Your Body : Dental Patients: Don’t Bite on Just Any Implant Idea

The 65-year-old San Fernando Valley businessman had a choice--full dentures that had to be taken out every night or individually implanted, artificial teeth that could chew anything, even apples. He happily opted for dental implants, considered by some the most revolutionary dental breakthrough in the last 50 years.

But after a $10,000 investment, he had to have them all removed because he developed severe gum infections due to an allergic reaction. Another woman had every implanted tooth redone because a dentist with little or no experience had placed them at an improper angle. At least one patient a week complains of problems at the UCLA Dental Implant Center. Even the Food and Drug Administration, which doesn’t often hear from consumers, has logged 15 to 20 complaints.

Dental implants, which have been on the market for 30 years, have exploded in the past two years because many more companies and dentists are offering improved technology. But it requires special training to insert the screw-like anchor into the jawbone and attach the non-removable tooth.

“Some manufacturers will sell to any dentist,” says Dr. John Beumer, professor of prosthodontics at the UCLA School of Dentistry who is an implant specialist, “regardless of whether they participate in training sessions.” Even in the best of dental hands, a patient’s underlying bones may not grow up to meet the anchor, a process known as osseointegration that’s vital to the success of implants. Faulty materials can also cause implants to fail.

Stricter Restrictions Sought

At least 26 manufacturers produce the implant systems, and critics say some are so shoddy that they are calling for stricter government regulation. Under the current FDA guidelines, new manufacturers can get clearance simply by proving their system is equivalent to products already on the market. In the future, the FDA will require manufacturers to submit clinical tests that prove their safety and effectiveness.

The American Dental Assn., which already requires five years of clinical data, has approved only one implant system--the Branemark. Three more--Core-Vent, Interpore and Oratronics, which are in the process of submitting the required clinical data--have been granted provisional acceptance.

But manufacturers insist their success rates are high. Dr. David Wacker of the Encino-based Core-Vent Corp. cites a 96% success rate in 623 implant patients after five years. More than 95% of 800 Interpore implants are still functional five years later, says George Smyth, president of the Interpore International in Irvine.

Be Inquisitive, Meticulous

For patients contemplating dental implants, experts offer these caveats:

Ask the dentist about his track record with such questions as “How many implants have you done?,” “What is your success rate?” or “Do you have special training?”

“Go with a well-proven implant system,” advises Dr. Steven Lewis, a UCLA assistant professor of prosthodontics.

Don’t go overboard. Limit to 10 implanted teeth, Beumer suggests.

Be meticulous about oral hygiene. “Someone who can’t maintain adequate oral hygiene isn’t a good implant candidate,” says Dr. Peter Woehrle, a dentist at the Harvard School of Dental Medicine. “They should floss daily, use special brushes to clean between implants and see their dentist every three months for an least a year.”

Dental Phobia

Some dental patients, terrified of drills, needles and pain, put off visits for years. Now, sympathetic dentists are trying to make office visits less frightening for just these dental phobics.

Instead of barking “hold still while I drill,” dentists are taking 15 to 20 minutes to discuss their patients’ fears. Dr. Nathan Friedman, head of behavioral dentistry at the USC School of Dentistry, suggests dentists strike a bargain. “The dentist should agree to proceed with treatment only with the patient’s permission,” he told a recent meeting of the International Assn. of Dental Research.

That feeling of powerlessness, in fact, is often the crux of dental phobia. “While patients will tell you they fear the needle or the drill, the major fear is a feeling of loss of control,” says Dr. Gordon Rubin of the Dental Phobia Clinic at Mt. Sinai Medical Center in New York.

To allay fears, Rubin teaches patients to relax with guided imagery: “We ask patients to take themselves to a relaxing place like a beach or a mountain lake.”

Dental phobics can find a dentist skilled in fear reduction techniques by calling their local dental society. Rubin also maintains a nationwide list.

Antibiotic Fiber

When gums are disease-ridden, dentists sometimes have to resort to lengthy gum surgery or painful procedures like scraping bacteria away from infected teeth. But soon there will be another weapon for this common problem that affects three out of four people sometime in their lives.

Under study is a thin, polymer fiber, soaked with the antibiotic tetracycline, that dentist can wrap around the infected tooth and gently push below the gum line. After 10 days of antibiotic treatment, the dentist removes it. “It’s a painless treatment,” says Laura Mills, a spokeswoman for the Palo Alto-based Alza Corp., which has applied for FDA approval to market the treatment.

And seemingly effective. In an in-house study involving 133 patients, the antibiotic fiber therapy improved all 626 affected teeth in some way. “The therapy is an effective way to control localized infections that cause gum disease,” says Dr. J. Max Goodson, the research dentist who developed the treatment at Boston’s Forsyth Dental Center.

But Goodson cautions it’s not a cure-all. Indeed, there are some potential drawbacks. Long-term exposure may cause allergic reactions in patients and create bacteria resistant to the antibiotics, cautions Dr. Roger Stambaugh, a respected West L.A. periodontist. “It may work best,” he says, “for early-stage gum disease.”