Comments

1. Jackie says:

   November 5, 2009 at 4:49 pm

   I am considering a titanium dental implant for a lower molar. I had the tooth pulled a year ago after having had a root canal for 15 years.
   My daughter’s orthodontist recommends that she have lower jaw surgery where her jaw would be “extended” with the help of titanium bands. She has an overbite; her bite is 1 full tooth off. And according to two different orthodontic offices, her bite could not be corrected without surgery.
   What is your opinion of the safety of titanium as part of these dental/orthodontic procedures.
   Thank you!
2. Dr. Marvin says:

   November 12, 2009 at 12:55 pm

   Hi Jackie,

   Thanks for the question.

   Like most things dental, you need to know what the whole body implications of putting something that’s “fake” into our bodies. Not only “on” the teeth but “in the bone.”

   Be cautious because our bodies have an innate defense system (immune system) that battles against anything that is not real.

   Just because professions say that bone can integrate around titanium mechanically, does that mean that the body accept it biochemically.

   We don’t know for sure.

   So in our practice, we error on the side of safety.

   Would I out titanium in my mouth? No.

   With the advent of metal free implants, it is promising.

   Re: orthodontics – I have very strong feelings against certain corrections of tooth and jaw problems. However, every case if unique and it would be difficult for me to recommend one way or another.
3. D says:

   November 21, 2009 at 12:01 am

   Hi Dr. Marvin,
   Regarding your opinion on titanium implants, my understanding is that titanium is inert and will not elicit any immunological reactions in the body. Being that titanium itself does not have any biological antigens, our own human antibodies would not see it as a foreign object, and thus no autoimmune reaction would occur. Now I could potential fathom that untreated titanium with surface oxides can cause problems, but this precaution has been made.

   I think that enough procedures have been done in the last two decades that would tell us that titanium is safe to use in the body – so I need to ask why it would not be “biochemically compatible”. If our bodies immune system attacks anything that is not “real”, as you state, then breast implants, contact lenses, piercings, etc would all trigger massive immune responses that would potentially kill people.

   I enjoy reading your site, holistic opinions always makes for an interesting debate for those of us who base our opinion on empirical studies and classical science.
4. Dr. Marvin says:

   November 21, 2009 at 10:58 am

   D, thanks for the comment. I welcome the debate, especially when someone implies that holistic medicine isn’t science-based. In fact, holistic medicine is implicitly science-based. It looks at medical science and empirical studies and looks at everything from a whole-body perspective, rather than a local perspective. For instance, traditional medicine typically tells us that if the stomach hurts, treat the stomach. Holistic medicine says that if the stomach hurts, find the source and prevent the problem — whether the cause is the stomach or somewhere else — just because the pain is in the stomach, it doesn’t mean it didn’t originate in a different location.

   Your comment here, though, is specific to titanium implants. The science behind it (and the complete answer to your question) is far too detailed to completely cover in a blog comment, so I’ll post a “quick” answer here and write a longer, more complete article covering both the pros and cons of titanium implants later this week.

   So here’s the “short” answer: Yes, titanium is a relatively “safe” metal. However, when you compare it to breast implants, etc. you’re comparing apples to oranges. When you embed a titanium post into your jaw, you’re sticking a metal rod into the bone and outside the body… In the oral cavity. The barriers between inside and outside the body have forever been compromised, allowing a host of problems. (Not to mention that piercings often lead to infections, contact lenses can cause sever reactions in some people, breast implants have a history of problems, etc. When you introduce a foreign object into the body, you’re playing a game of chance. Nothing in medicine is 100%… I choose to error on the side of safety when the “game” could be life-threatening).

   Have “enough procedures been done in the last two decades that would tell us that titanium is safe to use in the body”, as you state? In fact, locally the procedure works 90% of the time. Those aren’t good ratios to claim that the procedure is “safe.” Sometimes the failure is due to the material, and sometimes it’s to to poor craftsmanship (I recently examined a patient whose implants were infected and had been placed at the wrong angle in the jaw, not only leading to bone loss and infection, but also to a host of dental problems in the surrounding teeth). I also have plenty of first-hand experience, so while my information may be my “holistic opinion,” that ignores the fact that I’m a licensed, trained dental practitioner as well as a former educator in a dental school. In fact, I’ve had over 200 hours of implant training over the past 10 years and have placed my share of implants, bone grafts and restorations, so I have direct, first-hand experience to draw from.

   Here’s one particular story:
   A patient of mine went through the vicious sequence of filling, crown, root canal, re-treatment, and now dental implant. Radiographically it is perfect (as stated by 5 other dentists, including myself). But she has had pain in her ear and jaw since day-one of the placement. And no, it was not close to the nerve. Yet she insisted it be removed. Instantly, after the procedure, all the pain went away. Coincidence?

   Do we professionals claim to know everything about our bodies? For the most, part, we don’t. Every day new discoveries are made (remember, those “safe” breast implants a few decades ago? Those original silicone implants were “completely safe” according to empirical studies… until thousands of women became sick). Science is not exact, especially in medicine. It never will be. I guess that’s why they call them practices.

   So yes, anecdotally there are cases of implant failures. There are also cases of implant success. Things will never be 100% when it comes to medicine and our bodies. So are dental implants universally the choice of treatment for everyone? Of course not. Case selection is key. But in my practice, where health and safety is key, I won’t take those chances, especially when there are other, more proven and less invasive options available.

   I appreciate the comment. Comments such as yours help answer the questions that many people out there have, but are often afraid to ask. Hopefully this is step-1 toward a complete answer (I’ll work on a complete article analyzing the arguments for and against implants this week… look for it on the homepage before the end of the month).

   Thanks!
   Dr. Marvin