A Tooth for a Tooth by Elvira Maricic Dental implants can close the gap in many smiles print article      send to a friend

While modern implant techniques have been in use since the 1950s, they haven't always been consistently reliable. "Before 1982, there was nothing available on the market that had predictability," says Mark Nevins, DDS, a Boston periodontist.  Improvements in procedures and materials have given today's implants a ten-year average success rate of 90 percent or better. While Nadia's implants have withstood the test of time, she was in a lot of pain after having the procedure done. Plus she found it difficult to talk.

Today's implant procedure is generally not painful. "It's not a big deal at all," says Dr. Nevins. "Basically, where the patient is missing a tooth, we lift the gum tissue using a controlled series of drilling procedures. We prepare the site, insert the titanium screw into the bone, close the gum tissue around it, and let it bond to the bone for a couple of months. The bone grows right up to the titanium, and once it's integrated into the bone [a process known as osseointegration], we go back and add the tooth to it."

A Mouthful of Options and Benefits

There are many types of implants available today, and each is designed for a specific function:

Root Form: Root form implants, the screw-type implants that are the closest is shape and size to the natural tooth root, are the most commonly used. They are placed in wide, deep bone to provide a base for replacement of one or more teeth.

Plate Form: Plate form implants, which are flat, long, and narrow, are used when the jawbone itself is too narrow and not suitable for bone grafting.

Subperiosteal: The subperiosteal implant is used in cases of advanced bone loss. This custom-made implant is designed to sit on top of the bone, under the gums.

Unlike the dental implants of the past, which often looked different from a patient's natural teeth, today's implants can look, feel, and function like the original teeth and are often not even noticeable. However, depending on the circumstances, that may not always be the case.

"When you're done, you can have an implant with a crown that you may not be able tell was an implant," says Dr. Nevins. "You may have your front tooth replaced and no one could tell the difference. On the other hand, say your grandmother has worn dentures for 40 years and has implants placed. She's missing more than just one tooth; she is also missing a lot of soft and hard tissues. In her case, it may not look just as it did 50 years ago because it's not just one tooth that she's missing," he notes.

Although her teeth may not look the same as they once did, there are other benefits to her implants, Dr. Nevins points out. "Let's say that she had a denture that moved around and she couldn't eat well. The dentist could put two implants in the lower jaw where she has no teeth at all, build a little bar in between them, and then put two little clips in the denture. Suddenly, the implants have changed her quality of life because now she can eat," he says.

After having implants placed, even patients sometimes can't tell the difference between their natural teeth and the new teeth. "Certainly someone who has had one missing tooth replaced can't tell the difference between their natural teeth and the implant. Someone missing two or three teeth probably can't tell the difference either," says Dr. Nevins. He notes, however, that if a person is going from a denture that slides all over the place to having something that is fixed in place, he or she will definitely notice a huge improvement.

Getting it in and Getting It Done

Most implant procedures are done under local anesthesia, and depending on the circumstances, some of them can be done in under an hour. "If it's one tooth, it can take 45 minutes. If it's many teeth, maybe a couple of hours," says Dr. Nevins. "If you're doing surgery, you can do more than one at a time, but there's a healing period between when the titanium screws are placed and when the teeth can be built up." He notes that in the lower jaw this period is about three months, while in the upper jaw it's about six months. "Of course, if you got your tooth knocked out today and there was damage to the bone, you might have to rebuild that a little bit first before replacing it," he adds.

As with any surgery, there may be surgical complications such as pain and swelling. "You could have nerve change, which is pretty rare but certainly is a possibility," says Dr. Nevins. "There is a nerve that runs through the back of the lower jaw. Therefore, before you do anything with implants, you want to have proper radiographs to know where that nerve is so you can stay above it."

With dental implants, age is usually not a factor. In general, anyone healthy enough to undergo routine tooth extraction or oral surgery may be able to receive an implant. However, not everyone is up to the task. "Someone severely medically compromised, to the point where elective surgery wouldn't be indicated," wouldn't make a good candidate, Dr. Nevins points out. He also notes that the patient's general dental health should be addressed, so that if all the other teeth in the mouth were falling apart, it probably would not be a good idea to begin placing implants.  Additionally, certain chronic diseases, heavy smoking, or alcohol abuse may contraindicate implant treatment.

Twenty-five years ago, Nadia paid an out-of-pocket total of $3,000 for her implants. Today, the cost depends upon the number and type of implants placed and the type of replacement teeth needed. Typically, the replacement of a single tooth costs about as much as a dental bridge. But, when considering Nadia's experience, it seems a small price to pay for nearly a quarter-century of permanent teeth.