Dental implants are gaining favor over dentures

Number of procedures triples in last 10 years, to 400,000 a year

September 24, 2001|By Julie Bain | Julie Bain,NEW YORK TIMES NEWS SERVICE

NEW YORK - Carol Cotter vividly remembers the time when, as a squeamish 14-year-old, she had to help her grandmother put in her false teeth.

"I thought, `I don't ever want that to happen to me,'" said Cotter, 58, a social worker in Marlboro, N.J.

But by the time Cotter was in her mid-30s, she had already lost several teeth.

"Then, over the years, I developed periodontal disease, and my teeth began to loosen and shift, and I was just a mess," she said.

Now, she is confident that she will never have to resort to dentures. Four years ago, she had all her upper teeth and several lower ones replaced with dental implants. The implants look and feel natural, she said, and she can eat anything she likes. All in all, she is thrilled with the results.

An artificial tooth

A dental implant is an artificial tooth made of metal with a porcelain coating designed to make it look real. Its most important component is its root, a titanium screw anchor that is surgically implanted into the jawbone, usually by an oral surgeon or a periodontal surgeon. Patients usually need just local anesthesia.

Initially the anchor is implanted alone, without the tooth. Gradually, during a healing period that can take several months, the bone grows around the implant, securing it. Then a replacement tooth, or crown, is attached to the metal post. Implants can also be used to anchor bridges and permanent dentures when more than one tooth is missing.

As with any surgery, the main risk is infection, though it is not common.

Cotter said the implant surgery was less arduous than she expected. "Having the teeth removed years before was so much more traumatic than having the implants," she said. "I was really frightened, but it was nothing. I would much rather have the implant procedure done than have root canal or an extraction."

Many Americans lose their teeth, mainly because of cavities and periodontal disease. According to the Centers for Disease Control and Prevention, by age 17, 7 percent of people in the United States have lost at least one permanent tooth because of decay.

Among adults from 35 to 44 years old, 69 percent have lost at least one permanent tooth. By age 50, Americans have lost an average of 12 teeth (including wisdom teeth). And among adults 65 to 74, 26 percent have lost all their teeth.

Some people lose their teeth because of injuries. Christine de Lassus, a fashion stylist in New York, damaged her front teeth in a motorcycle accident years ago, and had them repaired with a bridge. When the bridge broke recently, she got implants.

"I'm extremely happy with the implants," she said. "They feel even more solid than my teeth, and they look totally perfect and I even forget I have something that's not mine."

The next-best thing

Dentists say that if a tooth cannot be saved, an implant is the next-best thing. Implants are considered better than bridges in most cases, in part because they are stronger and do not involve the neighboring teeth.

The number of implant procedures has tripled in the last 10 years, according to the American Dental Association. About 400,000 procedures are done each year. As the materials and techniques have improved, so have success rates.

"Implant dentistry today has among the highest success rates of any medical procedure," said Dr. Michael R. Wiland, who has practiced restorative dentistry in New York for 35 years and implant dentistry for 15 years. He is also co-author of a recent book about implants, "Smile: How Dental Implants Can Transform Your Life."

Dr. Martha Somerman, an associate dean for research at the University of Michigan School of Dentistry and president of the American Association of Dental Research, said: "Implants are much better designed than they used to be. Individual implants today are quite successful. However, the success depends on the integrity of the patient's own bone, and the ability to build new bone if needed."

Success rates of screw-type implants vary, depending on where in the jaw the implants are placed, ranging from about 96 percent in simple individual implants with good bone structure underneath, to about 85 percent in some cases where bone grafts are needed. A successful implant is defined as one that lasts 10 years or more. Many last a lifetime, Wiland said.

"And frequently, the failed ones can be replaced or repaired," he added. "It doesn't mean the case is not successful."

Still, implants are not for everyone. Patients' health and medical history may preclude them from being good candidates for implants, especially if they have bone loss, diabetes or certain cardiac problems.

But, said Dr. Babak R. Ghalili, a New York periodontal surgeon who specializes in difficult cases, "there are so many modalities now in bone grafting and implant technology that you can find a solution for nearly every patient" who has a suitable medical history and is motivated to take care of the implant so that plaque does not form and cause bone loss.

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