Dental Implants Are the Long Term Answer
Every American has heard about George Washington’s trials and tribulations with unhealthy
teeth and their wooden replacements, and some have even seen them preserved in the museum.
President Washington never smiled, because of his teeth. He was the most high-ranking
individual of the country at that time, yet could not enjoy the benefits of functioning teeth.
His teeth affected his quality of life. In contrast, the dental techniques of today offer various
alternatives for replacing teeth, as detailed in other chapters, so suffering is unnecessary. One
alternative still resembles a modern version of Washington’s teeth, known as a denture, and still
affects the quality of life today. There is a better alternative.
Patients with loose, ill-fitting dentures that cause mouth sores or interfere with eating enjoyable
food are great candidates for implants. Often, they see their natural smile in a ten-year old photo,
with facial tissue support or youthful teeth, and realize that they are now embarrassed to talk and
smile in public. Some simply are fed up with wearing goop inside their mouth just to keep the
denture in place, while others miss the sensation of actually “feeling” the food they eat. They
realize that their denture actually interferes with their quality of life! In fact, the whole world
revolves around their teeth.
Dental implants are now the best long-term solution for teeth replacement because they provide
predictable, precise, and categorized solutions for a secure future when eating, smiling, and
speaking. Today, implants enjoy a 97-99% success rate, (doesn’t mean 1% of the patients have
failure of all the implants but out of 100 implants one implant may fail which still brings to100%
patient success) restoring full function to the mouth for almost a million people each year.
Implants are precision-engineered and surgically inserted. Unlike traditional dental care that
fixes damaged teeth, insurance companies DO NOT cover implant procedures. Rather, implants
are an investment in one’s future health and offer the most comfortable and enjoyable quality
of life for a long time, much like a car, vacation, or a college education. Dental implants can be
financed with similar payment options that allow one to enjoy the benefits of improved quality
of life, which includes freedom for pain, discomfort, constant embarrassment and the inability to
enjoy favorite foods.
Implants have existed for a long time, in some form or another. Some archeological studies have
proven that implants existed in mummies! Until forty years ago, implants were plagued by a high
failure rate (over 50-60%) so the procedure was not very common. What changed? What has
made them so successful and long lasting.
Dr. Per-Ingvar Branemark discovered the phenomena of “osseointegration” (”osseo” meaning
bone; “integration” meaning fused, so the metal implant and bone get fused together) in the
early 1950’s that led to the development of dental implants. He was an orthopedic surgeon and
hematologist in Sweden, conducting research to improve surgical outcomes by studying blood
and bone changes during surgery. His research included a device made from the metal, titanium.
He observed that the titanium fused to live muscle and bone when placed in this tissue with
precise and well-controlled surgical procedures. Up until that time, implanted materials did not
integrate to bone because the surgical technique and control factors responsible for successful
osseointegration were not well known. But now, the two factors are known. These factors are:
A. the biologic response of tissue and bone, and
B. the appropriate use of the correct implant material.
For example, it is extremely important to control the temperature, the level of irrigation, and the
speed of surgical instruments to minimize the trauma to the bone. Similarly, dental implants
must have a 100% pure titanium surface which forms oxide layers when exposed to the air.
Manufacturers and researchers have since progressed further to design a variety of implants.
Increased knowledge, refined surgical methods, and a history of long-term results now facilitate
implants in not only healthy people but in health-compromised individuals such as diabetics,
cancer survivors, or those with limited bone in their jaw.
Implants consist of three parts:
1. Fixture that is actually implanted in bone.
2. Connector, known as an abutment, which connects to the fixture and protrudes above the gums.
3. Crowns or prostheses attach to the abutments, which look and function just like natural teeth.
Implants are performed as a team effort by highly specialized and skilled specialists like
Prosthodontists, Periodontists, and Oral Surgeons. These specialists have received several
additional years of training in implant restorations. Although many general dentists attempt
implants, a specialist most often performs the gentle and precise surgery in only one appointment.
A specialist, like a Prosthodontist, will take several appointments to create replacement teeth that
look and function like their originals, or better.
Steps for the implant procedure:
Step 1 Full clinical assessment and comprehensive review of the medical history, plus x-rays
and, sometimes, a CAT scan may be required. The CAT scan is particularly useful to produce
a three-dimensional image of the jaws. If the quality and amount of bone is suitable, the dentist
determines the number of implants needed based on the number of teeth missing, bone height,
bone quality, and the physical bite. If the quality or amount of bone is not optimal, the patient’s
bone, synthetic bone, or block bone from a cadaver reinforces the area and it must then heal for 4-
6 months. That is why one cannot jump into surgery right away, in some cases.
The bone must have adequate quality and the mouth must have no infection. It is
conceivable that an extracted tooth can receive an implant on the same day, if no infection
exists in the entire mouth. More than likely, however, a very thorough prophylaxis (cleaning)
and bacterial assessment are required. Teeth that are tipped or spread out, or gums that bleed,
usually have gum disease and would prove a poor foundation for implants. In this case, it is
wiser to have any bad teeth removed and leave with a temporary denture only until the foundation
stabilizes and a permanent implant is placed. It is analogous to building a home. One needs
stable, level ground before pouring the foundation. The foundation needs to dry. All the lumber
must be sturdy to support the infrastructure and roof. Only then, will the house be ready for long-
On the lower jaw, implant success is almost 100%. The one in one hundred that fails rarely poses
a problem that can’t be worked around or replaced by another design. In the upper jaw, the bone
is softer than the lower so healing takes a little longer and implants are successful between 96-
98% of the time. In case of failure, just like for the lower jaw, a solution is at hand. The Dental
Specialist monitors the Osseointegration during the healing period. If for some reason an implant
is failing, it can be easily removed and later replaced with a new implant. The site then heals.
If sufficient support remains from nearby implants, the area is left alone. The site may receive a
new implant. or new bone grafts. The science of implantology has expanded to provide recourse
should a failure occur.
Step 2 Surgical implantation of needed titanium implants in the jaw, with a choice of general or
local anesthesia. The gum tissue covers the entire implant while the area heals for 4-6 months.
The patient usually leaves this appointment with their old dentures or a temporary prosthesis
that is re-contoured to fit, plus pain medication for use, if needed. In many cases, one might do
without a temporary denture for 4-5 days to allow for proper healing. Patients will also visit for
Step 3 Exposure of the top of the implant, with healing cap placed. The healing cap prepares the
gum tissue around the implant so it looks natural and heals appropriately. Once again, the patient
goes home with a denture until healing occurs, which generally takes 4 to 5 weeks.
Step 4 The procedure to complete a permanent prosthesis (your replacement teeth) begins.
Several appointments are necessary to comfortably create molds, form the connector, correct
the bite, and select the color and shape for the prosthesis to look natural in the end. The dentist
consults with the patient at each step because there are several types of replacement teeth,
discussed in subsequent chapters. Anesthetic is not necessary.
Step 5 A permanent, esthetically pleasing prosthesis attaches to the implant after a very precise
procedure that ensures a 100% accurate fit. From experience, patients usually have no pain or
concern immediately after placement. An implant looks feels and functions exactly like a natural
tooth, without the discomfort caused by gum disease or cavities that occurs in natural teeth.
Documented studies demonstrate that they can offer a permanent solution for a long time. In our
practice, many patients who received implants over 25 years ago are still enjoying a wonderful
quality of life.
Step 6 Proper instruction for maintenance and follow-up is given to the patient, as it relates to
the type of prosthesis used. Many feel that it is easier to maintain than the natural teeth they
Patients often ask about the discomfort of an implant procedure. They anticipate time away from
work. After all, it is surgery. However, it is an “optional surgery”, unlike most surgeries done
to remedy an infection or treat an emergency, so the post-operative outcome is better. Even
though the procedure is complicated and requires precision, it must be gentle in nature to achieve
osseointegration. Most patients take pain medication for the first 48 hours and 85-90% never
requires more pain medication. Patients who have experienced an extraction, root canal, or
periodontal surgery claim that those procedures are far less tolerable than implants.
If President Washington could have improved his life with implants, science reveals that he could
have also preserved more bone and muscle tone in the process. The removal of teeth speeds up
the natural progression of bone loss as one ages, and an ill-fitting denture makes that even worse.
This, in turn, makes the denture even harder to tolerate. Of course, osteoporosis is now a known
concern as well. Implants have been shown to remedy this situation in three ways:
1. Maintaining bone structure in the jaw, which maintains the functional bite, and that minimizes
the loss of muscle tone to the face associated with wrinkles or sagging skin. Simply put, implants
defy nature by slowing down or almost stopping bone loss, and that is what helps one appear and
feel more youthful.
2. Our experience has shown that bone actually gets stronger and sturdier around implants and in
the jaw. In some cases, bone has even grown over the course of several years.
3. Defying the limitations found in aging and their effect on the choice of food eaten. Most
healthy food requires proper chewing. In contrast, unhealthy food choices such as coffee cake
and pudding do not. However, these foods have high caloric value that increases one’s chance for
weight gain with little nutritional substance.
People often think that biologic age has a bearing on implant failure, citing their age as a
deterrent for the investment. One’s age is far less important than the way they choose to live
and enjoy the remaining years of their life. As America ages, and survival rates improve, the
perspective on teeth must change. Individuals chew three million times a year, it is estimated, so
even ten additional years of adequately processing food should provide the incentive to restore
teeth properly and predictably. The lack of insurance coverage should not interfere with one’s
commitment of time and finances, because payment plans are available so they can enjoy life to
the fullest. No one should be forced to eat bread and soft food because they do not have enough
teeth to handle foods they used to enjoy. Likewise, no one should put up with dentures that
deteriorate the jaw “ridge” over time, making a good fit problematic, unless no other option
exists. Emerging research points to the fact that healthy teeth may also contribute to a longer life.
It is time to re-think the pre-programmed mindset that one can live well without teeth or the
aggravation of an ill-fitting denture, like Washington. Unlike him, people are now born in a
generation that enjoys the benefits of implants, unless they insist on continued suffering. The
reality is that one’s quality of life and personal comfort is more important that the length of their
life. Implants improve the quality of life. The dollar bill would have had a smiling President
Washington had he been able to invest in implants!
About The Author
© Dr. Anil K Agarwal; Winterset Dental Care