Implant Myths Versus Facts
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.