Tooth loss from accidents, gum disease, failed root canals, or decay is common—in fact, one in four adults lose all their permanent teeth by age 74, according to the American Association of Oral and Maxillofacial Surgeons.
In the past, dentures and fixed bridgework were the standard options to help fill in the gaps, but dental implants have become a popular alternative in recent years, partly because of to their more natural look. But even though dental implants certainly provide a nice aesthetic result, replacing missing teeth is more than cosmetic.
Once a tooth is lost, the alveolar bone in the jaw that supports the tooth begins to disintegrate, which can affect the structure of the face, including the jaw and its joints and muscles if many teeth are missing. Remaining teeth are negatively affected, causing shifting and issues with bite (the alignment of the upper and lower teeth). This can result in difficulty chewing and poor nutrition. That’s why it’s best to replace missing teeth as soon as possible.
Pros of dental implants
A dental implant is a screw or framework made of titanium and other materials that supports a replacement tooth. Implantation is typically performed in several steps. First, an oral and maxillofacial surgeon anchors the implant into the jawbone where the new tooth will be placed. Three to six months later, after the screw has fully fused with the bone, a reconstructive dentist attaches a replacement tooth to a small metal post protruding from the implant.
Unlike bridges, implants don’t rely on neighboring teeth for support, which can help protect remaining teeth from damage. And, unlike dentures, bone loss is usually avoided since dental implants actually replace the tooth and its root.
Implants look and function like real teeth, with no telltale “clicking” noises or speaking and chewing difficulties that can occur with dentures. People in good health have the best chance for successful implants, but having health issues doesn’t automatically preclude patients from getting dental implants. Success rates of dental implants are lower in smokers, and chronic conditions such as diabetes can delay healing.
You’ll care for your implants in the same way you do for real teeth—with diligent oral hygiene and regular dentist visits.
Getting dental implants is generally considered safe, but as with any surgery, complications may occur, including bleeding; infection; and nerve, sinus or nasal cavity injuries. Other points to keep in mind:
■ Dental implants aren’t a quick fix. Multiple steps are involved—including waiting up to six months for the implant to fuse with the jawbone, a process called osseointegration. (A temporary tooth may be worn over the implant site.)
■ Infections can still happen. The gum around the implant can be infected by bacteria, triggering periimplantitis, a periodontal disease that can result in bone loss.
■ Additional dental work may be needed. If your jawbone is weakened by osteoporosis, for instance, the surgeon may graft bone onto the weakened portion. Your sinus cavity may also have to be lifted (sinus elevation) if it’s enlarged and pushing into the area that needs a bone graft.
■ They’re costly. Insurance doesn’t typically cover implants. Expect to pay several thousand dollars for a single implant to tens of thousands for multiple teeth.
Despite these drawbacks, implants are a safe and reliable option for older adults. Surgery has a success rate of more than 90 percent, and implants can significantly improve quality of life.
Treat or replace?
While replacing already-missing teeth with dental implants has known benefits, extracting teeth with the purpose of replacing them with implants typically shouldn’t be done without first trying to preserve teeth. A team of researchers, in a review published in October 2013 in the Journal of the American Dental Association, expressed concern that the procedure’s popularity could lead some clinicians to remove teeth that are salvageable and replace them with implants with no reason to do so.
After analyzing 19 studies involving implant or tooth survival rate, researchers found that the survival rate of implants didn’t surpass that of teeth that were compromised but had been treated and maintained. In follow-up periods of at least 15 years, the rate of tooth loss was 3.6 to 13.4 percent in those with compromised teeth and 0 to 33 percent in those with dental implants, leading the researchers to recommend preserving natural teeth for as long as possible.
Dental implants may be the best option to replace missing teeth or ill- fitting dentures— they have a natural look, better functionality, and the ability to prevent bone loss. They can improve chewing ability, speech and self- confidence. Moreover, dental implants are considered long-term replacements that can last a lifetime, while bridges and removable dentures may need replacing every seven to 10 years.
For teeth that aren’t yet missing, however, it’s reasonable to try to maintain them as long as possible—surgery is not without risk, and extraction of a diseased tooth can always be done in the future as necessary with an implant at that time.