OUTNUMBERED > There are 10 times more
bacteria in the human body than there are cells.
Sally long feared she would share
this fate. In 1993 she lost all but six
of her teeth to periodontal disease.
Dentures helped her live normally,
but the disadvantages bothered her.
Her upper palate was covered, which
reduced her ability to taste food. Her
dentures also tended to slip, particularly when she raised her voice—a
liability for a fourth-grade teacher.
Eventually Sally heard of an
alternative: titanium dental implants.
When inserted into the jaw, these
metal posts bond with healthy bone,
creating artificial roots for false teeth.
Sally underwent a multistage process
that resulted in 12 titanium implants,
each capped with a porcelain tooth.
“It was a long ordeal,” she says, “but I
am really glad I had it done. I have the
straight teeth I always wanted, I can
eat healthy foods again, and I don’t
have to worry about losing my teeth
during a swim—and having to dive to
the bottom to retrieve them!”
Based on several such endorse-
ments, I make an appointment at
the University of Pittsburgh’s Multi-
disciplinary Implant Center.
The stretched-out “panoramic
radiograph” is pinned to the light
box. To this layman, it looks like the
X-ray of a gorilla’s mouth. Steven J.
Kukunas, D.M.D., Pitt’s director of implant prosthodontics, assures me the
mouth in question is owned by a much
smaller primate, namely me. He and
his colleagues will rely on X-rays and
a plaster model of my mouth to assess
my suitability for titanium screwing.
The good doctor’s first concern is
whether I still have enough healthy
bone to anchor the implants. A second
worry is two specific nerves: Are these
buried deeply enough in the jaw so
screws won’t penetrate them?
Some patients can have implants
only after their jawbones are built up
via bone grafts—a time-consuming,
expensive procedure. Others, includ-
ing those on intravenous drugs for
osteoporosis, shouldn’t have implants
because of the risk of bone disease.
GOOD AS NEW A threaded titanium
implant (a) bonds with jawbone to anchor
a metal abutment with a porcelain cap (b).
Kukunas tells me the success rate at
his clinic exceeds 97 percent for lower-jaw implants, but I must practice
scrupulous hygiene, including daily
flossing. Those who don’t are more
prone to failure—as are heavy smokers, alcoholics, and diabetics.
He says the process will take about
six months. “And then,” I ask, “I can
eat nuts and hard pretzels again?”
“You can eat whatever you want,”
It sounds like a miracle. But at what
cost? Across the nation the price of
implants varies widely, and dental in-
surance rarely covers more than half.
Because I’ve opted for treatment at a
dental school, my cost will be about
half that charged by a private-practice
specialist. I’ll pay $850 for the implant,
$380 for a metal abutment to cover it,
and $550 for each crown—a total of
$1,780* for each tooth I get replaced.
BRUCE PASTER, PH.D., MICROBIOLOGIST AT THE FORSYTH INSTITUTE AND THE HARVARD SCHOOL OF DENTAL MEDICINE
The placement of implants proves
a breeze—much less traumatic than
extraction. A supervised resident
numbs my jaw with lidocaine, cuts
and peels back the gums, then drills
four holes into the mandible. She uses
what machinists call a tap to slowly
cut threads inside my bone, then
screws a threaded implant into each
hole. Finally she screws in temporary
abutments and sews my gums around
the base of each. Regarding her handiwork in a mirror afterward, I see what
look like four stainless-steel nail heads
hovering at the gum line.
After a visit to have my stitches
removed, I need to wait four months
for jawbone to bond with the titanium,
a process called osseointegration.
When I come back, my mandible
earns another “Gorgeous!” from Ochs.
A resident makes a mold of my teeth
so a lab can fabricate lower molars.
En route to my final appointment
six weeks later, I make a detour to the
grocery store for pretzels and mixed
nuts. When I arrive at the office,
resident Faraj Sedeqi, D.D.S., replaces
each temporary abutment with a
permanent one and installs my bionic