Dental Implants: Prof. Yatish Agarwal, Health Columnist

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Rescuing Your Good Health and Smile from Tooth Loss

(Based on an interview with Dr. S.P. Aggarwal, Medical Director, Green Park Dental Institute and Research Centre, New Delhi, and tête-à-tête with individuals who have undergone dental implants) Author, Prof. Yatish Agarwal.

Twenty-year-old Aditya – a handsome young man and a heart-throb of many at the University – was simply devastated. The other day, standing up to the fastest bowler of his college team during a practice game, he found two of his upper front teeth knocked out by a ball that suddenly jumped up from a good length spot. With blood oozing out of his mouth, he had forlornly asked the team doctor, “Would I ever be able to bite an apple again, doc? Or smile?” His spirits nosedived when the dentist he went to, gave him a partial denture. The contraption kept falling out. He could not even talk. Aditya was in utter despair.

“The dentist did tell me that he could fix a permanent dental bridge, if I so wished. But that would have required grinding the two adjoining good teeth. I did not like the idea, since I felt that would have weakened them,” he says.

It was then that a friend told him about tooth implants. Aditya was quick to take the option. Now six-months later, he says, “It’s awesome! Like a miracle, a complete changeover. I no longer feel the tooth loss, and can smile and chew with ease, and be my normal self. Until now, I had read about modern medicine transforming people’s lives, now I know how!”

London-based Sushma vividly remembers the time when as a squeamish 14-year-old, she used to watch her grandmother wear her false teeth (denture). “I thought, I don’t ever want that to happen to me,” says Ms. Gupta, now 58. Yet by the time she was in her mid-30s, she had lost several teeth. “Then, over the years, I developed gum disease, and my teeth began to loosen and shift, and I was just a mess,” she said.

Four years ago, she had all her upper teeth and several lower teeth replaced with dental implants. “The dental implants look and feel natural,” she says, “and I can eat anything I like.” Sushma is delighted with the results.

About the surgery, she says, “The implant surgery was much less difficult than I thought it would be. At first, I was very afraid, but in fact, it was simpler than a root canal or a tooth extraction surgery.”

“My dentures would fall out when I talked,” says Mrs. Saroj Kohli, 72, a housewife from Delhi.

“I couldn’t taste my food — in fact, I could hardly chew. It was the most miserable time of my entire life.” Mrs. Kohli, who lost her teeth in her early 50s, eventually replaced her dentures with something better: dental implants.

Like Aditya, Sushma and Mrs. Kohli, millions of people go through the agony of tooth loss and suffer from its consequences. The causes of this loss can be many: the commonest being poor oral hygiene habits; however, sports injuries, vehicular trauma, accidents, certain diseases and genetic defects contribute in fair numbers. The best step forward is prevention. Practicing good oral hygiene, wearing a pro¬tective mouth guard when playing sports, and consulting your dentist immediately in the case of an injury can help prolong the life of your natural teeth. However, millions of people are unable to safeguard their teeth from a host of conditions and suffer tooth loss. The malady runs across ages, gender and social divide.

Consequences of tooth loss

Losing teeth can have a devastating impact, and can create a lasting social, psychological and emotional turbulence. A good smile is a key to an individual’s self-esteem and confi¬dence, which play a critical role in his overall health and happiness. Nothing can set your mood for the day like looking in the mirror and feeling great about how you look. The belief that you look good can dramatically affect your self-image and quality of life. Missing teeth can change all that for the worse – by affecting not only your self-esteem and confidence, but also the way you live.

Human teeth have three basic functions: they enhance the good looks, assist in proper speech, and, most essentially, are critical for the proper chewing of food.

In general, when people lose one or more of their front teeth, they feel awkward, anxious, and nervous or self-consciousness while going out in public. For this reason, they rush to a dental surgeon and seek an immediate remedy.

Most people, however, tend to be casual about the loss of one or more molars, the teeth at the back of the mouth, which help chew food. This can have grim consequences. The jawbone suffers, and begins to deteriorate. The accelerated bone loss makes it softer and more vulnerable. Over time, the loss is compounded: the remaining teeth begin to shift in an attempt to fill the newly created space caused by the tooth loss. This shift produces a malocclusion: the upper and lower sets of teeth no longer match with each other. Normal chewing becomes difficult and the victim may suffer a sore jaw and unexplained headaches. As more teeth are lost, the remaining teeth must work harder. This extra burden accelerates their decay and demise.

With the loss of teeth, the appearance of the face also suffers. Bereft of the carry that teeth offer to the muscles of the face, facial muscles sag and droop, resulting in deep facial lines.

The presence of teeth is critical also for maintaining the distance between the upper and lower jaws. When teeth are lost, the jaws collapse towards each other. This results in undue prominence of the chin and thin lips. As a result, the individual begins to look much older.

The loss and shifting of teeth also leads to speech problems, which leads to much social embarrassment and produces much emotional pain and distress for the individual.

The reduced ability to chew also affects the choice of foods. Many people take to soft diet, which does not require them to chew. Such soft diets are often high in carbohydrate and low in protein. This can produce malnutrition in the long run.

Options for tooth replacement

If tooth loss is unavoidable for you, there are many workable options for replacement that can help rescue your good health and smile. The options can broadly be categorised into two types: one, those that are removable, and the others, which remain fixed. The removable ones include a partial or full denture, while dental crowns, dental bridges and dental implants can be considered as the fixed replacements.

Dentures

Dentures are a removable prosthesis that replaces the missing teeth in a jaw. They can either be partial or complete.

Partial Dentures

A partial denture is a removable replacement for one or more missing teeth and adjoining tissues. They fill in the spaces created by missing teeth and prevent other teeth from shifting position.

Complete Dentures

Individuals who have lost most or all of their teeth are a candidate for complete dentures. There are two kinds of complete dentures: “immediate,” which are inserted immediately following removal of the natural teeth, and “conventional,” which are placed in the mouth about eight to 12 weeks after tooth removal.

Not many people, however, find the dentures acceptable. They are cumbersome, and not easy to adjust to. Before going to sleep, a user must take them out. Many users also worry about a denture slipping at a wrong moment and causing social embarrassment. Dentures may also produce gum irritation and physical pain, and cannot be used for partaking of certain foods.

Dentures often only work well for those people, who are looking for an economical way of finding a tooth replacement.

Fixed Bridge

A dental bridge is a false tooth, which is fused between two porcelain crowns to fill in the area left by a missing tooth. The two crowns holding it in place are attached onto the two adjoining teeth on each side of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth.

The underlying substructure of a fixed bridge is made up of metal or ceramic material, but the restorations are typically identical to natural teeth. Dental bridges generally last for a period of seven to 15 years. A good oral hygiene is must.

A fixed bridge is more economical than a dental implant, and that is its biggest advantage. However, its biggest drawback is that its fitment requires altering perfectly healthy adjoining teeth; only then they can act as anchors for the bridge. In many people, dental bridges cannot also be fitted for the want of healthy teeth to secure them with.

Danger of bone loss

Both dentures and fixed bridges suffer from a major drawback: they do not stop the bone loss in the jawbone that follows in the footsteps of the tooth loss.

The primary function of jawbone is to support the teeth. When a tooth is lost, the bone around the missing teeth begins to shrink. This process is called resorption. With passage of time, the bone shrinks to such an extent that it finds it difficult to hold a dental bridge or denture well. In that case, they fail to function well. Due to the bone loss, the face takes an older look.

Emergence of dental implants

Dental technologists and research scientists have been hard at work, trying to find a most fitting alternative for natural tooth replacement. A device that would bind with the jawbone and gums, work in harmony with natural teeth, and fulfil the need of a lifetime of form and function.

The birth of dental implants is an outcome of this holy quest. The concept is simple and straightforward. Where the lost tooth once had its roots, the dental surgeon first fixes a titanium screw in the same portion of the jawbone. And once this titanium screw binds well with the bone, a single-tooth crown, larger bridge or denture is secured on the top of it, with the titanium screw acting as a post.

The biggest advantage of a dental implant is it does not wiggle or slip, as dentures can, and it helps preserve the gums and jawbone.

The big fluky story

Strange to recount, but the dental surgeons have been experimenting with the idea of tooth implants since the times of the Pharaohs. Down the ages, tooth implants were crafted out of wood, ivory and a host of metals. None could do the job well: they lasted no more than a few years and opened the tissue to possible infection.

The big breakthrough came in the year 1952. Indeed, it was no more than a fluky accident. A Swedish university professor, Dr. Per-Ingvar Branemark, was investigating into how a living bone tissue recovers from wounds. The tiny titanium microscope he had inserted into the living bone became stuck in the bone tissue. This led him to a long string of careful experiments. Lo and behold, in no time, he could see that titanium easily fused with the bone tissue and did not evoke any unfavourable reaction.

Buoyed by his observations of this new phenomenon, Branemark developed the tools and technique for implanting a titanium screw (post) to anchor “false teeth” by 1965.

Over the years, the technique was perfected by conducting repeated clinical studies. By late 1980s, medical companies started manufacturing and marketing dental implants on a large scale.

Since the initial cost was high, in the beginning the use of dental implants was limited mainly to the Western countries. However, over time, as the manufacturing methods evolved and implant designs improved, the affordability became better. Today, dental implants have gained in popularity and usage the world over. Millions of people benefit from this modern marvel of medicine.

Stages of implant treatment

The dental implant treatment has four phases: first a treatment plan is drawn, second a titanium implant is fixed into the jawbone, third a tooth crown is fitted on the top of the implant, and fourth, due care is taken to maintain a good oral hygiene.

Stage I: Drawing a treatment plan

The dental surgeon will have the X-rays taken and create a model of the existing teeth. This will help determine how the implant should be placed. Occasionally, the individual may also require a bone or gum tissue graft. This may be needed to augment the site for placement of the implant.

Stage II: Fixing the implant

The titanium implant is planted into the jawbone. It is allowed sufficient time to bind in, before a crown is set on it. This usually takes three to six months.

Stage III: Fitting the tooth crown

The crown of the tooth is fitted on the top of the rock solid titanium screw which has by now found a firm embedment in the jawbone.

In some people, however, the surgeon may not need to wait for that long. If the biomechanical conditions are good, the dental surgeon may fit a tooth crown the same day as the implant.

Yet again, in some cases, a dental implant can be fixed just after the tooth extraction. This has the benefit of limiting bone loss.

Stage IV:  Safeguarding the oral hygiene

Maintaining a good dental hygiene is the key to the long-term success of a dental implant. This must become a part of the daily regime in patient’s routine.

Difficulties with dental implant treatment

Firstly, a dental implant is a rather expensive and lengthy procedure. Unlike a dental bridge, which can be fitted in a few days, fixing a dental implant usually takes about three to six months and it costs between Rs. 15,000 to Rs. 50,000 a piece.

Secondly, not everybody makes a good candidate for a dental implant. Some individuals may not have a sufficient bit of healthy bone in the jaw to support a titanium implant. Others may suffer from a poor general health. A person with diabetes or a smoker has a lower rate of success with a dental implant because of a poorer blood supply, which impedes a healthy fusion between bone tissue and the implant. The recipient must also have healthy gums. Before undergoing the treatment, a person may require periodontal treatment to get rid of the plaque and tartar on the teeth and gums.

Age of constant innovation and progress

The field of dental implants has been going through a constant evolution. Today, due to better designs and bone grafting methods, hardly anybody needs to be refused a dental implant. Highly specialized procedures allow a dental surgeon to restore the jawbone and allow it to hold a dental implant. The design of crowns, bridges and dentures has also evolved and they are now so designed that they can attach more firmly to an implant.

The appearance of dental implants has also been undergone a major refinement. At first, they were crafted out of grey titanium metal, but now a white coloured polymeric implant is being employed. This special polymer, known commonly by the name “biopic”, fuses with the bone just as well and enjoys a natural tooth like brilliance.

With these developments, dental implants have truly come of age. They offer a new vista of hope and wellbeing today for those millions of people, who have suffered a tooth loss.

(The author, Prof. Yatish Agarwal works and teaches at New Delhi’s Safdarjung Hospital. He is a well-known columnist, author, poet and health science communicator. He has 48 popular books on health, which have been translated into many languages, and have sold over 2 million copies.)

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