REVIEW
Dental Products Report / September 2003
Implants Reference
A Patient’s Guide to Dental Implants covers such topics as: who is a candidate for implants, advantages of dental implants, and stages of the implant process, implant placement, abutment connection surgery, prosthesis development and final restoration. Authored by implant specialists Drs. Thomas Balshi, William Becker, Edmond Bedrossian, and Peter E. Wöhrle, the 130-page book features 55 photos and illustrations, including several full-color patient before-and-after photos.
Addicus Books Inc.
www.AddicusBooks.com
REVIEW
Journal of Prosthodontics, Vol 14, No. 1 (March), 2005, pp 73-74
A Patient’s Guide to Dental Implants
Balshi, Becker, Bedrossian, & Wöhrle
Good patient education literature is hard to find, particularly when it comes to dental implants. Currently available patient education tracts are uniformly designed to sell a commodity, to raise prospective patient’s enthusiasm for choosing implants for their treatment. By the same token, these books generally fail to offer an unbiased discussion of dental implants, neglecting the inherent risks, potential disappointments, and other treatment options available. For these reasons, they fall short of educating patients to the degree necessary to give a truly informed consent. With this in mind, A Patient’s Guide to Dental Implants is a pleasure to find.
It must be made clear that this volume is designed to be a health improvement book for the consumer market, even though it has found considerable interest within the dental community. It was compiled by a team of authors who enjoy an enviable professional reputation and have extensive writing experience. Together, they provide a balanced perspective of the clinical fields of interest necessary for success in implant dentistry.
The uninitiated reader will be pleased to find that the text follows a logical progression of topics covering: (1) how implants work (2) a comparison of implants with other treatment approaches, (3) common questions patients ask, (4) a step-by-step discussion of the surgical and prostthodontic procedures, and (5) care and maintenance of implants. Plain language is used to introduce these concepts, making them accessible to readers of a variety of educational levels. Common questions are answered directly, and the discussion is accompanied by clear diagrams which illustrate the text’s main points. The book also includes a comprehensive listing of other readily available sources of information (ADA, implant focused organizations, etc.) and how to reach them, including website addresses for readers who wish to broaden their information search. Finally, there is a useful glossary of terms.
Although it not wholly with its moments of bias, this book comfortably meets the goal of providing a basis for the process of informed consent. It provides a good comparison of nonimplant and implant treatments as well as a realistic picture of the risks and expectations accompanying implant treatment. In chapter 5, the authors provide an excellent narrative of what a patient can expect during and following the implant placement procedure. This narrative would be particularly useful in reassuring anxious patients by allowing them to become familiar with, and therefore desensitize themselves to, each procedure before it is encountered. Further expansion of the narrative section dealing with the prostthodontic procedures would be welcome.
The book could be further focused by deleting occasional sections that do not speak directly to the mission of informed consent (e.g. Why We Lose Teeth?), but as this is a book written for the popular press, the inclusion is logical. The authors still tend to oversell implant treatment just a bit, which can be excused, however, given the lifetime commitment they have made to implant treatment.
Even though the book is priced very reasonably, the 106-page volume is probably too expensive to provide a copy to every prospective implant patient. It is, however, inexpensive enough that every practice could have 1 or 2 copies to place on the waiting room table, or to loan to those patients who need more time and information before making this important decision.
Charles W. Wilcox, DDS, MS, FACP
Associate Professor, Department of Prosthodontics
Creighton University School of Dentistry,
Omaha, Nebraska
ARTICLE
Bottom Line/Personal
Vol. 30, Num. 23, December 2009
Dental Implants: Two Breakthrough Treatments
Edward Bedrossian, DDS, author of A Patient’s Guide to Dental Implants
For generations, removable dentures were the only option for replacing teeth lost to decay, infection or injury. During more recent decades, dental implants have offered a more comfortable and natural looking alternative. And recent advances in dental technology—including “immediate loading” and computer guided insertion—have made implants more convenient and efficient.
Why Implants
Implants have several advantages over traditional bridges and dentures…
Bone health. Like other types of bone, jawbone requires pressure to remain strong. Biting with natural teeth transfers pressure via the root into the bone, but this force is lost when teeth are removed and one is chewing with dentures. Over time, the bone shrinks and deteriorates in a process called resorption.
Implants allow pressure to be transferred through the post into the bone during chewing, mimicking the pressure from natural teeth and helping maintain the jawbone.
Comfort. Implants do not irritate the gums or interfere with chewing, taste or speech, unlike dentures. They allow you to chew any and all types of food.
Cost
The main drawback of implants is the cost—approximately $2000 to $3000 per tooth for implant surgery, plus $1800 to $3000 per tooth for the crown. When a full arch is being replaced—the entire upper set of teeth or the entire lower set—$30,000 per arch is an average estimate. Insurance typically does not cover implant surgery, although some plans may reimburse part of the cost of crowns.
Three Stages
Traditional implant surgery is a three-stage process over several months. Your own dentist may be trained in performing implant surgery. More likely, an oral surgeon or a periodontist performs the surgery (in consultation with your dentist), and a restorative dentist makes and fits the crowns.
Stage 1: Insert the implants. After the dental professional has performed an examination and taken X-rays, implants are custom-ordered to the precise size. During the first surgery, lasting one to four hours under local or general anesthesia, the surgeon places the titanium implant (or implants) by making small incisions to lift away the gum, drilling a small hole, inserting the post and suturing the gum closed.
The jawbone then is give three to six months to fuse the implant before the tooth-like crown is placed. This fusing process is called osseointegration, is essential to the success of the implant.
Many patients are surprised to find that they have less discomfort after surgery than they expected. One to two days rest at home is enough for most patients, and pain can be managed with over-the-counter pain relievers and prescription medications, such as Vicodin. Applying ice to the jaw keeps the down the swelling.
Helpful: A rinse of warm water and salt (one tablespoon of salt in a cup of warm water) should be used four to five times a day, especially after meals, starting on the morning after surgery.
Slight bleeding is not unusual. One way to stop bleeding is to double-wrap a tea bag with slightly dampened gauze and gently bite on it for 45 minutes. Black tea helps the blood to clot.
Only soft food should be eaten for the first few weeks after surgery. If the implants are disturbed during the early stages of healing, osseointegration will not occur.
Be gentle brushing the surgical areas. Do not use and electric toothbrush during the three-to-six month period of implant healing.
During the months after the titanium screw is put in place, the space above it—where the crown will be—usually is left empty if the tooth is in the back of the mouth. If the missing tooth is in the front, the patient is given a temporary, removable denture.
Stage2: Connect the abutments. Three months (for implants in the lower jaw) to six months (upper jaw) after initial surgery, the implant is uncovered and checked manually by the doctor to make sure osseointegration has been successful.
If the implant is firmly rooted in the jawbone, then the surgeon connects the abutment—the foundation for the new tooth—to the implant and places a temporary crown on it. An impression of the mouth is then made for use in making the permanent crown.
Depending on the number of teeth to be replaced, it may take one to eight weeks for the new crowns to be ready.
When many adjacent teeth are being replaced, a special bridge often is used instead of individual implants and crowns. Similar to a traditional bridge, the implant bridge attaches to the titanium implants rather than to other teeth.
Note: If the implant moves at all—which happens in as few as 3 percent of cases—the implant has not fused to the bone, the procedure has failed and the post must be removed.
After allowing about three months for the bone to heal, the procedure can be tried again. Further implants are likely to be successful.
Stage 3: Complete the restoration. The crown is fitted to the abutment. This phase is called loading the implants.
Care afterward—brushing and flossing—is the same as for regular teeth.
Newer Options
Immediate loading. Some specialists use an accelerated process in which they insert implants, attach abutments, and place temporary crowns during a single session. The patient still must eat soft foods and return in several months—after the bone has fused to the implant—for a permanent crown.
In addition to being convenient for the patient, immediate loading helps preserve surrounding gum and bone by more quickly filling the gap left by missing teeth. It can be a good option for people with receding gums and for patients missing a few or all of their teeth.
The procedure requires a great deal of technical skill—not all dentists are familiar with the procedure—and it costs more than traditional implants.
Computer-guided insertion. Using a CT scan of the patient’s jaw, the dentist plans the position of the implant on a computer. A laboratory makes a surgical template (similar to a drill press) to fit the patient’s mouth. The technology makes it possible to place implants by drilling through the gum without making incisions. The goal of this treatment approach is to place the implants, connect the abutments and secure the temporary teeth all in a single session. After three to six months of osseointregration, the final bridges can be made.
Who Should Avoid Implant Surgery?
Though many people can benefit from implants, they are not appropriate for everyone.
Usually children under 18 should not have implants. The jaw and teeth need to have stopped growing before the procedure is performed.
Smokers have a higher implant failure rate than nonsmokers. Smoking impairs blood circulation and healing, increasing the likelihood that the implant will not fuse to the bone.
People with uncontrolled diabetes are not good candidates for implants, because diabetes is associated with bone loss, gum loss, and difficulty healing in general. Implants can be considered after diabetes is under control.
Patients who have lost substantial bone from the jaw generally are candidates for replacement of all their teeth with the immediate-loading approach. However, in rare cases, if bone is not available to accommodate implants, bone grafts—using bone from elsewhere in the patient’s jaw or body—can sometimes heighten or widen the jawbone enough to make implants possible.
Bottom Line/Personal interviewed Edmond Bedrossian, DDS, director of implant training at The University of the Pacific Oral and Maxillofacial Surgery Residency Program in San Francisco. He also maintains a private practice in San Francisco and is a fellow of the American College of Dentists (FACD) and fellow of The American College of Maxillofacial Surgeons (FACOMS). Dr. Bedrossian is co-author of A Patient’s Guide to Dental Implants (Addicus Books), as well as three dental textbooks.
