For those who can afford the treatment, the possibility of replacing teeth with implants has offered a major advance in oral health.
But in the almost 30 years since the procedure was first offered as an alternative to bridges or dentures, issues have emerged, even as the science has advanced.
I learned about some of this first-hand because of problems that developed with one of the half-dozen implants in my mouth. The surgeon who discovered bone loss around it referred me to an expert – periodontist Véronique Benhamou, who specializes in installing implants and dealing with problems that might have developed.
Dr. Benhamou is a Moroccan-born McGill graduate with degrees in Science and Dentistry and a three-year residency at Boston University in periodontics. She is an associate professor at McGill’s dentistry faculty (she directed the periodontics department at McGill for 15 years) and this year serves as president of the Quebec Federation of Dental Specialists.
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How do implants work? The surgeon installs a titanium-alloy screw to replace the missing root and it is then used to support a porcelain crown.
In my case, she examined the bone loss around one implant – caused by the inflammatory process that damages the tissues that surround implants. She treated the infection, cleaned the gum area, and inserted freeze-dried bone material to replace what was lost. She estimated a successful outcome at 70 per cent.
Some 30 years ago, dentists believed that the success rate, after a surgeon installed a titanium anchor was about 98 per cent.
Since then, there have been changes in materials, and the best of the newest models result in “a better fit” when it comes to the implant holding on to the bone, Benhamou said. There have also been changes in “very strict protocols,” when only highly trained specialists performed the procedure.
“This is one of my pet peeves. Some of the implants available on the market, usually those from the leading companies, have been subjected to rigorous testing. Then there are the ‘copy cats’, smaller companies that design similar implants that do not have the same rigorous testing behind them.
“As specialists, we should be explaining what we are going to do, and that the price can change depending on the materials. Some professionals will charge the same but use cheaper implants.” Patients should ask for the advantages of various materials and the relative cost.
“The advantage of going with bigger companies (implant manufacturers) is that they have been around for a long time, and maintain an inventory of implants. As the implant industry grows, some people will have had older implants and will need replacement parts. The bigger companies maintain that inventory, the smaller companies don’t.”
As implant surgeries became more popular, “the envelope of the protocols has been pushed further and further.”
There was pressure to complete the process faster and not to wait for complete healing and as a result “we can no longer rely on the success rate of 30 years ago.”
The reason for complications after a successful implantation depends partly on the ability of the surgeon, but there are other reasons.
Newer implants have “very rough surfaces,” but over time, “the roughness becomes a problem because the bacteria in the mouth will enter the nooks and crannies of the rough implant and cause more damage, or more bone loss.”
There also are general health factors that have an impact on whether an implant develops complications. “Research shows that people who have a history of gum disease are more likely to have problems with their implants,” she said.
When she places an implant, Dr. Benhamou insists that patients return once a year so she can detect any sign of complications as early as possible.
The usual protocol for replacing lost bone is to use freeze-dried human bone. Alternatives include bovine bone and synthetic material.
Since the procedure is fairly expensive and often not covered by group insurance, some North Americans are resorting to so-called dental tourism and flying to Costa Rica, Mexico, Cuba, Columbia, Peru, Turkey, Czech Republic, Romania, Thailand or India for their implant operations.
The savings from cheaper fees ostensibly cover the cost of the trip.
Says Dr. Benhamou: “The problem with dental tourism is that there is no way of knowing if the person who is telling you that they will provide the treatment has the qualifications.
In Canada and the U.S., there is a registry that you can check. In many other countries there may not be a registry. You also have to make sure that the material they use is available in North America. When you return home, the material to fix any problem may not be available.”
Problems do arise as a result of dental work performed abroad, she said. “There isn’t a month when I don’t see a few patients that have issues with dental tourism, serious issues.”
The cost of an implant depends on the extent of bone loss. The cost in Quebec ranges from $1,000 to $5,000. If bone has to be rebuilt, the patient has to pay for the material and the surgeon’s time. The cost of material alone is about 50 percent of the total, and the fee will include several visits.
The total cost covers the projected work for the procedure to have optimal results.