Implants
Implants are increasingly popular. In the USA alone, more than 150 implant companies now exist. An implant is not like a filling where any dentist can readily treat it. Implants are brand-specific with their own unique parts, tools, and designs. An internet search will show you the dominant names in implant manufacturing. Less established companies can appeal with various methods, such as lower prices. If the company goes out of business, discontinues its production line, or the dentist who provided the implant is no longer available, parts and tools to service the implant may become difficult or impossible to find. So research the suggested implant before you receive it, and don’t be afraid to get a second opinion!
In addition to USA-based implant companies, other countries have their own vast array of implant manufacturers and designs. All these implants can have specific parts, tools, and protocols. Another dentist may not have the equipment to service your implant should something go wrong, especially if you are leaving the country, have a less common implant, or if you get a new dentist that uses a different system. You may consider purchasing some service parts for your own implant from the manufacturer. This would primarily include retention screws and the driver kit (the “screw drivers”). Your dentist may advise some other specific parts. It may cost more up front, but if you find yourself in a circumstance where providers don’t have the parts or tools to service your implant, the dentist that agrees to fix it will likely have to charge you for the equipment they order, the treatment, and an hourly rate, which can come close to, or exceed, the cost for buying the parts yourself up front. The tools will likely remain in the dentist’s ownership once you’re finished as well.
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The specific type of implant someone has can be difficult or impossible to identify without documentation (do you know what type of implant you have?). With the numerous brands of past, present, and future implants on the market, it can be very helpful to keep a personal record of your implant’s specifications should it ever be needed in the future.
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“Implant clinics” are becoming an increasingly popular presence in modern society. In the same way “veneer only” offices were mainstream before the great recession, these offices ride a profit wave and tend to satisfy only the immediate need. If you receive the popular “all-on-four” or “all-on-six” implant configuration, where a dentist places 4-6 implants, and then screws an entire arch of teeth on top of them, these offices plenty often will not offer cleaning services for the prostheses, and have you sign an informed consent acknowledging such things. It is vital that you have follow up care with an office that can remove the teeth from the implants, desirably every 12-24 months, to clean the residue beneath them. While popular for their psychological comfort, arches of teeth screwed onto implants have some serious shortcomings, one of them being the difficulty to sufficiently clean them at home, and the in-office maintenance care they require. A dental office removing the implant teeth to clean them ever 12-24 months may need to charge $300-600 an hour for the service, or even more, and this expense can be difficult, resulting in patients choosing to defer the service. It is very important to continue proper recalls and understand the long-term financial commitment, otherwise, bone loss around the implants may result, and implant loss may follow.
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When it comes to implants that restore an entire arch of teeth, the typical foundations are the popular “all-on-four” or “all-on-six” implant & teeth sets, which describe a dentist placing either 4 implants to hold an entire arch of teeth, or 6 implants. The teeth are then screwed onto the implants. There are serious differences to consider which may not be apparent at first. The “all-on-four” option is appealing for price, and it is marketed heavily. Less implants means less expense, thus saving several thousand dollars up front. The downside is if one implant fails, which can happen often, the entire case fails and you will not have enough implants to hold all the teeth up. You then have to transition to a removable denture, and pay the full fee to do so. This is in the informed consent you sign, possibly in very fine print. Should this happen to you, the expense for all this dramatically exceeds the initial up front fee for the “all-on-six” option. With six implants holding an entire arch of teeth, you can lose two of the six, and potentially still have everything work. This makes the “all-on-six” arrangement superior in almost all comparison.
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Interestingly, the profession of dentistry does not have an official timeframe an implant should perform to be considered successful. Implant longevity varies dramatically, some lasting several years, some performing beyond 30 years with minimal problem. Most implants will lose some bone naturally each year of performance, and as a result a pocket will develop in the gums around an implant which then traps increasing amounts of food and bacteria, resulting in continual bone loss. There is no method in existence yet to stop this natural phenomenon. Ideal oral hygiene mitigates this the best. A general timeframe for long-term success is an implant performing between 10 to 20 years, and some beyond.
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Dental implants have incredible marketability and are the latest-and-greatest hype in restoring teeth. It is important to avoid offices that are quick to condemn a tooth and advance straight to implants. Due to the variation in longevity seen in implants, it is more prudent to follow the following philosophy: implants are great for replacing missing teeth, root canals can save existing teeth. It is better to save an existing tooth if it can carry a good prognosis, than extract it and hope an implant can perform as well. Most do not in this author’s opinion. Even getting an endodontic consultation or second opinion before an implant can be invaluable. Implant technology has improved greatly, however, so have root canals. The root canal experience has become more comfortable and simple. If a tooth may be saved by a root canal, as opposed to an extraction and an implant, the root canal should be strongly considered. Root canals often last 10 to 20 years, or more, which is similar to implant durations. After decades when a root canal may fail, an implant may be properly considered. This puts you 20 years ahead of needing an implant, and saves thousands of dollars.
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If your implant crown has come loose several times and had the same inner screw tightened several times, inquire with your dentist about swapping out the existing screw with a new one. The same implant screw should not be tightened multiple times over, due to the risk for it breaking and getting stuck inside the implant.
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Less-known details about implants:
- Implants have to be cleaned just like regular teeth or they will get gum disease.
- Implant crowns may come loose over time and need retightening and additional financial expenditures.
- “Same day implants” are common in advertising. Most implants require 3 months for a bone graft, 3-6 months for healing following implant placement, and up to a month to make the crown. Most implants take up to a year to reach final completion. Same day implants have a substantial risk of bone loss resulting in permanent cosmetic and functional defects.
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Smoking or diabetes will result in delayed or altered healing, less bone regeneration, and a decreased overall prognosis in recently placed implants, and likely result in a shorter lifespan of the implant. It is advisable to stop smoking for 1-2 months after implant placement, and to consider complete smoking cessation for the best long-term results. Diabetics will need to maintain good glycemic control, defined as an HbA1c of 6.4 or less. If your HbA1c as a diabetic is above 6.4, your implant may lose bone faster than average and lead to premature failure.
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Long term can be less predictable with implants. This can occur biologically from bone loss or other sequela which jeopardize integration, or mechanically, which includes screw or implant fracture and non-restorable conditions, as well as the availability to find parts or tools to service the implant. A standard implant length is 9-12 millimeters. Implants lose a certain amount of bone every year, usually 0.1-0.3 millimeters. In some cases, bone loss can be dramatic and exceed 0.5mm per year. This bone loss is a strong predictor of long-term implant success and varies by each individual.
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Don’t forget! An implant must be restored in a timely manner (3-12 months), or restorative complications may arise, such as adjacent tooth migration rendering restoration of the implant difficult or impossible.
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Implants will require maintenance throughout their service lifetime. Fees may be billed anywhere from $300-600 an hour depending on the dentists’ time, or specialty. Fees for necessary parts may also be applied on top of this. Such expenditures are not found in other areas of dentistry regarding alternative restorations.
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Because implants are typically made of metal, There is the potential for a gray metal band or hue to become visible at or beneath the gumline at some point in the implant’s lifespan, which may be permanent. This should be considered when thinking about keeping a natural tooth or resorting to an implant.