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Winter 2005
Dr. Robert Chapman, A63, D67, K74 (right), chair of the Department of Prosthodontics and Operative Dentistry, holds a mounted model of a patient’s mouth as Dr. Maria Papageorge, professor of oral and maxillofacial surgery, confers with him and Dr. Daniel Oreadi, a fellow at the Dental School, about the patient’s upcoming implant.
photo by Rose Lincoln
Something to Smile About

Fourth-year School of Dental Medicine student Catherine Loeser is looking at Catherine Kostecki’s teeth. It’s easy to get a close-up view because they are not, at the moment, in her mouth. They are also not really her teeth, although, for all practical purposes, they soon will be.

Kostecki, 45, of Boston, is scheduled to have a set of dentures attached permanently. They will be affixed to two screws stabilized by two posts, which jut up from two implants buried in the bone beneath her lower gums. It is the last stage of a two-year dental implant process that will change the way she looks and the way she feels about herself.

Kostecki, who blames bad gums for loose and cracking teeth, recalls the time the implants were placed as “the happiest day of my life,” because she knew she would regain her smile and full function of her mouth. She joins many other patients who come to the School of Dental Medicine clinic seeking help with problem or missing teeth and finding a solution through dental implants.

She is also part of a growing trend. The clinic placed approximately 900 implants during the most recent academic year, nearly double the number from five years ago, with most of the surgical procedures done on the fifth floor of the School of Dental Medicine building at One Kneeland Street in Boston, in a suite designated for that purpose. “We see a population of patients who seek the quality of life they had 10 to 20 years ago,” says Dr. Nopsaran Chaimattayompol, an associate professor in the Department of Prosthodontics and Operative Dentistry, who is overseeing Kostecki’s treatment.

Dr. Robert Chapman, A63, D67, K74, chair of the Department of Prosthodontics and Operative Dentistry, says “media buzz” also brings in patients. “More and more people are becoming aware of implants,” he says. “Patients are talking with friends, they’re seeing implants used successfully in television programs, and they no longer assume the loss of teeth is inevitable. Many elderly people used to be resigned, for instance, to dentures. Now, we’re seeing people of all ages who consider implants as an alternative to the loss of teeth. They also are being used together with dentures to make that option more reliable.”

The school’s interest in implant technology makes Tufts a strong resource for implant care, says Chapman. Tufts was one of the first dental schools to introduce implant procedures into the predoctoral curriculum. The school is also actively seeking novel approaches to make what can be a complicated, time-consuming, and costly procedure much easier, faster, and more affordable. Chapman, for instance, along with Dean Lonnie Norris and Dr. Maria Papageorge, professor of oral and maxillofacial surgery, recently traveled to Brazil to meet with the “founding father” of modern implants, Dr. Per-Ingvar Branemark, to explore developing cooperative research that would focus on zygomatic implants—implants that would run the length of the upper jaw.

Implants have been available for 20 years in the United States (a rudimentary version, however, was first performed more than 2,000 years ago by the Etruscans). Though some people who have lost teeth adapt well, Chapman says, many others say their quality of life is diminished without them.

“The function of teeth is more than just chewing and eating,” says Chapman. “There’s a social component for smiling and for speech, and then the function of eating is a part of it. And it may be related to aesthetics or it may be psychological—if you lose a tooth it’s like an amputation and some people can’t stand that.”

The clinic, he says, determines if patients are viable candidates and educates them—and, of course, dental students—about the multi-step procedure, which begins when (an implant fellow screens) candidates are screened.

In order to receive an implant, the patient must have enough jaw bone to secure the implants and not suffer from a condition, such as radiation treatment or severe diabetes, that may interfere with healing following surgery. For implant patients, an oral and maxillofacial surgeon or periodontist inserts metal bolt-like anchors made of titanium, a material that is compatible with bone, in the jaw bone. After the area mends and the bone heals to the implant fixture, another surgery exposes the implants under the gums for placement of the crowns, which typically a general dentist or prosthodontist fashions through an impression of the mouth.

Patients don’t want implants per se, says Chapman. They want teeth. And this procedure provides them with a facsimile. Patients who benefit the most, he says, are those who don’t have any teeth; placing two implants in the lower jaw will help stabilize the lower denture. Implants also serve patients who are missing one tooth but whose other teeth are in good condition. “Unlike any removable dentures, it’s going to stay in place, and it’s not going to do any damage to the teeth on either side as there would be when you prepare those teeth for a bridge,” he says.

There are downsides to implants. Surgery leaves the patient at risk for infection. The porcelain on the crown could chip or break or wear. The screw that holds the crown to the implant could loosen. And implants are expensive, although the Tufts clinic charges about one-third the cost of a private practitioner.

The need for implants will lessen in the future with advances in treatment and preventive care, says Chapman. Still, implants will be an important part of dentistry for many years to come, he says. At Tufts, surgical implant placement is part of the curriculum in the postdoctoral program only, but all students—both predoctoral and postdoctoral—are now trained to restore them and understand the procedure.

“Students should know what dental implants are, the biology behind them, and how the crowns are attached to the implants, and they should have some sense of the variation in techniques,” says Chapman.

You can see that walking around the clinic, where Jean-Paul Boudreau, a fourth-year student, prepares what’s called a wax-up, a mold of a mouth of a patient who is undergoing treatment for three implants. “It’s a great experience, says Boudreau, who plans to practice endodontics. “It helps me when we restore these implants to know what direction of placement they go in.”

Loeser, who plans to practice general dentistry, appreciates the opportunity to see implants being placed and to observe the techniques she has heard about in class. She appreciates, too, seeing a patient coming to the end of a sometimes difficult, but ultimately gratifying, process.

“It was just so satisfying,” she says, as she looks at what will become Kostecki’s teeth. “You go through the whole process and just snap it in.”

And at that, Kostecki smiles.