Kissing Dentures Goodbye

Toni Granat's smile is brought to you by way of 11 false teeth-but she doesn't wear dentures. "I had never worn them before, and I didn't want to start," says the 44-year-old Louisiana farmer. Instead, for more than a year, she drove the 180-mile round trip from her home in rural Amite to the dental school at Louisiana State University in New Orleans. There she was fitted with individual implants-artificial tooth roots placed surgically in her jawbone. In 1990, 65,000 Americans underwent the same procedure; each plunked down from $1,500 (for a single tooth) to $20,000 (for the rare full-mouth restoration). Most say the results are well worth the time and money. "We grow vegetables on our farm and now I can eat corn on the cob with no problem," says Granat.

Implants now offer many patients with damaged or missing teeth a more stable, comfortable and enduring alternative to dentures. In the first phase of treatment, a surgeon opens the gums, drills into the jawbone and implants a small piece of titanium (chart). The bone in the jaw attaches to the implant and forms a stable foundation for replacement teeth. Next, the gums are sewn up and the patient receives a temporary tooth or removable denture to wear during a three-to six-month healing period. Then the same practitioner opens up the gums again, makes sure the bone has bonded to the implant and attaches a small metal post to it.

The patient continues to wear temporary replacement teeth during about four weeks of visits to a restorative dentist, who screws or cements the new teeth to the posts. Like conventional bridges, they are made of porcelain, metal or polymer resin. Although going the implant route is much pricier than opting for dentures (which can cost as little as $1,100 for a full set of uppers and lowers), they last much longer. Dentures usually need replacement after five or six years, while more than 85 percent of implants last at least 10 years, says Dr. Alan Simons of University of Detroit Mercy School of Dentistry. Some have endured for two decades, and may even last a lifetime. Insurance plans usually don't cover implants, but some dental schools will offer them for a fraction of the standard cost.

The American Dental Association has approved in-the-jaw implants, but emphasizes that they are not always the appropriate choice. Candidates must be in good health and able to withstand the risks of anesthesia. There must also be sufficient hard bone in the jaw to permit bonding with the implant. Sometimes this fails to happen, or the gums don't heal properly. The implants may fail to integrate and become loose; they can also cause bone loss or damage to adjacent teeth. But for many of the 100 million Americans missing one or more teeth, a chance to live life without dentures is worth any risk.

Diagram: Love at First Bite

1 The surgeon opens the gums, drills into the jawbone and implants a plug of titanium. After several months the bone bonds firmly to the implant.

2 When the bone has grown around the titanium, the surgical specialist attaches a metal post to the implant.

3 During four weeks of patient's visits, a dentist who specializes in restoration fits the newly fashioned tooth and finally screws or cements it to the metal post.