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Health, Beauty & Fashion

Smiling again, thanks to dental implants

More people are going for implants instead of conventional dentures and bridges, even though they cost more.
The Straits Times - September 13, 2012
By: Joan Chew
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Smiling again, thanks to dental implants PHOTOS: DIOS VINCOY JR FOR THE STRAITS TIMES

Like many people who experience some degree of dental phobia, retiree Richard Soh, 59, put off a visit to the dentist until he could not stand his toothache anymore.

By then, the tooth could not be salvaged and had to be extracted.

Although it gave him relief, it took three years of losing more teeth before the former cab driver finally gave in and agreed to be fitted with dentures in 1998.

For the next decade, the father of two grown-up daughters wore dentures, which he removed at bedtime and soaked in a cup of water.

But he continued to lose more teeth to decay and had to have new dentures made every year or so.

He recalled: "When I lost a tooth, I would use the dentures I had until they were no longer comfortable."

There were other inconveniences, such as having peanuts trapped underneath the false teeth and the threat of them falling out into the water every time he went swimming.

These issues were resolved in February last year when he had artificial teeth permanently anchored on dental implants - small titanium screws placed into his jawbone - over two procedures in the span of a year.

The self-professed foodie said: "I enjoy food more now because I don't need to worry when I eat. In fact, I feel young again. It is fantastic."

A dental implant replaces the root portion of a missing natural tooth, hence reducing the risk of the bone loss that occurs when a tooth is gone. It also provides a stable platform for different types of artificial teeth such as a crown, bridge or denture.

In recent years, dental implants have become increasingly popular among people who have lost one, a few, or all of their teeth to decay, periodontal disease or physical trauma.

Last year, the National Dental Centre (NDC) of Singapore put 538 dental implants into 371 patients, compared with 198 implants for 156 patients in 2005.

T32 Dental Centre has affixed between 400 and 500 implants in a year, up from 300 five years ago, said its managing director Wong Keng Mun.

The Specialist Dental Group declined to reveal how many patients its three clinics has treated but said it has had a 10 per cent annual increase in the number of people seeking dental implants.

ALMOST AS GOOD AS THE REAL DEAL

Although dental implants topped by prostheses can cost more than 10times the price of conventional dentures and bridges, they are gaining popularity with growing affluence and greater awareness of their superior benefits.

People can also use up to $1,250 from their compulsory medical savings accounts, Medisave, for the procedures, which helps to make them more affordable.

Dentists are now offering implantation more routinely.

They say dental implants that are topped by artificial teeth feel, function and look like natural teeth.

For instance, conventional dentures give a bite force that is just 20 to 30 per cent of normal teeth and cover so much of the roof of the mouth that they rob the wearer of much of the taste of food. They must also be adjusted every few years.

In comparison, dentures fixed onto dental implants are shaped like horse-shoes and do not cover the roof of the mouth. They function just like normal teeth and do not need periodic adjustment.

Also, in the case of a conventional dental bridge - a row of at least three artificial teeth - the supporting teeth of either side of a missing tooth or teeth must be filed down to accommodate the bridge. This increases their risk of decay.

But bridges can be fixed to dental implants without affecting the adjacent good teeth at all.

IMPLANTS PROBABLY RISKIER

Studies have shown that the five-year complication rate of implant-supported single crowns is 28 per cent, said Dr See Toh Yoong Liang, an associate consultant at the prosthodontic unit at the department of restorative dentistry at NDC.

Complications include inflammation to the soft tissue and bone around the implant and failure of the implant.

Dr Yong Loong Tee, a consultant at the department of oral and maxillofacial surgery at NDC, said the implant is a failure if it does not fuse with the jawbone or is positioned incorrectly so that it damages adjacent teeth or cannot hold the artificial teeth, he said.

It could also hit vital structures, such as a nerve, and lead to permanent numbness in the lower lip and chin, he added.

Dr Wong said implants improperly placed in soft tissue instead of bone could lead to infections and could loosen.

On the whole, the NDC figures suggest the failure rate is low, at 1.45 per cent. This is below the 3 per cent considered acceptable by overseas institutions.

Nonetheless, there are probably higher risks associated with dental implants than for conventional bridges or dentures.

Complication rates for dental implants at 10 years are not available but they would most likely be higher than the 28 per cent rate at five years, DrSee Toh said.

On the other hand, the 10-year complication rate of dental bridges is at 28.9per cent. The complications include tooth decay, a need for root canal treatment and the bridge coming loose.

There is little information on the complication rate of conventional dentures. Common complications include loss of denture retention from gum shrinkage, fracture of denture base, ulcerations and fungal infections.

NOT FOR EVERYONE

Despite the advances in the technology, dental implants are not for everyone. Patients should discuss their options for tooth replacements with their dentists before committing to one, said GPA Dental Group founder Wilson Goh.

Dr Goh, a dental surgeon, said he now handles three to five cases of implant failures a month, when he previously had hardly any.

In many cases, patients have been talked into procedures by dentists eager to cash in on the growing market, he said.

Only patients in good general health should consider dental implants.

Those with medical conditions that compromise bone healing have a higher risk of complications from the procedures, Dr Goh said.

These include heavy smokers, people with poorly controlled diabetes and those who have had recent radiotherapy in or around the jaw area, such as for nose cancer.

Patients with poor bone or gum quality may also be better off opting for conventional dental bridges.

A bridge takes a week to complete, compared with a year it could take for an implant, if patients need to have bone or gum added to the area prior to an implant.

Dr Chng Chai Kiat, executive secretary of the Singapore Dental Council, the professional regulatory body for dentists, said both general dental practitioners and specialists such as prosthodontists are allowed to carry out implant procedures.

But they should practise within their competence and refer a patient to other medical professionals if the need arises, he said.

Dentists urge people who have missing teeth to replace them immediately, whatever their choice.

Dr Chong Kai Chuan, a dental surgeon at Q&M Dental Group, said teeth have the ability to drift, so a lost molar, or back tooth, can create unsightly spaces in the front teeth.

Teeth also have a tendency to erupt, or move towards the space opposite them. Only the presence of a tooth to chew against on the opposite jaw keeps a tooth from doing this.

If a tooth erupts, the bite becomes unbalanced and a person could even fracture his tooth because he is unable to bite down properly, he added.

Dr Chong said patients tend to ignore missing back teeth when they should not.

He said: "I always tell people to regard a tooth like a part of their body, such as a finger or an eye. They need it to function properly."

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