COMMENTARY

The Evolution of Dental Implants: Regulations Matter

Marjorie Jeffcoat, DMD

Disclosures

June 27, 2012

In This Article

Dreaming of Replacement Teeth

I would like to consider a broad perspective on dental implants -- the current state of the art, how we got here, and the role of the US Food and Drug Administration (FDA). I wouldn't be going too far out on a limb to say that the success of dental implants is the single greatest advance in dentistry that I have seen during my career. (I wasn't around when fluoridation was introduced, before you challenge me on that!) The dream of a one-to-one replacement for missing teeth has probably been around since man first chewed on mammoth steak, but remained elusive until very recently.

A great deal of research and creative energy went into finding the materials and configurations to make a long-lasting satisfactory tooth replacement. Now, in a few short years, osseointegrated dental implants have come into their own as an entirely new treatment option for patients with missing or compromised natural teeth. Implants are no longer just a research area, but a technique applied on a daily basis.

The Breakthrough: Dental Implants

What made the difference? What changed dental implants from a dream to a practical everyday option was Per-Ingvar Brånemark's breakthrough recognition that there were 3 ingredients to success[1,2]:

  • A biocompatible material, such as titanium, that bone could grow against and potentially adhere to;

  • Atraumatic site preparation, using a low-speed instrument that wouldn't burn the bone; and

  • A relatively long period of protected osseointegration, during which the implant site remains "submerged," away from physical and microbiological insult.

Brilliant stuff, and as close to a Nobel Prize as we are likely to see in dentistry. Dr. Brånemark reportedly had a long uphill fight before the scientific and academic communities finally acknowledged that his method worked, and worked well. By the mid-1990s, however, the so-called Brånemark techniques had pretty well supplanted all those wild-and-woolly ideas from the early days.

For many years now, I have had absolutely no hesitation recommending implants when indicated. In the typical patient, an implant that is carefully manufactured, placed, and restored (keeping in mind those 3 ingredients for success) -- more or less independent of manufacturer -- has at least a 95% chance of being a satisfactory replacement for a natural tooth over the long haul. We also know the big risk factors for implant failure, such as smoking, diabetes, and a compromised immune system.

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