They can change a life, but they’re not a cure-all
By Wendy Haaf
When are dental implants a good option for replacing one or more teeth? While this method of restoring missing teeth is highly successful under the right circumstances, it’s not right for everyone. Here’s what you need to know if you’re thinking of getting dental implants.
It’s a big commitment.
The surgical procedure itself—making a space in the jawbone and surgically inserting the titanium screw that will act as a root for the artificial tooth—is only the beginning. (These implants can also serve as a base to hold a bridge or removable denture.) Even in the most straightforward cases, it takes three to six months for the bone to bond to the surface of the implant sufficiently. Only after that can the process of building the rest of the prosthetic tooth begin. (Typically, it’s composed of a metal superstructure called the abutment, topped by a crown.)
And those are still just the first steps. “It’s very important to understand that implants need more maintenance than natural teeth,” stresses Dr. Liran Levin, a professor of periodontology with the School of Dentistry at the University of Alberta in Edmonton. “You need to brush more, you need to see the dental hygienist more, and you need to be more careful with maintenance follow-ups.” Specifically, “patients need to have regular maintenance done every four or six months, as well as have regular radiographs done to ascertain that the bone levels [around the implant] have remained stable,” says Dr. Neena D’Souza, a Mississauga, ON, prosthodontist and a spokesperson for the Ontario Dental Association.
Implants are also much more susceptible to disease than your own teeth. The same bacteria that trigger the bone-eroding gum inflammation (a disease called periodontitis) that can lead to tooth loss can similarly strike implants (a condition known as peri-implantitis). “The problem with peri-implantitis is that our knowledge and tools to treat it are much less effective than are treatments for periodontitis,” Levin explains.
Consequently, where possible, it’s better to try to save your existing teeth rather than to leap directly to an implant. “Sometimes I’ll see patients who require two root canals and a crown, and they’ll say, ‘Why don’t we take the teeth out and replace them with an implant?’” Levin says. “Implants are there to replace missing teeth, not to replace teeth.” He recommends that if your dentist is suggesting you have teeth extracted, ask whether that’s the only option available.
Finally, there’s the financial outlay: single implants start at roughly $3,000 to $4,000, while the cost of two implants plus a lower denture begins at around $4,000 to $5,000. (That’s assuming the procedure is straightforward, and that the practitioner is a general dentist, rather than a specialist—in which cases, costs can soar.)
Early consultation is ideal.
“If people are considering implants, it’s advisable to get a consultation even before having the teeth removed,” D’Souza says. The reason: The moment a tooth is extracted, the surrounding bone starts shrinking progressively—and the amount and quality of bone are two factors that determine whether it’s possible to place an implant. Early consultation gives you the luxury of time to educate yourself and do some legwork before deciding whether or not to proceed. “My recommendation is to get a couple of opinions from different practitioners,” D’Souza says.
You should do a little research before booking these appointments, says Dr. Les Kalman, a general dentist and professor of restorative dentistry at Western University’s Schulich School of Medicine & Dentistry, in London, ON. “Make sure the person is reputable and that he or she has some continuing education, because most of this stuff we learn beyond a general dental education.” (In addition to general dentists, care provider options for implants include prosthodontists, periodontists, and oral surgeons, all of whom undergo three to four years of specialty training following dental school.)
Once you’ve selected a potential provider for a consultation, he or she will perform a clinical assessment. “Imaging—it could be radiology, it could be a CT scan—is needed to see where the nerves are, where the sinuses are, and where we can put the titanium screw,” Kalman explains. “Imaging looks into not only the quality of the bone but also the quantity.”
If the amount of bone available isn’t sufficient, it’s sometimes possible to add it in the form of a graft, with bone taken from elsewhere in the mouth or using either synthetic or animal-derived bone, Kalman says. However, this adds extra expense, not to mention months of additional healing time before the implant can be placed. Moreover, “implants in grafted bone do not have the same success as implants in bone that is not grafted,” D’Souza says.
Medical history also factors into the equation. Placing implants is considered too risky for people with conditions that might impair healing or pose an increased risk for infection (such as uncontrolled diabetes), those with compromised immune function (for example, from chemotherapy or radiation treatment), those with a recent history of heart attack, and people with uncontrolled periodontitis. In addition, the procedure is risky for those taking intravenous bone-building drugs called bisphosphonates, which are linked with a small risk for a rare but serious condition called osteonecrosis of the jaw, in which cells in the jawbone begin to die. “Those are patients in whom we wouldn’t put implants, because they are in an active disease process,” D’Souza says.
Other contraindications are relative, meaning that the procedure can be done, but with caution. Take smoking, for example, which has been shown to inhibit implant healing. “Experienced practitioners and oral surgeons would be able to help taper the patient’s smoking and advise them not to smoke during the healing period,” D’Souza explains.
Even your personality—specifically, how conscientious you are in taking care of your existing teeth and overall health—comes into play. “We want patients to look after their implants,” Kalman stresses. This includes sticking to the strict maintenance protocol and a schedule of scrupulous brushing and flossing, and “making sure that, if they have any medical issues, they’re well-controlled.”
Implants aren’t risk-free.
Despite some advertisements asserting the contrary, “implant placement is always a surgery,” Kalman emphasizes, and as such, carries some degree of risk. “Any time you have surgery, you have that tiny envelope of complications that can occur,” Kalman notes. “For example, if you’re placing implants and you haven’t mapped out the anatomy, you can have some nerve damage.”
It’s also possible for the implant to fail. “Sometimes we follow all the rules and do everything right, but the dental implant isn’t accepted by the body,” Kalman explains. Consequently, it doesn’t bond to the bone.
“Those initial, early failures happen in about five per cent of cases,” Levin says. Longer-term complications include mechanical damage to metal components of the prosthetic tooth and peri-implantitis, in which, as we noted earlier, inflammation around the implant eats away at the bone to which it is anchored.
However, overall, “implants are very successful,” Levin says.
“We know from studies that the success rate percentages today are in the high 90s,” D’Souza says. “They’re highest in the front of the mouth and in the lower jaw, as compared with the upper.”
It’s also possible to end up with a less-than-perfect cosmetic result. To reduce the chance of this happening, D’Souza recommends that patients ask prospective providers, “Can I see what this tooth is going to look like?”
“We don’t just place a screw and then build a tooth over it—we plan out what the teeth are going to look like in the patient’s mouth and work backwards” to determine where best to place the implant, she explains. “There are many factors to consider. What do the adjacent teeth look like? Where is the gum line? We create templates of what the future teeth are going to look like and use these templates as a guide to place the implants.” Without this kind of planning, she adds, “the aesthetic results can be disastrous.”
“Patients should make sure they get all their questions answered,” Kalman stresses. “They need to know the pros and cons and what they’re in for. I think that’s really important. I always recommend taking the informed-consent form home and reading it over with a significant other or family member,” he adds. “This isn’t like buying a car, where you just sign on the dotted line.”
However, for many people, particularly those with a full denture, the ultimate outcome is worthwhile. For example, implants help prevent the massive bone loss experienced by people with regular dentures—and the consequent “caved in” appearance of the mouth
—plus they help avoid related possible difficulties with dentures’ good fit, and help keep any dentures stable and in place. In fact, the results are sufficiently superior that under these circumstances, implants have become the standard of care. “It’s a tremendous boost to someone’s life when their dentures can be held in better,” D’Souza says. “It enhances their eating, speaking, self-confidence, and social life.”