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From Cutting Teeth to Cutting Edge.
Written by | Dave Ward.
A Hi-Tech Solution for Tooth Replacement.
After our Deciduous teeth (or baby teeth) have been replaced by the secondary or permanent set, there are no third chances– meaning that once a secondary tooth is lost, our body is unable to grow back a replacement.
It’s only when we lose something we once took for granted that we truly come to appreciate its real value. Nothing can more accurately reflect this statement than when glancing in the mirror at the glaring breach, staring back at you between an otherwise pristine set of pearly whites.
The Crowning of a natural root affords the recipient the aesthetics and functionality of a regular tooth, from which they can benefit for many years. However, once the root becomes weakened or infected it cannot support a crown, and the only option left is extraction. Those unfortunate enough to have been in this position can relate only too well, to the devastating effect such news can have on one’s self confidence– especially as with my case, where the affected teeth are located in the front of the mouth.
This is bad enough in itself, but when you are also dealing with an unsympathetic dentist– one who attempts to fob you off with the quickest solution by limiting your options, it just adds insult to injury. Hence my dissatisfaction with the offer of a single solution provoked a lengthy debate– which resulted in being referred to a Periodontist, who would determine whether or not I was a suitable candidate for Crown Lengthening. This is a procedure where part of the jawbone is filed away, exposing more of the root structure, on which a crown can be secured.
During this consultation however I received the worst case scenario. Since neither of my two roots were healthy or strong enough to support a crown– and therefore commencing with this procedure would only delay the inevitable. Despite this harrowing news, I learned about several other options from this Periodontist, who unlike my general dentist was willing to sit down with me to discuss each one at length.
The one solution which appealed to me the most was the Dental Implant procedure, since the end result would more closely mirror a regular tooth in terms of permanence, aesthetics, and functionality. However, at the time of writing this option is by far the most expensive– and considering the fact that I was not covered for this procedure by my insurance policy, this would leave me responsible for 100% of the bill.
Another significant cost which needs to be considered with regard to dental implants is the time factor, given that the entire procedure constitutes several intermittent stages, each of which requires a period of healing before progressing to the succeeding one. Taking all of this into consideration I was now swaying towards the second option of a permanent Dental Bridge— which is considerably cheaper and far less time consuming.
On returning to my general practitioner I endeavoured to get answers regarding why these additional options had been withheld from me– yet the response I received back was disappointingly evasive. My continued insistence however spawned a collaboration between my dentist and one of her colleagues, whereafter it was determined that a permanent bridge fitting, would indeed be a viable option. However it was quickly followed by a disclaimer stating that it would also result in a stark colour mismatch with the surrounding teeth.
Video: What is a Dental Bridge
On hearing this, my confidence started to diminish ever more rapidly. Inasmuch that I myself was already knowledgeable, regarding the ability of a dental lab specialist to colour match bridges, crowns and so forth– clearly this practice was sacrificing good service for profit. Despite this my dentist was adamant that the lab they partnered with, did not afford such courtesies, wherefore at this point I made a concrete decision to go with the dental implant option.
Undeterred by the additional cost there was no turning back– nonetheless, before committing to any particular implant specialist, I decided to postpone the treatment for a month, with a view to performing a detailed comparative analysis.
During my intense research I came across a company called ClearChoice— an organization that specializes in a patented technique for fitting dental implants. The major selling point from their carefully crafted marketing campaign is that “customers can enjoy a full set of newly implanted teeth in just one day”. With this promise also comes a guarantee that no bone grafts are required, and at considerably less cost than conventional implants.
The whole concept sounded incredibly appealing, but at the same time just too good to be true, yet I figured it was worth checking out. So I booked the standard free consultation– after about ten minutes into the discussion however, it became apparent that this was “Clearly Not” (pun intended), the breakthrough it was marketed as being.
Far from being a true permanent dental implant, this technique simply attaches a set of regular dentures using four titanium rods strategically placed at a precise angle– in order to lock an entire set of dentures into place, which have to be removed at least twice a year for cleaning purposes, obviously this requires a visit to a licensed ClearChoice practitioner each time this procedure is carried out..
I’m sure that for many people this solution works out extremely well, however for someone only looking to replace a couple of teeth it would be a totally ludicrous thing to do. Be that as it may, kudos to the consultant at ClearChoice for their candid and transparent assessment of my individual case.
After researching several other dental implant specialists, I chose Smile Designers, the place I was initially referred to– due to their standard 25% discount which is offered to all policyholders not covered by this procedure, this gave them an edge over their competitors.
On calling to set up an appointment to initiate the procedure however, I discovered that the Periodontist I had initially consulted with was no longer practising there. Nevertheless, I was assured that his replacement Dr. Nares, who is also the Chief Periodontist at the University of Illinois in Chicago, was a highly skilled surgeon with excellent interpersonal skills– and I have to say I was not disappointed on either count. By virtue of the fact that I had never met Dr Nares before, he requested a primary consultation with me before commencing with the implant treatment as chronicled below.
Stage One: The Bone Graft.
When a tooth is broken or damaged in some way it does not function at full capacity, whereby it ceases to apply pressure to the jawbone during the chewing process– consequently the affected area suffers bone loss over a period of time. This is similar to the loss of muscle mass when say a limb fails to get sufficient exercise, e.g. such as when one is recovering from a broken leg.
Hence in many cases a bone graft is required before any implant can be realized, and this can add considerable expense to the overall cost– not to mention the additional months of healing time. Unfortunately this was applicable in my case, whereby after my two teeth were extracted the breach had to be packed tightly with finely ground bone– with the gum subsequently being sutured back together again. Now this may sound pretty gruesome, but I can assure you it is no more painful than undergoing treatment for a cavity, with the surrounding gum tissue being numbed with Novocaine in the same way.
After the effects of the local anaesthetic wear off however, there will be some minor discomfort for a couple of days, in order to alleviate this you will be prescribed pain killers. A word to the wise here though; don’t buy the prescription you are given because you will be charged upwards of 40 dollars. Instead do as I was advised and buy some regular OTC Advil or Tylenol, this will work just as well and at a fraction of the cost. As for myself however; being one who hates taking drugs of any kind I endured the pain without medication.
Once the bone graft is complete your gum will be soft and plump, and you may be left wondering how on earth your body will ever be able to grow back new bone from this. Nonetheless, you will find that after a few days the swelling will reduce significantly, and there may be a few grains of bone intermittently falling out, this does not mean that your jawbone is exposed, it is merely the excess bone shedding itself.
After just a few weeks, (just over a month in my case), you will start to feel the gum area hardening as new bone starts growing back into place. Approximately four weeks after the procedure, the Periodontist will remove the sutures– and take an X-Ray just to see how things are progressing. If all is well with the bone graft, you will be asked to schedule an appointment for the actual implants, which should be in about another six to eight weeks.
Stage Two: The Implants.
When you reach this stage, either it has already been determined that you have enough bone in which to embed the implants, or you have grown back sufficient bone from a bone graft. Now it is time for the surgeon to implant the metal rod which will serve as a root, this procedure is somewhat less invasive than the bone graft described above– since it requires a much smaller surface area of penetration in order to drill into the bone and insert the implant, hence there is less novocaine required.
It takes roughly 15-25 minutes to place in one implant, which as previously mentioned consist of small metal rods around 3.5 mm in diameter and about 6 or 7 mm in length. These implants are constructed from titanium, which is one of the hardest metals known to man, and is also highly resistant to corrosion.
During this procedure the biggest discomfort I experienced was a dry mouth and aching jaw, from having to keep my mouth wide open for an extended period of time– which as we all know is just one of the standard side effects one must endure, with any type of dental treatment.
After the implant(s) are securely in place, there is a waiting period of around seven to eight weeks before the next stage can commence; this is in order to allow bone to grow around the titanium rods.
Stage Three: Fitting the Healing Abutment.
Once the bone has started to grow around the implant it’s time to fit the healing abutments, these are small cylinders of metal which are screwed onto to the implant. The purpose of a healing abutment is to train the gum tissue to mold itself around them in preparation for the final crown. Once the healing abutment has served its purpose, it will be replaced by a more permanent fixture, known simply as an abutment.
Video: Showing Dr Nares Performing the Healing Abutment Procedure
Dr. Nares graciously allowed me to film him carrying out this procedure with a micro camera, to view this for yourself click on the video above. Although a few people have expressed how excruciating this looks, I assure you this is far from the truth. As with the previous procedure, this also affords minimum invasion– requiring just enough to expose the implant onto which the healing abutment is attached.
Stage Four: The Crowning Glory.
So now we reach the ultimate stage of our journey, where a stunning new crown will be permanently locked into place, securely supported by a precision implant. For this final step it will require a minimum of two visits, the first one is to take the impression, and the second is for the actual crown fitting.
Depending upon each individual case there may be additional visits that are required, and this will be determined by whether or not any corrections are needed– for instance it may be that the color has to be adjusted in order to more closely match the surrounding teeth. In my particular case there was partial abutment exposure above one of the crowns, whereby the crown in question had to be returned to the lab for modification.
Are Implants for me?
Obviously wherever possible, a conventional crown would constitute the better option, on account of the fact that there is already an underlying structure to work with– i.e., the root of your tooth, which makes the treatment considerably cheaper and far less time consuming. Be that as it may, when a conventional crown is no longer feasible, a choice has to be made from the remaining options.
In order to effectively evaluate which is the best option for you requires an in depth discussion with your dentist, who will be able to advise you on the best option possible– howbeit, don’t be afraid to challenge your dentist if you feel you are being sold short on your options. This is where any independent research you carry out on your own will help you to discern whether or not your dentist really has your interests at heart.
Every case is unique, and there is no one size fits all solution, since by nature people have different expectations, income brackets and tolerances on what they are prepared to put up with. Therefore each individual must decide for themselves how much money they are willing (or able) to spend, as well as the amount of time they are prepared to invest in the actual treatment.
Below is a summary of the current options available for tooth loss replacement.
Removable Partial Denture
The denture is fitted into place by attaching it to the surrounding teeth with metal clips, this is the cheapest solution but can feel unnatural. There is also the risk of color mismatch and the added inconvenience of having to remove them daily for cleaning purposes.
The mid range option: which consists of two or more crowns at either end, serving as the anchoring (or abutment) teeth in a similar way to conventional crowns. In between these crowns are the fake teeth which literally bridge the gap left by the absent teeth.
This constitutes a more permanent solution than the partial denture, but is more expensive– it also requires more detailed care when cleaning, by using a special type of dental floss specially designed for bridges. Although more expensive than a partial denture, it comes cheaper than implants.
This is undoubtedly the most expensive option regarding financial cost and the investment of time that is needed, the final result however is far superior in terms of functionality, aesthetics, and convenience.
Dental technology has come a long way in a very short time, and according to Dr Nares, it was only a few years ago that the implant process took a whole year to complete– this has now been reduced to several months. There is also current ongoing research where scientists have succeeded in actually regrowing new teeth, with the use of stem cell technology.
It is incredible to think that one day soon, this technology which is still in its infancy could become an option of mainstream dental treatment in the near future. Ideally of course, the best option which I’m sure most will agree, is to minimize the risk of tooth loss through daily cleaning and regular dental check ups. Nonetheless, if the unthinkable does happen during your lifetime, it’s reassuring to know that there is an ever growing number of options available.