Never had a patient notice anything out of the range of their expectations.

    This is absolutely true.

    I can echo what Amatus says--I've never heard a patient complain about
this.
    Chewing (natural function) is not the same as tapping on an
implant-borne crown.  Yes, the proprioception is different.  Patients
have still reported that they feel pressure or vibration, and it is not
the same as a natural tooth.
    IOW, you lose a very small amount of proprioception.  But at the same
time, if you lose a tooth and don't replace it, you've lost those
proprioceptive fibers in that periodontal ligament as well.  And while
patients may lose chewing efficiency (esp. if there are multiple teeth
involved) they never complain of anything that sounds like it is the
proprioceptive response.
    Your other point--that the PDL provides a cushioning effect to the
tooth is not without significance when it comes to implants.  The fact
that even periodontally healthy teeth have some "give" to them while
implant fixtures are essentially fused to the bone means that connecting
multiple crowns or bridges onto both teeth and implants is a bad idea.
Generally the bridge will loosen up, posing increased chance of decay on
the tooth abutments.  And the fact that implants don't move means the
stresses are carried disproportionately on the implants in these cases,
sometimes leading to failure of the implant.

Steve

How about hearing from a dentist who actually has an implant ?

It doesn't feel any different and I only think about it when
someone asks about it.

Wouldn't hesitate to get another if the need arose.

I have two implants about 2 years old, #9 and #12. The #9 implant,
being right up front, has a noticeable lack of sensation compared to
#8 next to it.

I don't notice anything different about #12 unless I tap it with my
finger nail or a dental tool and compare it to #11 or #13. It's
probably less noticeable because it's further from the lips and
incisors and needs less information.

However, these differences do not bother me and I am usually not aware
of the changes unless I start thinking about them or if I have to
extract some debris from between the teeth.

Dick Ballard
ballardr@att.net

On Mar 12, 5:33 am, mark.fer...@yahoo.com wrote:

The following is from Open Wider: your wallet not your mouth page325

There is a trend in dentistry that is starting to emerge from all this
success wiht implants. If you go to a surgeon for an extraction, often
they are selling you a bone graft so they may place an implant in 6
months rather than waiting for bone to fill the space where the root
of the tooth was. Of course there is a charge for the bone graft.
These holes will almost always fill on their own. Extraction sites
have been healing and filling with bone since the first teeth were
extracted. It just takes a little longer, say 9 months.

I had one patient who went to a surgeon to have a tooth extracted. The
surgeon insisted on doing the graft even though the patient had no
interest in replacing the tooth. Six months later the graft was loose
and there was an infection in the area. The graft was being rejected.
The patient now needed to have the graft removed and was left with a
larger bone defect than if it had just healed normally without the
graft. He still does not want
the implant. Surgeons with somewhat elastic ethics insist on grafting
all extraction sites. It does add a fee of about $300 per extraction.

Endodontists, those specialists who do root canals, are getting into
the game. Some of the more aggressive among them will look at a tooth
that will be a difficult root canal and simply extract it and place an
implant. Of course the cost of the implant is about 3 to 4 times the
cost of the root canal.
I can understand this if the root canal is impossible but I have a
little trouble when it is done just because there is a difficult root
canal.
Some restorative dentists also do implants. If they see decay that is
difficult and will require extra time to do a crown and maybe an
implant, they will do an implant instead. The argument is that the
crown may not last, so let's do the more predictable implant. Of
course we will never know that the crown will not last if the tooth is
removed and an implant is placed. Of course, the implant fee is many
times that of a difficult crown and possible root canal.

Implants work, but I fear they are being over prescribed. They are
much more invasive and costly than a root canal or a difficult crown.
Who should place implants?

Well, clearly, oral surgeons are trained to do implants. The problems
I have seen are that they sometimes do not align the implants very
well. This makes restoring the case with crowns very difficult if not
impossible. They also tend to be rougher with the gum tissue and the
bone. Periodontists are my favorite implant placers. They tend to be
much kinder to the tissue and the bone. Perio surgery is a much more
precise surgery than removing teeth.

I think general dentists should place implants. The techniques are not
that difficult and the average dentist who is willing to take some
continuing education courses and purchase some additional equipment is
capable of doing implants.
If you need an implant, I would suggest that you have someone who does
10 a month not someone who does 5 a year. They are technique
sensitive. Do not do them just because it is easier to do than a root
canal or a crown. While they are very predictable they do occasionally
fail.

Fred Quarnstrom, DDS
Author Open Wider: your wallet not your mouth