Should you get a dental implant instead of a bridge?
Dr. Robert Heller of Oral Implants & Reconstructive Dentistry places a dental implant on a patient as his staff assists. (Photo courtesy of Midwest Implant Institute)
Just a few years ago, if you lost a front tooth, your dentist would recommend grinding the two adjacent teeth down to nubs and using them as anchors for a three-tooth bridge, thereby sacrificing two healthy teeth to replace one. Nowadays, you have an alternative that involves much less collateral damage: a single-tooth implant.
According to the American Academy of Implant Dentistry, about 3 million people receive 5.5 million implants each year in the United States, which is growing by an additional 500,000 more patients each year.
Dental implants are similar to traditional crowns, in which the root of a damaged tooth is capped. But when there's not enough left of the natural tooth to support a crown, an artificial root can be implanted to anchor the crown.
Inserting implants requires teamwork in an assembly that comprises three parts. The implant itself is a titanium post that the oral surgeon screws into the jaw. After insertion, tissues in the jawbone grow onto the post, affixing themselves like barnacles in a process called osseointegration. This creates a more stable and secure anchor for the crown.
Next, either the dentist or oral surgeon places an abutment over the top of the implant. The abutment juts out from the gum line as tissue grows over it. Finally, a prosthodontist creates a permanent crown that the dentist attaches to the abutment.
“The amount of implants I’ve done over the past five years has increased significantly,” reports Dr. Paul Tiernan, who opened his private practice in Santa Rosa, Calif., in 1991. “In the first 15 years of my practice, I hated implants because the product was terrible, but they’ve since come out with a much better structural integrity on the implant.”
According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), “Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.”
Risks of implant surgery
The AAOMS touts the procedures as having “an overall success rate of about 95% and almost 50 years of clinical research to back them up.” Even so, because dental implants require surgery, you always run some risk of complications. You might get an infection at the site of the implant, suffer damage to the surrounding teeth or blood vessels or experience nerve damage that can numb your mouth.
Sinus problems could result from implants placed the upper portion of your mouth, but “the old way of thinking where you’re not going to put the implant in the posture of the maxilla (upper jaw) is pretty much gone," says Dr. Tiernan. "The limiting factor of your lower jaw is your nerve.” While an oral surgeon can reposition that nerve — Dr. Tiernan says he has done that only once in his 21 years of private practice — most people will opt out at this point because of the risk of a numb chin and an extra four or so hours of surgery (with resulting higher costs).
In other cases, the bone doesn’t fuse to the titanium implant, which requires removal, cleanup, replacement and a few more months of healing. Other implant procedures that can prove tricky involve large bone grafts that can be unpredictable and can fail.
These risks are relatively rare, but the two factors that most affect the decision are time and money.
An implant procedure often takes two or three times longer than a bridge, though in a perfect scenario the time investment may be more comparable. Dr. Tiernan calls this a “slam dunk” and says, “The implant takes me less than 20 minutes to put in. You drill the hole, you screw it in and you put a healing cap on it. Two weeks after you do that, they’re chewing on it like it’s their own teeth.”
However, most take longer. For example, if the original tooth still needs to be removed, expect about two months of healing before you proceed to the implant. If you need a bone graft, tack on another three to nine months before the transplanted bone can support the implant. By comparison, traditional bridgework can be completed in two or three weeks.
Cost and insurance
In addition to the time spent, cost can be a big factor. Dr. Tiernan estimates that a single implant, a clean abutment and a reasonably priced crown will cost about $4,000, and the patient should expect to pay all or most of this. Unlike more traditional dental procedures, dental implants may not be covered by your insurance or may be covered at a lower percentage.
The most expensive part of the whole procedure is not the implant itself, but the crown, and it’s often the part that gives patients sticker shock. Whether you're having the crown applied to an implant or to the root of a natural tooth, the procedure and price is substantially the same. However, some insurance policies may not cover crowns that are applied to implants, so check with your insurance provider before deciding what to do.
Whether it's a crown or some other expensive medical procedure, you can find out how much it should cost in the Heathcare Blue Book. This is a free online guide that calculates the "fair price" based on surveys of what most health care providers have accepted from insurance companies as the full payment of a particular procedure. According to the Blue Book, the national fair price for just the crown is $861. If your dentist quotes you a substantially higher price, you can use the Blue Book estimate to negotiate for a lower amount, or you may decide to look for another dentist to do your crown.
Are you a good candidate for implants?
For a successful dental implant procedure, age doesn’t necessarily play as important a factor as much as health does. Because this procedure requires healing to work effectively, candidates who aren’t ideal include smokers, patients with weakened immune systems or patients with diabetes. You probably shouldn’t get an implant if you grind your teeth while sleeping. Also, oral surgeons generally rule out children because their jawbones have not yet matured.
The best patients are those with a healthy upper or lower jawbone capable of supporting the implant. “I’d say 99 percent of the success of your implants is in your workup,” says Dr. Tiernan. That workup includes examining the adjacent teeth, how they’re fitting together (the occlusion) and how the present condition of your mouth may affect the implant.
He also weighs his patients’ current state and history of oral hygiene. “I determine whether to do implants from what the patient looks like now and what he’s going to look like ten years from now," he says. “If somebody hasn’t been taking care of his teeth very well and you pump in a couple of implants, how long do you think those implants are going to last?”
Dr. Tiernan recommends an implant instead of a bridge for broken or infected front teeth with healthy surrounding teeth. But if your adjacent teeth have had a root canal, have crowns or are missing, you may want to consider a bridge instead.
If you have extensive bone loss, your oral surgeon will have to place a bone graft to support the area. For Dr. Tiernan, one thing is more important than good bone. “If you have good soft tissue around an implant, you’re going to have a successful implant for a very long time.”