Dental implants and edentulism

Dental implant procedures can vary from the simple and clear cut to complex cases. A general dentist who has received training to place and restore implants would be qualified to provide care for straightforward dental implant procedures, like replacement for a single missing tooth.

For more aesthetically demanding cases, general dentists should refer to a prosthodontist, periodontist or an oral and maxillofacial surgeon, depending on the medical conditions of the patient. Even so, dental specialists themselves still vary in their level of experience and training relative to dental implant procedures, therefore referrals are advised.

When we think of dental implants today, we think of endosseous, that is when the implant is placed into the bone where osseointegration takes place between the bone and the implants. This process creates a stable relationship that allows for single crowns, bridges or dentures to be retained and supported by the implants, thereby giving the patient increased chewing capability with ease and comfort, better aesthetics and self confidence from knowing that their teeth would not slip or dislodge while speaking or eating. Any patient who is missing one or more of their teeth is a candidate for implant therapy. In addition, patients who have had trauma and cancer to the head and neck area can be treated with implants both intraoral and extraorally.

As a practising prosthodontist who regularly restores dental implants, I know that implants are predominately made of titanium or a titanium alloy because titanium is very biocompatible. Due to biocompatibility, titanium is the most common material for all bone and joint implants throughout the body; in particular, hip and knee as well as dental implants. For dental implants, the abutment that connects the implant to the crown, bridge or denture can be made of a wide variety of materials depending on its function. In areas where aesthetics are of a greater concern, a ceramic abutment may be used to meet the patient's expectations whereas in areas of high force, a stronger metal may be used for added protection against breakage. It's important to remember that the surface of the implants may differ on a microscopic level from one company to another. Also, the demands of the individual patient's needs will determine the materials used. On a whole, implants have a high degree of success.

Edentulism is one of the most common clinical conditions requiring dental implants. Edentulism refers to a patient who has no teeth in his/her mouth. Partial edentulism means that they are missing some of their teeth. According to the National Institutes of Health in Bethesda, Maryland, USA in 2010, 2.3 % of the global population representing 158 million people worldwide were edentulous.¹

Furthermore, prevalence of tooth loss between sexes increased gradually with age. According to the International & American Association for Dental Research, there has been a huge increase around the seventh decade of life that was associated with the highest number of incidences at 65 years old.² This pattern has not changed during the past 2 decades.

The main cause of the increased prevalence of edentulism amongst individuals is multifactorial but poor oral hygiene such as lack of effective brushing and flossing - which can lead to caries and periodontal disease, oral trauma, tumours - and to a smaller extent, genetic conditions contribute to the loss of teeth.

Regardless of partial or full edentulism, both conditions can naturally affect chewing capabilities, self-confidence and all the associated effects that may be related to these factors. Being without teeth can have nutritional impact on an individual, as patients turn to a soft and chewy high caloric diet filled with carbohydrates resulting in obesity, diabetes and a whole host of co-morbid conditions. The individual's quality of life is impacted as a result of missing teeth, especially in the anterior region. They feel socially embarrassed and tend to avoid social situations, which for many can lead to loneliness and depression.

Nevertheless, not all is gloom for the edentulous patient. It used to be that conventional methods required several patient visits to design, fabricate and fit dentures. Today, prosthodontists' use of digital technology can now decrease the number of patient visits so it takes less time away from a patients' work or family to have exquisite, natural looking dentures. However, since dental implants are surgical procedures, it is advisable that patients discuss with their providers or prosthodontists prior to any dental procedure and get a second opinion just as with any surgery. In fact, the American College of Prosthodontists (ACP) includes a list of questions patients can ask their providers in the ACP's Position Statement on Dental Implants (www.prosthodontics.org/assets/1/7/2._Dental_Implants_-_Affirmed1.pdf), as we believe that informed patients can improve their outcomes.

In addition, to err on the side of caution, prosthodontists know that the best option is preventing tooth loss. Saving one's natural healthy teeth for as long as possible throughout one's life is the best option for one's oral and general health as well as quality of life. Oral hygiene along with nutritional instructions provided by dental professionals to patients would go a long way to prevent loss of teeth. All these are possible, and it is within a patient's control.

About the author

Dr Carl F. Driscoll is a Diplomate of the American Board of Prosthodontics and President of the American College of Prosthodontists (ACP). He currently serves as Professor and Director of Prosthodontics Residency at the University of Maryland School of Dentistry. Dr Driscoll is also Past President of both the American Board of Prosthodontics and the American Academy of Fixed Prosthodontics.

References

1. The goal of the Global Burden of Disease 2010 Study, done by the National Institutes of Health has been to systemically produced comparable estimates of the burden of 291 diseases and injuries and their associated 1,160 sequelae from 1990 to 2010.
2. Between 1990 and 2010, the global age-standardized prevalence of severe tooth loss in the entire population decreased from 4.4% to 2.4%, a 45% decreases. The graph shows the prevalence (proportion) and number of incident cases of sever tooth loss in 1990 versus in 2010. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293725/figure/fig2-0022034514537828/