(Written by: Dr. Dominique Laatz MSc. MSc., Oral Surgeon and Implantologist, German Dental & Dermatology Center, Doha, Qatar)
If you lost, or are about to lose a tooth or multiple teeth, dental implants are certainly an option which at one point has to be considered carefully. But reliable, sophisticated yet understandable resources are rare and hearsay from friends and acquaintances can be either blessing or curse – which leaves you where you started – Insecure and perhaps even nervous. This isn’t a good base for what interested patients really need and crave for – sufficient, understandable information to help making a decision, whether to have implants or alternative treatment options or perhaps simply nothing.
While dental implants are not for everybody, a vast majority of cases can be treated without any extensive efforts. But the general conception of dental implants as a highly complicated transplant-type procedure differs from this fact. Over the years, I have experienced, that many patients wrongfully doubt their qualification as an implant candidate. They either think that their bone is insufficient or that they tend to heal badly or that their body simply can’t accept a metallic foreign body. Most of the times, these are misconceptions, based on hearsay or low-quality online resources.
To properly prepare potential implant patients, it is therefore of utmost importance, to clearly state risks and chances and to explain who is a good candidate for dental implants and who is not. In the following, I try to sum up the most basic obstacles and preconditions for successful implant procedures in 4 points. Another purpose of the following words, is to help the reader to distinguish between what is popular belief and scientific evidence in the limitations of dental implant procedures.
- The tissue is the issue
Modern dental implants are designed as either tapered or non-tapered screws. These are placed into your jawbone, after your implantologist prepared a suitable bony hole in the size of the diameter of the planned implant – which leads us to our first precondition: sufficient bone tissue. Limiting structures are the “lip nerve” in the lower jaw and the maxillary sinuses (as part of the of the group accessory nasal cavities) in the upper jaw. While normal jaws regularly display more than enough bone height, to place average-sized dental implants without further measures, implants usually have to be placed in the compromised and often atrophic jaws. Especially long-time edentulous jaws exhibit a phenomenon of atrophy due to inactivity. This can create a situation, where implants can’t be seated safely without endangering the sinus or nerve integrity. But also, these obstacles (which are quite common), can usually be overcome by experienced oral surgeons and more advanced implantologists. The traditional way is to simply augment the missing bone to the needed extent. In bone augmentation, multiple more or less invasive methods have been introduced and are mostly well-established (more details on these augmentation methods will be discussed in a separate article). Another way, which due to its simplicity is gaining more and more followers, is the utilization of so-called short implants, which are usually only between 4-6 mm in length.
Other techniques, like the so-called All-on-4 protocol even try to evade implanting in the proximity of the lip nerves and sinuses altogether.
Regardless, which method is applied, your prospects of getting a functional and dependable implant-supported solution are very good, in the hands of a properly trained and experienced practitioner.
- Foreign body reactions and allergies
This seems to be a hot topic among potential candidates. But it is not as hot as some more or less unscientific articles might suggest. Both phenomena have rarely been described in scientific literature due to the extremely seldom occurrence. In the scientific scene there isn’t even a consensus that these kind of reactions to medical-grade pure titanium implants exist or not.
Certainly, a sound decision-making process should not be guided by any kind of far-fetched assumptions.
- The general health status
Another often misunderstood factor is the influence of one’s general health status on the prospects of implant surgery. The two most cited chronic diseases Diabetes and high blood pressure – if medically controlled – are no contraindications to implant placement. Common sense, falsely leads many patients to think that Osteoporosis must be a typical contraindication for implants which, of course, depend on bony quantity and quality. While this may sound very logical – it is not true. According to literature, the jawbone density isn’t directly affected by osteoporosis.
With that being said, there are still a few absolute contraindications to implant surgery, like certain immunologic conditions, but most contraindications are temporary in nature like a fresh heart-attack or heart valve replacements, stent placements and coronary bypasses. A very important contraindication is the chemotherapeutic medication with intravenous Bisphosphonates. These are mainly used to stop the growth and proliferation of bony metastases and down-regulate the bony metabolism. Unfortunately, any elective surgery involving and exposing the jawbone must be evaded in this scenario.
Also in contrast to popular believe old age isn’t a contraindication per se. But the general strength and stress resistance of each elderly patient should be carefully considered before any type of elective surgery (including implant procedures).
- Smoking allowed?
If there is one thing almost all implantologists agree on, it’s that they’d prefer a non-smoker over a smoker any day, when it comes to the prospects of dental implants. Tobacco negatively affects the outcome of most surgical and even some non-surgical therapeutic procedures performed in the oral cavity. And implants are no exception here. Scientific data strongly suggests a considerably higher failure rate for osseointegration (bony integration of the implant body) of dental implants, which results in early implant losses.
Also, the risk of late implant failures seems to be significantly higher in smokers, due to a higher chance of chronic gum complications such as peri-implantitis.
However, smoking isn’t considered an absolute contraindication since the success rates for dental implants in smokers, is still very high and surpasses most other dental reconstructive solutions by a wide margin.
For receiving more detailed information, I strongly encourage the reader to reach out to an implant specialist for a consultation and examination.