Is a third set of permanent teeth the future of dentistry?

Is a third set of permanent teeth the future of dentistry?
By Erika Rose
Times Correspondent
Monday, August 04, 2008

Juliann Kus jokes that when all is said and done, she will have a "million dollar smile," or at least maybe a six-figure one.

The 52-year-old Chicago woman is on her way to having a complete second set of permanent adult teeth thanks to dental implants. Though the road is long and her case extreme, her gum disease slowly leading to the extraction of nearly all her teeth, Kus' experience serves as testimony for how far dental implants have come, who they can help and why they may be edging out bridges and dentures in the dental world.

Anyone with a loose denture or missing teeth, who is considering a bridge or partial or complete denture, oral surgeons, dentists and their patients make a strong case for implants. See story, C3.

Missing teeth? Loose dentures? Consider implants

When 18-year-old Alex Cohen of Munster faced losing a permanent front tooth, there was no question she would get an implant. At her young age, she needed a new permanent tooth that not only looked natural, but was strong enough to bite, chew and function and not require any follow-up maintenance or replacement.

In her mid-80s, such qualities were no less important or obtainable for Nathalie Pennington, now 87, of Highland, who had an implant placed within her upper jaw. After her fractured tooth was extracted, she returned for an implant which was later fitted with a permanent crown.

Gladys Crossk, 76, of Hobart had a complete upper and lower denture that had begun moving around and causing discomfort as the absence of teeth causes the jawbone to melt away. But she had enough bone to stabilize two implants, which now enables her new "overdenture" on her lower jaw to be "snapped" securely into place.

These three patients of Highland Oral Surgeon Dr. Eric Pulver, who worked alongside each of their general dentists, are proof that for young and old and for a wide variety of situations, dental implants are becoming the preferred option for missing teeth, over the conventional methods of a bridge or complete or partial denture.

"A dental implant is a man-made titanium screw that replaces the root structure of a tooth," Pulver explains. "Onto that, a crown is built just like it would be put on top of one of the units of a bridge."

Just as a basement provides a strong foundation for a skyscraper, Pulver explains, an implant placed into a sufficient amount of bone, provides a stable foundation for a crown that is strong enough to bite into apples or corn on the cob.

Dr. Michael Gordon, a dentist who practices in Schererville and Munster, says though implants have been around for some 30 years, the materials used have greatly improved and have a proven track record. He recommends implants to patients about 75 percent of the time.

"Implants have evolved over the last 25 years so that if you had a relative that had one placed 20 years ago and didn't have success, the odds are this is not the same type of material that they were using," he says.

Bridge, denture or implant?

Weighing an implant versus the traditional bridge, Gordon says, "If I were to lose a tooth, I would get an implant without a second thought."

The reason, he says, is to preserve the healthy adjacent teeth which must be ground down and compromised to prepare for a bridge. The previously healthy teeth are then crowned and soldered to the one in the middle, bridging the gap.

Dr. Jay Platt, a Schererville oral surgeon, points out that bridges are also at risk for decay at the margin and will have to be replaced in about 10 years, whereas an implant doesn't decay and has a track record to last a lifetime.

Plus, Platt says about 18 percent of teeth prepared for crowns require a root canal later.

Another alternative for missing teeth is a partial or complete denture or a retainer that has a single tooth for looks only. The obvious disadvantages are that they are removable and not as functional.

However, implants can be used in conjunction with dentures, making them more secure.

Calming fears, doubts

Replacing the root by screwing a foreign object directly into the bone, might seem a drastic measure, but is actually the least traumatic approach, Pulver says.

"In many cases," he says, "it's possibly a more conservative restoration because you are able to maintain it and keep the adjacent tooth structure and you don't have to weaken that tooth structure." Another plus, he says, is that implants help preserve the bone structure which will melt away without any forces put upon them, which typically happens fast in the case of a denture or missing tooth.

Addressing the most common questions patients typically have, Gordon says getting an implant is not as taxing as the tooth extraction and the entire process takes about 10 to 12 appointments over three to six months. Patients with implants have said root canals are a far more uncomfortable procedure.

What is the cost?

Pulver says he doesn't want those who opt for bridges or dentures to feel they have something substandard because they still function very well. With a new set of permanent teeth comes a significant up front investment in both cost and time. But looking at it over the long haul, he says, an implant is perhaps the best value.

"Over the long run, it's less expensive than a bridge and more importantly to your health, it's a whole lot less of a toll on putting excess forces on the adjacent teeth." Platt agrees, saying the cost is comparable to a bridge once you consider that a bridge is really three crowns to an implant's one.

Not to mention, by the time a bridge has to be replaced, which it most definitely will, it may have matched the cost of the implant.

Worth the investment for quality of life

Patients like Juliann Kus, 52, of Chicago, who anticipates going back and forth between Platt, who is her oral surgeon, and her general dentist for years to come, says it's worth the time and money even though her insurance doesn't pay for implants.

Presently, Kus has eight implants which secure nine crowns. Suffering from the same gum and bone disease that plagued her father and brother, Kus is certain more will be needed as the remaining teeth continue their downward decline.

Eventually she will have a complete new set.

After seeing her dad and brother suffer through the drawbacks of dentures, such as not being able to enjoy food and having them slip around, Kus views implants as necessary to her quality of life.

"They honestly look like mine. They feel like mine," she says. "I don't know that they're not my teeth."

Pulver says when it comes to implants, nearly everyone is a candidate.

"Age isn't a factor. Loss of bone isn't a factor. The fact that you haven't had teeth for 30 years isn't a factor," says Pulver, who has worked on many patients who have been willing to go through bone grafts and other site restoration procedures to accomplish a permanent solution.

He adds, "if it's something that bothers you and you don't smile a lot and can't eat and chew . . . there's something you can do."

© Copyright 2008, The Times, Munster, IN
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