Dental Implants

Dental implants are changing the way people live. They are designed to provide a foundation for replacement teeth which look, feel, last and function like new natural teeth. The person who has lost a tooth or teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. Patients with dental implants can smile with confidence.

What are Dental Implants?

The best way to visualize a dental implant is to compare it to a natural tooth. A tooth has two parts, the crown and root. The crown is visible in your mouth and is what you bite and chew with. The root anchors the crown to the bone and gums. When a tooth is lost, both crown and root are removed. When the tooth is replaced, the root is replaced first and later a new crown is made to fit on this new root. Essentially an implant is a prosthetic or artificial root.

Once a tooth is lost, a socket or space in the bone remains. Over next 6 to 8 weeks following the removal of the tooth, the socket heals with the formation of new bone, ultimately appearing as if a tooth was never there. Eventually, if nothing is done to restore the area, the bone will continue to remodel and will develop a defect in the area where the tooth was located, as there is no longer a physiologic need for the bone in that area (there is no tooth to support). This resorbtion or remodeling of bone is largely prevented by placing a dental implant is the location of the removed tooth as the body now treats the implant just as a new natural tooth and the bone is thus preserved. Ideally then, when a tooth is lost, an implant is placed within months of its removal and eventually as a crown is made and placed, stress is applied to the bone thus preserving it. This new, prosthetic root and crown will, in most cases, last like a new natural tooth.

One might ask what choices exist other than implants for replacing teeth. The oldest technology, one that has been used for hundreds of years, is removable appliances. These are partial or complete dentures which clasp into the mouth and are made with replacement teeth in place of the lost teeth. They are fairly quick to fabricate, relatively inexpensive and predictable. However, they do nothing to prevent further bone loss, are bulky and often uncomfortable to wear and sometimes affect taste and speech unfavorably. They are rarely well accepted choices for a single missing tooth.

Another traditional option is the fixed bridge. This appliance, like regular dental crowns, is made by first grinding down the adjacent teeth, making a record via a dental impression, and fabricating a metal ceramic appliance, which is cemented in place. While predictable and relatively quick it is substantially different than natural teeth. You are no longer able to clean and floss around the bridge normally as all three teeth are fused together. Hygiene is particularly important around bridges because recurrent decay usually dooms the appliance to a finite life span, usually about ten years. Additionally, now all the chewing force is placed on the two supporting natural tooth roots and while generally this is not an issue, in some cases, it can be too much stress on the adjacent teeth. Lastly, the economics of prosthetic dentistry is such that the comparison in costs between a single implant and a typical three unit bridge reveals little cost advantage to bridgework unless there are multiple adjacent missing teeth. The implant is roughly the same cost and far more durable, and largely prevents the bone remodeling that proceeds following tooth loss.

There is a bonded or cemented type of bridge which is more conservative in the modification of adjacent teeth, often referred to as a Maryland bridge. They can be useful in very limited situations typically on front teeth. The below illustration shows all of these different tooth replacement options.

The Placement Procedure

Early dental implants were always performed in two stages: an initial procedure in which the implant was placed under the gum tissue, and a second procedure where the implant was uncovered or exposed by removing the overlying gum and a cap or abutment placed to allow the gum to heal in preparation for fabrication of the new tooth or crown. Eventually, it was discover that in many cases, the implant and abutment or cap could be placed simultaneously avoiding a second procedure. Again, early in the history of implant dentistry, implants were allowed to heal without a crown or tooth in place for 3 to 6 months to ensure that the implant bonded or fused with the jaw. It was eventually discovered that this waiting period could often be decreased significantly and now often the implant is ready to restore with a crown within weeks. Your doctor can discuss with you the timing and techniques which will best ensure predictable success.

In any case, the placement of the implant is made via a small incision in the gum tissue. While sedation or general anesthesia can be provided for control of anxiety, very often a local anesthetic is quite adequate. After the implant is placed, recovery is typically very rapid, often allowing a return to work the next day. During the waiting period while the implant is integrating or bonding to the bone, your diet will not be modified and any temporary appliance can be worn to allow better function and esthetics.

Surgical Advances

Just as the original protocols for implant placement have been modified to allow single stage placement the most recent advances in implant technology have allowed earlier implant placement and restoration. In some cases an implant can be placed immediately following removal of the tooth. Likewise, it is possible in some cases to place a temporary crown on the implant at the time of implant placement allowing immediate tooth replacement. Your doctor can discuss these techniques with you at your consultation visit.

Who actually performs the implant placement?

Implants are a team effort between an Oral and Maxillofacial Surgeon and a Restorative Dentist. While your oral surgeon performs the initial tooth extractions and actual implant surgery, , the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.

What types of prostheses are available?

A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis ( similar to the fixed bridge described above) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis replaces all the teeth in your upper or lower jaw. These are sometimes made to be removable by the patient and sometimes they are fixed in place like regular bridgework. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis attaches to a bar or ball-in-socket attachments, whereas a fixed prosthesis is permanent and removable only by your dentist.

Your doctor performs in-office implant surgery in a office operating suite, thus optimizing the level of sterility. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs or for those who need extensive bone grafting from the jaw, hip or tibia.

Why would you select dental implants over more traditional types of restorations?

Implant supported crowns and bridges are the most “tooth-like” replacements available. If your goal is to have your original natural teeth again, there is nothing closer than an implant supported prosthesis. Traditional bridgework necessitates the grinding down of natural teeth and dooms them to the typical schedule of every ten years requiring additional work or replacement. The bridge, unlike implants, will not prevent the bone loss associated with tooth loss and requires special hygiene to clean.

If you are a denture wearer, implants will allow a very secure structure to ensure that your protheses are solidly retained and give you a firm structure on which to function and chew. More importantly, implants will help prevent the future bone loss which inevitably causes dentures to loosen over time.

Do Dental Implants need special care?

Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.

Are you a candidate for dental implants?

If you are considering dental implants, your mouth must be examined thoroughly and your medical and dental history reviewed. Most patients are candidates for dental implants and most can proceed directly to case planning and placement of the implant fixtures. Some, particularly if too much time has past since teeth were lost, may require some additional preparation to get them ready for their implants. Most commonly this involves bone grafting or transfer of bone within the mouth or, more commonly, the placement of synthetic grafting materials to prepare the implant site. Bone grafting sounds involved but most often is a minor adjunct to the implant placement.

Treatment Planning

As two doctors, your oral surgeon and your restorative dentist, are collaborating on your ultimate restoration, often they will meet or discuss the case ahead of time. This may involve impressions of your mouth to allow plaster or stone models to be fabricated. The models facilitate the collaboration between your dentist and oral surgeon. Additionally, sometimes the new teeth are “mocked up” in wax on your models to allow both doctors to visualize precisely where to locate the implant(s) and ensure an ideal outcome. Sometimes this information is used to custom make a guide or stint to allow implant location to be precisely transferred from the “mock up” to you, at the time of your procedure. Your doctors can discuss with you whether such planning aids will be necessary prior to your treatment.

 

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