The first attempts to utilize what we now call dental implants were discovered in 3,000-year-old skulls of ancient Mayans. In this advanced ancient culture, seashells were carved into appropriate shapes and hammered into the jawbone in the sites of missing teeth. Ancient Romans also utilized gold posts drilled or hammered into the jaws to replace teeth. An amazing aspect of these early attempts is the fact that all of this was done without the benefit of any anesthetic. Although these early efforts were likely of limited success, they foreshadow a future which facilitates a predictable way to replace any missing tooth.
In modern Western society, dental care has undergone many amazing changes in the past century. Dentistry has evolved from a profession that primarily centered on management (and sometimes creation) of acute pain and a slow progressive loss of teeth, into what is now an incredibly sophisticated science of managing and reversing the processes of dental disease.
In spite of this amazing advance of science, many people still eventually lose one or even all of their teeth. This can result from lack of access to care at various times in life, lack of compliance on the part of the patient, poor dental care, poor diet, drug abuse, trauma or other medical disease. It is an amazing reality that even in the United States today, it is not uncommon for teenagers to require removal of all of their natural teeth due to advanced decay.
Why is it important to replace teeth? The primary reason we replace teeth is obviously for function. Although bridges are still utilized to replace teeth, this technology has significant disadvantages including the potential to lead to the loss of more teeth. Removable dentures are still often used to replace teeth, but anyone with a denture can tell you they function nothing like natural teeth. Utilizing dentures instead of implants is comparable to giving a walker to a patient instead of a hip or knee replacement.
A less obvious reason to replace teeth using dental implants has to do with bone loss. Once a tooth is lost, the bone that was present to support the tooth begins to atrophy. Wearing dentures actually accelerates this process. Eventually, this bone loss will prematurely age the patient’s face due to loss of support. Also, patients with dentures will eventually lose so much bone they will be unable to even wear a denture, and can be at risk for spontaneous jaw fracture. It is not uncommon for individuals missing teeth over the long term to become totally debilitated by this bone loss.
Utilization of dental implants fools the body into thinking the natural teeth have returned, and the process of bone loss stops.
Who can have dental implants? Virtually any patient that is healthy enough to undergo a minor surgery is a candidate for dental implants. We occasionally see patients who have been told they are “not a candidate” for dental implants due to bone loss or other factors. The truth is that a trained oral and maxillofacial surgeon has the skills and technology at his or her disposal to overcome limitations that would only a few years ago have made treatment impractical.
The basic technique of replacing teeth utilizing dental implants has been well established over the past 60 years. Although we still hear implants described as experimental, this technology is no more experimental than the use of penicillin. This has become the standard of care for replacing teeth.
Modern dental implant technology from 1952 until the present has continued to evolve and advance. The basic technique involves essentially placing a titanium post into the jawbone in the site of a missing tooth. This post then fuses to the bone and becomes the root of the new tooth. A crown, usually made of porcelain, is then attached to the implant. This combination then looks and functions like a natural tooth.
Dentistry has explored various techniques over the past several decades to make this process faster, simpler, more comfortable, and less costly. Twenty years ago, this process took six to eight months from start to finish. Success rates for dental implant procedures 30 years ago were routinely approximating 80 percent.
We now routinely complete the same procedure in far less time and with much better levels of success. With some preparation, we can now remove an entire mouth of teeth, place dental implants, and give the patient a brand new smile in just one day. Using advanced materials and techniques we now see success rates above 98 percent.
Are dental implants expensive? Of course there is always expense associated with the highest level of care in any profession. However, the advancements associated with delivery and technology have allowed the expense of utilizing dental implants to actually decrease in recent years. It is also important to realize that because of the long-term success of implants, over time they represent the most economical form of tooth replacement.
Who places dental implants? Although oral and maxillofacial surgeons are the most highly trained specialists in the placement of dental implants, any licensed dentist can place dental implants. It is important, no matter what kind of doctor one is seeing, that the patient not be shy about asking about the qualifications of the doctor. Any dentist or specialist placing dental implants should be able to describe extensive training after dental school in performing this type of surgery. The patient should also ask how much experience the doctor has performing these procedures. Even more important than training, this level of experience is an excellent predictor of the likelihood the procedure will be successful.
As medicine and dentistry continue to advance, we see every greater opportunity to restore bodies that disease, trauma and time have degraded. There is no better example of this phenomenon than the modern dental implant, which allows us to replace a missing body part with a substitute that most patients cannot distinguish from the original.
Questions or comments can be addressed to John Holtzen, D.M.D, c/o Cosmetic Surgical Arts Centre, 1201 Westwood Drive, Hamilton, MT 59840.
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