slide

Implant Dentistry

  • During the last 30 years the use of dental implants has changed dentistry beyond recognition. Implants are no longer considered experimental and it is equally rare to come across situations where they cannot be used at all.
  • Today there is another option for patients who are missing permanent teeth.
  • Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that “fuses” with the jawbone through a process called “osseointegration,” dental implants never slip or make embarrassing noises that advertise the fact that
  • you have “false teeth,” and never decay like teeth anchoring fixed bridges.
  • Because dental implants fuse with the jawbone, bone loss is generally not a problem.    
  • After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime.
  • A dental implant designed to replace a single tooth is composed of three parts: the titanium implant that fuses with the jawbone; the abutment, which fits over the portion of the implant that protrudes from the gum line; and the crown, which is created by a
  • prosthodontist or restorative dentist and fitted onto the abutment for a natural appearance.
  • Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime. Similarly, a removable partial denture may contribute to the loss of adjacent teeth. Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.

 

Dental Implant Benefits

 

  • Reduce the need to cut down adjacent teeth for bridges
  • Help preserve remaining natural bone structure
  • Support face shape and smile
  • Eliminate the need for removable partials and dentures – and the sores that may go along with them
  • Convenience and no need to worry about denture adhesives or having dentures slip, click or fall out when speaking
  • Reduce the need for the roof of the mouth to be covered by removable partial or complete dentures
  • Look, feel self-esteem and work just like natural teeth
  • Provide confidence when eating, speaking and smiling

 

Who is suitable for dental implants?

Some people are interested in getting implants to replace teeth that have been missing for a number of years. Others may need implants to replace teeth that were extracted recently because of severe decay, periodontal (gum) disease, infection of injury. In some cases, the teeth can be extracted and the implant placed at the same time.

However, if you have a severe infection in a tooth root or your gums, your dentist may wait a few months after removing the teeth to allow the area to heal. Not all people are good candidates to get dental implants. A person who is most suitable is someone who is in good health, has healthy gums, and has enough bone in his of her jaw to allow an implant to be placed in the jawbone. To determine if you are suitable to get an implant, you will have to be examined by a dental professional.

 

Some people may not be good candidates for implants. They include:

  • Young patients whose jawbones have not developed completely.
  • Pregnant women.
  • Heavy smokers – Smoking impedes healing in the mouth and can reduce the likelihood that implants will be successful.
  • Alcohol or substance abusers.
  • Patients who have received high – dose of radiation of their head or neck.
  • People with chronic diseases or systemic problems, including high blood pressure, diabetes, connective – tissue diseases,
  • hemophilia and significant immune deficiencies, among others – You still may be a good candidate for implants even if you have
  • one of these conditions. It depends on the extent and severity of the condition.
  • Patients who take certain medications such as steroids or drugs that suppress the immune system.
  • People who severely grind or clench their teeth – These habits can place too much pressure on the implants and increase the
  • risk of failure.

 

Imaging ?

When you first enquire about dental implants it is often in response to an awareness of ongoing dental problems or the recent loss of teeth. Each of these problems will need to be diagnosed and treated in a logical manner, often placing implants in order to establish healthier conditions.

Although it is tempting to focus on the more glamorous aspects of teeth supported by implants, basic dental health, which includes the treatment of gum disease, repair of decay and the elimination of abscesses will be just as important of the long-term success of your treatment.

If you are aware of bad breath, loose teeth, or have noticed excessive bleeding,particularly when your teeth are cleaned professionally, you may have gum problems. Periodontal (gum) disease is a major cause of bone loss and with reduced bone; dental implant treatment can be more complicated.

 

Will I feel pain during or after the procedure ?

Routine dental X-rays show large amounts of detail, but in only two dimensions. From these views it is generally possible to judge the height of bone available for implant placement, however, more advanced imaging techniques are sometimes needed to determine the equally important bone width, which can otherwise only be estimated from clinical examination.

Dental CT scans - There are now a number of advanced x-ray techniques which allow your jaw bone to be looked at in all three-dimensions. The most accurate and widely available is known as the CT (computed tomography) scans. Images obtained by CT scanning will normally be able to show all of the information required about your bone, including quantity and quality, but most importantly the presence of anatomical structures that must be avoided.

 

Will the tooth need any special care or additional treatment ?

Before a dental implant is placed, you may need to have the bone in the area built up to increase the chance of success. This is a common procedure called bone grafting or augmentation. You may have the bone graft done and get the implants at the same time, but your dental specialist may decide to do the bone-graft procedure first and give the bone time to heal before placing the implant. If the bone graft is done first, you will need 4 to 12 months to heal before having the implants placed in your jawbone. However, you can wear your dentures or bridge during this time, so you won’t be without teeth.

 

Sinus augmentation
In the upper jaw above the back teeth, it is possible to increase the height of bone available by creating new bone in the sinus. This procedure is called a ‘sinus augmentation’. A skilled surgeon can deliver very predictable results in this location and without the general success of this technique many patients would be unable to have implants in a part of the mouth where teeth are so commonly missing.

 

Onlay grafting
There are many ways in which bone can be added to, however one simple concept is to take a piece of gone from somewhere else and secure it as an ‘onlay graft’ to a deficient area. The new piece of bone will slowly join to the underlying region and when healed and mature, and implant can be placed in a more favorable position.

 

How long does treatment take?
The time frame for completing the implant and crown depends on many factors. When the traditional method of placing an implant is used, the shortest time frame for a complete implant (including surgeries and placing the permanent crown) is about four months in the lower jaw and four to six months in the upper jaw. However, the process can last up to a year or more, particularly if bone needs to be built up first.

 

Implant placement process
In the traditional method, two surgeries are required, with three to six months between them. During the first surgery, an incision is made in the gum where the implant will be placed. A hole is drilled in the bone, the implant is placed into the hole in the bone, and the incision is stitched closed.

At the end of the healing period, a second surgery takes place. It involves making a new incision to expose the implant. A collar, called an abutment, is screwed onto the top of the implant. The abutment is used to support the crown.

 

One-stage implant
The implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. In this procedure, your dentist can place the implants, and place a temporary crown or bridge all in one visit. The implant will not normally be ready to support a tooth for several weeks of months.

 

Two-stage implant
The implant is placed into a new, healing of healed extraction site and then covered by a layer of gum so that it cannot be seen – this is the first stage. At the second stage some weeks of months later, the implant is uncovered and components added bringing it above the gum ready to begin placing a new tooth.

Same day implants
This technique is most often used to treat the lower jaw and requires considerable planning before the actual day of surgery. Several implants are installed and a few hours later a complete arch of temporary of permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.

Immediate implant
For this technique a tooth is removed and an implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one- or two-stage procedure. Not all patients are suitable for this approach.

Immediate implant and early loading
This is distinctly different from an immediate implant placement. It is effectively a one-stage technique where the implant is placed into a new, healing or healed extraction site and is fitted with a new tooth at the same appointment. This first tooth will normally be kept out of direct contact with opposing teeth for a healing period of more than 3 months, after which it is finally restored. This technique tends to be more common in regions of the mouth where optimum aesthetics are important. Again, not all patients are suitable for this approach.

 

How long will the implants last?

 

Will I feel pain during or after the procedure ?
During the period after the new teeth are fitted, the success of each treatment stage will be the main factor determining how the implants are performing. Once the implants and surrounding soft tissues are seen to be healthy and the new teeth comfortable and correctly adjusted, it is the quality of your home care and willingness to present for regular maintenance reviews that will have most influence on how long they will last.

When poorly cared for, implants will develop a covering of hard and soft deposits (Calculus and plaque) which is very similar to that found on neglected natural teeth. Untreated, these deposits can lead to gum infection, bleeding, soreness and general discomfort, just as can occur around natural teeth. It could probably be said that implants much like teeth will last for as long as you can keep them clean.

Well maintained implants placed into adequate bone can be expected to last for many years and probably for your lifetime. However, just as you would expect conventional crowns, bridges and fillings to need occasional repairs or replacements during their lifetime, you
implant-supported teeth may also have similar maintenance requirements over theirs.

 

Complications from Surgery

Any surgery carries the possibility of complications. Complications of implant surgery include bleeding, infection and injury to nerves, sinuses (located above your upper teeth) or nasal cavity.

When implants are used to replace lower teeth, your dentist could nick the nerve that runs through the jawbone during drilling. This can cause pain or numbness. If numbness occurs, it usually affects the lower part of the lip and chin or one side of the tongue. It can last for several months until the nerve heals or it may be permanent.

In the upper jaw, there is the possibility of drilling through the jawbone into one of your sinuses or nasal cavity, which could result in an infection. To avoid this, special X-rays will be taken prior to your surgery will help the surgeon to determine where the nerves, sinuses and nasal cavity are located.

 

Implant Failure

Implant surgery is successful more than 90% of the time. Occasionally, an implant fails to bond with the surrounding bone. Potential reasons for implants failing to integrate with surrounding bone include:

  • Surgical trauma
  • Infection around the implant
  • Smoking – This appears to decrease blood flow to the healing gums and bone, which could interfere with the bonding process.
  • Lack of healthy bone –If there is not enough bone for the implant to remain stable, the implant may move around within the bone and bonding will not occur.
  • Titanium allergies –These are extremely rare.

 

Implant Failure

  • Diagnosis and treatment planning after which it may be necessary to carry out repairs or treatment to any remaining teeth.
  • Implant placement is usually followed by a period of healing lasting from 6 weeks to 6 months. Often the implant are completely hidden beneath the gum, however one-stage procedures where the implant is visible from the time of placement are also commonplace. Stitches are normally removed 7 to 10 days after the implant placement.
  • Several visits may be needed over the next few weeks to adjust temporary teeth of dentures and to monitor healing.
  • Once the implants have healed uneventfully for the required time, they are uncovered if necessary and made ready to connect the teeth. Sometimes the time allowed for implants to integrate may be increased or decreased to suit the local bone conditions and the overall quality of healing.
  • In some cases the first teeth fitted to your implants are not the final ones, but replicas of the intended design. This stage can be used to assess the implants, control early loading and in areas where aesthetics are more critical, also gives the gums time to mature around each implant before final teeth are fitted.
  • Final teeth are commonly fitted between 3 and 9 months after the implants were first placed. The way that the teeth fit together is carefully adjusted so that they do not interfere with each other.
  • Regular examination and hygiene appointments are then all that is required to maintain the health of the mouth, teeth and implants.