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POINT / COUNTERPOINT : Answer to Toothless Question

November 20, 1990

Many toothless patients opt to wear dentures. But growing numbers are asking for dental implants, artificial teeth that are surgically and permanently implanted. Here, two dental experts discuss the advantages and limitations of each approach.

Dentures: Dr. Howard Landesman, USC's Rex Ingraham professor of reconstructive dentistry.

"In our lifetime, dentures may become passe. But many people still do well with dentures. Implants are cost-prohibitive for some people: They are still the province of the middle class.

"In dentures, the greatest improvement has occurred in the area of aesthetics. We can now make a denture for a patient so that it is difficult to know the teeth are false.

"We also have a greater understanding of how to maintain dentures to inhibit underlying bone loss. For instance, a patient should remove dentures whenever possible to allow oxygen and blood to get to the tissue, thus minimizing bone and tissue loss and inflammation.

"The biggest problem with dentures is their use in the lower jaw. In a given time span, four times as much bone loss occurs in the lower jaw as the upper. It is harder to keep lower dentures in place due to this bone loss, mouth mechanics and other factors.

"The cost of dentures varies. If a general dentist makes them, they cost about $800 to $1,000. A prosthodontist (specializing in replacement of missing teeth) can charge $2,000 and up."

Implants: Dr. John Beumer, UCLA professor of prosthodontics.

"Implants are especially good for two groups of toothless patients. One group is those who have worn dentures for many years and have recession of underlying bone. These patients can be helped by implants if there is enough bone (left) to anchor the implants.

"The other patients who can benefit are the partially toothless. Say you lose two of your back teeth or your front teeth. If there is a substantial amount of underlying bone, the implants can work well. It can eliminate the need to wear removable partial dentures.

"The cost of implants ranges from $4,000 to $30,000. A single tooth can cost about $2,200. Some dental carriers are beginning to write policies to cover implants. Implant patients need to see a dentist more frequently than other patients--about four times a year.

"In the future, implants may be feasible for more people due to the perfection of bone-grafting techniques used in combination with bone substitutes.

"But for people happy with their dentures, my advice is, leave them alone. I would not recommend that every denture patient be evaluated for implants."

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