Six Important Factors To Take Into Consideration Before Deciding To Place An Implant
Dental implants are big business. It is estimated that in 2005 almost a million implants were placed in people's mouths in the United States. Today many dentists recommend that a tooth be extracted and replaced by an implant instead of doing a root canal or periodontal surgery.
Unfortunately, dental materials are routinely placed in patients' mouths without due regard for the health implications for those materials.
For example, recently a young woman came into my office complaining of problems following the placement of a gold crown on one of her molars. The gum tissue around the crown and the opposing cheek tissue were red, ulcerated and painful. The dentist said the inflammation could not be an allergic reaction to the crown as it was mainly gold. He referred her to an oral surgeon because he was worried that the tissue could be cancerous. The oral surgeon removed the offending tissue. Unfortunately, the gum tissue did not heal. It turns out that the crown was 73% gold, and 17% palladium, a metal to which many people have a reaction. Her dentist was unfamiliar with this issue and did not want to replace the crown. Upon hearing my belief that her problem was an allergic reaction, she pleaded for me to immediately remove the crown. I did so, and the tissue is now healed. Things we do in the mouth do have consequences!
Well, what about implants? What are the possible systemic effects?
I believe there are a number of factors that must be taken into consideration before deciding to place an implant:
1. The overall health of the patient
2. The meridian upon which the implant will be placed
3. The implant material itself
4. The habits of the patient
5. The impact on the patient's self esteem
6. The status of the rest of the mouth
1. The Overall Health of the Patient
I believe that placing a foreign object into the bone of an unhealthy person is potentially a disaster in waiting. This goes for root canals as well as implants. By unhealthy, I do not necessarily mean someone who has a diagnosed illness; I do mean anyone who has a number of annoying symptoms, especially if any of those symptoms are controlled by a drug. I also include anyone who previously had a serious illness like cancer. In my opinion, in almost all of the above instances, an implant is risky and should not be considered without first working to improve the health of the patient desiring that implant. (See past newsletters: Some Musings on the Nature of Disease Part One and The Nature of Disease - Part 2)
2. The Meridian Upon Which the Implant Will Be Placed
In conjunction with assessing the patient's overall health, I believe it is also important to consider the acupuncture meridian upon which the implant is being placed. Remember, every tooth and its surrounding area is located on an acupuncture meridian, and therefore relates to specific organs, muscles, vertebrae and tissues. For example, placing an implant on the breast meridian of a woman who has a family history of breast cancer may not be prudent.
3. The Implant Material
While dental implants are traditionally made of titanium, materials such as aluminum andvanadium are often alloyed with the titanium. Dissimilar metals in the mouth or bone will give off corrosion by-products which then disseminate throughout the body. Placing any sort of metal crown upon the implant will also induce corrosion. If a patient is going to have a titanium implant, it is a good idea to have a compatibility test in order to identify which brands are best for that particular individual. This does not address the issue of corrosion by-products but will help with reactions to them. (Read about compatibility testing in these past newsletters Which Dental Materials Are Right For You - Part One and Part Two) Also, because placing any sort of metal crown on the implant will induce corrosion, the crown should not contain any metal. The corrosion I described is caused by galvanic currents between dissimilar metals. Also, what are the potential effects of these currents upon the body?
Zirconia dental implants are now being introduced into the United States. Zirconia implants have been used in Europe for a number of years. The advantage of these implants is that they are ceramic, and thus there is no corrosion. There has been some confusion with the fact that zirconium is a metal and is just below titanium on the periodic table. However, zirconium oxide is being used for the implant material. Zirconium oxide is a ceramic and is called zirconia.
These zirconia implants are very bio-compatible and the gingival tissue reacts very favorably. At this time, there are some limits to their use from a restorative perspective. While these implants are preferable to titanium implants, I am still concerned about the potential for creating health problems by placing a foreign object on an acupuncture meridian.
4. Habits of the Patient
Given that implants can fracture, one must consider whether or not to place implants in the mouths of patients who brux (grind their teeth). Habits such as smoking or chewing tobacco may also negatively affect the long term success of implants. Patients with implants must be conscientious in about keeping their mouths clean.
5. Impact on the Patients' Self Esteem
Some people cannot bear the thought of anything removable in their mouths; they equate this with old age. Something removable in the upper anterior part of the mouth will not be as appealing to a patient as a fixed bridge or an implant. If the person is so self conscious that he or she won't smile, I feel this may be worse than the potential negative effect of an implant (see past newsletter on Self Image and Treatment Choices). It is important to consider the whole body and person.
6. What is the Status of the Rest of the Mouth?
When placing a titanium implant, I recommend that there be no other metals in the mouth, so as to minimize both corrosion and electrical currents. In Whole-Body Dentistry we are always juggling the pros and cons of what we do. For instance, if there are no lower molars present, and patients cannot properly chew their food, something must be done. For many, a removable partial denture will not be comfortable. Also the chewing forces of removable partial dentures are not nearly equal to those of natural teeth. Only an implant will approximate the force and function of natural teeth. Being able to eat nutritious food may be more important a concern than the potential negatives of an implant.
Clinically, I use EAV testing on patients considering implants. Watch Our Video Demonstration and Explanation of EAV Testing. If I find issues, I correct them. When patients have been brought to a high level of health and they are generally of a robust constitution, they generally tolerate implants very well. Can this tolerance for the implant change with time? I believe this is possible. Age, illness and emotional trauma may affect the status of the implant, just as these factors may affect the person generally. I recommend periodic checking of the implant with EAV testing.
© 2010, Mark A. Breiner, DDS
The information presented is for educational purposes only. You should consult a qualified health practitioner for diagnosis and treatment.