DENTAL practitioners have tried to develop artificial teeth to be placed in the jawbones since the origin of dentistry. However, it was not until about five years ago that there has been increased activity in the area of implant dentistry. Modern implants were initiated by Swedish researchers in the 1960s, with the placement of small titanium cylinders or screws into the jawbone. This relatively simple procedure has progressed from experimental and highly criticised to common usage by many dentists.

The titanium–screw concept popularised implant use, but other types of implants were available much earlier. Examples are blades placed into the jawbone, with heads protruding above the gums, and subperiosteal implants placed on top of the bone and gums. These types of implants are still popular. But do these tooth substitutes (dental implants) work? Yes! In numerous situations their ability to function rivals that of natural teeth. In severe cases, they have allowed persons unable to wear traditional artificial dentures to chew well and appear normal. This author was trained in the United States to do the most popular current concept (cylinders and screws) which just requires two clinical sessions.

1. The gum tissue is opened, and the screw-like titanium implant is placed into the bone. This implant combines with the bone as the bone cells grow into its surface. This process, which has been called osseointegration, takes several months. During this time, the implant is usually sealed below the gum, away from mouth fluids and debris, while it heals into place.

2. A small hole is made in the gum tissue, and the implant is exposed. A healing cap is placed on the implant for a short time, and a head is placed onto the implant body. The gum tissue heals for a short time, and the dentist places some artificial teeth onto the implant(s). These artificial teeth can be made to appear and function as well as or better than natural teeth.

Do all dentists provide implants? No, there are two distinct divisions in the implant procedure described. The placement of the implant into bone is a surgical procedure performed by a professional who should have significant experience in oral and maxillofacial surgery. If your general dentist does not provide this service, he or she may refer you to a practitioner who performs the surgical portion of the procedure. The second portion is the attachment of artificial teeth (or total dentures if the ridge is too flat), onto the implant(s). This can be accomplished by a general dentist. Both portions of the implant procedure are exacting techniques requiring high skill, and because it is costly, only an experienced dentist should attempt it, an optimal result.

If implants are so good, why doesn’t everybody have them instead of natural teeth? Numerous aspects of the implant concept are complicated and difficult for dentists placing them, making the process less predictable than desired. Remember that implants are expensive, and, as with natural teeth, require upkeep by patients and dentists. When implants are really needed, they do not have satisfactory substitutes. Notwithstanding, the task for you and your dentist is to determine whether your oral needs would be served best by using dental implants to replace the root structure of the natural teeth, followed by some form of a prosthesis (artificial replacement) for the missing tooth structures because at times it just does not worth the trouble.