Careful with those screws in your mouth

On the 17th of August, 2017 the Dutch newspaper NRC Handelsblad published a very interesting article about the dangers of dental implants and the risks of peri-implantitis.

blue®m has known about these risks for a long time. Our founding father, dr. Peter Blijdorp, pointed out the dangers of this disease already in the eighties. He was actually the wise man, who introduced and named this disease, he called it peri-implantitis! He was too far ahead of his time, because when he shared his thoughts in 1989 to a large group of dental surgeons and implantologists they thought it was ridiculous. They did not share his vision back then…

Fortuntaly times have changed and there is more awareness regarding the risks of diseases around implant and the importance of special care for implants. In Holland more implantologists recognise peri-implantitis as a serious problem as you will be able to read in the translated article. However, a quantitative research under 3.000 Brazilian implantologists shows something else, very concerning.

“53,2% of implantologists sees no problem in peri-implantitis, only 0,6% acknowledges the risk”

Because the newsitem in NRC is so close to our hearts and our core, ‘implant care’, we have translated the article to create more awareness on these serious problems.

Article NRC “Let op die schroeven in je mond”

Michiel Eijkman | NRC, August 17, 2017 Implants are practical, since bridges, crowns or dentures can simply be clicked in. However, many people don’t get them checked, and infections can be dangerous. More than a million and a half Dutch people have implants in their mouths, and in the next few years dentists are expected to fit the teeth of around 100,000 to 150,000 new patents with artificial roots such as these. That seems a smart idea, since crown, bridges and artificial dentures fitted onto a foundation anchored into the jawbone rarely become loose. However, in a recently released manual for dentists, Amsterdam-based dentist Gordon van der Avoort warns that the Dutch often don’t take proper care of their implants – and this negligence can have serious consequences.

43% suffer from gum infection

According to Van der Avoort, no less than 43 per cent of people with implants suffer from a fairly serious bacterial gum infection, known as peri-mucositis. Much more dangerous is peri-implantitis, an infection whereby the jawbone around the implant can be seriously harmed. Nearly a quarter of people with implants in their teeth have this difficult-to-treat infection This involves in a substantial risk of the implant and the often expensive dentistry structures being lost. On average, the costs of an implant plus a crown are around €2,400. Chronic infections in the mouth can furthermore cause serious health problems; with the closely related periodontitis, often involving poor blood circulation of the gums being known to potentially disrupt insulin levels, which could lead to type-2 diabetes. Moreover, there are indications that periodontitis affects the occurrence of cardiovascular diseases and the worsening of these.

Check your patients frequently

People with implants in their mouths have to be checked very frequently, says Van der Avoort, preferably using x-rays and then followed by an oral examination. In practice, the majority of people neglect to do so, and only visit the dentist when problems arise. In addition, dentists are increasingly having to deal with so-called ‘implant tourists’, who are patients who, for financial reasons, have their implants fitted into their mouths abroad – usually in Hungary, Turkey or Thailand. While the number of Dutch people with such implants in their mouths is unknown, dentists in the Netherlands regularly see them in their practices – at times with serious problems.

Titanium and ceramic

The majority of artificial roots are manufactured of almost pure titanium or a titanium alloy, which the body usually tolerates well and are highly resistant to fracturing. Other implant materials such as ceramic are also emerging. However, there is considerable variation internationally in the nearly 2000 types of implants, with inferior materials sometimes being used abroad and design also differing. This is why it is at times unclear to Dutch dentists which type of implant they have to replace, and how exactly they should treat the patient. Dentists and patients should think carefully beforehand whether fitting an implant into the jaw is in fact necessary. This solution, which might seem so easy and long-lasting, can sometimes turn out to be extremely uncomfortable and expensive.

History From rabbit bone to human jaw

The implant is an accidental invention by Swedish orthopaedic surgeon Per-Ingvar Brånemark (1929-2014). In 1952, Brånemark was conducting research into bone healing at the university of Lund. In one of his tests, he introduced titanium screws into rabbits’ leg bones. A few months after the experiment had ended, Brånemark wanted to remove the screws in order re-use them. However, to his frustration he discovered he almost couldn’t get them out again.The bone had grown solidly around the screws. Brånemark soon realised that this inconvenience could have useful applications, since this way replacement molars or teeth could be securely anchored into the jaw. Brånemark fitted the first four titanium screws into a human jaw in Göteborg in 1965. Gösta Larsson, a man who no longer had any teeth due to an illness, put himself forward as a test subject. It was a success, and the “osso-integration” – as Brånemark called his technique – soon spread all over the world. The implants of the first patient Larrson lasted right up to his death in 2006. This article was originially written bij Michiel Eijkman, dentist, professor and correspondent for NRC. blue®m translated this piece to create more awareness regarding risks of dental implants.