Over
the past twenty years, dental implants have become a standard of care
for the replacement of missing teeth. Still, it seems clear that there
is reluctance on the part of some clinicians and patients to provide
and receive implant treatment. This reluctance on the part of
clinicians to provide the treatment and on the behalf of patients to
accept it largely resides in the persistence of several myths related
to dental implants. The purpose of this article is to attempt to dispel
these myths by providing more factual current information. Here, in no
particular order, are the most common misconceptions related to dental
implant treatment.
1. MYTH: Implants are too expensive.
FACT:
As we know, dental implants are most often not covered by insurance
carriers. This, in no way, however, should dictate our choice of
treatment for the patient. Obviously, our role is to provide the
patient with treatment options and to emphasize those options which are
in their best interest regardless of insurance coverage. Still, when
one looks at the cost of a single-tooth dental implant versus a
three-unit bridge, one can make the argument that implants are actually
cheaper. We all know that posterior bridgework has an average lifespan
between 5-10 years when evaluated critically. Insurance companies will
often pay to replace a bridge as frequently as every five years.
Obviously, the patient has an out-of-pocket share for this each time it
occurs, and each time a bridge is replaced, the likelihood that the
teeth serving as abutments will fail increases. In my office, patients
are advised that a properly cared for dental implant can last as long
as a properly cared for natural tooth. The same cannot be said of
bridgework.
2.
MYTH: Tooth #3 is missing and #2 and 4 are heavily restored and
require crowns anyway. It is probably best to provide this patient a 2
x 4 bridge instead of an implant at #3.
FACT:
While this appears reasonable when taken at face value, it is not
logical. If teeth #2 and 4 were virgin teeth, no one would argue that
an implant should certainly be placed at #3 to avoid having to
unnecessarily prepare these unrestored teeth. However, when one thinks
logically, why would a clinician take two heavily restored teeth, crown
them, and then hang a third tooth onto them, thus increasing their
load? The logical thing to do would be to crown each of these teeth
individually and then perform a dental implant at #3 and let each of
the three teeth stand alone supporting only themselves. Thus, one does
not unnecessarily increase the load on already compromised teeth.
3. MYTH: Implants are somewhat experimental.
FACT:
Implants not only are no longer experimental with 40 years of data
behind them, they now are the standard of care. Straumann (ITI)
provides international statistics of 96% success rate for dental
implants and other implant companies provide similar success rates.
These are better statistics than one can often provide for natural
teeth! When faced with a tooth that might require crown lengthening and
extensive restorative work with a questionable prognosis, a much more
predictable alternative is often removal of that tooth and
placement of a dental implant.
4. MYTH: Implants in the anterior region are not as aesthetic as bridgework.
FACT:
Implants actually provide greater aesthetics than bridgework when
properly placed. The key is proper site preparation prior to the
implant placement. Patients who are missing a tooth in the anterior
region are usually also missing some degree of hard and soft tissue.
Replacement of this tissue or simply placement of the implant using an
osteotome technique to expand the bone recreates the lost volume as
well as the appearance of a root eminence through the tissue. A
properly performed dental implant will have aesthetics equal to that of
a healthy natural tooth, something that a pontic in a bridge will never
achieve.
5. MYTH: Implant placement and associated bone or soft tissue grafting are very painful.
FACT:
Dental implant placement is one of the most comfortable procedures
performed by the Oral and Maxillofacial Surgeon, allowing most patients
to resume normal activities the following day! Additionally, the vast
majority of associated bone and soft tissue grafting procedures are
performed in the Oral Surgeon's office, harvesting tissues for grafting
from intraoral sites (connective tissue from the palate, bone from the
mandibular ramus). Clinicians should know that if they do not hesitate
to refer patients to a specialist for third molar removal, then they
certainly should not hesitate to refer for bone or soft tissue grafting
of deficient sites as these are very similar procedures with similar
recoveries.
These
are just some of the myths surrounding dental implants. Our challenge
as clinicians is to educate our patients regarding the predictability
and desirability of anatomic replacement of missing teeth by adding
dental implants rather than settling for subtractive dentistry with
bridgework and partials. Many patients have already accepted the
life-changing benefits of dental implant treatment. As these numbers
continue to increase, the positive "buzz" surrounding dental implants
will also increase and patients will become more active consumers of
these services. It seems, therefore, incumbent upon us as dental
professionals to continue to participate in the continuing education
required to not only provide these services with excellence, but also
to educate our patients as to their benefits.
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