Finally an end to the clickety-clack

By Dr. W. Gifford Jones

George Washington, the first President of the United States, always looks tight-lipped in his portraits. But he had good reason not to smile. The President had difficulty keeping his wooden dentures from falling out. Today there's been a vast improvement in dentures, yet it hasn't entirely removed that clickety-clack noise. Or the embarrassment of having to remove false teeth. Or the difficulty of eating certain foods. Conventional dentures however, will soon be as antiquated as the Model-T Ford. We have entered the age of dental implants. They are a momentous breakthrough in the history of dentistry.

Down through the ages the lack of teeth or the discomfort of false teeth has plagued mankind. In Roman times attempts were made to use animal teeth or ivory to replace lost teeth. A report in Executive Health states that archeologists discovered a skull from pre-Columbian Central America with a tooth carved from stone implanted in the lower jaw. In the 16th century Europeans with decayed teeth paid volunteers for their healthy teeth. Queen Elizabeth I is reported to have placed rolls of cloth inside her mouth to pad out her lips. And Henry Ford allegedly offered a million dollars to anyone who could provide him with a set of securely attached teeth. But for all his megamillions no-one could supply them.

Dentists have long pondered the possibility of implants. They knew that orthopedic surgeons had been screwing broken bones together for decades and getting good results. So why couldn't dentists attach new teeth permanently to the jawbone? The idea proved unworkable for several reasons. Unlike bones that lie underneath the skin safe from infection, dental screws protrude into a mouth laden with bacteria. Orthopedic screws are often temporary crutches until the bones heal. Dental screws must remain in place permanently and maintain their strength.

Another huge problem presented itself. Researchers initially assumed that since it's possible to screw a door firmly to a wall, it was surely feasible to attach a tooth to solid jawbone. But they soon discovered this was a major pitfall. Dental implants reacted as if they had been screwed into rotten wood. They did not withstand the constant forces of chewing. Or grinding the teeth at night. What was needed was something like "Crazy Glue" to hold the teeth in place.

Dr. George Zarb, an internationally renowned researcher, heads the University of Toronto team that has been grappling with this concept for years. He says the Crazy-Glue turned out to beÔ 0*0*0* titanium which is so far the only metal that fuses solidly with bone.

In the implant procedure six titanium unalloyed threaded screws are first inserted into the jawbone at regular intervals and the gum closed over them. These screws form the strong supports on which teeth will eventually be placed. But they must remain buried beneath the gum for four to six months in order to become firmly attached to the underlying bone. Dentists refer to this phenomenon as osteointegration in which there is direct implant-to-bone bonding.

During a second operation, the gum over the dental implant is re-opened and a connecting piece is screwed onto the titanium post. This will provide a support for either a single tooth or an entire bridge. Healing requires another two weeks and then the tooth or bridge is attached to these underlying supports.

Who will be helped by this new technique? The cost of about $2,000.00 for one tooth and up to $10,000.00 for one full arch will prevent many people from availing themselves of this technique. But there's more to the problem than money. DR Zarb stresses it's not a solution for patients who want instant teeth. Patients have to be well-motivated to accept the long waiting period for solid fixation of the titanium posts. And for the intricate dental procedures that follow.

Patients must also be willing to follow sound oral hygiene during and after the procedure. The threat of further cavities is removed. But the success of dental implants also depends on the continuing presence of healthy gums.

This is a vital message that must be driven home to those seeking implant surgery. The reason patients lost their teeth in the first place is often a history of poor dental hygiene. Like barnacles that collect on the hull of a ship plaque was allowed to build up on teeth destroying the gums and underlying supports as well. Dental implants are doomed to failure if lazy dental habits continue. And we all know how hard it is to teach an old dog new tricks!

But for those who are well motivated to mend their ways dental implants are the dentistry of the future. No more clickety-clack. No more having to refuse certain foods for fear the teeth may slip. No more bulky and uncomfortable dentures.

How long will implants last? It's too early to be certain. But Dr. Zarb says that some patients still have healthy implants after 20 years. He's convinced that with sound dental hygiene they should last a lifetime.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod