Dental implants are increasingly being used to replace missing or failing teeth instead of dentures or bridges, which can be uncomfortable and hasten further deterioration. But implants can be very expensive and rarely are covered by insurance.
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Experts say dental implants — usually titanium screws inserted into jawbone and capped with a permanent crown — are long-lasting and the best option for most people. About 1.9 million Americans are expected to get one or more dental implants this year, up from 1.6 million in 2016, according to market research firm Decision Resources Group.
"It's probably the greatest thing that's happened to dentistry since fluoride came to the water," says Dr. Carl Driscoll, former president of the American College of Prosthodontists, the specialty providing artificial tooth replacement.
When missing teeth aren't replaced, the jawbone below deteriorates faster, chewing can become difficult and one's smile and self-confidence can be affected. Implants feel and function like natural teeth and can last a lifetime, partly because the titanium helps maintain surrounding bone.
That's helped make them the standard of care over older options: Dentures need to be replaced periodically as fit worsens, and bridges are attached to adjacent teeth that must first be ground down, increasing jawbone loss and risk of cavities.
Driscoll, who teaches at the University of Maryland School of Dentistry, says many early implants from the mid-1980s are still fine.
A research review found 95 percent of implants lasted 13 years or more, on average. Newer implants have improved designs that heal faster and better integrate into jawbone.
Still, implants can cost thousands of dollars and there are caveats: Implants can't be used for children and young adults, whose jaws are still growing, and often aren't suitable for patients with dental infections, some cancers, poorly controlled diabetes and weak immune systems.
Some things to consider before getting a dental implant:
ASK THE DENTIST
First, ask if your tooth can be saved, which is always best, says American Dental Association spokesman Dr. Robert Pick. Ask how an implant would benefit you, what complications are possible and whether there are any good alternatives.
Ask about the dentist's training and experience with implants and if they're board certified in a related specialty, such as oral and maxillofacial surgery, periodontics or prosthodontics, or by the American Academy of Implant Dentistry. Check online reviews and look for certified dentists at the academy's website .
Ask why they're using a particular implant and how long the company has been in business. In the U.S., dental implants are considered medical devices and are approved by the Food and Drug Administration before they can be sold.
Dental insurers generally categorize implants as cosmetic. They rarely cover them, other than perhaps the crown's cost. Costs vary depending on location, the dentist and other factors, but one implant, crown and related work can cost $2,000 to $10,000 or more.
The dental association recommends asking for a written treatment plan first. Most implants require multiple trips to the dentist and you'll also need regular checkups afterward.
Ask what the quoted price covers so you don't get a surprise bill later. It should include high-tech mouth imaging, the implant, a temporary crown needed for several months while the implant integrates with the bone, and a permanent crown.
If you can't afford an implant, ask if the dentist offers discounts or installment payments. The dental association suggests other lower-cost options that include getting the work done at a dental school or a community health clinic. If you are a veteran, check to see if you're eligible for dental care through Veterans Affairs. If you use third-party financing or medical credit cards offered at some practices, carefully review interest terms and penalties.
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