Missing Teeth: Always Out of Fashion

Did you that Neanderthals had impressively good dental hygiene?


With more than 35 million toothless Americans, according to the College of Prosthodontists, tooth loss continues to be a pertinent issue in the United States.
“Periodontal disease is associated with age, and as Americans live longer and retain more of their natural teeth, periodontal disease may take on more prominence in the oral health of the U.S adult population,” Paul Eke, CDC epidemiologist said. “Maintaining good periodontal health is important to the overall health and well-being of our aging population.”


Although the landscape of the human population is ever-changing, many of the problems we face today have persisted for hundreds, if not thousands, of years. Tooth loss has always been an issue for humans and we continue to look for solutions or preventative measures. Today, tooth loss is a common problem in the older population, but can occur in other individuals for a variety of reasons. Whether it’s gum disease and or dental accident, tooth loss can bring plenty of additional health concerns, especially when left untreated.


Fortunately, modern dental treatments like dental implants can give patients a natural-looking smile that feels and functions just like natural teeth. These modern solutions are a far cry from early attempts at restoring missing teeth. In fact, different societies have tried their hand at restorative dentistry throughout history, but few had actually been successful. The earliest attempts have been traced all the way back to 600 A.D. and techniques to restore missing teeth have continued to evolve from the early primitive attempts at tooth restoration.


Why Are Tooth Restorations Needed?


Believe it or not, tooth restorations weren’t needed for a portion of human history. This is because problems with the development of dental caries didn’t become a serious issue until the emergence of farming.


Our hunter-gatherer ancestors actually had very healthy teeth. Of course, it wasn’t their dental hygiene that kept cavities away. Their pristine oral health can actually be attributed to their diet, which mainly consisted of meat, vegetables, and nuts. As farming populations grew, problems with gum disease and cavities became more prevalent because the increased consumption of carbohydrates and sugar. Researchers believe that disease-causing bacteria thrived and dominated over other beneficial bacteria in the mouth because this type of bacteria was efficient at using carbohydrates. As a result, the ecosystem of bacteria in the mouth is low in diversity and full of pathogens that can effectively utilize the new change in diet.


A study from the Australian Centre for Ancient DNA observed calcified plaque from 34 prehistoric human skeletons. The study found that bacteria in the mouth changed dramatically in conjunction with the shift in diet. Researchers believe that the two big shifts in diet, which include the “the adoption of carbohydrate-rich Neolithic (farming) diets and the more recent advent of industrially processed flour and sugar,” are the root causes of dental diseases.


Ancient Attempts at Tooth Restoration


After the emergence of farming and carbohydrate-dense diets, oral disease became a prominent issue for nearly every civilization across the globe. The earliest explanation of dental problems came from the Sumerians around 5000 B.C. The Sumerians, along with other ancient societies, believed that tooth worms were the culprits of tooth decay. Historians note that some dentists would even try to yank out nerves that they mistook for tooth worms. The idea of tooth worms lasted into the 1700s when it was finally proven false. As tooth decay became more and more prevalent, tooth loss also became a prominent problem. Different ancient civilizations tried various methods for restoring missing teeth. Some of the most notable attempts at tooth restoration among ancient societies include:


Mayans: Researchers found evidence of crude dental implants in the Mayan civilization after excavating a burial site in 1931. Archaeologists found that three tooth-shaped pieces of shell were in a mandible that belonged to a woman in her twenties. At the time, researchers believed that the pieces of shell were placed after death for cosmetic reasons. In 1970, a dental academic took a closer look at the mandible and noticed that bone had formed around the shells. From this observation, researchers now know that the implants must have been placed while the woman was still alive.


Ancient Chinese: Archaeologists have also found evidence of tooth restorations from the ancient Chinese. These researchers have found evidence that show that bamboo pegs were used to replace lost teeth.


Egyptians: The Egyptians also recognized the importance of having a complete smile for the afterlife. Researchers discovered one mummy with a copper replacement tooth hammered into the upper jaw. It’s believed that this was placed after death because of the excruciating pain and infection that would occur if the restoration was placed while still alive.


The Ancient Egyptians dabbled in pre-modern dentistry with...interesting results.
The Ancient Egyptians were strong believers in having a stunning smile in the afterlife.


Celts: An ancient dental implant was also found at a Celtic burial site in present-day France. Researchers noticed that the iron tooth replaced a central maxillary incisor, which is one of the most visible teeth when you smile or speak. With this in mind, they believe the intention behind this restoration was most likely aesthetic. Although the skeleton’s teeth had no signs of cavities or tartar, researchers believe that the tooth was probably lost from a punch or a fall. It’s unclear whether the false tooth was placed while the person was alive or after death.


The Development of Modern Implants


As time went on, most attempts at dental implants remained largely unsuccessful. It even became common practice from the 1500s to the 1800s to collect teeth from other humans. Many Europeans would collect teeth from the poor or would steal teeth from the deceased to either create dentures or attempt an implant. Scottish surgeon, Dr. John Hunter, is particularly known for his work with human teeth during this time period. Dr. Hunter would work with people that rob graves, also known as “resurrectionists,” and was able to carefully observe the anatomy of the mouth and jaw. He also experimented with the idea of moving teeth from one human to another by testing the implant procedure on roosters. He found that one tooth became firmly implanted into the comb of the rooster where the blood vessels of the rooster embedded straight into the pulp of the tooth. This was a major accomplishment during this time, but implants still continued to fail in a majority of cases.


Dr. Hunter believed that the low success rate of dental implants could be attributed to the size and “freshness” of the tooth being implanted. In reality, we now know that implanting another human tooth will most likely end up being rejected by the body. During this time period, implanting a tooth from another human would create infections and spread diseases.


More sophisticated attempts at dental implants began in the 1800s with implant techniques published by French dentist, J. Maggiolo. The French dentist attempted to place an implant made from an 18-karat gold alloy into a fresh extraction site. The gold implant tube was placed and that site was able to heal where a crown was later placed. This implant is considered the first modern dental implant but unfortunately, the gums became severely inflamed following the procedure.


Osseointegration: The Key to Successful Implants


Experimentation with the material and shape of implants continued for the next century. However, the most important discovery wasn’t made until the 1950s by Swedish professor, Per-Ingvar Brånemark. Brånemark is known as the “father of modern dental implantology” for his discovery of osseointegration, or the fusion of a dental implant to the jawbone. Brånemark unintentionally discovered osseointegration while studying the effect of blood flow for bones. During his study, he placed titanium devices to the legs of rabbits to observe the healing process. At the end of the study, Brånemark intended to remove the device but was surprised to see that the titanium device had actually fused to the bone.


Brånemark dubbed this process “osseointegration” and soon realized that the biocompatibility of titanium would make a perfect material for implants to anchor artificial teeth. This was a revolutionary discovery because it was widely-known that introducing any foreign material to the body would lead to inflammation and rejection. Brånemark continued to study the compatibility of titanium and bones, but his discovery was poorly received by the rest of the medical and dental world.


The late Per-Ingvar Brånemark.
The late Per-Ingvar Brånemark, Swedish physician.


Brånemark placed his first titanium dental implant in Gosta Larsson, a patient with a cleft palate, a deformed jaw and no teeth in his lower jaw. He placed four implants to anchor a denture for the man in the mid-1960s. These implants stayed in place for the next four decades until Larsson’s death.


Although Larsson’s implant process was a success, Brånemark’s discovery wasn’t accepted until 1982. He won recognition for his discovery after a professional meeting in Toronto where he made his case for osseointegration. Since then, osseointegration has allowed for countless patients to enjoy the comfort and stability of implants.


Modern Restoration with Dental Implants


Dental implants were first used for patients that had lost all their teeth and couldn’t stabilize dentures. Eventually, dental implants became a popular restoration for patients with a variety of cases. Dental implants can successfully restore a patient’s smile whether they’re missing one tooth or an entire row.


According to the American Academy of Implant Dentistry, three million patients have implants and that number is growing by 500,000 per year. Modern dental implants are the most effective and long-lasting solution for tooth loss on the market. Since the implant fuses to the jawbone, patients can enjoy a restoration that is stable just like their natural teeth. The longevity of dental implants with the proper care makes this the preferred restorative treatment for many patients, which is a giant leap from the primitive implants of the Mayans!


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