing at least one tooth. Most missing teeth are filled with dentures and bridges. However, both of these devices have limitations. They can be uncomfortable, weaken your bite and cause harm to neighboring teeth. 2

Dental implants, which are artificial teeth surgically anchored to the jawbone, are becoming increasingly popular. Adds touting the benefits of these implants are more frequent. It is estimated that over half a million implants are performed in the United States each year.

Implants work very well for many persons. However, they are very expensive and have certain risks. If many implants are needed the cost could be in the tens of thousands of dollars, you may spend a lot of time at the dentist's office and it could take over a year for your "new teeth".

As a relatively new procedure there is no current method for certifying that dentists performing implants have the training or experience needed to ensure consistently good outcomes. (This is true for many new surgical procedures). Some dentists call themselves "Implantologists"; however, Implantology is not a recognized or accredited dental specialty.

You'll need to be an assertive patient, checking out the credentials of the dentists and the implants they use. Some dentists who do implants do not have proper training, and some implant materials have not been thoroughly studied. 2


What is a Dental Implant

A dental implant is a metal screw, generally made of titanium, that is placed into the jaw bone. It acts as an anchor for a false tooth or a set of false teeth. Titanium is light and durable metal that has a low rejection rate by the body. It fuses very well with bone.

The technique mentioned above is called an endosteal (into bone) or "root form" procedure. Modern root implants using Titanium were first performed in 1965 and gained ADA (American Dental Association) approval in 1986. 1

CLICK HERE to see step by step diagram of root implant procedure


Several other procedures do not involve implanting a metal screw directly into the jaw bone: 1 , 3 , 4

If the jawbone is too narrow or short for immediate placement of root form implants the area may be enlarged with bone grafting. When the jawbone is too narrow and not a good candidate for bone grafting, a special narrow implant, called "plate form", can be placed into the bone.

In cases of advanced bone loss, the "subperiosteal" implant, may be prescribed. It rests on top of the bone but under the gums.

Further discussion will focus on root form implants.


What is Involved in Dental Implants?

The actual implant procedure involves the surgical placement of the implant or implants, a healing period (osseointegration) and implant restoration to replace the missing tooth or teeth. The treatment may be a cooperative effort between a surgical dentist who actually places the implant and a restorative dentist who designs, prescribes and inserts the final replacement teeth. Some dentists have advanced training and provide both of these services.

The process of drilling holes, inserting fixtures and attaching teeth can be time consuming and tedious.

Root implants generally require two surgical operations: 1 , 3

The first implant placement is followed by a healing phase. For a full set of teeth, four to six fixtures are needed in the lower jaw, and six to eight in the upper, where bone is less dense. Patients wear temporary bridges while the bone heals, which takes three months for the lower jaw and six for the upper.

The second stage involves uncovering the implant when soft-tissue healing is complete. It can take three or more months to take impressions, fashion individual teeth or multi-tooth segments, and attach them to the fixtures. The exposed replacement tooth (or teeth) are then connected to the implant by means of an occlusal screw, to create a unit that can be removed by a prosthodontist. The replacement teeth can take some time to get just right. The bite needs to be well adjusted to distribute pressure evenly.

While implant results are generally excellent for most people it is important to understand the amount of time and inconvenience involved. Persons receiving implants must commit the necessary time and care required to ensure success.


Who Can Get Dental Implants?

Most people in good health who want to replace missing teeth and have enough bone in the area of the missing tooth are candidates for dental implants. The youngest age a person should get implants is not known. 1

Are you a good candidate? Moreover, you must have enough bone for the fixtures to hold. Otherwise, you may be headed down an expensive detour: thousands of dollars (and an extra nine months) for bone grafts. Finally, since your gums won't cling to artificial teeth as tightly as to normal teeth, some dentists recommend additional surgery to make your gum line look more natural. 2


Who Should Not Get Implants?

Although there are few absolute contraindications to implants they should be considered very carefully in persons taking certain drugs and having diseases that compromise healing. Corticosteroids or uncontrolled diabetes, moderate to severe anemia, collagen vascular diseases or other disorders that can interfere with healing lessen your chances of a good result. Smokers and heavy drinkers may not get good results, either.

Implants are not recommended in those under 15-16 years of age because facial structures are not done growing. There is evidence that the jaw of women continues to grow into the late teens and that of men into the 20's suggesting that use of implants be delayed even further. 1


Who Should Perform Your Implant

Some dentists operate after taking only a weekend course. Avoid them. It's best to be treated by an experienced pair of specialists, one to operate and the other (a prosthodontist or general dentist) to craft your new teeth.

  • Look for a team that has done at least 50 cases overall and 10 to 15 like yours.
  • Ask to speak with some other patients.
  • Ask any potential oral surgeon or dentist whether the hardware he or she uses has been accepted by the American Dental Association. To gain ADA acceptance, manufacturers must conduct two five-year clinical studies to show the hardware holds up in real use. Not all implant systems have ADA acceptance.

What is the success rate of dental implants?

How permanent are these new teeth? No one knows for sure, as large well controlled double blind randomized studies (giving the most accurate and unbiased information) have not been done long term implant survival. 1

Most failures appear to occur early on, if a fixture fails to integrate with the bone, or if it comes loose.

An implant's reliability seems to be influenced by its location. The survival rate after five years is about 95% for implants in the front of the lower jaw but about 85% for implants in the sides and rear of the upper jaw.

In a small number of patients patients, implants fail completely. Dentists usually can replace loose fixtures by letting bone refill the socket and drilling again in a few months.


How Much Do Implants Cost?

There is no set answer to this question. The general answer is quite a bit compared to most other dental procedures.

Each fixture can cost $800 to $2,500. Each crown, $600 to $1,500. While the total cost for a single-tooth implant ($1,500 to $4,000) isn't much more than that for a small fixed bridge, costs quickly rise from there. A full upper or lower jaw can cost as much as $18,000 to $30,000. That's 10 to 15 times as much as a full denture. 2

Cost will depend on the particular dentist, number of teeth involved, location of involved teeth as well as any additional work the dentist must do. For example, persons requiring bone grafting or other special procedures would incur more expense.


How Do Implants Compare To Other Devices?

Implants generally look and feel more natural than removable bridges. They provide about the same amount of biting force as fixed bridges (much more than dentures) but are easier on surrounding teeth.


Causes of failure

Failures in dental implantation are often traced to insufficient professional education and continuing education, insufficient experience by the treating dentist or dental team, poor selection of patients for specific procedures.

In properly performed implants long-term success depends largely on the continued health of the gums and jaw bone. The main causes of implant failure are infection and occlusal force stresses (pressure on the teeth from chewing).

Good dental care and avoiding premature stress on the implants are crucial for long lasting and healthy implants.


Older, Less Expensive Choices

Dentures and bridges have a lot going for them. You can get them fitted in a matter of weeks, the bill won't exceed a few thousand dollars and dental insurance usually will pay part of the cost. 2 But they do have their drawbacks:

  • Removable dentures can be hard to eat with because they provide only a fraction of the chewing force of natural teeth.

  • A full lower denture can be dislodged by jaw and tongue movement.

  • Ill-fitting dentures can be irritating and painful with hard plastic riding atop a thin layer of gum tissue over bone.

  • Partial dentures, which replace a few missing teeth, can also promote tooth decay around their clasps and, by mechanical action, weaken the surrounding teeth.

For people missing just one or a few teeth, a fixed bridge looks and feels more like the real thing and provides near-normal chewing force. It's cemented in place over the natural teeth on each side of the gap. But those end teeth first must be ground to stubs, to accommodate caps. Bridges can also weaken other teeth: A fixed bridge that spans too wide a gap can loosen the teeth it's cemented to.


Summary

Implants make sense if you have dentures and can't adjust to them, if you want to fill gaps without involving surrounding teeth, and if you have the money. Still, it is not a decision to make lightly. Consider not only the cost but the effort involved in finding a dental team you are comfortable with, putting up with months of procedures and temporary teeth, meticulous hygiene. Also accept the small chance that the effort may fail and you'll end up with dentures anyway.

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References

  1. " Biomimicry, Dental Implants and Clinical Trials" - http://www.nidcr.nih.gov/slavkin/slav0298.htm

  2. "Dental Implants"
    http://www.qualitydentistry.com/dental/implants/index.htm


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