Imagine you are watching TV and a commercial comes on about dental implants.  You might think, “Wow, it’s amazing what they can do these days!”  You may also say to yourself, “Gosh, I could never afford that,” or in disbelief you could say, “Yeah, so what’s the catch?”

While marketing of dental implants has been largely successful, the communication of basic information has not.  So let’s get to the basic question at hand: what are dental implants?  In this post I will share with you the answer to this question and three others: How do they work?  How are they different from natural teeth?  And finally, are they worth the cost?

What are dental implants?

Put very plainly, dental implants are small posts made from surgical grade titanium that are placed in the jawbone to serve as artificial roots for a tooth.  Most often we think of dental implants being used to replace a single tooth.  But actually, dental implants can serve in a wide variety of applications such as extra support for dentures or partials and full mouth reconstruction.

Traditionally, we have used dental bridges to replace a single missing tooth.  That is, the teeth on either side of the gap are shaved down to receive dental crowns, or caps, and two crowns are made for these teeth with a false tooth bonded in the middle, creating a “bridge” to fill the gap.  This dental bridge is then permanently cemented in place.

There are several disadvantages to this process.  First, sometimes the teeth on either side of the gap are healthy and don’t need treatment, so we sadly end up shaving down two healthy teeth to replace one missing tooth.  Second, you cannot pass dental floss between the bonded teeth in a dental bridge, so cleaning underneath a bridge can be quite difficult.  This increases the risk of decay in these areas, and fixing such decay often requires removal and remaking of the bridge.

Now, let’s look at the same situation but instead of a dental bridge, we’ll replace the same missing tooth with a dental implant.  This process does not require us to treat the adjacent teeth, so otherwise healthy teeth do not have to be unnecessarily shaved down.  A single implant-supported tooth stands alone, and can be cleaned and flossed like a regular tooth without the extra effort required to clean around a dental bridge.  Finally, dental implants and their restorations are made of titanium and porcelain, respectively, and are therefore immune to the decay process!

In fact, research shows us that once an implant is properly placed and restored, and the patient does their part in properly maintaining it, research demonstrates implants have a 10 year success rate of more than 97%!

How do dental implants work?

Dental implants are surgically placed into strategic places of the jawbone.  Once an implant is placed, the bone around the implant will then integrate with the biocompatible titanium surface and lock the implant in place, a process termed “osseointegration”.  After a period of several months to allow for proper healing, the implants can then have teeth attached to them, a process we call “loading the implant”.  Implants can be loaded with single teeth, dental bridges, and denture attachments to name a few applications.

The healing process following surgery varies between the upper and lower jaw.  The bone in the lower jaw is much more dense than bone in the upper jaw.  As such, we generally allow for 4 months of healing time for implants in the lower jaw, and 6 months of healing time in the upper jaw.  Patient health also plays a factor in healing time.  For instance, we may choose to wait longer to load an implant in a patient with osteopenia or osteoporosis, as these conditions cause lower density in bone.  Loading an implant too early before the implant is properly integrated can lead to implant failure.

There are exceptions with loading times.  In the right conditions, we can sometimes load implants on the day of surgery, a process called “immediate loading”.  This is most often seen in cases where multiple implants in the jaw are used to support one prosthesis to replace all of the teeth.

Other times we can load implants 6 weeks or so after surgery, a process called “delayed loading”.  This technique is often used when an implant is intended to replace a single missing front tooth.  In a case like this, an implant is surgically placed, and after 6 weeks or so of healing a temporary crown can be made to attach to the implant to fill the gap in the smile and also influence how we want the gums to be shaped around the tooth to get the best final result.  After complete healing, the temporary crown is replaced with a final crown to achieve the desired esthetic appearance.  Generally for the back teeth we choose to wait the full recommended healing time before loading because these are the areas in the mouth that take the greatest chewing forces.

How are dental implants different from natural teeth?

Of course, there is never a dental restoration that will be better than a healthy natural tooth.  As such, there are some significant differences between natural teeth and dental implants that patients should be aware of.

First, a natural tooth has a structure that surrounds the root called the periodontal ligament.  This is illustrated in the image below by a thin, pink line surrounding the roots of the natural teeth.  Notice this structure is not present around the implant!  This ligament acts as a shock absorber for the tooth and bone when a person chews their food, or when they sustain mild trauma to the teeth.  A dental implant does not have such a ligament, but instead directly interfaces with the bone.  As such, they do not have the shock-absorbing capability of natural teeth, so care must be taken on the dentist’s side in designing the final bite, and care should be taken on the patient’s side to minimize the risk of trauma to the area.

Secondly, the gums around a natural tooth secrete a substance called gingival crevicular fluid which helps to flush small amounts of debris out of the pocket and also carries antibodies to directly attack bacteria that would cause harm to the tooth and soft tissues.  In a dental implant, there is no gingival crevicular fluid, meaning the natural defenses that protect the gum attachment of a natural tooth are no longer present.  This serves to emphasize the importance of the patient taking care to clean around their dental implants and to seek regular implant maintenance from their dentist to ensure the hard and soft tissues around their dental implants remain healthy.  Specialists have found that the only adequate way to properly clean the gum pocket around an implant is with a product called a Water Pik, which we recommend to all of our patients who receive dental implants.

Are dental implants worth the cost?

Here’s the burning question!  At this point you may be thinking “everything we’ve talked about so far is great, but how will that change once we put dollar signs to it?”

Let’s use the example of a single missing tooth to answer this question.  You are faced with the choice of replacing the tooth with a dental bridge for $3750, or replacing the tooth with a dental implant for $5000.  It is true that you will save more up front with a dental bridge.

Now, let’s follow this scenario 10 years into the future.  We mentioned earlier that a review of the literature by implant guru Carl Misch demonstrates implants have a 10-year success rate of 98%.  Other research studies reviewed by Misch have found that bridges to replace single teeth have a 10-year success rate of around 88-90%.  If we follow that to 15 years, implants are still holding strong at 95% or higher, whereas bridges have dropped to 70%.

A 3-unit bridge to replace one tooth could cost $3900 today.  In 10-15 years after inflation, that same bridge could cost closer to $4800 or more.  Let’s say one of the teeth used to support the bridge has decayed enough to where it also must be extracted and replaced as well.  A 4-unit bridge then could cost over $6400 in 10-15 years.

After 15 years, the person with the $5000 implant is most likely needing no additional treatment with that tooth.  There’s a great chance the patient with the $3750 bridge is looking at paying another $4500-$6000 to restore the area again, bringing us to a total of $8250-$9750 long-term with a greater potential to lose more teeth in the area.

Now, suppose one of the teeth used to support the bridge is the very back tooth in the arch and that tooth now needs extraction?  We no longer have any teeth on which to place another bridge, and the patient is looking at either having 2 implants placed or having a removable appliance made to replace the missing teeth.

But insurance will pay for the bridge, right?  Yes, to an extent.  Let’s apply dental insurance to this scenario.  Your insurance plan may tell you it will cover up to 50% of the cost of a bridge.  However, a typical dental insurance plan has a maximum annual benefit of $1000.  This  has been the norm since the 1970s.  In reality, this will cover less than ⅓ of the bridge, bringing your initial out-of-pocket costs to around $2900.

For an implant, the surgery is not covered by insurance, but they may pay for up to half of the crown, which will lower the out-of-pocket costs of the implant process to about $4250.  Now, let’s fast forward 15 years like before.  Dental insurance will still likely only cover up to $1000 in a calendar year, so that $6000 4-unit bridge will require an out-of-pocket expense of around $5000 minimum.  Even with insurance factored in, your long term out-of-pocket expenses are still greater with a bridge than with a dental implant in this scenario.

The following table more concisely illustrates this potential long-term scenario.

	Dental Bridge	Dental Implant
Original Cost	$3900	$5000
Max insurance coverage	-$1000	-$750
Cost after insurance	$2900	$4250
Potential cost in 15 years	$6400	$0
Max insurance 15 years	-$1000	n/a
Long-term Total	$8300	$4250

This is not to say dental implants never fail.  They do, and there is an entire field of dentistry dedicated to researching, treating, and educating others to treat dental implant complications.  The bottom line is for the case of a single missing tooth, the implant has a significantly greater chance of long-term success and does not require the treatment of otherwise healthy teeth.  We still do dental bridges, and are careful to do them extremely well. But we will always discuss the well-documented, evidence-based advantages of dental implants so patient’s can make an informed decision for their oral healthcare.

Conclusion

Dental implants are here to stay, and the world is better for it.  Research and clinical experience have demonstrated their advantages and the exciting success rates.  We know how they work, why they work, and the dental profession has had great success with their utility.  The exciting part is, they are only getting better with more time and research, and clinicians are developing successful new applications every day.  Implants have already changed the lives of millions of people around the world.  If you believe you are a candidate for dental implants, please call us today!

References:
CHAPTER 1 Rationale for Dental Implants (Misch 1)
Misch, Carl E. Dental Implant Prosthetics. Mosby, 2005. VitalBook file.