Dental Implants: What Your Dentist Hasn’t Told You

A female dental patient became a “migrant” between multiple dental offices for months. Several clinics declined to treat her one after another. They were reluctant to take over a failed implant that had been performed elsewhere, or unable to heal her inflamed teeth. Certainly, the patient suffered unspeakably. She couldn’t eat normally—the implant location in her mouth kept getting infected and festering. 

At last, after great effort, the patient met with Dr. Ming-Ko Li, executive director of the Association of Asian Reconstructive Dentistry and head of Ricon Dental Clinic in Taiwan. Since the patient had almost used up her limited dental budget, Li chose implant-supported overdenture, which helped her restore her chewing ability and ended her nightmarish experience.

In fact, the patient’s experience is far from alone.

In dental implant failure cases, many victims would have a torn, swelling pain and biting weakness while eating food. Some are so upset that they feel like snapping the implant body out of their mouth. Others even develop ugly-looking rabbit teeth. Besides, there has also been an enormous gap in the cost of up to $3,000 or $4,000, varying from clinic to clinic.

Since the start of implant technology, chaos has been plaguing the sector for decades, for which greed for large financial benefits and inadequate clinical training of dentists is to blame.

Can a Dental Implant Last for Life? 

A dental implant is a screw made of titanium with a treated surface that interfaces with the bone to be inserted into the jawbone and functionally replaces the “root of the tooth.”

Certain cells in the jawbone secrete minerals and mesenchyme, which fuse with the implanted screw to create osseointegration, thus making the device more stable and supportive of the occlusal force. Then, based on the patient’s needs, the surgeon places a movable or fixed denture on top of the screw to serve as the tooth.

If the implant body itself is free from bacterial infection and damage, it can be theoretically used forever. “Theoretically,” Li stressed. 

2 Reasons Dental Implants Fail

Infection is the primary contributing factor, depending on the patient’s tooth brushing, whether he or she is a smoker or has chronic diseases, and whether the dentist has helped create an easy-to-clean-and-maintain oral cavity environment for the patient.

Damage includes broken bite surfaces, components, or the implant body.  These problems may arise from tooth grinding during sleep, poor resistance to implant materials, or poor bite. You may not imagine that, when you are eating, the bite force is about 12 kg per square centimeter! That means many parts, including the implant body, are subject to the pounding of such a weight. Grinding teeth at night is even more impactful, with a force roughly six times that of normal chewing. The actual weight measured in tooth grinding is 74 kilograms. Li described the scenario as a 74-kg person with high-heeled shoes and a heel area of one square centimeter dancing on the teeth. “That’s the horror of clenching one’s teeth,” said Li.

Under such long-term pressure, the implant body may easily become broken or simply bitten off even if it has good resistance—however, cases of the implant body being bitten off are rare. Li has seen only three or four such cases throughout the course of his more than 20 years of clinical experience.

Implant bodies with poor resistance wear out faster due to being “pounded” by daily meals. Resistance varies from brand to brand, depending on your choice. Besides, prices range remarkably. Implants from well-known brands cost more, while counterfeit implants usually sell at a quarter of the former’s prices, potentially as low as $64 to $97 for a complete set of parts.

However, you get what you pay for.

To maintain their market shares and reputation, well-known brands use materials featuring good resistance and offer good after-sale service for parts replacement. You are likely to obtain their products as long as you place an order, even though their production line for these products may have ceased. You may even get a custom order. Moreover, major players invite researchers, clinicians, and school representatives to deliver lectures and provide study reports for them. Therefore, Li notes, dentists can fully understand the implant bodies they use and significantly enhance product safety once they access long-term clinical follow-up reports, success rates, and basic research on particular products. 

In comparison, other manufacturers may cut costs with materials, production processes, and research and development, to sell cheaper products. Their low-priced counterfeits are prone to loosening, fracture, and wear. Also, they offer no guarantee for parts replacement. If such small companies suspend their operations, you cannot possibly access their original drawings of parts or other information.

Some dental clinics may purchase such low-cost implants to attract clients. However, the patients would risk having no parts for replacement in the future. Or they risk changing their complete sets of implants in the future, which will be a painful process, involving both financial loss and bodily pain.

Top Reason for Failure: You Chose the Wrong Dentist

If we elaborate on the topic, however, the key to determining whether you fall into pitfalls or even experience serious side effects after surgery is whether you choose a dentist who is both virtuous and well-experienced in the sector.

Alice Zhu, a licensed Chinese medicine doctor in the United States, said that she had several friends in their 40s and 50s who are also medical professionals and have had dental implants. One of them chose a dentist who is reputable, but not skillful enough in the specific area. So, her surgery turned out to be a disaster. Zhu sighed, “The implant body fell out, and she suffered a lot, not knowing what to do in the future.” 

Patients receive implant surgeries mostly due to severe tooth decay, breakage, periodontal disease, and bone or gum loss. Therefore, the dentist must take the following steps, depending on the patient’s physiological conditions.

  • Restore the alveolar bone

The alveolar bone serves exactly like the foundation of a house. Since the shrinking bone will not grow on its own, it needs to be filled with bone mineral powder, requiring a wait of several months to grow enough new bone.

If the implant body is placed directly into the sunken bone, food scraps and dirty things will get stuck between the teeth later. So, the implanted tooth will easily become infected and inflamed, while the infection is precisely the most likely factor that causes surgical failure.

Another possible scenario is the growth of “rabbit teeth.”  Although it can be inserted deep enough to fit into the base of the alveolar bone and stay in place, the implant body has a limited length. Therefore, if a long denture is placed directly into the remaining part, it will look longer than a natural tooth.

  • Restore gums

If the shrinking gums are left unrepaired, that will make the implant look unattractive. Even worse, the patient will get hurt when brushing his or her teeth, due to the lack of gums around the teeth, so he or she may not brush them as often as they need to.

The dentist must help the patient restore the gums and install temporary dentures to adjust and fix the shape of the gums.

  • Adjust for a good bite

Only when the dentist helps the patient achieve the best bite can the patient have a smooth chewing experience and avoid implant damage.  

A good bite is crucial. Otherwise, the following effects may occur: the implant itself being subject to undue weight; temporomandibular joint and chewing muscles being affected; myofascial pain syndrome; and depression, which may even affect the patient’s overall health in severe cases.

In addition, if you have periodontal diseases, the first thing you need to do is remove the plaques and calculi in your mouth thoroughly to avoid surgery failure.

In the case of the “migrant” patient we mentioned at the beginning of this article, her dentist failed to perform the aforementioned steps for her.

Li pointed out that if the first-time implant abuses the original alveolar bone and causes bone infection and inflammation, the second attempt will be extremely dangerous and tough. If it fails once again, you can almost bet that there will be a third one. However, how many implant surgeries can a person endure in a lifetime? “I’ve seen patients who have had a full mouth replacement. I’ve seen and treated them, but I’ve never seen one that could undergo the second replacement,” said the doctor.

Is the ‘Immediate Implant Approach’ Really Feasible?

There are some dentists who focus on and advertise the “immediate implant approach,” a shortened option that they claim applies to business professionals or those who do not have time to visit dentists. However, the course of treatment from bone restoration and implant placement, to waiting for osseointegration, tends to take months, depending on the patient’s health. So, is the immediate implant approach feasible? 

Li pointed out that it is feasible only with a small portion of patients.

He recalled a world-class lecturers’ conference that was held in Berlin, Germany, a few years ago, where all the attendees were trained physicians. At the conference, the participants were requested to vote, by pressing a button, on the question “What are the chances that you would take the immediate implant approach if you have clinical conditions ready for the option?” The result showed that less than 10 percent of the votes were for the strategy, which highlighted the fact that very few patients are clinically good candidates for the immediate implant approach.

The option requires two preconditions: the alveolar bone is not infected and is strong, and the gums remain undamaged. Nevertheless, Li argued, “Why would a patient want to get that tooth removed if he meets those conditions?”

Usually, the situations we face are that the tooth is irreparably broken, but the breakage location is right at the root, while the alveolar bone is not damaged; or the tooth has gradually decayed until only the root and the alveolar bone remains uninfected.

On the contrary, the dentist risks complications, sequelae, and implant failure, if he does not treat the infected and shrunken alveolar bone, and ignores the inability of the gums to completely cover the tooth, before drilling the implant body directly into the remaining alveolar bone.

How to Choose a Trustworthy Implant Dentist

What is a successful implant? When the entire procedure is completed, the following must be met:

  • Natural and aesthetical appearance  
  • Smooth chewing after the procedure without jamming or interference with the bite
  • Strong biting so that no food is left unbreakable
  • Ease of cleaning; food scraps are unlikely to get stuck between the teeth
  • Stable and long-term use

Whether the implant is a success or failure—two opposite outcomes—completely rely on the dentist and whether he or she is clinically well-trained and willing to take responsibility for the patient. The process involves the selection and placement of implant components, alveolar bone and gum restoration, and adjustment for a good bite.

So, how can the public choose a trustworthy dentist? “It’s not an easy job, actually,” Li admitted.

The reason is that dental implants involve medical education, massive financial investments, and doctors’ philosophy of treatment that varies tremendously. “To put it bluntly, doctors work for ‘a better life,’” said Li. “But some do so for their self-interests, while others do for their patients.”

In the former case, the dentist will, of course, maximize his or her gains within a short period of time. It is not difficult for a skilled dentist to drill five to six holes in a mouth and insert five to six implant screws. The large profit per hour is virtually a great temptation for a dentist.

Li, who has been invited to deliver lectures in Japan and multiple Southeast Asian countries, discloses another fact—that there is currently no implant-related training in Taiwan’s schools. Dentists in Taiwan have to sign up for relevant courses. Moreover, every step involves a course. However, not many doctors are willing to invest to that level. 

Even worse, some could buy dental implant licenses and place them on the wall in their clinics to prove their qualifications as specialists.

Underqualified dentists are seen not only in Taiwan, but also in China and the United States.

Therefore, once you make a decision about a dental implant, the most important thing for you is not to compare brand prices, but to find a dentist that you can trust to take responsibility for your oral cavity health for the rest of your life.

Li suggested that you ask your dentist the two following questions. 

Do you provide follow-up cleaning and care after surgery?

Could you solve short-, medium-,  and long-term denture problems, if any?

No matter what good condition a fresh implant is in, it will definitely wear out with daily use, and dirt will accumulate on it, which can cause periodontal diseases. Just like a car that needs to be washed and get its parts maintained and replaced on a regular basis, a dental service provider needs to offer long-term maintenance and cleaning after implant placement.

2016 study shows that post-surgery care reduces implant failures by 80 percent. 

Furthermore, the dentist is expected to provide short-, medium-, and long-term options to care for the patient’s teeth. For instance:

What if a minor infection occurs at the implant location and parts get somewhat loosened five years later?

Will there be a chance to replace parts if the bite surface is broken and the dentures fall out 10 years later? 

What if an implant damaged by wear and tear becomes even more serious 15 years later?

In reality, Li emphasized, “almost no dental care provider would like to take over implant bodies that are done by other facilities” if something goes wrong with them in the future. Placing an implant is like selling a car, which will produce a considerable gain, while repairing involves only a small fee. No one will regard an automaker as trustworthy if it doesn’t care about the after-sales service.

Could you show me your previous implant achievements?

If the doctor’s answer is “Yes,” you can follow up with questions about his or her treatment methods, measures, and previous cases and results, including original before-and-after surgery images from their patients.

After all, any careful treatment must be recorded in writing. A trusted physician will at least keep X-rays, photos, and clinical records with regular follow-ups.

The two questions above prove whether a clinic has follow-up visits after five or 10 years, or if it takes good care of its patients. “I believe that’s a very simple test of trust,” said Li. He said that some good dental clinics “have patients who follow up with appointments after 20 years and that some implants look as new as they were placed 20 years ago.”

A dental implant procedure is not as simple as “placing as many teeth as you’ve lost.” You also need to consider whether you’re able to look after them.

Take elderly people as an example. Spending a long time getting many implants will be a grind for them. Besides, with less flexible fingers, they may not brush their teeth properly. Comparatively, a solution featuring implant-supported removable dentures would be a better option for them. With a good appearance and stable and easy-to-clean structure, those dentures would accompany and serve them long enough in their remaining years. 

For younger patients, the dentist should restore each tooth to its original natural appearance and function as much as possible, so that they can go with their owners for about 50 years to come.

Li said, “What a dentist should keep in his mind is to seek custom implant treatment and offer long-term care for the sake of his or her patients.”

Of course, patients should also strive for a better quality of life for themselves. For example, smokers should put in some effort to quit cigarettes, which has proven to increase implant failure by 250 to 300 percent. Those with chronic diseases need to keep their conditions under control. Diabetic patients, for instance, may have an implant survival rate that is not significantly different from that of healthy people if their blood sugar is well controlled. Meanwhile, patients are expected to develop good oral hygiene habits. Only by doing this can they reduce the risks of subsequent infection and failure.

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