- The Washington Times - Monday, March 26, 2007

Jean Silva of Waldorf, Md., says living with false teeth has been “a complete nightmare.”

“They don’t fit right, and it’s hard to chew food,” says Ms. Silva, 54.

Earlier this month, she set aside her dentures for good.

Ms. Silva underwent a high-tech dental implant procedure that gave her a new, permanent smile.

The process uses a mini-CT scan and computer imaging to make sure the implants go in precisely where they should. A set of new teeth goes in next, anchored by implanted screws made of bio-friendly titanium.

Dental implants are hardly new. People have been replacing their lost teeth, whether a couple at a time or a whole set, since the 1950s. However, emerging technologies make the process faster, less invasive and more accurate.

The high-tech course isn’t ideal for everyone, particularly those with limited funds, and some people can eat an ear of corn with their dentures without pain or discomfort. However, those seeking a permanent solution to dental loss can inquire about implants.

Dr. Joseph Kravitz of the Bethesda-based Washington Center for Image Dentistry, says the CT-scan-based procedure takes two steps to complete. The first asks the patient to undergo a scan to create a three-dimensional map of his or her mouth. In Dr. Kravitz’s office, the CT scan is smaller and less noisy than ones found in hospitals. A patient sits in the machine ,and a semicircular ring rotates around his or her head. A few minutes later, the information is transmitted to an office computer for consultation.

“You can move through the jaw from the eyes to the spine,” Dr. Kravitz says, adding that the small CT yields 90 percent less radiation than a hospital CT scan.

The graphics allow oral surgeons to avoid inserting an implant near a nerve or the sinus cavities.

“You have a blueprint for success,” Dr. Kravitz says.

He says the CT scan occasionally reveals a hidden tumor or cyst in the mouth, which must be removed before any implantation is done.

The physical implant process begins with the doctor screwing titanium posts into preselected sites in the jaw. The screws are seen as bone by the surrounding bone tissue, and new bone grows around them.

Previously, oral surgeons sliced open the patient’s gums to find the proper implant areas on the jaw. The traditional implant method also causes minor bone loss, Dr. Kravitz says, which can be problematic for a small number of patients with an already small amount of implantable bone area.

The second and final step for Ms. Silva’s implantation went as expected recently.

It’s a methodical but perfunctory process, and Dr. Kravitz snaps pictures every step of the way.

“If gum color changes over time, we have a baseline [for comparison],” he says.

He installs a few teeth at time, first installing the titanium posts and then attaching the new teeth. He occasionally tightens a screw by hand as if assembling something from IKEA.

His touch is delicate and practiced.

Dr. Kravitz constantly checks on Ms. Silva’s comfort level. When the implants begin to pull unpleasantly against her gums, he provides some local anesthetic.

Gum fibers stretch, but the pulling sensation is temporary.

Not every oral surgeon thinks this surgery-less technique is necessary.

Dr. Richard Giuliani, an oral surgeon based in Chevy Chase, says existing methods offer rewards similar to those of the newest techniques.

Using the CT scan isn’t crucial for some patients, he says.

“If there is enough bone in sight, then you don’t have to physically look at the bone [with the 3-D images],” he says.

Dr. Giuliani also says pain is not a big issue with current implant patients.

“There’s much less pain with dental implants than with having a tooth out,” he says.

Where the CT scan technology becomes important, he says, is if a patient has a marginal amount of bone and it requires great precision to place the implants just so.

Dental implants became widespread in the United States in the early 1980s, says Dr. Boyd Tomasetti, an oral and maxillofacial surgeon in Littleton, Colo.

The latest, high-tech implant procedure began in 2004 and remains rare across the country.

In some instances, that doesn’t pose a problem for those with missing teeth.

“You certainly don’t need it for every patient, but those who have problems with the amount of bone available [in their mouths] would certainly benefit,” says Dr. Tomasetti, past president of the American Association of Oral and Maxillofacial Surgeons

Bone loss is more common with people who already are missing a significant number of teeth, the group who most need dental implants.

No matter the technique, “implants are the best alternative to dentures, particularly the lower dentures,” Dr. Tomasetti says. He has implants in his own mouth.

He calls the new CT-scan-based work “a small and helpful leap” in implant circles, allowing for more accuracy and less concern with bone issues.

The existing method still works, though.

“Cutting the gum is not that big a deal,” he says, adding that oral surgeons don’t have to peel gums back too far to find the right spot for the implants.

The bigger pain comes when it’s time to pay for the procedure.

Dental implants will run a patient about $2,100 for a single tooth to $40,000 for an entire set of teeth at the Bethesda center.

“Dental insurance is not like medical insurance,” Dr. Tomasetti says, adding that many policies have a maximum to be paid out each year, a number dental implant work routinely dwarfs.

He advises potential dental implant clients to talk with their insurance companies. Even if a dental implant procedure isn’t covered, the company may foot the bill for a bridge. The patient can ask his or her insurance company if it can take the money that would go for the bridge and apply it to the dental implant, he says.

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