Advances in dental implant technology are helping people take a big bite out of life.
Designed to provide function and feel like natural teeth, patients with dental implants can smile and chew with confidence.
Archeological findings support the claim that humans have attempted to replace missing teeth with root form implants for thousands of years! In fact, archaeologists have found remains from ancient Egypt, Mayans and China (dating 4,000 years ago), with carved bamboo pegs, stones or shells tapped into the bone to replace missing teeth. Although some of these were successful based on the patient surviving the procedure and based on soft tissue and bone growth around the “implant,” their percentage of successful cases was probably quite low.
Today’s modern-day implants were first discovered back in 1952. It took almost 20 years of further research and clinical trials to prove their effectiveness before they could become commercially available to the public in the 70’s. Word of mouth has spread the good news and benefits of implants. More and more people with missing teeth are beginning realize they do not have to suffer. Todays implants have become so successful and beneficial that there has been exponential growth in this field during the last 45 years. In the United States alone, over 5 million implants have been placed and a further 500,000 are placed each year…worldwide well over one million dental dental implants are placed each year!
Dental Implants Today
The dentistry world today excels in its ability to provide patients with the closest alternative to natural teeth using dental implants, short of being able to grow a third set of natural teeth.
With ideal and proper treatment planning, surgical protocol and ideal prosthetics that accounts for bone loading and physiology, function, health, esthetics, speech, ease of cleaning and finally proper patient maintenance, you can expect ten year success rates in excess of 98%. To put this in perspective, traditional crowns, bridges and root canals only have a 10-year success rate of 85% – many medical procedures have 10-year success rates of only 75%.
Let’s go ahead and take a closer look at the key factors involved in the long-term success of dental implants.
Why Do Natural Teeth and Crowns and Bridges on Natural Teeth Fail?
The top 4 reasons why crowns, bridges and root canals on natural teeth fail is due to:
- Gum disease,
- Fracture of the tooth or root, and
- Infection from inside the tooth.
These same things that cause all of us so much grief do not affect dental implants. They do not decay; they do not fracture (other than mini implants or some of the very early designs); they do not develop gum disease like natural teeth; and they do not become infected or abscessed.
The main reasons an implant will fail in the long term is often due to
- Excessive stress or pressure on the bone
- A lack of attached tissue around the implant (the thick, pink gum tissue that normally surrounds a tooth and has ligaments which provide a seal)
- Or very poor dental hygiene. There can be some other causes such as general health problems or certain medications but I generally see very few that I cannot directly relate to the first three mentioned.
When a natural tooth is overstressed, the tooth will become loose and or move out of the way. However an implant cannot do that, and instead excess stress causes bone to be lost around the implant. Once this bone is lost a space is created for food and bacteria to collect, thereby creating a local chronic infection and making the situation worse. This is why the treatment planning is so critical to long term success. Not using enough implants, not placing them in a postion and angle whereby they can withstand the loads placed upon them, using too small or too short of an implant…these are all factors that your dentist needs to consider when creating your treatment plan.
I understand why patients sometimes will choose a treatment plan from Dentist A vs Dentist B because Doctor A says he/she can do the work at a lower cost using fewer implants. Sometimes this will work for awhile (up to ~5 years) but the risk of long term failure will increase. The long term prognosis is always a good question to ask your dentist especially if you are comparing two very different treatment plans.
How To Ensure Your Implants Will Last
1. General Dental and Overall Health
In order to be considered a good candidate for dental implants, your mouth must be in a healthy condition. That means no untreated tooth decay or active periodontal (gum) disease. Although many of the patients that I have treated lost their teeth due to gum disease that doesn’t prevent them from having successful implants in the long term. We may need to get their gum disease under control and/or remove some hopeless teeth, but once that is done the prognosis for success is no different.
Gum disease is a bacterial infection that affects natural teeth. If the natural teeth are lost the gum disease is also gone. If the gum infection is brought under control then the risk of the infection affecting the neighbouring implant(s) is negligible.
In addition to local issues within the mouth, other factors such as certain medications, systemic health problems, cancer, uncontrolled diabetes, radiation to the jaws, alcoholism and various other ailments which may affect your healing whether dental implants will fuse to your bone properly. One of the first things that we do as part of preparing a treatment plan is a thorough medical history. If there are any potential issues or concerns, we may order specific blood work and or consult with your physician(s) to determine your suitability for this type of treatment.
In many of the health situations listed above, such as diabetes, we have been able to place implants successfully and have them successful over the long term, however it often has required some steps to ensure that the person’s’ medical condition is either under control or non-contributory.
2. A Proper (and Engineered) Treatment Plan
As I alluded to above, a properly thought out and executed treatment plan is essential for long term success. This is something that your implant dentist needs to prepare, and should take into account the forces and loading on the implant, the availability of bone in the area, your health, design and fabrication of teeth, cleansability of the teeth, function, speech and esthetics to name just a few.
It is very important to work backwards, much like constructing a building starts with architectural plans. Once we know where the teeth need to be placed, the esthetic, speech and functional requirements, the type of teeth and the forces/loading on the teeth etc we can determine how many implants would be required and where and how they need to be placed. Once that is determined, we will also know whether there’s enough bone in place to make it work or if it may require some bone grafting in order to build up the volume of bone.
3. Hygiene and Maintenance
Good oral hygiene is always important even when dental implants are in place. Simple brushing, flossing and getting your teeth and implants checked on a regular basis will help contribute to the long-term success of your implants. Also, after your treatment is completed, you’ll need to be willing to attend regular follow-up appointments on with your implant dentist, so that he or she can assess the implants and take the necessary steps to prevent any complications at an early stage.
I have treated many patients who lost all their teeth due to very poor hygiene and maintenance (gum disease and or decay). Some of these same patients did not change their habits even after they spent a considerable amount of money on dental implants… one of my patients looked like he hadn’t brushed his teeth since I last saw him (six months earlier)! Although implants do not decay or develop gum disease like natural teeth I really impress upon my patients that if they wish to see many years of success with their implants, some daily brushing and flossing will be very important.
4. Saving the Implant
There are few things that last a lifetime and dental implants are no different. Even with a success rate in excess of 98%, complications can arise. Should that happen, it normally takes place during the first six months to a year following surgery during the period of bone healing. How that is sorted out will vary from dentist to dentist, but in my practice there is no question-I will replace the implant at no cost.
After this time frame, problems are less frequent but unfortunately can still occur.For that reason it is important to have regular check ups with a dentist. Because implants do not have nerves associated with them they will rarely cause any pain or discomfort even if a problem develops, except in the very late stages. You may notice some bleeding, inflammation and or pus but I find patients are often unaware that something has started. Usually, your dentist will notice bone loss or one of the above problems around the implant, and if caught early enough we can usually rectify or stop the process and save the implant.
Rectifying the problem requires determining and correcting the initial cause. If there has been some bone loss, we will often do a combination of cleaning the area followed by grafting for any bone loss or modifying the site to make it more hygienic and healthy
I have had a few patients who see a dentist regularly but their dentist did not identify the early stages of a problem. For this reason, whenever I place implants and the patient has their own dentist, I ask them to return for a follow up check with myself personally at 1 year, 3 years and then every 3-5 years later.
I hope this information has been helpful to you. Each week I try to write a blog on what I think will be helpful, sometimes based on questions that I am asked by patients. If there is something specific that you feel you would like me to write about, drop us a note at [email protected] (and put “blog” in the subject line). Thank you!