Dental Implants

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 endorsements, 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, including those on intravenous drugs for osteoporosis, shouldn't have implants because of the risk of bone disease.

But the news for me is good. Even though my four lower molars have been missing for 11, 8, 7, and 1 year respectively, my underlying bone has not begun to erode. And the nerve canals are deep enough that the titanium screws can't reach them.

"Gorgeous!" says Kukunas's colleague Mark Ochs, D.M.D., of my X-ray. "You have great bone."

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," says Kukunas.

It sounds like a miracle. But at what cost? Across the nation the price of implants varies widely, and dental insurance 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.

I do a rough amortization based on best-case life expectancy. My conclusion: Each tooth will cost 17 to 19 cents per day, a relative pittance. Moreover, not getting the implants could have its own costs, especially if I continue on the ice-cream-and-lard diet that has become my routine.

I sign up for four.

(*Prices have risen since the writer's procedure.)

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 teeth. In less than an hour, it's done.

"When can I eat?" I ask eagerly.

"Anytime you want," says Sedeqi.

In the car I rip open the pretzels and nuts and chomp down ferociously. The implants feel fantastic, which is to say, they don't feel anything — exactly what I've always hoped for in a tooth. The upper molars, on the other hand, prove a little more boisterous. It's not pain, exactly, but it occurs to me that teeth, like people, resent too abrupt a transition from indolence to labor.

Two weeks later my whole mouth has successfully made the switch.

I call up my twin to ask him how his final mandibular molar is hanging. We both know it's only a matter of time before he will face his own rendezvous with dentistry. For now, however, there's a new winner in the molar sweepstakes: John 1, Jim 4.

Pennsylvania freelancer Jim Thornton writes for Men's Health, Field & Stream, and Swimmer, among other magazines.