STORY BYThe dental implant is nothing new. Egyptians used gold wire in their jawbones. Ancient South Americans used semi-precious stones. Middle Eastern skeletons from the Middle Ages were found with ivory, and Roman soldiers used iron. Its recent popularity in the United States has led to dental experts from all areas of expertise, including forensics, to learn the craft.
For persons missing some or all of their teeth, dental implants can be a permanent restorative option to bridges or dentures. Dental implants are metal posts which are surgically placed in the bone under gum tissue. After the implants are inserted, the bone grows around the implant during the healing period. A replacement tooth or crown is then attached to the metal post for a permanent restoration that looks and feels like a natural tooth. Depending on the situation, the total treatment can be anywhere from a day to six months.
“The most current dental implant is made of titanium, since it is bio-compatible and the crowns can be made from a variety of materials such as ceramic,” says Neel Bhatavadekar, DDS, assistant professor in the Department of Periodontology at The University of Texas Dental Branch at Houston.
Regardless of age (except for children), good candidates for implants are adults who have lost some or all of their teeth and are in relatively good health. Fortunately, most patients do not have many dental implant complications. However, problems can sometimes occur such as infection, rejection, dental implant overload (too many implants in the mouth), implant failure, implant bone loss, implant inflammation or incision opening.
“Implants usually have a high success rate. However, patients who are heavy smokers or have uncontrolled diabetes and other systemic conditions that may impair wound healing, should be cautious,” Bhatavadekar says.
Implants also are not recommended in those under 15 years of age, since the facial structures are still growing. Studies have shown that even some patients in their 20s have jaw bones that continue to grow.
Dental bridges and dentures have been used in restoring smiles for decades, but in today’s age of teeth bleaching and aesthetic dentistry options, the dental implant is a more permanent, functional and healthier option that can also contribute to the “perfect smile.”
“For a single tooth implant, it’s easier to clean because dental floss can go between the teeth, instead of underneath when compared to a fixed bridge anchored by two natural teeth,” says Sudarat Kiat-amnuay, D.D.S., assistant professor in the Department of Restorative Dentistry at the UT Dental Branch. “There is a higher failure rate for fixed bridges, especially the posterior ones, because they are hard to clean.”
“In addition to their use as replacements for teeth, the implants can be used to anchor the patient’s dentures,” says Kiat-amnuay. “For complete dentures, especially the lower ones, patients usually complain that they do not fit well, which can affect the patient’s oral health, appearance or even their self esteem.”
Metal posts inserted into lower jawbone.
Preparation for anchoring lower denture.
Completed dental implant of lower denture.
The dental implant is designed to function like the patient’s real teeth, and is so permanent that implants are being studied as good identifiers by forensic dentists.
“The presence of dental implants in persons needing identification is becoming more prevalent as the technology gains popularity,” Veronique Delattre, DDS, forensic dental expert and assistant professor in the Department of Restorative and Biomaterials at the dental branch. Since dental implants are still relatively uncommon in the general population, this can be of real value to forensic dentists. “Practitioners who place these implants often keep detailed dental records and radiographs which facilitates the dental identification process,” Delattre says.
Delattre and Lillian C. Lions, DDS, clinical assistant professor in the Department of Periodontics at the dental branch, are working to develop a forensic pictorial guide of dental implants, which will help forensic experts confirm when the procedure was done and identify the country in which it was made or performed.
Dental Implantology is a fairly new area of dentistry in the United States and the costs are still high. Presently, most dental insurances do not cover dental implants. Interested patients are encouraged to ask their oral health care providers about dental implants.
The American Dental Association (ADA) suggests looking for a dentist qualified to place dental implants. Patients should ask key questions:
How much training has the dentist had in the procedure?
How many implant procedures has he or she done successfully?
How long has the dentist been working with implants?
If more than one dentist is involved, do they have a sound plan for coordinating treatment?
Implant placement is not a dental specialty. According to the ADA, often a team of dentists—general dentists or specialists—will work together to provide different parts of the treatment. One dentist may perform the surgery to place the implant into the bone. Another dentist may place the crown on top of the implant.
Some of the dental specialists may include:
The current periodontal and prosthodontic residency (post-graduate training) programs are three years,” says Bhatavadekar. “Specialists such as periodontists, prosthodontists and oral surgeons go through dental implant training during their residencies, while some general dentists might learn the procedure through continuing education courses or through some one-year general residency programs.”
In addition, other treatment options may be necessary prior to the surgery depending on the patient’s condition. Patients should speak to their oral health care providers to see if they are candidates for dental implants and for more information about the procedure.
“Comprehensive treatment planning is key to success for dental implant therapy,” says Bhatavadekar who adds that total treatment can be anywhere from a day to six months, depending on the situation.
“I would highly recommend this procedure to anyone, and it was definitely worth the investment,” says Martha Rivas, 51, who has worn dentures for 30 years.
Rivas is a complete denture patient and now has two lower implant-retained “overdentures,” meaning her bottom dentures are anchored by two implants. For years she had been suffering with her lower dentures due to severe bone loss.
“Thanks to the implants, they were able to replace my lower dentures,” says Rivas. “Now that I have the implants I feel way more confident. I can eat everything and the best part is they look just like my natural teeth and I’m comfortable!”
Last Updated: 7-23-2008
Dr. Neel Bhatavadekar is an assistant professor in the Department of Periodontology at The UT Dental School.
Dr. Sudarat Kiat-amnuay is an assistant professor in the Department of Restorative Dentistry at the UT Dental School.
Dr. Veronique Delattre is an associate professor in the Department of Restorative Dentistry and Biomaterials at the UT Dental Branch.
See Dr. Delattre also at:
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