Dr. Mintzer's "Take Home" message for Implants:
Implants are the state-of-the-art replacement for teeth, from a single tooth to all teeth. Our mission is to attempt to have our patients keep their teeth for a lifetime, and when that is not possible, to replace them with implants, still keeping the remaining teeth and new implants for a lifetime. Teeth are lost for only a limited number of reasons:
- They had decay that lead to restorations, from fillings & composites/bonding to complete crowns, sometimes with root canals.
- They broke, cracked or were traumatized.
- Their root canals failed. Half of the teeth I replace with implants fall into this category.
- They never developed or you were born without some of them.
- They became lost due to periodontal disease: Bone loss around teeth often associated with mobility or inflammation. Incidentally, if you have ever had a history of periodontitis, then you have a significantly higher chance of having problems with implants.
While implants are a good solution to missing teeth, it's important to know that implants are far from a perfect solution, and the only advantage of implants are that they can't decay and are resistant to fracture.
Who can place implants?
Legally, every licensed dentist can place implants without any special training. There are even a few dentists that call themselves "Implantologists," but this specialty does not exist or is recognized in the U.S. There are nine specialties taught in U.S. dental schools and implants are not one of them, strangely enough. Only periodontists and oral/maxillofacial surgeons were taught implant surgery or to place implants routinely as part of their dental "school" or residency training. A minority of Santa Barbara periodontists (exactly two of us) have had this third year of implant training as part of their residency. That being said, if you do something long enough and seek additional training, you should be able to do it well. There are a number of fine dentists that place implants for their patients. For clarification, see ADA Dental Specialties.
The problems with implants:
The disadvantage of dental implants are that they are prone to Peri-Implantitis or Peri-Implant Disease. This is because only the bone attaches to implants and not the gum. This is a critical distinction: Hygiene is more important for implants, in may ways, than for teeth. I encounter many people who thought that, "Well, I have implants so I don't have to worry any more." This is far from the truth!
Peri-Implantitis usually occurs without any pain or discomfort, because there is no nerve in the implant, like a tooth.
The early signs of Peri-Implantitis include:
- Signs of bone loss on x-rays, especially "peri-apical" x-rays, which I advise should be taken at the same time as "bite-wing" x-rays.
- Signs of periodontal pocketing or inflammation around teeth or implants; e.g. bleeding or puffiness of the gums.
Moderate Peri-Implantitis occurs when
- There is more bone loss around the implant, up to half of the implant threads are without bone.
- Discharge is seen from your implant(s).
Severe Peri-Implantitis occurs when
- There is loss of more than half of the supporting bone. Treatable in some occasions.
- There is mobility of the implant. Untreatable, the implant must be removed.
I see the consequences of Peri-Implantitis almost daily and it's best treated if caught at an early stage. At the risk of seeming simplistic, it's like buying a new car and then refusing to change the oil or have it serviced. Implant "ownership" has requirements that place responsibilities on you, your hygienist and your dentist/periodontist. Your first and second set of teeth were pretty much "free" but they are the beginning of the story and not the end!
To "service" your implants:
Maintaining dental implants is an evolving art. In our opinion the frequency of Peri-Implantitis is high enough that, if you teeth were originally lost to periodontal disease, you should alternate your recalls between your family dentist and a periodontist, every 3-4 months. Dr. Mintzer or an experienced hygienist will provide a "cleaning" now referred by many names such as a Periodontal Maintenance Procedure, Supportive Periodontal Therapy, Prophy, Recall, etc. The name isn't nearly as important as what is done during this appointment.