One look at Lana Hodge's beaming smile and it's hard to believe the Riverside, Calif., esthetician was toothless at 16.
"There was no money to fill the teeth, so they just pulled them," remembered the 58-year-old, whose tooth decay was hastened by childhood illness. "I was teased. It was horrible."
At one point, Hodges used money she earned from cleaning houses and baby-sitting to buy a bridge for her front teeth. It never fit well. Later in life, she had a full set of dentures that slipped and looked unnatural.
Then she found out about dental implants -- titanium rods surgically implanted into the jawbone to replace tooth roots. Artificial teeth are screwed onto the rods, providing what dentists say is the most realistic and comfortable option for missing teeth.
Implants are among the most important advances in dental treatment during the past 20 years, said Michael Rethman, president of the American Academy of Periodontology. And they've become mainstream, with the number of implants tripling since 1986, according to a national survey of oral and maxillofacial surgeons.
"It's a slam-dunk improvement over what existed previously," Rethman said. "Most of the time, the implant is the way to go. You can almost always get a better-looking result. The advantage is that it gives you more anchorage, better anchorage, is more comfortable and it's much more natural for the patient."
Hodges had all of her bottom teeth replaced by implants 12 years ago; she kept a denture on top.
"There's no comparison. It's like real teeth. Now I can bite into a sandwich without the meat slipping out," said a gum-chewing Hodges after a check-up at Loma Linda University's Center for Implant Dentistry in Loma Linda, Calif.
But the process can be long, painful and more expensive than other treatments. A full set of upper implants costs about $35,000, compared with $2,000 for a denture. Replacing a few teeth with implants, however, costs about the same as a crown or bridge.
Treatment is lengthy -- six months or more while the implant takes hold in the jawbone.
The first step is to evaluate the quality of the bone and determine whether the patient is a good candidate for implants. People who smoke and have chronic diseases that compromise their immunity aren't. If there isn't enough bone to hold the implant, the dentist does a graft.
Most patients have implants done under local anesthesia. A small incision is made in the gum, a hole is drilled in the bone, the post is tapped into place and the gum is sewn up.
"The actual surgery is pretty much the same as having a tooth taken out," said Eugene Rathbun, a Riverside implant periodontist.
Pros and cons of dental implants
A dental implant is a titanium rod surgically placed in the jawbone. It acts as an artificial tooth root to hold a replacement tooth or bridge.
Pros: Adjacent teeth don't have to be compromised, as they do with traditional bridgework. Implants are more comfortable than full dentures and allow for easy chewing of most foods; they look and feel like real teeth. For a single tooth or two, implants cost about the same as a bridge.
Cons: A full set of implants costs tens of thousands of dollars, much more than traditional dentures, and insurance companies usually won't cover the bill. Placement can be uncomfortable, sometimes painful, depending on the number of implants and their location. Implants can break and become infected. The implant process can take six months to a year, if you need bone grafting. During that time, patients wear temporary teeth that can limit what they eat.