Question: How Much do Implants Cost?
Answer: The cost of Implants can be considerable.

     The implant surgery (typically preformed by an oral surgeon or periodontist) can cost from $1250 to $6500 a tooth. The higher figure represents additional procedures designed to increase the amount of bone needed to hold the implant (bone augmentation procedures).  Do not count on dental or medical insurance to cover these bills and be sure you discuss fees with the surgeon before the procedure.  If you have any questions about the necessity of any augmentation procedures, do not hesitate to get another opinion and/or discuss the situation with your general dentist.   I have had patients who were very surprised  by their surgical fee and I have been surprised at some surgeon's fees myself. 
     The fees for the restoration of the implants (the crowns, bridges, dentures that fit over them) can be estimated fairly accurately by the restoring dentist (the general dentist or prosthodontist).  Prices usually are determined by units.  For instance, if one crown will fit over the implant, the price will be the price for one crown.  The price for a crown over an implant will be more than the dentist's usual cost of a crown because more visits are necessary and because of the cost of implant devices (tiny wrenches, etc.).  Depending of the size of the "over case"  a restoration can range from $2000 to $35,000 or more (for a full mouth restoration).

Question:  What are some benefits of implants?
Answer:  Implants can be wonderful in certain circumstances.  They can allow a bridge to be placed where there is no tooth on which to attach it. Implants can also keep toothless bone from resorbing (dissolving/shrinking) and this can help a patient look younger and can also help to hold a denture in place. It is even possible to restore an entire toothless jaw using implants.  Sometimes an implant allows a single tooth to be replaced rather than a bridge.  This can save the teeth on either side of the space from being stripped of enamel in the making of a bridge.  In certain situations this can allow for a better looking restoration.

Question:   What are some of the "downsides"  to implant dentistry?
Answer: Implants take time and multiple visits to complete and treatment in complicated cases can easily extend one to one and a half years, or more.  Implant surgery involves discomfort, although this can be alleviated with medication.  Implants do not always integrate.  In other words, an implant can fail.  Failure rates vary with, the health of the patient, the types of implant used.  Failures can occur much more frequently in patients who smoke or have certain diseases.  Diabetes can be a negative factor, especially if it is poorly controlled. Finally,  the costs of an implant may not be covered by insurance.  (A bridge is more likely than an implant to be partially covered; all plans are different).

Question:  What is the Success Rate of Implants? How often do implants fail?
Answer: This frequently asked question is not easy to answer.  Success rates of 95% have been quoted where the implant is placed in natural bone and done under optimal conditions.  The success rate will be lower in grafted bone (where bone has been added in a pre-implant surgery) and success rates may dip to 50-60% in smokers.  (Smokers do not heal normally due to impaired small capillary circulation; many surgeons will not do implant or optional plastic procedures on a smoker).  Of course, the success rate goes up with the skill of the surgeon and restoring dentist.  Choose carefully.

Question:  I have heard that implants are becoming a more frequent cause of malpractice cases.  Is this true?
Answer:  Yes. Whenever expensive and complicated cases are involved,  or when surgery is part of a case, more people may be inclined to complain when things do not turn out well.  Failures can occur even when everything was done meticulously and this is a risk that a patient who has been informed accepts.  But in a few cases,  misjudgments and mistakes can and do occur.  Implants can be placed so that they are not in enough bone,  are perforating the sinus or extending into the main lower nerve.  This happens when dentists are not experienced in implant surgery and/or do not do the needed diagnostic workup.
     Other problems can occur after the surgery in the restorative phase of the case.  The fact is,  not all dentists are good at complex prosthetic work.  The restoring dentist may have difficulty restoring the case if the surgeon has placed the implants in an unfortunate place.  What am I telling you here?  I am telling you that you must be sure, before signing on, that your implant "team" is good and experienced at doing implants and that they are used to working together. They should also be familiar with the same implant systems.

Question:  Is there an implant specialty? How can I choose an implant dentist?
Answer:  The American Dental Association recognizes certain specialties and approves and accredits  that specialty's graduate programs. But there is not an ADA Implant specialty.  There are training institutes and programs that confer certificates and requirements for these credentials.  If your dentist presents him or herself as having special implant credentials, ask about the organization and it's requirements.
The ADA does recognize specialties in Periodontics (gum specialists) , Oral Surgery and Prosthodontics (crowns, bridges, dentures, replacements).  Oral Surgeons and periodontists frequently do surgeries and most routinely place implants.  Prosthodontists are specialists in crowns, bridges, dentures and are used to doing large and complicated restorative cases. Finally,  some general dentists do advanced restorative cases and do them well.

It's not an easy task to find the right dentist but a patient needs to feel confident before beginning an implant case.  Calling specialists in the area and asking to which restorative dentist they would recommend an implant patient can help.  If you are already in the care of a periodontist, ask for a recommendation to  a restorative dentist whose work he or she knows.  Do not hesitate to get additional opinions. Recommendations from other patients can help (but can be misleading also).   At a minimum, talk to the dentist proposing the treatment, ask how often he/she does implants, what his or her background is, how long he or she has practiced. Ask the hygienist or assistant how often they are done in the office.  It is even possible in most counties to check local court records to see if a dentist is a frequent defendant in lawsuits, and to call the Board of Dentistry (located in the state's capitol) to ask if a dentist has had any complaints.  Most states have a website for occupational affairs as well.   Sometimes physicians in the area will have an idea which dentists are doing good advanced restorative work.

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