What to know about dental implants

If you are missing a tooth, or multiple teeth, you may be a candidate for dental implants.

But knowing if dental implants are an option is specific to each individual according to Dr. Christopher Barwacz, associate professor and department executive office of Family Dentistry at the University of Iowa.

“Previous to implants there were various modalities to replace missing teeth,” Barwacz said. “If you were talking about a single missing tooth a bridge was a very common modality to use and still is to this day but is becoming less common. There were also removable devices, such as partial dentures if you were missing multiple teeth.”

Today, dental implants are a state-of-the-art option for tooth replacement in dentistry.

“Probably the most common patient that we see, in terms of frequency is patients who are looking to replace a single tooth, either that they've already lost or maybe they've had several procedures on that tooth and it has been deemed nonrestorable, meaning it can't be saved,” said Barwacz, noting that this can occur from an infection, loss of tooth structure or trauma for instance.

“Dental implants are state-of-the-art in terms of replacing a tooth because we can be less invasive and not disturb surrounding teeth,” he said. “Whereas with a bridge, we’d have to prepare the adjacent teeth on either side of the missing tooth to anchor the bridge.”

Age is also a factor to consider, Barwacz said. “We definitely want to make sure patients are fully grown for dental implants,” he said. “For most patients we don't start treating them until their skeletal growth is complete…usually no sooner than the late teens and early twenties.”

“I would say the majority of patients tend to be middle aged or older,” he added, “but tooth loss can happen really at any age.” He noted that some older patients come in because they have lost several teeth to periodontal disease and are looking for assistance with implants.

While dental implants can be conservative in impacting other teeth, Barwacz said it can be more involved surgically to prepare for the implants and can also be costly.

“Some patients come in and they've already been missing a tooth for several years,” he said, noting that financial or other life circumstances may have kept them from getting care sooner. “They come in at a point in their life financially and mentally to move forward and actually replace a missing tooth.”

But it is likely they will be seeing more than one dental professional. “Dental implantology tends to be on average more of a multidisciplinary type of treatment because usually we're involving an oral surgeon or a periodontist in conjunction with the restorative dentist or their general dentist, Barwacz explained. “The amount of that multidisciplinary nature is going to be based on how complex the situation is. So if we're talking about a single implant, some general dentists do have training and, and place their own implants and restore them in their offices. Other times you may have your case sent to a surgeon.”

Timing can be important, Barwacz said. “There's not a keen awareness by the public that the bone around our teeth is really there just to support our teeth. What often happens if a patient lost a tooth, either due to trauma or it being extracted…there's a series of events that the body naturally goes through where the bone in the jaw that's basically there to support the root of the previous tooth tends to undergo a process of resorption or atrophy.”

If a patient loses a tooth and three years later they decide they are ready to move forward with an implant to restore this tooth, they may have to have bone augmentation to rebuild the bone that was lost by the body economizing.

“If a patient knows they're about to lose a tooth, we can manage those situations more effectively because we can extract the tooth and do some grafting procedures called bridge preservation where we basically place a bone particulate graft into the extraction socket to mitigate or minimize some of those restorative processes that the body naturally will undergo,” he said. “For a patient who really didn't have a plan of action or maybe he wasn't seeking care at that point, when they are ready to proceed with implants oftentimes we have to reconstruct that ridge because we can't place an implant if we don't have a solid foundation of bone.”

Dental implant technology, not surprisingly, just keeps improving as well. “I would say one of the things that's probably changed the most is that when dental implants first came out, there was a lot of research going into how to make them more surgically predictable in terms of minimizing bone loss and maximizing stability of the implant over the lifetime of the patient but that has all become fairly routine,” Barwacz said, noting they are very highly successful today in the 90th percentile. “So what has really changed, I think in the last 10 to 15 years is the technology of how this therapy is executed. We're using a lot of virtual planning software, including 3-D printing as well as virtual scanning technology to plan the implant and create a 3-D printed surgical guide that basically allows the surgeon to place the implant exactly as it was virtually planned.”

He noted this minimizes surgical complications and time the patient spends in the chair for surgery. “Prior to those technologies, the surgeon would have to open up a site and they may not know exactly what they're walking into, but now with three dimensional radiographic imaging, oral scanning, 3-D printing, we really have a software packages that allow you to plan and know what you are walking into.” This also allows the patient to have a clearer understanding of what they will be undergoing. “It makes the patient more a part of the process compared to what it may have been 15 to 20 years ago.”

That said, dental implants often take a bit of a time commitment. “Unlike a bridge which can usually be done in a couple of visits and fairly rapidly within a couple of weeks from start to finish, implants can often take months and sometimes up to a year depending on the complexity,” said Barwacz. “So even though it can be more conservative, and I think patients prefer an implant if given all the options because it's essentially like having their natural tooth, it's definitely the most time cost and resource-intensive type of therapy compared to other treatment modalities.”

All these factors in mind, the key in deciding if dental implants are an appropriate choice for you is having a provider you know and trust. “I think the most important thing for patients is that they have a dental home and somebody that feels comfortable managing an implant case,” Barwacz said. “If your dentist doesn’t feel comfortable, there's nothing wrong with being referred to somebody who has more expertise and feels comfortable managing an implant case.”