LUCY SCHULTZE

Leland Chrisman, DDS

As a standard today for tooth replacement, dental implants are becoming a more practical choice for both patients and oral surgeons — despite the challenge of paying for them.

The introduction of technologies like three-dimensional imaging is further improving what was already a preferred alternative to partials and bridges, said Leland Chrisman, DDS, an oral and maxillofacial surgeon based in Tupelo.

His five-member practice was the first in the state to begin using the NobelGuide™ system from Nobel Biocare. The system three-dimensionally models a patient’s skull and jaw in order to more accurately plan for the implant procedure.

“With the conventional 2D X-rays, you never knew that third dimension,” he said. “You could measure the height of the bone but never knew exactly the width or density, or perhaps if there were some intra-bony defects you couldn’t see.”

That meant the need for an incision around the jaw just to take a look before the actual implant process began, he said.

“Many times you would get in and the bone would be inadequate,” he said. “So you either had to perform a bone graft or change the position, which complicated the procedure significantly.”

Since the addition of the new system about a year and a half ago, Chrisman and his partners have been able to perform a virtual implant before making any actual incisions. Chrisman then e-mails the model of the virtual implant to a company in Sweden. It generates a plastic guide for him to set in his patient’s mouth, showing precisely the right points to drill.

“I can place 10 implants in someone’s jaw in a matter of an hour (when the patient is) under IV sedation without making an incision,” he said. “There’s no blood loss and virtually no post-operative pain on the part of the patient.”

Although it’s not cost-effective to use the system for simple implants, it makes a huge difference in more complicated cases — such as in replacing many teeth for a patient who has lost bone volume along with his or her teeth. Those complicated procedures make up about 15 percent of the implants Chrisman performs.

Among the most rewarding procedures from a patient standpoint, he said, has been using implants to help those people who have complete dentures. While the top portion usually stays in place, the lower part is subject to trouble from tongue movement as well as the dissolving of the lower jaw bone.

To remedy that situation, Chrisman is able to place two to four implants in the lower jaw to which the lower denture can be attached using a snap mechanism.

“Patients love it, because it changes their life,” he said. “They go from a terrible situation where they have a denture moving all over the place to something that now holds still as a rock.”

Much as dental implants contribute to patients’ quality of life, they are not covered by Medicare. Instead, the burden falls to patients and their families to pay the typical $1,500-$1,800 per tooth cost for implants. The situation isn’t much better even for insured patients.

“While private insurance often does pay for implants, the problem is that typically most people have a maximum amount of coverage per year — and they can reach that amount very quickly with implants.”

In addition to the cost of an implant is the fee a restorative dentist charges to place a crown on the titanium-post implant, Chrisman said.

Although oral health traditionally has not been as high a priority as that of other parts of the body, its connection to a person’s overall health cannot be ignored, Chrisman said.

“I sometimes hear physicians say, ‘Oh, that’s the mouth, I don’t really think about that,’” he said. “But you have to look at all the parts to see the whole, and to be aware of what’s out there for patients.”

He added, “People don’t have to suffer with a dissolving lower jaw or a loose denture. It helps with their nutrition status and everything else when their teeth are right.”



June 2008