Q. I'm considering a dental implant for a missing tooth. How reliable are they? Are they expensive?

Dental implants, which started to become accepted in the 1980s, are both reliable and expensive.

Dental implants are among the most successful procedures in dentistry. Studies have shown a five-year success rate of more than 90 percent. After more than 20 years of service, the vast majority of dental implants still function. With proper care, dental implants can last a lifetime.

Cost is dependent upon the dentist, the type of implant and the materials used. A single implant costs between $1,000 and $5,000. The cost of dental implants for an entire mouth can be as high as $100,000.

Removable dentures rest on the gum line. Fixed bridges use adjacent teeth as anchors. Dental implants, which are designed to replace a single tooth, are made up of a titanium screw that fuses with the jawbone; the abutment, which fits over the part of the implant that protrudes from the gum line, and the crown, which is fitted onto the abutment.

Dental implants look like real teeth and are more durable than dentures and bridges. A single implant can be used to support a bridge and increase the stability of dentures.

There are difficulties with removable dentures and fixed bridges.

Dentures can slip and make annoying clicking sounds. They may also lead to bone loss where there are teeth missing. Fixed bridges often have a negative effect on adjacent healthy teeth. Bridges and dentures usually need to be replaced every 7 to 15 years.

Dental implants are not perfect. They can fail if the implant doesn't fuse to the jaw bone. Implants may break or become infected. Crowns can loosen. Smoking puts implants at risk.

More and more seniors are choosing dental implants to replace lost teeth. If you can have routine dental treatment, you can generally have an implant. You're never too old to receive a dental implant.

The implant procedure reminds me of carpentry instructions.

First, a small "pilot" hole is drilled into the jaw. This hole is slowly widened to give the implant screw room. After the screw is in the jaw, a protective cover is placed on top to permit healing and for the titanium to anchor. This anchoring is called "osseointegration."

After several months, the protective cover is removed and a temporary crown is placed on top of the dental implant. The gum grows and shapes itself around the temporary crown. Later, the temporary crown is replaced with a permanent one.

There are narrower "mini-implants" available for small teeth and incisors. These smaller implants, which are about half the width of traditional implants, are less costly.

Seniors today are more likely to keep their teeth than they were a decade ago. However, studies indicate that older people have the highest rates of periodontal (gum) disease and need to do more to maintain good oral health. Some facts:

Ÿ About 25 percent of people age 65 and older have lost all of their teeth.

Ÿ Periodontal disease and tooth decay are the leading causes of tooth loss in older adults.

Ÿ At least half of noninstitutionalized people over age 55 have periodontal disease.

Ÿ Receding gum tissue affects the majority of older people.

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