Showing off your Smile [Alberta Edition]

The loss of a tooth or multiple teeth, for whatever reason, can cause a lot of distress. Often times, people are given one solution: dentures. However, the stigma behind having to remove one’s teeth every night can make dentures an unappealing option. Dr. Nathaniel Podilsky, a dentist at the Edmonton Centre of Aesthetic Dentistry, focuses on cosmetic dentistry. He handles many cases of tooth loss, and has some advice on an alternative solution — dental implants.

Dental implants have been around for more than 20 years, but have only gained popularity in the last five to seven years. Titanium is commonly used to make the implants due to its high strength, low weight, corrosion resistance and excellent biocompatibility. According to Podilsky, implants work due to the osseointegration phenomenon. He says, “By definition, this means that the functional implant surface comes in direct contact with living bone with no interposed soft tissue at the microscopic level. The dental implant, once inserted and once the bone has totally healed, does not move during eating and grinding, unlike a natural tooth.”

A full dental examination and a full medical workup are required before a patient can get any implants. It’s important that patients are in good health before undergoing dental implant procedures. Otherwise, any disease or health issue they might have needs to be treated before implant therapy. “At the full examination, appropriate radiographs are taken, a full set of impressions and models, photographs, and any other diagnostic tools to determine if an individual is a good candidate for dental implants. I-CAT or three-dimensional x-rays are a great tool to determine three-dimensionally if the patient has enough height, width and quality of bone,” says Podilsky. Quality of bone is important because your implants need to be anchored securely onto bone tissue.  

Losing a tooth or multiple teeth can be a problem. If left without any sort of treatment, adjacent teeth can tip and rotate causing food impaction and difficulty cleaning. A patient’s occlusion (bite) may be altered as well. There are other options aside from dental implants, but Podilsky says they aren’t all equally reliable. “Replacing a missing tooth with a bridge is an option, but this procedure requires the drilling of good healthy teeth on either side of the space. These teeth over time may be lost due to caries, gum disease or may become infected. Infected teeth then require either further treatment with root canal therapy or extraction.” The human jaw bone needs function to remain healthy. The only stimulus to maintain the bone is a healthy tooth or an implant. “On average, dental implants have a 97% success rate for 10 years… Without an implant, the patient loses bone in both height [and] width, and the quality of the bone deteriorates,” says Podilsky.

Patients who need full dentures often don’t wear their lower dentures or change their lifestyle to eat only softer, processed foods. Using dentures alone can cause what Podilsky calls a “sunken face,” over a long period of time. These individuals often have to replace their dentures as the bone loss continues. He says that bone loss continues throughout the entire life of the individual, so dentures need to be relined often — otherwise, it could lead to sores and pressure points on the fragile gums. Food may not be chewed properly without lower dentures, and this can cause other health and stomach problems.

Each year, millions of dollars are spent on denture adhesives to reduce embarrassment of loose dentures. Along with the financial benefits, health benefits from dental implants can also lead to a healthier lifestyle and improved self-esteem, because patients won’t feel debilitated or old. People who need their teeth extracted can immediately have implants. That means that patients will be able to “maintain their jaw bone and continue to have improved function,” says Podilsky.

“ROUTINE VISITS EVERY THREE TO FOUR MONTHS TO THE DENTIST AND HYGIENIST IS RECOMMENDED TO REMOVE PLAQUE AROUND NATURAL TEETH AND IMPLANTS.”

Once you have dental implants, don’t forget about maintenance. “Maintenance is very important. Routine visits every three to four months to the dentist and hygienist is recommended to remove plaque around natural teeth and implants,” says Podilsky. Just like your natural teeth, flossing and brushing is key. Visits to the dentist allow them to examine patients for signs of inflammation and signs of implant mobility. Patients are provided with extensive oral hygiene instructions, which include the use of a soft nylon bristle floss and oral rinse. Implants can develop gum disease around them just like your natural teeth, so remember to keep them clean.

Unfortunately, not everyone is a good candidate for dental implants. People who have had a recent heart attack, severe renal disorder, generalized secondary osteoporosis, treatment-resistant diabetes are, as Podilsky notes, “absolute contraindications for implant surgery.” He also says, “Patients undergoing radiotherapy for cancer have a low immune system and are more prone to infections and therefore should not have implants during the radiation treatment.” Other conditions such as chronic alcoholism and drug addiction are also contraindications for implants.

Podilsky warns that although implants are 95% successful, they can fail. Failure of an implant usually means the loss of bone followed by mobility of an implant. He says, “This is as a result of active infection [indicated clinically by purulence, bleeding and swelling].” The first month after implant insertion and surgery holds the greatest risk of implant failure.  The amount and quality of bone at the implant site and the general health of the patient also determine implant success. Like any other surgery, there are risks — though they are limited. “Benefits like improved function and aesthetics with improved self-esteem because of dental implants outweigh this risk factor,” says Podilsky.

People sometimes regard dental implants as a cosmetic solution for “bad” teeth. However, Podilsky doesn’t advise patients who just want them for aesthetic reasons to get them. “The biggest reason for this is that the healing of the patient’s soft tissues is unpredictable,” he says. “Every patient heals differently.” If a person has crooked, discoloured or uneven teeth, it may be wise to look at other options like porcelain veneers or a combination of braces and veneers. •