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photo by Rose Lincoln |
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Something to Smile About
by Lewis I. Rice
Fourth-year School of Dental Medicine student Catherine Loeser
is looking at Catherine Kostecki’s teeth. It’s
easy to get a close-up view because they are not, at the moment,
in her mouth. They are also not really her teeth, although,
for all practical purposes, they soon will be.
Kostecki, 45, of Boston, is scheduled to have a set of dentures
attached permanently. They will be affixed to two screws stabilized
by two posts, which jut up from two implants buried in the
bone beneath her lower gums. It is the last stage of a two-year
dental implant process that will change the way she looks and
the way she feels about herself.
Kostecki, who blames bad gums for loose and cracking teeth,
recalls the time the implants were placed as “the happiest
day of my life,” because she knew she would regain her
smile and full function of her mouth. She joins many other
patients who come to the School of Dental Medicine clinic seeking
help with problem or missing teeth and finding a solution through
dental implants.
She is also part of a growing trend. The clinic placed approximately
900 implants during the most recent academic year, nearly double
the number from five years ago, with most of the surgical procedures
done on the fifth floor of the School of Dental Medicine building
at One Kneeland Street in Boston, in a suite designated for
that purpose. “We see a population of patients who seek
the quality of life they had 10 to 20 years ago,” says
Dr. Nopsaran Chaimattayompol, an associate professor in the
Department of Prosthodontics and Operative Dentistry, who is
overseeing Kostecki’s treatment.
Dr. Robert Chapman, A63, D67, K74, chair of the Department
of Prosthodontics and Operative Dentistry, says “media
buzz” also brings in patients. “More and more people
are becoming aware of implants,” he says. “Patients
are talking with friends, they’re seeing implants used
successfully in television programs, and they no longer assume
the loss of teeth is inevitable. Many elderly people used to
be resigned, for instance, to dentures. Now, we’re seeing
people of all ages who consider implants as an alternative
to the loss of teeth. They also are being used together with
dentures to make that option more reliable.”
The school’s interest in implant technology makes Tufts
a strong resource for implant care, says Chapman. Tufts was
one of the first dental schools to introduce implant procedures
into the predoctoral curriculum. The school is also actively
seeking novel approaches to make what can be a complicated,
time-consuming, and costly procedure much easier, faster, and
more affordable. Chapman, for instance, along with Dean Lonnie
Norris and Dr. Maria Papageorge, professor of oral and maxillofacial
surgery, recently traveled to Brazil to meet with the “founding
father” of modern implants, Dr. Per-Ingvar Branemark,
to explore developing cooperative research that would focus
on zygomatic implants—implants that would run the length
of the upper jaw.
Implants have been available for 20 years in the United States
(a rudimentary version, however, was first performed more than
2,000 years ago by the Etruscans). Though some people who have
lost teeth adapt well, Chapman says, many others say their
quality of life is diminished without them.
“The function of teeth is more than just chewing and
eating,” says Chapman. “There’s a social
component for smiling and for speech, and then the function
of eating is a part of it. And it may be related to aesthetics
or it may be psychological—if you lose a tooth it’s
like an amputation and some people can’t stand that.”
The clinic, he says, determines if patients are viable candidates
and educates them—and, of course, dental students—about
the multi-step procedure, which begins when (an implant fellow
screens) candidates are screened.
In order to receive an implant, the patient must have enough
jaw bone to secure the implants and not suffer from a condition,
such as radiation treatment or severe diabetes, that may interfere
with healing following surgery. For implant patients, an oral
and maxillofacial surgeon or periodontist inserts metal bolt-like
anchors made of titanium, a material that is compatible with
bone, in the jaw bone. After the area mends and the bone heals
to the implant fixture, another surgery exposes the implants
under the gums for placement of the crowns, which typically
a general dentist or prosthodontist fashions through an impression
of the mouth.
Patients don’t want implants per se, says Chapman. They
want teeth. And this procedure provides them with a facsimile.
Patients who benefit the most, he says, are those who don’t
have any teeth; placing two implants in the lower jaw will
help stabilize the lower denture. Implants also serve patients
who are missing one tooth but whose other teeth are in good
condition. “Unlike any removable dentures, it’s
going to stay in place, and it’s not going to do any
damage to the teeth on either side as there would be when you
prepare those teeth for a bridge,” he says.
There are downsides to implants. Surgery leaves the patient
at risk for infection. The porcelain on the crown could chip
or break or wear. The screw that holds the crown to the implant
could loosen. And implants are expensive, although the Tufts
clinic charges about one-third the cost of a private practitioner.
The need for implants will lessen in the future with advances
in treatment and preventive care, says Chapman. Still, implants
will be an important part of dentistry for many years to come,
he says. At Tufts, surgical implant placement is part of the
curriculum in the postdoctoral program only, but all students—both
predoctoral and postdoctoral—are now trained to restore
them and understand the procedure.
“Students should know what dental implants are, the biology
behind them, and how the crowns are attached to the implants,
and they should have some sense of the variation in techniques,” says
Chapman.
You can see that walking around the clinic, where Jean-Paul
Boudreau, a fourth-year student, prepares what’s called
a wax-up, a mold of a mouth of a patient who is undergoing
treatment for three implants. “It’s a great experience,
says Boudreau, who plans to practice endodontics. “It
helps me when we restore these implants to know what direction
of placement they go in.”
Loeser, who plans to practice general dentistry, appreciates
the opportunity to see implants being placed and to observe
the techniques she has heard about in class. She appreciates,
too, seeing a patient coming to the end of a sometimes difficult,
but ultimately gratifying, process.
“It was just so satisfying,” she says, as she looks
at what will become Kostecki’s teeth. “You go through
the whole process and just snap it in.”
And at that, Kostecki smiles. |
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