Part of my answer will be based on input from a colleague of mine, an experienced and talented implantologist, Dr. Tim Kosinski. Tim is in private practice in the Detroit area, and I’m interested in his take on implants and the advances that are rapidly improving dental implantation, giving patients ever more satisfactory results. I thank him for contributing his time and insights to this book.
Mary Sue Stonisch :
Tim, I think we all agree that good overall health is a must for anyone considering an implant. It’s about healing. Patients with diabetes, cancer, or rheumatoid arthritis, for example, would take much longer to heal, not only because of their illness but also because of the medications they must take. They may also be more susceptible to infection—a major consideration in surgery of any kind. Lifestyle choices such as use of recreational drugs also inhibit healing.
Tim Kosinski : You bet! I would add high blood pressure, Mary Sue, and diseases that suppress immunity, such as AIDS. Another factor is the patient’s own healing history. If you’re typically a good healer, you’ll heal faster, and if a slow healer, then more slowly.
Mary Sue : What about smoking?
Tim : Smoking is an absolute no-no for success with implants. Smoking decreases the blood supply to the bones and gums. Without an adequate blood supply, the bone doesn’t integrate into the sides of any implant properly and the implant can fail. It’s important for smokers to realize that the risk of their implant not succeeding increases dramatically.
Mary Sue : I would just add that, smoking aside, having an illness doesn’t necessarily mean you can’t have an implant. We just have to approach it with
more-than-usual caution. Your dentist will probably want to consult with your physician. In fact, I recommend getting an okay from your physician for the implant. It’s surgery, and your doctor should know about it in advance.
For your own safety, please give your dentist all your health information before decisions are made in order to avoid unnecessary and dangerous complications.
Adequate bone is another requirement. Implants need to be entirely submerged and anchored in the jawbone to be fully functional. If there’s not enough healthy bone or if nerves interfere with the location of the implant, a bridge or partial may be a better solution. On the other hand, with today’s technology, we can grow bone.
Tim : Yes, the patient has to have enough good bone that we can implant without damaging a major nerve that runs along the lower part of the lower jaw. If we harm that nerve, we cause numbness. In the upper jaw, we have the sinus, which is an empty space, an air cavity that allows our skull to be light and that warms the air. We don’t want a metal implant to protrude into that space for lack of bone.
Fortunately, we have a lot of new tools such as a CT-scan that allow us to evaluate in three dimensions the amount of bone we have to work with. And today, as you said, Mary Sue, we can grow bone. We can transplant bone from another part of the jaw, we can use synthetic bone, or we can obtain bone from a bone bank. Every situation is unique, so it’s important for the patient to work with someone who has the experience and skill to plan every step.
Mary Sue : Adequate gum tissue is needed too. Nature gives us thick, strong gum tissue wrapped snugly around each tooth to protect the root from infection and allow us to clean vigorously without pain or injury. Enough such tissue must be available for implants, which mimic the way natural teeth are anchored in the jaw and function in everyday life.
Tim : Sometimes, because of infection, loss of teeth, or age, there isn’t enough gum tissue left to service an implant. In most cases, fortunately, we can make up the deficit by grafting tissue to the gums before, during, or after implant placement.
Mary Sue : We also need enough room in the patient’s mouth to put replacement teeth. When people lose all or most of their teeth and don’t replace them, their bite—the distance between their jaws—collapses over time. This reduces or eliminates the room necessary for dentures or other appliances.
Tim : And let’s not forget adequate healing time. All the money, time, and energy expended by patient and dentist to create perfect implants will be wasted without adequate healing, which takes four to six months. The unfortunate result of hurrying the process will be an implant that fails to integrate properly with the jawbone.
Mary Sue : The best thing about implants is that they’re as close to natural teeth as you can get. Once they’re in, you can eat, live, and laugh without thinking about your teeth. And there’s a bonus—they don’t darken with age, as your natural teeth do.
Before we close, Tim, what’s on the horizon for implants?
Tim : Implant technology keeps on improving, Mary Sue. The materials keep improving and so does the design of implants, as well as the caps and crowns we use. Pretty much everything is going CAD-CAM, which stands for computer-aided design – computer-aided manufacturing. We have computer-generated sculpting and planning of the surgery. I’ve even heard of individual implants being created chairside that would fit the patient sitting there. The technology is progressing very, very fast.
Mary Sue : Thanks for your input, Tim!