Say the words ‘dental implants’ to someone else and their likely response is to shudder. Contemplating the very meaning of the two simple words brings lucid images to mind, and triggers off a mental image involving a dentist drill, searing pain, and the flowing of blood from the mouth. However, for a variety of reasons, dental implants are an important part of dentistry, helping to give the recipient a restored sense of normality. Initially, when implant procedures were first being performed, an implant was inserted with an abutment, to which the prosthetic was screwed.
More recently, advances in dental adhesives have allowed the attaching of the prosthetic to the abutment with dental cement. As with many aspects of dentistry, implants have a cosmetic element to them, in that while the procedure is valid and has merit, one of the main benefits it bestows is the closing of unsightly looking spaces in the mouth. As with other bodily indicators, having a full set of teeth, which are white and even, suggests overall health in the possessor. Dental implants are required for many reasons, and before looking at what uses they fulfill, we will have a look into the history of dental implants, how they are fitted, as well as the cost. This Vimeo video displays very nicely how dental implants work:
History of Dental Implants
The first use by humans of replacing lost teeth with root form implants dates back thousands of years. Archeological findings indicate that in Ancient China, over four thousand years ago, humans tapped carved bamboo pegs into the gaps in their mouths, to replace their lost teeth. Two thousand years ago in Egypt, mummies have been excavated that show corpses with transplanted human teeth, and in other instances, teeth made of ivory.
A remarkable find was uncovered in 1931, when the teeth of a young Mayan female dug up in Honduras, dated to about 600 AD, showed to have teeth replaced by pieces of shell, filed and sharpened to resemble teeth. Bone formation around the shell as well as the formation of calculus show that the replaced teeth were functional as well as aesthetic. It was in the 1950s that it was discovered that titanium grows in such close proximity to bone that is was for all intents and purposes, adhered. This phenomenon was studied closer and over the years, and it was in 1965 that the first dental patient received a titanium implant. Since then, dental implants have evolved over the years, into three main types:
- Root form implants. The most common type of implant worldwide, and suitable for all uses. There are around 18 types of implants, all made from titanium, and shaped differently. No particular style has a superior longevity.
- Zygomatic implants. A longer implant that can be anchored to the cheek bone by passing through the maxillary sinus to retain a complete upper denture when bone is absent.
- Small diameter implants are low diameter, one piece constructions that are sometimes used for dental retention, or orthodontic anchorage.
How Do Implants Work?
The primary use of dental implants is to support dental prosthetics. Modern implants make use of osseointegration, a process by which bones biologically fuse to materials such as titanium or some ceramics. Combining both implant and bone can result in supported physical loads in the mouth for decades without failure. This basically means that once a suitable receptacle has been placed correctly in the mouth, the natural bonding of the bone to the titanium or ceramic material can result in an almost permanent fusion which can support the user for a very long time. Of course, to people with unsightly gaps in their mouth, this is an appealing and more importantly permanent procedure to fix the problem. People with bone deficiencies and gum diseases are more likely to suffer rejection of new implants, which seems quite rare. There are five main surgical steps generally adhered to when fitting a dental implant:
- Soft tissue reflection involves an incision being made over the crest of the bone. The aim is to achieve a thick band of tissue around the implant, and the two ‘flaps’ created by the incision are pushed back to expose the bone.
- Drilling at high speed is used after the incision is made, creating pilot holes into which the implant will be fitted. High precision drills at highly regulated speeds are employed, to prevent burning, or pressuring the bone.
- Drilling at slow speed is next, using a series of slower speed drills to widen the pilot holes. A cooling saline or water spray is usually used to maintain a low temperature.
- The placement of the implant is the next stage, and is inserted using a specified torque, so as not to overload the surrounding bone.
- Tissue adaptation is last, and is the attempt to promote healthy tissue growth around the implant. In some cases, the tissue can be manipulated to completely cover the top of the implant, requiring a future procedure if it needed to be moved.
No one said it wasn’t painful! In fact, many consider this to be a worthwhile procedure, despite the pain, as the end result is usually considered permanent. The components that actually make up the implants are the base implant, which is basically like a big screw, and is the part inserted securely into the mouth, the abutment which is a smaller piece of material which attaches to the base, and can hold a number of dental prosthetics, and the last part is the actual prosthetic itself, whether it is a crown or a bridge. Once properly fitted, these implants can last a lifetime.
How Long Does the Procedure Take?
Expect the whole procedure, on average, and without complications, to take from five to around eight months in total. Around three months alone is required to allow the biological fusion of the bone to the implant material. Immediately post procedure, there are three main risks associated with implants:
- Infection. While pre and post procedure antibiotics can be administered, infection still remains a serious risk.
- Excessive bleeding. Can usually be stemmed, but in rare cases can necessitate further action by the dentist.
- Breakdown of the flaps. Although this happens in just 5% of cases, it can be problematic and require further surgery to correct.
An implant is usually tested between two and four months to check for proper alignment and stability. Although different standards are used to check for these, in general if a patient is not suffering pain, mobility of implant, infection and the condition of the gums surrounding the implant area is satisfactory, then a dentist will usually be contented with these signs, which he will take as a positive result of the implant. Of course, the end quality of the implant does depend on a few factors, such as the skill of the dentist performing the procedure, the amount of bone available at the site to work with, and the patient’s own oral hygiene. Clearly though, the main aim is to achieve implant stability, which once attained, usually allows for a successful procedure to follow on.
How Much Do Implants Cost?
As with most things, the price of a dental implant will vary from place to place and by dentist to dentist. Although they are available in the United Kingdom on the National Health Service, they will only be funded if a genuine medical condition necessitates their use, for example when a patients jaw has shrunk and can longer support dentures. From a private dentist, expect to pay between 390 and 480 GBP. Overall, this seems to be a fair price, as one can have the realistic expectation of the implant lasting many, many years. Indeed, research has shown that after a five year period, single crown implants have a 96.8% chance of surviving and performing satisfactory work. This is an impressive figure, and has no doubt been helped by modern advances in the understanding of bone fusion to metals and ceramics, helping to achieve the all important implant stability. For those who need several implants, the only good news considering the amount of pending dental work required would be that the more implants you require, the cheaper you get them per unit – the buy in bulk principle in action, if you like!
As with most areas of perceived improvement in physical appearances through the purchasing of different commercial products and procedures, dental implants allow an individual to recapture some self confidence following the appearance of unsightly gaps in their mouth, through whatever reason. Like the body implant surgeon looking to make a living off of other peoples perceived flaws in their body, and their willingness to pay money to alter it to their desire, the dental implant surgeon is merely satisfying a demand, a demand that produces millions every year in turnovers for the dental implant manufacturers and distributors. The simple idea of replacing a lost tooth with something else, in some cases with other human or animal teeth, has clearly been around for a very long time indeed.