Dental implants are nothing more than artificial tooth root replacements.  The surgeon places dental implants in the area of the jaw where the restoring dentist requires roots in order to build a crown, a bridge or a more secure denture.  An implant is not unlike a foundation underneath a house; invisible to the casual observer but necessary for proper support of the final product.  An implant is made of titanium metal and is completely biocompatible-that is, accepted by the body without rejection.

2. How long does it take?

The duration of the implant placement procedure varies on the number of implants being placed.  The time could be as little as one half hour for one implant or as much as several hours for multiple implants.   During that time the patient receives local anesthetic and, optionally, a sedative for relaxation purposes.  In terms of total time from the placement of the implant(s) until the placement of the final restoration, the time varies depending on several factors.  These factors include whether the implants are placed in the upper or lower jaw, the quality of the bone in the jaw, the quantity of the bone in the jaw, etc.  A good basic guideline would be that the implants must settle and bond to the bone for approximately four months for the lower jaw and six months for the upper jaw.  After the bonding of the implant has occurred then the restoring dentist can begin the procedures necessary to make the final crowns, bridges, or dentures.  Therefore, a good basic guideline for time frame from start to finish would be approximately six to nine months with variability based on the factors described above.

3. Will it hurt?

Patients have described to us that the implant placement procedure is far more comfortable than what they had originally anticipated.  It has been described as being more comfortable than an extraction or a root canal procedure.   Patients are given a variety of medications to take before the procedure in order to reduce swelling, pain or potential infection.  Patients are also given strong pain medication to take after the procedure.   However, many patients find that they need to take perhaps one or two of the strong pain pills and then they find themselves comfortable within a day or so.  Many patients, even after multiple implant   procedures in one day, have found that they were ready return to work the following day.

4. How long will I have to go without teeth?

In most cases, the patient will not have to be without teeth at all.  We are often able to provide temporary replacement teeth the same day the implants are placed to allow for proper cosmetics and chewing function.  There are some exceptions to this rule, usually involving full denture cases.  Some of those patients may need to be without a denture for a period of five days or so during the most critical phase.  However, most people can expect to leave the office with temporary replacement teeth the same day the implants are placed.

5. How long do the implants last?

Implants have been phenomenally successful in the vast majority of patients.  Proper patient selection and proper technique are a must to insure a great longevity for the implants.  Once implants are placed properly, it is up to the patient to make sure that  they are maintained properly.  The dental office will provide all the information needed to accomplish this task.  Implant success rates of over 96% are not uncommon.  The small amount of failures that have occurred with today's modern implants are on those people who are  in high risk groups such as heavy smokers, diabetics, people with bone diseases, etc..  That is why various diagnostic tests and oral habit discussions occur before implants are placed.  Smokers can have very successful implants provided that they refrain from smoking during certain parts of the healing phase.  Even implants placed thirty years ago, which are not of the technologically advanced type being placed today, are still in place and servicing the patients involved.  There are no guarantees as to the longevity of any medical/dental procedure, but with proper patient  selection and proper maintenance procedures after implant therapy, an excellent prognosis is expected.

6. How do the implants look in my mouth?

In the vast majority of the cases, the implants are undetectable to the patient and anyone close enough to look in the patient's mouth.   We attempt to place implants under the gumline in an area where they are completely hidden from view.  All that should be visible in most cases will be the final prosthetic product such as the crown, bridge or overdenture.  In some rare cases involving an unusual gum or bone situation, a small amount of metal may be visible usually in a non-esthetic area.  Again, this is rare and should be discussed on an individual basis prior to implant therapy.

7. How much does implant therapy cost?

It is very difficult, if not impossible, to accurately determine the cost of implant therapy without an individual examination and consultation.   There are over forty varieties of implants available for use in oral rehabilitation, and an unlimited amount of situations present in the mouths of the patients requiring care.  A discussion with the patient concerning their needs, desires, and expectations is also needed to achieve the best end result.  And provided that a magnification corrected panorex film is available, a complimentary consultation can easily determine the exact cost of implant therapy for a patient's particular situation.

8. Will insurance help cover the cost of implant therapy?

Yes and no.  Yes if the need for implant therapy was created by a motor vehicle accident, some birth defects, or if there is a medical problem that has been created due to the inability to chew food (i.e. diverticulitis caused by involuntary diet restriction due to severely shrunken jaw bones that will not allow conventional dentures to be worn or worn comfortably enough to chew certain foods).   The most common insurance response to implant reimbursement is, however, no.   Insurance companies will often provide an alternative benefit for the implant situation.  For example, when a patient suffers a vertically fractured tooth and submits a claim for an implant and crown, the insurance company may offer a benefit for a three unit fixed bridge.  A prosthetic benefit may be paid on the prosthetic work after an implant has been placed.  This situation has been very frustrating for many years for implant dentists as well as patients.  There is no logical reason for insurance companies to deny implant coverage to the patient other than the insurance companies' unwillingness to spend any more than the minimum possible on insurance claims.   For these reasons it is best stated that insurance companies often provide reimbursement for acceptable services but not always for the best, or ideal service for a particular situation.

9. Who does the final prosthetic work (i.e. crown(s), bridge(s), and denture(s))?

The patient's general dentist is the quarterback of the implant team.  The general dentist will decide who will place the implant, what laboratory will make the final prosthetic products and who will actually do the prosthetic work.  Most commonly the restorative general dentist who suggests the need for the implant therapy to the patient will perform the final prosthetic services.  In most cases, the implant surgeon will place the implant and final abutment or post that is connected to the implant.  The general dentist will then use the implant and final abutment post to complete the necessary prosthetic work.  Some general dentists do not do any implant restorative work themselves, and will therefore make other arrangements with their patients for restoration of the final implants.  But as a general rule, general dentists will do the final prosthetic work themselves.

10. Are there any other pros and cons that should be discussed concerning implant therapy versus any other types of treatment?

Again, this is a highly individualized situation which therefore requires individual consultation to determine the best answer to this question.   As a general guideline, implants can allow the patients to get rid of removable appliances such as partial dentures and complete dentures.  Implants can also be used to stabilize very loose dentures.  To people who dislike removable appliances in their mouths, it would be very difficult to find many negatives in the opportunity to make their teeth  part of their bodies again.  In situations where the patient is trying to decide between an implant and a fixed bridge, there are several pros and cons which should be discussed.  Implants will allow the teeth on either side of the missing tooth space to be preserved in their current form and not drilled on at all.   A bridge closing the same space will involve the grinding down of the teeth on either side of the space.  Where this is not much of a concern in a situation where the adjacent teeth on either side of the space need to be crowned anyway, it is a concern in situations where the adjacent teeth are whole or only have very small fillings.   Grinding down virgin teeth also may run the risk of greater sensitivity on the teeth than if we had left them alone and placed an implant in the space instead.  The maintenance of an implant versus a bridge is also an important area to discuss.  A single tooth implant and crown may be maintained by brushing and flossing just like any other tooth in the mouth, whereas a three tooth fixed bridge will need to be maintained with special floss threaders or other instruments at home to allow for complete plaque removal in a situation where standard flossing cannot be accomplished. 

Dr. Banda writes a periodic column for the Observer-Eccentric Newspaper - article reprints are available upon request.
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