This article was inspired by a conversation I had with an Australia Post subagent. We interact with each other, generally, as we go about our daily lives. Often, we do not pay attention to many of the people that we meet because we feel that we just do not have the time. In this instance, what this elderly gentleman had to say to me struck a chord. I went back and interviewed him further for this piece – “octogenarian shares his dental implant experiences over a quarter century”. Who knew that oral health wisdom lay so close at hand?

Age Shall Not Weary Arthur At The Post Office

Arthur is 89 years old and still fronting up each working day to open his store and deal with all the mail business for his community. Wisps of white hair dance sparingly atop his scone. Arthur’s gait is laboured and not getting any quicker over the floor space of his sub-post office. Parcels arrive and are checked out by customers from their post office boxes, which usually means via Arthur behind the counter. By chance, Arthur had just returned from a visit to the dentist and we struck up a conversation along related lines. 

25 Year Old Dental Implant Still Serving Its Master

We were talking about dental implants and their cost these days. Arthur shared with me that he had got his first one 25 years ago. It cost him $2100 back then and since then he told me that he has had 2 more. That first dental implant has served him well and he had had no complaints about it. This impressed me and I began paying close attention to what he had to say. It’s funny how learned knowledge is available in unexpected places. Older people and their teeth become more sagacious as you get older yourself, we may find.

The Price Of Dental Implants

Arthur went on to tell me that the price of the subsequent implants tripled to $6600 and that these have not been as good. It got me wondering about how we do things and how production values can decline despite markets expanding. The search for ever greater profitability can damage outcomes – just ask Boeing in America. The corporatisation of healthcare is not automatically a good thing. You would think that bigger companies with greater resources at their disposal would make things better for customers but that is not always true. Did you know that 78% of all doctors in America now work for corporations? I share this because Australia tends to follow the US in business trends. Private equity groups have taken over previously ‘not for profit’ hospitals and medical centres. The push for ever greater profitability, especially following highly leveraged buy outs, is not often in the best interests of patients. Similar things are happening in healthcare here in Australia and it is something we should be vigilant about.

The History Of Dental Implants

A look at the history of dental implants goes back much further than Arthur’s life. It seems that the teeth issue has been with humanity for a very long time. Many different forms of implants have been created through the use of various materials.

“In approximately 2500 BC, the ancient Egyptians tried to stabilise teeth that were periodontally involved with the use of ligature wire made of gold. Their manuscripts and texts allude to several interesting references to toothaches. About 500 BC, the Etruscans customised soldered gold bands from animals to restore oral function in humans; they also fashioned replacements for teeth from oxen bones. At about the same period, the Phoenicians used gold wire to stabilise teeth that were periodontally involved; around 300 AD, these innovative peoples used teeth creatively carved out of ivory which were then stabilised by gold wire to create a fixed bridge. The first evidence of dental implants is attributed to the Mayan population roughly around 600 AD where they excelled in utilising pieces of shells as implants as a replacement for mandibular teeth. Radiographs taken in the 1970’s of Mayan mandibles show compact bone formation around the implants-bone that amazingly looks very much like that seen around blade implants!“
– Abraham CM. A brief historical perspective on dental implants, their surface coatings and treatments. Open Dent J. 2014 May 16;8:50-5. doi: 10.2174/1874210601408010050. PMID: 24894638; PMCID: PMC4040928.

The Innovative Evolutionary Journey

More recently, the 20C saw greater successes in screwing in materials which did not cause terrible infections and reactions within the human body. Platinum was tried, then chromium-cobalt alloy as biocompatibility was sought after for more effective dental implants. Spiral designs were used in the 1940s, which allowed bone to grow into the metal. The latter part of the 20C would see further innovations around the globe improving dental implant technology.

The spiral shaft was further enhanced during this decade by Dr. Giordano Muratori by the addition of internal threading to the shaft of the implant [5]. The basic spiral design was turned into a flat plate with various configurations by Dr. Leonard Linkow in 1963. In 1967, there were two variations of the blade implant that were introduced by Linkow, making it possible to place it in either the maxilla or the mandible. Linkow developed the Ventplant implant. The blade implant is now recognised as an endosseous implant. Further on, Dr. Sandhaus in the mid-60s developed a crystallised bone screw whose composition was mainly that of aluminium.”
– PMC.NCBI

Surface Bone/Tissue Interface

The healing time is a major consideration for the commercial viability of dental implants. Ossointergration is determined by the makeup and surface coating of the dental implant. The implant/tissue interface affects the mechanical strength of the implant. The incredible stress experienced during the act of biting down and chewing has to be transferred and shared across the area for it to work effectively and endure. Surface treatments were found to effect the growth and metabolic action of cultured osteoblasts. Increased surface roughness improved growth factor-beta production and thus cell propagation. Etching surfaces of titanium via acid treatments allowed for rougher surfaces. Coating surfaces via hydroxyapatite creates a strong bond between bone and implant. This is a layering of calcium and phosphate on the implant. Plasma spraying can control the thickness of the coating on the titanium. As you can ascertain a number of techniques have been tried and employed over the innovative evolutionary period of dental implant technology.

Dental Implant Failure Data

“Despite the different age profiles of patients in the SIC and MandIOD groups, age as a stand-alone factor has not been established as having an influence on implant survival even though there was a four-times greater risk of implant failure in MandIOD compared with SIC In 2004–2005, 32% of the 65 years and over age group reported one chronic medical condition, with 23% reporting three or more chronic medical conditions but in the context of implant treatment it has been suggested ‘no systemic factor or habit is an absolute contraindication to the placement of osseointegrated implants in the adult patient’.
The significant association between implant failure and operator was quite clearly explained by the referral of more complex cases, particularly MandIOD, to specialist operators. Our finding contradicted recent reports in the literature that support greater survival rates of implants placed by operators with more experience; however, this association has been acknowledged as being multifactorial. “
– Twenty-year analysis of implant treatment in an Australian public dental clinic by A Duong & J Dudley, Feb 2018

Being Able To Chew Your Food Becoming Ever More Costly

Octogenarian shares dental implant experiences over quarter century. Arthur is happy that he decided to go the dental implant route, despite a few later ‘ups and downs’. It is an amazing technology and it has been an exciting scientific journey. It must be the noted that the cost has tripled over the last decade and a half for a dental implant. With average costs quoted at around $6600. Comparing this huge jump with other items in Australia. Housing has seen huge increases with property values tripling over the last 20 years. Rents are making up for lost time in this regard over the last few years too. Having a roof over your head is a basic along with, one would think, being able to chew your food. These basics are very pricey in the 21C downunder.

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