Why dental implants? There is one simple answer: there is an overwhelming need. Within the last one to two generations, there have been vast societal changes, including the fact that people are now living longer with greater motivation to maintain the function and esthetics of their natural teeth. It was common for people just 60 or so years ago to lose most, if not all, of their teeth well before retirement age. As a result, dentistry prior to the 1960s was largely focused on providing restorations for carious teeth and fabricating removable appliances such as removable partial dentures (RPDs) and complete dentures (CDs) as the final dental solutions for missing teeth.

Partial and Complete Edentulism in the Twenty‐First Century

The population is aging and, by 2030, more that 20% of the U. S. population will be aged 65 years or older, Fig. 1.1 [1].

These projected data indicate that within 10–12 years, about 20% of the population will be “senior citizens,” namely 65 years or older [1]. Although advances in medicine and pharmacology, together with improved nutrition, dietary awareness and exercise, have significantly improved the average life expectancy, the outlook for maintained and even improved dental hygiene as well as overall oral health still looks bleak. In fact, partial or complete edentulism is increasing. Whereas fluoridation has markedly reduced dental caries [2, 3], the prevalence of tooth loss through periodontal disease, enamel erosion, wear, trauma and disease (e.g., cancer) is growing [4–7].

According to the American College of Prosthodontics, more than 35 million Americans are edentulous, and 178 million people are missing at least one tooth and these numbers are expected to grow over the next two decades [8].

What is distressing about these statistics is that edentulism affects our most vulnerable populations – the aging and the economically disadvantaged, Fig. 1.2. In the geriatric population, for example, the ratio of edentulous to dentate individuals is 2 : 1, with about 23 million being completely edentulous and some 12 million are edentulous in one arch. About 90% of edentulous patients have dentures and some 15% of edentulous patients will have dentures made each year [8].

The consequences of partial or complete edentulism are well‐known and include many facets of the quality of life (QoL) as well as facial appearance, self‐image and self‐confidence. Overall, health consequences of edentulism encompass significant nutritional changes, digestive issues, obesity, diabetes, and coronary artery disease to name but a few.

The Reality of Dental Implants

Although there have been minor variations over the past few years, the current life expectancy for the U.S. population in 2020 is 78.93 years [10], and we can anticipate increases in tooth failures. Vertical root fractures, endodontic failures, restorative failures, and periodontal disease may result in tooth loss. In contrast to the practice of dentistry in the nineteenth and twentieth centuries, modern dentistry focuses on the replacement of lost teeth utilizing implants, combined with comprehensive analysis of function and esthetics.

In modern dentistry, the dental implant is the best tooth replacement option for nearly all situations where a tooth is missing or is failing. The primary reason for this is the extremely high success rate achieved with dental implants. Saving teeth at all costs is no longer the norm because of the unpredictability of the longevity of heroic dentistry. In other words, preserving bone and tissue regeneration are now considered to be more important than trying to prolong tooth retention. This approach not only promotes bone healing and preservation but ensures that implants are placed in a predictable and solid bony environment with a high rate of success.

The consensus regarding dental implants within the international dental community can be summarized in Table 1.1. Whereas the order of the comments may vary with the individual clinician, most would agree that these comments are valid and pertinent.

Implants and the Edentulous Patient

Over 32 million people in the U.S. wear partial or CDs [11] and approximately 33% of these patients complain that their dentures fit poorly, tend to loosen or dislodge during activities such as chewing and laughing, and/or there is pain on mastication. Flat ridges and/or shallow palatal vaults add to denture retention and instability problems and most dentists are aware that the mandibular CD presents retention issues.