Shopping for dental implants

For those of us old enough to have bad teeth, mostly because we were born in the wrong family or too many moons ago, or both, when a tooth is dead and when a crown or a bridge won’t do the job, an implant becomes the needed solution. 

The system wasn’t invented yesterday; in the 1950s, a Swedish orthopedic surgeon Per-Ingvar Brånemark accidentally discovered the process of osseointegration, where titanium implants could bond with the jaw bones. In 1965, a first patient received a titanium dental implant, marking the beginning of the procedure.

Its success and further trials and errors led to further advancements in implant design and materials, making dental implants a popular and effective treatment for missing teeth. I had my first two implants in the late 80s, but both failed and had to be replaced. Today, I have three more, plus an additional one scheduled to be placed next month, so I know a few things about them, but still have a lot to learn… 

Typically, implants consist of a titanium screw replacing the root of a missing tooth, with a variety of designs depending on their end use and the manufacturer. A majority of dental implants are made of pure titanium, but some are alloys. 

Most have a textured surface (through etching, anodic oxidation or blasting) to increase the surface area and the integration with the bone.  As long as it contains more than 85% titanium, an alloy will form a titanium oxide surface layer that isolates the other metals, preventing them from contacting the bone and compromising the bond. 

There are also metal-free implants, like Zirconia, that are suitable for patients allergic to metals. More malleable than titanium to facilitate fitting to the abutment and that also less costly than their titanium counterparts. In older patients like me, bone grafting is needed when bone is insufficient to stabilize the implant. 

Typically, the goal is to have a minimum of 0.39 in in bone height, and 0.24 in in width. To compensate for a lack of bone, various bone grafting techniques are available, using either natural bone coming from the patient or a from cadaver and that filling is then covered with a semi-permeable membrane for healing. 

During the healing phase that can last several months, the graft forms the new bony base that will receive the implant. Tomorrow we’ll talk about the growing popularity of implants, their marketing and their cost to the patient... (To be continued)