AAMC Magazine

Fall 2002

Dental Implants: Something to Smile About!

The days of covering your mouth when you laugh to hide a missing tooth have all but disappeared. Oral surgery has advanced to provide a number of highly successful options for people missing teeth. Dentures and bridgework, previously the standard option, now are being nudged aside by dental implants.

A dental implant is a titanium anchor attached to the jaw on one end and to a crown (or several crowns) on the other. However, when you lose one or more teeth, your jaw naturally shrinks, often making it inadequate support for an implant. Yet in the last decade, dental surgeons have begun adding or grafting bone to the jaw, thereby giving many patients the option of a more permanent replacement for lost teeth.

Dental implant surgery may increase recovery time, but for patients who live with dentures that may loosen in time because of jaw shrinkage, jaw reconstruction can mean a much more permanent replacement. And for those patients who are considering bridgework, dental implants can prevent filing down healthy teeth adjacent to the missing ones to create the “bridge” for the false tooth.

The success rate of jaw reconstruction is about 95 to 96 percent, says Dr. Cornelius Sullivan, Oral and Maxillofacial Surgery (OMS), chief of OMS at the hospital and one of four dental surgeons who perform jaw reconstruction at AAMC. The others are Dr. Clifford Walzer, Dr. Lubor Hlousek and Dr. Edward Zebovitz.

Dr. Walzer said for an implant to be effective, the jawbone must be high and wide enough to hold the anchor or “root” in place. While many patients have jawbones that are sufficient for implantation, about one fourth need jaw reconstruction for a dental implant. And it doesn’t matter what age the patient is. Older patients have equally good outcomes as younger ones, he said.

Jaw Reconstruction

Jaw reconstruction is sometimes performed in the dentist’s office. In cases where general anesthesia is used, reconstruction is performed at the hospital as an outpatient procedure. Each case is obviously different, but in general, a bone graft is taken from another part of the body and firmly attached to the jawbone with titanium screws. After several months, the screws are removed and a titanium implant or “root” is inserted. In a few months, the crown of the tooth is attached to the implant.

Dr. Zebovitz compares the process to building a house, with the house being the crown of the tooth, or the part of the tooth that’s visible above the gum line. “Before you start construction, you have to make sure the site is properly prepared. That is, you have to make sure the foundation—or the jawbone—will adequately support the footers, or the implant, which is the root of the tooth.” The graft is usually taken from the back of the jaw near the wisdom teeth or from the hip. After about four months, the new bone has grown over the jawbone. “It always amazes me to see it,” said Dr. Zebovitz. “You can hardly tell the difference between the jawbone and the graft.” The implant is inserted into the jawbone and the patient waits another four to six months for complete healing. “Then we attach the tooth or teeth to the implant,” said Dr. Zebovitz.

Jaw Reconstruction and Implant versus Dentures or Bridges

Bone grafts and a 10- to 12-month waiting period may seem like extreme measures to endure for implanted teeth. But Drs. Sullivan, Walzer and Hlousek, who do semi-annual seminars at the hospital about implantation, have found themselves speaking to packed audiences. “These are people who want to have teeth again,” said Dr. Walzer. “Maybe they couldn’t afford it earlier, or didn’t know it was available to them, but having a permanent solution makes a huge difference to their quality of life.”

“When you’re missing teeth, you’re limited in your choice of foods. It can make you feel isolated socially or on the job. It can affect your relationship with loved ones. And it can place stress on the remaining teeth, which can lead to further tooth loss as well as cause the jawbone to resorb or shrink,” said Dr. Hlousek.

Since implants are attached to the jawbone, they have distinct advantages over dentures or bridges. For example, Dr. Sullivan said implants allow for normal chewing so a person can enjoy foods previously too “difficult” to eat. It eliminates irritated and painful gums and improves speech often affected by full or partial dentures. There’s also an increased level of confidence knowing replacement teeth won’t move or loosen, and the patient regains the closest thing to the look, feel and function of natural teeth.

For more information, check with your dentist about your needs and options.

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