Use of dental implants grows, yet patient education remains the key

The 40-something woman, an attorney and mother of two, recently came into the Haworth offices of dental implant specialists Dr. Andrew Spector and Michael Migdal in a panic after calling for an emergency appointment.

Her clenched lips told the story-- she had lost a bottom front tooth the night before and was feeling anxious and depressed over her condition.

Her situation is hardly uncommon. According to the American Association of Oral and Maxillofacial Surgeons, nearly seven in 10 Americans between the ages 35 to 44 have lost at least one tooth due to an accident, gum disease, or tooth decay. By age 74, more than one in four American adults have lost all their permanent teeth.

Not so long ago, the options for replacing missing teeth were limited. A fixed bridge or removable dentures were the most common options. These choices worked for cosmetic reasons, and allowed the individual to eat and speak clearly.

However, they also posed restrictions--fixed bridges require the filing down of healthy teeth, can weaken adjacent teeth and inhibit maintenance (e.g. ,you can't floss between them), while removable dentures can slip, cause embarrassing clicking sounds and lead to bone loss around teeth they are hooked onto.

Fortunately, modern technology has made dental implants the standard of care for patients needing to replace missing teeth. Recent advances involving treatment and diagnosis have now made implants less invasive, reduced the overall time period, and improved the success rate (to about 96 percent nationally), while increasing the number of people who would be successful implant candidates.

"Dental implants are the closest thing to natural teeth and when properly maintained, they can last a lifetime," said Dr. Spector, who until recently taught dental implants to practicing dentists as an instructor at NYU Dental School and has been providing his patients with implants for over a decade. "However, as beneficial as they may be to those suffering the loss of missing teeth, patients need to be educated before making any decisions. This includes taking an objective look at certain implant procedures that are being aggressively marketed today."

According to Dr. Spector, the first step involves proper diagnosis. In most cases, digital radiography is used to measure the height of the bone in the patient's mouth. In the case of patients where there may be questions, such as where the work may be more extensive or the bone loss more problematical, a dental catscan is recommended.

Usually covered by medical insurance, this gives doctors the precise dimensions of the patient's bone support to allow for the most accurate planning.

Today, most people are candidates for dental implants except those with uncontrolled diabetes, which can be a contraindication, or heavy smokers, which can reduce the success rate by 30 percent.

Even if the area lacks bone support, specialists have the means to graft and grow it. Following the diagnostics, a "stent" of where the tooth should be placed is made and used as a guide during the placement of the implant itself.

"Use of the laser today makes placing implants into the bone a minimally invasive procedure today, eliminating the need for scalpel and sutures and virtually all bleeding," said Dr. Spector. "Rather than stripping the gum away from the bone, which needs to be done with traditional implant surgery and can disturb the blood supply to the bone causing potential problems in some patients (such as those who take medication for osteoporosis), the laser gives us easy access to the site of the missing tooth or teeth. It makes the patient's post-op experience much easier and less involved."

Using implant rotary instruments, the specialist then creates an area for placing the titanium implant. The procedure takes no more than 35 to 40 minutes for the single implant while the patient is anesthetized with local anesthesia or nitrous oxide, if desired.

A mold is made for the patient's permanent crown at this time, with the patient leaving the office with a temporary tooth while the implant matures in the bone. In many cases, only one more office visit will be necessary, at which the permanent tooth is attached and there is no need for anesthesia or drilling.

An educated consumer
The recent advances notwithstanding, implant patients need to educate themselves on the process, according to Dr. Spector.

"For example, a newer technique has been developed and heavily marketed in the rush to make things better and faster for the patient who needs a new set of upper or lower teeth," he said. "In what is known as the 'All on Four' technique, the practitioner loads a non-removable full set of new teeth on four well spaced implants--a job that would normally require eight to 10 implants. While the research and clinical success of 'all on fours' can point to some promising results, this may not be the way to go for every patient."

There are, in fact, two main reasons why implants fail.

Statistically, one to three percent of all implants will not take hold. Should this occur, patients will know within two weeks of placement (with a tiny, usually painless gum blister forming as a symptom).

This is not the end of the world--the badly performing implant can be easily removed within minutes and a new one replanted several months later. However, the other reason for implant failure happens when the case has been "under-engineered."

"This occurs when the implant works and is solid, but the doctor has built too big a house on too small a foundation," said Dr. Spector. "That's why diagnosis and treatment planning are essential to the success of implants. The best thing the doctor can do to ensure success is to tell the patient when the site is not right or needs upgrading before proceeding. "

The cost
Dental insurance for implants is nominal at best, rarely covering the entire cost of the procedure. Yet, even the biggest case can be financed for less than $500 a month and for a single tooth for as low as $80 per month, in most dental offices.

Specialists like Dr. Spector also have options for patients who, because of economic or medical reasons, may be seeking other options. Specialists tack down what are called MTI's or mini-implants into the patient's existing dentures. Performed in a single visit, they have a high rate of success and longevity. They also provide immediate results.

For more information, go to NYU Dental School.

To read more about implants, go to implants.

To comment on this subject, go to PennWell Dental Community site.