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-

term use.

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

follow-up checks.

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

once had!

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 Agarwal is an award winning Prosthodontist in Orland Park, Illinois. Connect with him on Google+

© Dr. Anil K Agarwal; Winterset Dental Care