Only a few decades ago, people who lost their teeth due to gum disease, neglect, or accidents were relegated to wearing full or partial dentures to replace some or all of their teeth. Dental implants now allow dentists to replace individual teeth, create bridges or to create denture supports that are much more natural and better-fitting than normal dentures.

The Problem with Dentures

People who have lost bone in their jaws due to years of denture use can also expect changes in their appearance. A person's face will show exaggerated signs of aging because the bone loss in their jaws can cause the chin to jut forward, and also to shorten the distance between the chin and nose. The groove between the nose and corner of the lip (nasolabial angle) deepens, and the muscles of the face can sag, causing unsightly jowls or the dreaded witch's chin.

Implant Basics

Fortunately, dental implants, a discovery by a Swedish scientist and orthopedic surgeon, Dr. P.I. Brånemark, have led to a vastly improved quality of life for the many people who suffer from the problems associated with missing teeth. Dental implants are titanium rods about a centimeter long that are placed inside the jawbone and serve the same purpose as the roots of teeth. They can replace missing teeth and prevent bone loss under dentures. Implants may have a smooth texture, be threaded, perforated, hollow, solid, coated, or textured. One common coating for implants is hydroxyapatite, which has the same composition as the mineral content of our bones.

Implant dentistry involves careful planning and highly trained and experienced dentist(s). The implant procedure is usually planned by the patient's general dentist or a prosthodontist (specialist in placing crowns (caps) and bridges). The dentist must first discuss with the patient what their goals are, and then must give the patient all of their options, expected outcome, risks and benefits. Every dental situation is unique, and in many cases, there are several alternatives for replacing missing teeth other than dental implants. The medical and social histories of the patient are also important. Diseases that affect the immune system such as diabetes, and habits that reduce blood flow and healing such as smoking, must be identified because they can reduce the success of implant surgery.

The Implant Procedure

If the x-ray or CAT reveals that there is not enough bone height to place the implant, a bone graft may be required. If the maxillary (upper jaw) sinus is in the area where implants need to be placed, a procedure called a sinus lift must be preformed. If a bone graft or a sinus lift is required, the procedure becomes more involved. With a sinus lift procedure, a small window of bone is formed and the delicate membrane of the sinus is pushed up. Bone can then be grafted into the area where the sinus was. Many dental surgeons prefer to use bone from the patient (an autogenous graft) to add the needed jawbone height to place implants. The grafts are usually taken from the iliac crest of the hip, a different area of the jaw, or the skull.

Although any dentist can surgically place implants into the jaw, a dental specialist called a periodontist (gum disease specialist) or an oral surgeon (specialist who does more advanced dental extractions and other dental surgery) is most commonly used for the procedure. To place a dental implant, the dentist uses local anesthesia to numb the surgical area. In most cases, the procedure is well tolerated by the patient, and can be done while the patient is awake, or with light sedation. An incision is made into the gum to expose the underlying bone. The stent is placed over the jaw to guide the implant placement. A series of drills in progressively widening diameters are used to create a hole in the bone. The implant is then placed into the hole so that the top of the implant is at or slightly above the crest (top) of the bone, where it meets the gum-line. A screw is then inserted into the implant to prevent the gum and other debris from entering the implant. The gum is then stitched up over the implant. The first stage of the implant surgery is then complete.

After implant surgery, denture wearers will be asked to not use their denture for two weeks as the implant(s) heal. An antiseptic mouth rinse containing chlorhexidine gluconate such as Peridex is usually given during the first few weeks after implant surgery. Antibiotics and pain medication are prescribed routinely to prevent infection and alleviate pain.

After the implants are placed, they require 3 to 9 months to connect to the jawbone. The lower jaw (mandible) generally requires 3 to 6 months, and the upper jaw (maxilla) requires 6 to 9 months.  (Recent research and experience has allowed some dental implants to be used immediately after they are surgically placed.)

Several months after the implant surgery, a second surgery is preformed to remove the cover screw and attach a larger screw to the implant, called a healing cap. The healing cap sticks out above the gum. An x-ray is taken to confirm that the bone has attached to the implant, and that osteointegration has occurred.

Building on the Implant

Single tooth with a screw fastening it to the implant

2 implants supporting a 3 tooth permenant bridge

As I mentioned before, implants are especially useful when securing loose dentures. Although there are many different types of attachments for dentures, I prefer magnets. Magnets are very predictable, cost-effective, low maintenance, and create a very tight bond between the implant and the denture. The use of magnets in dentistry gets a bad rap because they have a reputation for corroding over time, and causing an ugly metallic stain in the denture. The difference today is that the magnets are encased in plastic, eliminating this problem.

One memorable implant case I did was for a petite Spanish woman in her mid seventies. She spoke no English, and her husband came to me upset that his wife could not eat comfortably, and that she recently had had several ill-fitting lower dentures made. I examined his wife and found that she had very little lower jawbone remaining. I explained that I would not be able to help her unless she had at least two implants placed in her lower jaw to secure the denture. Although they were skeptical, I eventually had my colleague, a periodontist, place the implants. After they healed, I put attachments on the implants and magnets inside her denture. When the denture was put into her mouth, the magnets grabbed hold of the implants and enabled her to enjoy eating and speaking normally again. Needless to say, that result would have been impossible without dental implants.

Use of dental implants has more than tripled in the last 10 years, according to a study by the American Dental Association, and has a high success rate. The success rate of dental implants varies, but a well planned and skillfully executed case approaches 90%, possibly higher in implant denture cases. Anyone considering dental implants, and hopes to have a successful result, must be committed to performing excellent oral hygiene around the implant, and come to his or her dentist at least twice a year for maintenance. I always tell my patients, "Don't buy the Ferrari and forget about the oil change!" I say Ferrari and not Ford because implant dentistry is more expensive then traditional dentistry. The cost of a single implant includes the surgical cost which is anywhere form $1500 to $3000, and the cost of the tooth connected to it, which can run from $1000 to $2500. All totaled, a single tooth replaced by an implant costs from $2500 to $5500. If you need several implants, well, you do the math.