A little-known piece of dental trivia is that implant dentistry is the second oldest discipline of dentistry with oral surgery (tooth extraction) being the oldest. Logic dictates that tooth loss must precede tooth replacement, but what is surprising is that surgical implantation of an artificial tooth dates back thousands of years. More than 4,000 years ago, the Chinese carved bamboo sticks into pegs and drove them into the bone as a way to permanently replace a missing tooth (ouch!!). 2,000 years ago, Egyptians implanted pegs made of precious metals like gold and silver into the jaw as a tooth replacement. The ancient Incas’ version of dental implants utilized seashells that were carved into tooth-like shapes and tapped into the bone.
Fortunately over the ensuing millennia, dentistry and surgical techniques have evolved into a more refined (and humane) discipline in which the willing implant recipient need not be held down and restrained while someone hammers a poor excuse of a tooth into his or her jaw.
Modern implant dentistry, as we know it today, is based on the research of an orthopedic surgeon named Dr. P.I. Branemark, who in 1952 discovered that titanium is able to fuse with healing bone in a process he termed osseointegration. Branemark’s discovery of osseointegration and his work with dental implants revolutionized dentistry making it possible to permanently replace anything from a single missing tooth to an entire complement of teeth. Ok. History lesson is over.
So What is a Dental Implant?
A dental implant is a cylindrical or tapered post generally made of commercially pure titanium or titanium alloy that is designed to replace the root of a tooth. People often refer to an implant as a post, but this is confusing because the term post is not implant specific. Posts are also used to restore natural teeth that have had root canal treatment, as in a post and core, which helps supports a crown.
The simplest application of a dental implant is to replace a single missing tooth. In traditional dentistry, the two teeth on either side of the space (once occupied by a tooth) are prepared (cut down) for crowns and the replacement tooth is then attached to them. This is called a three-unit bridge. Implant dentistry is an alternative to “cutting down” two otherwise healthy teeth. A dental implant is surgically placed where the root of the missing tooth once resided. After a prescribed period of healing, the implant is restored with a crown.
I know this can get confusing so, let me break it down to the basics. The crown of the tooth is what you see when you smile and what you chew with when you eat. An implant is a root replacement and serves as the supporting foundation for the crown. The abutment is what connects the crown to the implant. If a person is missing multiple teeth or even all of their teeth, implants can be strategically placed to support a permanent bridge (like the one I described above) or even help support and stabilize removable dentures that would otherwise move around when one eats or speaks.
Dental implants offer many restorative options to the edentulous (meaning “missing teeth”) or partially edentulous patient.
Choosing Dental Implants
There are upwards of 100 dental implant manufacturers in the world offering a wide range in quality and design. In the year 2000, there were over 1,300 implant designs and 1,500 abutments in a variety of materials, shapes, sizes, and surfaces. There are five grades of titanium used to manufacture dental implants with Grade 5 being the strongest and Grade 1 being the weakest.
Which implant is the best is not such a simple question to answer. There are many factors to consider including the reputation of the manufacturer as well as practitioner preference, but careful consideration must be utilized. There are many fine implants available, but there are also many that do not offer the same quality control that the “leaders” in the field do. Interesting aside, I have noticed advertisements in the local papers for implant services that quote fees that are “cheaper” than the actual cost of the implants that I use in my practice (Nobel Biocare). While cost of care is of course a consideration, the cost of failure is even greater. Educate yourself and ask questions before proceeding.
Implant dentistry….we’ve come a long way from bamboo pegs!
Michael Sinkin is a dentist in New York City. He loves being a dentist and is known throughout the city for taking wonderful care of his patients and for his wicked sense of humor. To contact Dr. Sinkin, link here