health&healing

Missing teeth often can be a source of embarrassment, changing how people feel about their looks and even making them hesitant to smile. But as Cary dentist Dr. Carl McMillan points out, many people don’t recognize the other risks they pose.

“More than a cosmetic issue, missing teeth can be the source of a myriad of health issues,” he explains. “Problems include tooth and gum sensitivity, damage to adjacent teeth, as well as alignment issues that occur from other teeth shifting that may impact chewing and biting. In addition, damage to adjacent teeth could increase risk of infection.”

Seemingly unrelated issues, such as headaches or speech problems, can be caused by missing teeth, notes Dr. McMillan, “and oral infections can spread to the rest of the body — which is why poor oral health can increase the risk for heart disease and other serious conditions.”

Fortunately, Dr. McMillan notes, patients have many different options to address missing teeth. “Missing teeth can be replaced by removable dentures, for example, or by dental bridges—which rely on neighboring teeth for support—or with dental implants, which are fused into the jaw bone.

“Dental implants restore the integrity of the jaw,” he explains, “because they reduce the load on other teeth. And they can be particularly long-lasting and durable, which makes them an excellent option for people who are good candidates for the procedure.”

Health&Healing: What makes someone a good candidate for dental implants?

DR. McMILLAN: Patient selection is the first key to success, even before the surgery. First, we check the obvious criteria: the patient is missing one or more teeth and has adequate bone structure to support an implant. We also make sure the patient is reasonably healthy, not taking certain medications, and has no chronic uncontrolled disease, such as diabetes or especially anything affecting bone.

As a holistic dentist, I consider other factors carefully—including nutritional and metabolic issues—in determining whether someone is a good candidate. These relate to the patient’s ability to heal and to have a successful implant. For example, I look for vitamin D levels above 70 to ensure they have strong, healthy bones. I also want to see LDL cholesterol levels below 142, since hyperlipidemia increases the risk of graft failure.

Frankly, I think these considerations should apply for any bone surgery, but I know them to be extremely important in ensuring the success of a dental implant.

H&H: Once you’ve determined someone is a good candidate, how does implantation work?

DR. McMILLAN: As a first step, I surgically place the body of the implant, which is a specialized screw with a threaded post. It goes into the bone and then the bone grows around it. Then we allow it to heal anywhere from three to six months without a tooth on it before the next part of the implant process. After that, I uncover the implant and place either a custom-fabricated or prefabricated abutment—which will hold the new crown.

I know that “same-day” implants are popular, but the process I use—with very few exceptions—is to place the abutment later, to allow healing after the placement of the implant. There might be exceptions for a front tooth, for example. And on rare occasions we will do what’s called an immediate load, meaning that we put a temporary crown on the abutment, which is placed at the time that we place the implant. But real care has to be taken. At that point, that temporary tooth cannot get bumped back and forth or have pressure on it.

Here’s my analogy: it’s like putting a mailbox post in the ground and pouring cement down the hole, with the post standing up straight. Let’s say someone then comes along and pushes against it, while it’s still setting—it could lean over or crack the cement and make it fail. In the same way, if we wiggle an implant and interfere with the bone healing around it, we might lose the implant.

Again, I know that some people are interested in same-day implants, but the failure rate for those procedures can be quite high—at least four times higher than the failure rate for a traditional step-wise implant process; and that’s just for a single tooth. And often, we place implants to hold abutments for multiple teeth, which makes it even more critical that the underlying implant is strong enough to support them.

So, there are many different considerations that play into whether we make a decision to do same day, or if we make a decision to let it heal six months instead of three months.

H&H: What else do you do differently from a holistic perspective?

Dr. McMillan: The most important difference between a conventional dental implant and a holistic one is in the materials we use. For much the same reasons that I won’t use mercury amalgam fillings, I consider metal implants unhealthy, and believe they should not be used in the mouth. So I stopped placing titanium implants back in 1994.

There are many issues. Conventional titanium implants contain trace amounts of nickel, which is the most allergenic metal and happens also to be carcinogenic. But beyond that, mixing metals creates what some call “battery mouth,” which isn’t healthy for us either.

This effect, where your mouth basically becomes a battery, can affect systems that run on electrochemical energy, such as your body’s nervous system. The extra currents generated from the metal in your mouth can interfere with proper function of that and other systems. I use zirconium dioxide—or zirconia—implants in my practice instead. Although it took until 2008 for zirconia to get approved in the U.S., it has been used successfully in Europe for much longer. While zirconia itself is a metal, it is what’s considered a “transitional metal.” This means it has the strength of metal, but, because it is oxidized, it actually has the properties of glass, which is neutral electrically and doesn’t conduct heat and cold. While titanium can sometimes cause an immune response, zirconia does not elicit any immune response. There’s even some research indicating that zirconia implants are easier to care for, creating better oral hygiene for the patient.