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In 1952, an orthopedic surgeon discovered that a certain metal could be fused to bone without being rejected by the body’s immune response. In 1965, another orthopedic surgeon, Dr. Branemark, placed a titanium dental implant into a human volunteer. It lasted for 42 years, until the patient died! Dental implants have progressed, designs have changed, and techniques have improved dramatically through the years. Today, we use “root form” implants, titanium alloy cylinders (and screws) that have excellent long-term success rates. At first, they were considered experimental and quite expensive. Today, they are still expensive, but more affordable than ever. The fees that my surgeons charge have not changed for about the last ten years! Every year more and more people are getting implants and they have now gone mainstream. What is so special about implants? They are the only way to restore a missing tooth while preserving the underlying bone. Dentures and fixed bridges do not stop the loss of bone- actually there is a tiny bit of bone loss that occurs around implants- about a tenth of a millimeter per year, which is practically nothing. Implants are the state-of-the-art solution because there is no extra material-like a denture, the tooth is not joined to adjacent teeth like a fixed bridge, and it can be flossed just like a natural tooth. When you think about it, it is a great investment. You can go on a vacation and come home with great memories, lease a more expensive car, and enjoy the luxury, or invest in implants and chew comfortably and look and feel better every day for many years to come.
Implants offer solutions to many dental problems. They can replace single teeth, small or large spans of teeth, and even a complete arch. Also, they are commonly employed to enhance retention on full dentures when there is extensive bone loss and annoying loose dentures. Implants can be connected to different types of attachments. Some attachments are made to retain crowns and bridges. Some are like snaps that can be used to snap in replacement teeth and pink gum replacement material when there is extensive bone loss. Snaps can be used to hold in dentures instead of more expensive crowns.
Currently, the estimated success rate of implants is over 90%. They are not for everyone, though. Brittle diabetics, smokers, and those with compromised immune systems may not be good candidates, and have lower long-term success rates. We generally expect a minimum of ten years for implants, but many last much longer. Patients must maintain good hygiene, because even implants can become infected. Anyone who decides to get implants should understand that they are a big commitment, and there are no guarantees. Surgeons wisely suggest using extra implants for larger cases in case one implant fails. Many people may have heard about the “All-on-Four” implant method which replaces an entire dental arch (upper or lower) using only four implants. It is relatively economical, but there is one big potential problem: if one implant fails, the whole case fails! I am hesitant to recommend this option, but many people have had long-term success with it, hence, it’s popularity.
Implant restorations require sophisticated planning and coordination between the surgeon, restoring dentist and laboratory. Technology has exploded in the last few years with 3D x-rays, CAT scans, computerized design, milling, templates and placement, as well as bone grafting, immediate placement and same day restoration protocols. Most of the technology is in the laboratories, surgeon’s offices and on the internet. It is a very exciting time for us, and it is amazing what is now possible.
-Michael Acquista DDS
By Michael Acquista, DDS
October 7, 2019
