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April 12, 2008

By Carol Tekavec, CDA, RDH

While more and more dental plans are covering implants, annual plan maximums make the patient primarily responsible. This article focuses on discussing implants and insurance with patients. Here are some examples of common questions and easy-to-understand answers. (Excerpted from my patient brochure, "Implants and Others: When Teeth Go Missing")

Q: Why should missing teeth be replaced?

A: Most people would not want to have a tooth missing where others could see. What you might not know is that along with appearance, any missing tooth can actually affect the health of your mouth and the way that the rest of your teeth fit together. Teeth in the opposite jaw can drift up or down into the open space. Teeth on either side of the empty space can become loose, start gum problems, or even cause headaches due to changed biting forces. In other words, missing teeth can cause other teeth to move around in ways that we do not want. What's more, when a tooth is lost, the bone that used to support that tooth starts to disintegrate. Without a tooth root to give the jawbone purpose in that area, the jawbone deteriorates. It doesn't happen overnight, but a gradual decline occurs. In most cases, a person's own tooth and tooth root (with repairs if necessary) are better than any replacement might be. However, when teeth are lost, replacements are essential to the continuing health and appearance of the mouth. Modern dentistry offers us several high-quality choices for replacements. These are tooth-supported or implant-supported fixed partial dentures (also known as "bridges"), tooth-supported or implant-supported removable partial dentures, complete removable dentures, implant-supported "overdentures," and implant-supported crowns.

Q: How do I know if I am a good candidate for implants?

A: It is important for your dentist to find out if you have enough bone to hold an implant in place. Special X-rays (panographs, tomographs, or cone beam radiographs) or models may be needed for your dentist to determine if your bone is "thick" enough. If your bone is not thick enough, you may still get an implant, but a bone graft may be needed first. Severe, ongoing periodontal (gum and bone) disease may also be a problem. Periodontal disease can create an environment that is detrimental to an implant. If you have lost a tooth because of gum disease, control of that disease is important before considering an implant. A traumatic (extremely hard) bite relationship between top and bottom teeth may also be an issue, as well as smoking. Your general health and any drug therapies you are using must be considered too. Your dentist may consult with your physician prior to placing implants.

Q: How long will a dental implant last?

A: When an implant integrates, or becomes a part of the bony structure of the mouth, it can last indefinitely. However, as with any type of dental replacement, the longevity of an implant and any restoration placed upon that implant depends greatly on home care by the patient. Regular and frequent check-ups and special maintenance with the dentist and/or hygienist is also required. If you decide to have an implant, you must be committed to talking excellent care of your mouth from now on.

Q: What do implants cost?

A: Implant materials and tooth replacements are expensive and customized. They are "one-of-a-kind" and made just for you. Surgical costs also must be factored into the total fee. Your dentist or his/her staff will go over your particular situation and let you know what your financial obligation will be. You are entitled to know the costs involved prior to your treatment.

Q: Will my insurance pay for my implant?

A: Implant dentistry has evolved into a popular and proven treatment modality. Therefore, more and more dental insurance plans are including these services in their contracts, within the confines of applicable yearly maximums (typically $1,500 to $2,000). Some plans may stipulate a "least expensive alternative treatment" benefit, meaning the carrier may only pay what they allow toward a nonimplant-supported crown, bridge, removable partial denture, or full denture. If your insurance contract specifically excludes implant procedures, then such procedures will not be covered, despite what you and your dentist may request. Under some contracts, the implants may be denied, but the crowns or bridges placed on top of them may be covered. Medical plans rarely pay toward dental implants, unless they are required to do so as the result of an insured accident or trauma. Implants may also fall under a dental "preexisting" clause, further limiting insurance coverage. Your dentist can apply to your insurance carrier for an estimate prior to starting your treatment. That way you will know what your total financial obligation will be.

Dental implants have come a long way from where they began more than four decades ago. They are a good solution for many people with missing teeth. It is important for patients to understand the basics of how implants work, as well as the limited nature of dental insurance coverage.

Carol Tekavec, CDA, RDH, is the president of Stepping Stones to Success and a practicing dental hygienist. She is the author of the "Dental Insurance Coding Handbook" and six patient education brochures, which can be seen on her Web site. Contact her at (800) 548-2164 or visit www.steppingstonestosuccess.com.

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