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Expected, not experimental

May 1, 2009
Creating hope with dental implant therapy
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Creating hope with dental implant therapy

by Lisa C. Wadsworth, RDH

Here's a secret. Twenty-one years ago, I became a success story for the emerging technology known as dental implant therapy. This experience set the course for the rest of my professional career.

It is said the most valuable asset we possess is our smile. It defines us, provides us our identity. We greet the world with our smile! Quite frankly, the beauty of our smile can boost or crush our self-esteem and confidence. Don't you agree that one of the attributes we cherish most is our smile? Why else would our population spend billions of dollars a year on cosmetic dentistry?

Our mouth and teeth provide us with the ability to chew, nourish our bodies, and even breathe effectively. We communicate and express our affection with our voice and smile — all the things that bring us joy and a feeling of wellness.

Patients living with lost or missing teeth are compromised in many physical ways yet often the emotional scars are more debilitating and go undetected.

Implant therapy is the fastest growing specialty within dentistry. In only two short decades, the implant industry has grown from a few million dollar industry into a staggering multibillion dollar specialty. Implant therapy improves, rebuilds, and occasionally even saves lives. As dental professionals, we must understand the principles for treatment-planning implant dentistry. If dentists are not presenting implant therapy as a viable treatment option, they may find themselves in court. Dental implants are not experimental; they are expected and highly successful.

I like to follow the lead of many of my colleagues and describe them as “the most natural replacement for a lost or missing teeth.”

Dental implants are most commonly made of titanium — an element easily accepted by the body. When properly placed, dental implants become one with the jaw bone through a process known as osseointegration. Early on, titanium allowed for the invention and success of hip, knee, and other joint replacement surgeries.

Many of you know someone living with the aid of a joint replacement. The numbers are huge; the experts suggest that the orthopedic specialty is growing rapidly as baby boomers demand to remain mobile and active. Our health-conscious society expects more from the dental professional than ever before. It is prudent for us to be closely aligned with the medical community for changes in medical protocol as well as emerging surgical technology.

Why all the fuss

Dr. Branemark from Sweden, who is often considered to be the father of modern implant technology, defined edentulism as a medical condition with debilitating and often critical consequences. These critical consequences are depicted, for example, in ancient societies such as the Egyptians. Evidence within their ruins offers some extreme examples of the measures people would endure to regain form and function. Items such as seashells, animal teeth, and rocks were found lodged within the jawbones of mummies as a reminder of how much we want and need our teeth.

Once a tooth or teeth is lost, the jaw bone immediately begins to resorb. In fact, within the first year after losing a tooth, a patient may lose up to 50% of the bone height in that area. Over time, especially in the mandible, the bone can become so weak that spontaneous fractures are not uncommon. This situation creates a medical emergency with possible life-threatening situations.

So, what have we learned? We realize that disease, trauma, or genetic syndromes have caused our patients to lose their teeth, and we must share hope through dental implant therapy. As dental professionals, we must be willing to examine the technology that helps our patients regain fuction, health, and their identity. We must become proficient in our communication skills, enabling us to move our patients into the highest standard of care without fear or question.

In closing, reflect back to my secret. The definition of a secret is: Beyond ordinary understanding and mysterious. I hope you will embrace the fact that implant dentistry is not a mystery; implants are the most natural replacement for lost or missing teeth. They are expected, not experimental!

Loose teeth? Just get false ones!

My feeling is that, before we allow another patient to remain edentulous or even partially edentulous for even one more day, let's examine three well-documented and successful areas for implant therapy.

• Teeth lost to disease. Periodontal disease affects approximately 85% of our population and is the major reason for tooth loss. Many patients — approximately 35% — are missing one or more teeth. How does this affect them physically? It reduces their ability to chew, which inhibits the beginning stages of digestion, leading to swallowing deficiencies and ultimately malnutrition. If enough dentition is lost, it can lead to obstructions of the airway and breathing problems.

I know you all have a story like the one I am about to share. We all have elderly patients who wear dentures.

My patient had become physically disabled. Her only social interaction for the week was her bridge club. She enjoyed the chats with lifelong friends and the food. Each time we met, she shared with me how happy she was to have her weekly outing that provided her company and the assurance of one good meal for the week.

At our most recent appointment, she seemed disturbingly withdrawn and frail. I asked a few medical history questions and nothing jumped out. I then asked the question that historically had brought a twinkle to her eye. “How are your friends at the bridge club?” I asked. She sadly told me that she had chosen to stop participating, had not been in several months, and was now housebound.

With all seriousness, she shared with me that the women in the bridge club had been her friends for 60 years and that she did not want them to know that eating had become a major challenge. Her denture was not fitting well and would drop out unexpectedly during meals. She was too embarrassed to tell her friends of her plight or to discuss revisions to the menu that might assist her. So she just stopped going. Her friends did not know the reason for her change of heart and soon lost touch due to their own troubles with travel.

Do you think implant therapy could have impacted this woman's life in a positive fashion? Do you think she suffers from more than physical scars? Undeniably.

The technology now at our fingertips provides us with implant interventions as simple as the placement of two implants to support her denture and drastically change this woman's life.

• Teeth lost to trauma. Imagine an accident or illness (cancer, car accident) that leaves us scared and hurt. Emotional trauma from these events may run deeper than the physical scars. How does psychological trauma affect us? Loss of identity? Lowering one's established place in society? Our outward appearance can forever change how we are perceived by others. Often, this leads to a more troubling process about how we perceive ourselves.

Prior to dental implants, many trauma victims had to face life at younger ages with removable dentures or partials. The most profound loss is in those patients living with mandibles or maxillas that are no longer able to support daily functions.

Advances in therapy — such as implants as long as 23 to 25 millimeters embedded into the zygomatic process — bring options to even the most complex reconstructive case. These options bring hope not only to our patients but to their families who are also impacted by their loved ones' health.

• Genetically missing teeth (anodontia). Anodontia is a genetic disorder commonly defined as the absence of all teeth, and is rarely encountered in a pure form without any associated abnormalities. Rare but more common than complete anodontia are hypodontia and oligodontia. Hypodontia is genetic in origin and usually involves the absence of from one to six teeth. Oligodontia is genetic as well and is the term most commonly used to describe conditions where more than six teeth are missing.

These conditions may involve either the primary or permanent sets of teeth, but most cases involve the permanent teeth. These phenomena are associated with a group of nonprogressive skin and nerve syndromes called the ectodermal dysplasias. Anodontia, especially, is usually part of a syndrome and seldom occurs as an isolated entity.

Visualize a child sitting in a schoolyard realizing that he or she is somehow different. What do all children talk about and wait for with great expectation? The tooth fairy. Imagine the emotional trauma of having to tell your child that he or she will never have baby teeth, let alone permanent teeth!

Growing up is tough enough without a syndrome that, prior to dental implants, left one permanently disabled.

Now there is hope. In 2007, the FDA approved the use of small (mini-implants) to be placed in the developing jaws of children — placed so they do not disturb the growth pattern of the jaw. Yet mini-implants assist the children in wearing comfortable, stable dentures. The implants can form their smile, establish their identity, and allow them to eat and speak without embarrassment. These children can now embrace a bright future knowing that once they mature, larger implants may be permanently placed to anchor permanent teeth or a denture.