By Natalie Wong Camarata
(Updated: Oct. 8, 2014)

Planting Teeth

The 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, a dental implant prosthesis may be a restorative option compared to bridges or dentures. Dental implants are metal posts which are surgically placed in the bone under gum tissue. After the implants are inserted, bone grows around the implant during the healing period. A replacement tooth or crown is then attached to the metal post for a restoration that looks and feels like a natural tooth. For individuals missing all of their teeth, implants may serve to support a removable denture or a fixed restoration that doesn't need to be removed on a daily basis. Depending on the situation, the total treatment can take anywhere from a day to six months or longer.

Dr. Weltman

Dr. Robin Weltman is a board certified periodontist, the director of the advanced education program in periodontics, the director of advanced education and an associate professor in the Department of Periodontics and Dental Hygiene at the UTHealth School of Dentistry.

"Candidates for dental implants should be aware that the dimensions and quality of their jawbones will be determinants for the type of implant restorations best suited for their oral rehabilitation?" says Robin Weltman, DDS, MS, associate professor in the Department of Periodontology and Dental Hygiene at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry.

All adults in good general health who have lost some or all of their teeth may be good candidates for implants. Fortunately, most patients do not have many dental implant complications. However, problems can sometimes occur such as infection, rejection, dental implant overload (excessive biting forces on the implants), implant failure, implant bone loss, implant inflammation or incision opening.

In healthy individuals, high implant survival rates have been reported with more than 90 percent implants remaining in function for more than a decade, Weltman notes. Smokers or those who have conditions that affect systemic healing such as diabetes or immunocompromised disease are at a higher risk of implant failure, she adds. "While the literature has shown that the survival of implants in post-menopausal women taking oral bisphosphonate medications to improve bone density is similar to implant survival in women of similar age who don't take bisphosphonates, the effects of bisphosphonate drugs on bone metabolism may increase the risk of implant failure especially in one on intravenously administered drug preparations?" she says.

Implants are not recommended in those under age 15, since the facial structures are still growing. Studies have shown that even some patients in their 20s have jaw bones that continue to grow.

Better form and function

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."

Dr. Sudarat Kiat-amnuay

Dr. Sudarat Kiat-amnuay is the director of advanced education program in general dentistry and a professor in the Department of General Practice and Dental Public health at the UTHealth School of Dentistry.

"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, DDS, prosthodontist and professor in the Department of General Practice and Dental Public Health at the UTHealth School of Dentistry. "There is a higher failure rate for fixed bridges, especially the posterior ones, because they are hard to clean. Moreover, two natural teeth needed to be trimmed for fabrication of a fixed bridge."

In addition to their use as replacements for teeth, implants can be used to anchor the patient's dentures. 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, Kiat-amnuay says. "With new technique and technology in implant dentistry, we can now attach the prosthesis immediately after placement of dental implants in a day if the patient's bone structure, bone quality and anatomy fit the criteria," Kiat-Amnuay says.

Metal posts inserted into lower jawbone.

Metal posts inserted into lower jawbone.

Good enough for "C.S.I."

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," says Veronique Delattre, DDS,

Preparation for anchoring lower denture.

Preparation for anchoring lower denture.

forensic dental expert and professor in the Department of of General Practice and Dental Public Health at the UTHealth School of Dentistry. 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.

Completed dental implant of lower denture.

Completed dental implant of lower denture.

Delattre and Lillian C. Lyons, DDS, former clinical assistant professor in the
Department of Periodontics and Dental Hygiene at the dental school, worked to develop a forensic pictorial guide of dental implants aimed at helping forensic experts confirm when the procedure was done and identify the country in which it was made or performed.

Dr. Veronique Delattre

Dr. Veronique Delattre is a professor in the Department of Restorative Dentistry and Biomaterials at the UTHealth School of Dentistry.

How to find an expert

Dental Implantology is now considered a popular dental treatment in the United States and the costs are still high. More and more dental insurances start covering dental implants. Interested patients are encouraged to ask their oral health care providers about the treatment.

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.

These experts may include:

  • a periodontist, a dentist specializing in gum disease and surgery
  • a prosthodontist, a dentist specializing in the replacement of missing teeth and the restoration of natural teeth
  • an oral surgeon, a dentist specializing in treating and diagnosing defects, injuries and diseases of the mouth, jaw, teeth, neck, gums and other soft tissues of the head
  • a general dentist, a primary dental care provider for patients of all ages who diagnoses conditions and offers general treatments without specialty training.

Advanced education programs provide comprehensive didactic courses and clinical experiences in site preparation, implant placement and implant restoration, says Weltman. "Interdisciplinary use of the most current 3-D computer technology aides in the diagnosis and treatment planning of complex restorative cases."

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," Kiat-amnuay says.

Anchored dentures

"I would highly recommend this procedure to anyone, and it was definitely worth the investment," says Martha Rivas, who has worn dentures for more than 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," she says. "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!"

This article, which has been updated, originally appeared on HealthLEADER, an online wellness magazine produced by The University of Texas Health Science Center at Houston (UTHealth). Visit HealthLEADER for more articles on a broad array of health and wellness topics.