INDIANAPOLIS — Pro basketball player Vern Fleming used to worry that when he was hit in the mouth, his teeth would spill out onto the court. Years of neglect had left the Indiana Pacers guard's upper teeth decayed and loose.
Georgia Price never had real teeth, only soft tooth buds barely emerging from her gums where her baby teeth never came in. The Bloomington, Ind., nurse, now 41, received her first dentures at age 3 1/2 and a second set at 12.
Both have found relief with permanent implants, teeth anchored on metal rods supported by frameworks hidden underneath the gums.
"I always thought how wonderful it would be to feel like I have teeth," Price said. "I speak clearer now without my teeth flying across the room."
Dental implants have been around since the early Egyptians but remain largely unknown among the public. More frustrated denture wearers are receiving them, though, as implants gain wider acceptance among dentists.
A National Institutes of Health conference last year said in a statement that the number of dentists performing implants had grown tenfold in five years and that 300,000 Americans a year will be getting implanted teeth by 1992.
Implant dentistry was a $150-million industry last year, estimated Dr. Richard Guaccio of Lake County, president of the 2,000-member American Academy of Implant Dentistry.
Some dentists caution that implants are not for everyone, particularly those with overriding health problems and those who will not give the devices the care and cleaning necessary to prevent infection and prosthetic failure.
Few people enjoy having to take dentures out at night, and some are embarrassed to let their spouses or others see them without their false teeth, said Dr. Craig Cooper of Indianapolis, who does 300 to 400 implants a year. "They eat better, but it's way beyond that from a psychological point of view."
Sixty percent of the respondents to a marketing survey last year had never heard of implants, said Cooper, who directs the faculty at the Midwest Implant Institute in Columbus, Ohio, which has trained 600 dentists in implantology since 1981.
But a survey three years ago by the National Institute of Dental Research suggests many people could use them. Forty-two percent of Americans over age 65 and 4% of those aged 35 to 64 have no teeth, it reported.
The growing older market, a wealthy segment of the population, provides implant dentistry with a tremendous opportunity for growth, and manufacturers have provided a variety of devices, Cooper said. "It's exponential growth. There are fewer and fewer patients we cannot treat."
The American Dental Assn. has reservations.
"In general, the feeling is that implants can be used on a selected basis, depending on the patient and the patient's condition," said Dr. Wayne Wozniak of ADA's Chicago laboratory on certification and product research. "It should only be done on people the dentist feels can properly maintain the implant. It requires meticulous oral hygiene after the device has been placed. So it requires a highly motivated individual."
Infection around the implant would erode the bone where many of the devices are implanted; lack of adequate bone would immediately eliminate some patients from being implant candidates. One implant, subperiosteal, is not based in bone and consists of a wiry framework fitted between the bone and the gum.
Depending on the type, implants can cost as little as $600 for a single tooth or as much as $10,000 for a full upper or lower arch, and some procedures are covered by Medicare. Most are performed as outpatient surgery.
The NIH statement said there was little information on long-term effectiveness of implants and called for a national registry to collect data. However, it is generally considered that 80% to 90% of implants are successful for at least five to 10 years.