Implants
A dental implant is an artificial tooth root that a periodontist places into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.
While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support.
Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own! Under proper conditions, such as placement by a periodontist and diligent patient maintenance, implants can last a lifetime. Long-term studies continue to show improving success rates for implants.
WHAT ARE THE TYPES OF DENTAL IMPLANTS?
There are many implants available, each designed for a specific function. Most are made of titanium, an inert metal which has been proven to be effective at fusing with living bone, a process known as "osseointegration". The cylindrical or screw type implant, called "root form", is similar in shape to the root of a tooth with a surface area designed to promote good attachment to the bone. It is the most widely used design and generally placed where there is plentiful width and depth of jawbone. Where the jawbone is too narrow or short for immediate placement of root form implants the area may be enhanced with bone grafting to allow for their placement.
When the jawbone is too narrow and not a good candidate for bone grafting, a special narrow implant, called "plate form", can be placed into the bone. In cases of advanced bone loss, the "subperiosteal" implant, may be prescribed. It rests on top of the bone but under the gums.
The actual implant procedure involves the surgical placement of the implant or implants, a healing period (osseointegration) and implant restoration to replace the missing tooth or teeth. The treatment may be a cooperative effort between a surgical dentist who actually places the implant and a restorative dentist who designs, prescribes and inserts the final replacement teeth. Some dentists have advanced training and provide both of these services.
Root Form Implants
Root form implants are the closest is shape and size to the natural tooth root. They are commonly used in wide, deep bone to provide a base for replacement of one, several or a complete arch of teeth. After application of anesthetic, your dentist will expose the area of the jawbone to be implanted and prepare the bone to accept the implant. The number of incisions and bone preparations depends upon the number of implants (and teeth) being placed. The implant is carefully set into place and the gums are closed with several stitches. The healing period usually varies from as few as three months to six or more. During this time osseointegration occurs. The bone grows in and around the implant creating a strong structural support. In fact, this bond can be even stronger than the original tooth's. When healing is complete, your implant is uncovered and an extension or abutment is attached to it. Now the implant and abutment act as a solid unit ready to support your new tooth or teeth.
Plate Form Implants
Plate form implants are usually used when the bone is so narrow it may not be suitable for the root form implant and the area is not suitable for bone grafting. The plate form implant is flat and long so it can fit into the narrow jawbone. After application of anesthetic, your dentist will expose the area of the jawbone to be implanted and prepare the bone to accept the shape of the implant. The number of incisions depends upon the number of implants being placed. The implant is carefully set into place and the gums are closed with several stitches. Like root form implants, there is usually a healing period for osseointegration, although some plate form implants are designed for immediate restoration.
Subperiosteal Implants
With very advanced jawbone resorption there may not be enough bone width or height for the root form or plate form implant. In these cases the subperiosteal implant may be prescribed. The subperiosteal implant is custom made and designed to sit on top of the bone, but under the gums. There are two methods for its placement.
The "dual surgery" method. After application of anesthetic, your dentist will expose the jawbone and take an impression or model of the bone using special materials. This model is used by a dental laboratory to carefully create the custom implant to fit your jaw. A second procedure is then carried out where the jawbone is exposed and the implant placed. The gums are closed with several stitches and replacement teeth are put into place.
For the "single surgery" method your dentist will order a special CAT scan of your jawbone. Using the CAT scan data and advanced computer modeling techniques, a model of your jawbone is constructed. This model is used by a dental laboratory to fabricate the custom subperiosteal implant to fit your jaw. A surgical procedure is then carried out where the jawbone is exposed and the implant placed. The gums are closed with several stitches and the replacement teeth are put into place.
Bone Grafting
Sometimes, when resorption has excessively reduced the jawbone, it can be rebuilt through modern bone grafting techniques. Bone grafts can build up or fill in jawbone defects allowing the placement of dental implants. These techniques represent one of the greatest advances in modern dentistry.
There are generally four types of bone grafts used:
- Autografts are those where the bone to be grafted to the jaw is taken, or harvested, from your own body. The area where the bone is harvested from, known as the donor site, is usually the mouth or the hip. This is your own bone and is very compatible with your body. Autografts are generally the best graft technique and usually result in the greatest regeneration of missing jawbone.
- Allografts are taken from human donors. Many countries have donor programs where you can specify that in the event of your death, parts may be harvested from your body to save or improve the life of others. Heart transplants are one type of allograft. This can represent one of the greatest "gifts" you can ever give. Bone obtained in this mannor undergoes rigorous tests and sterilization. Your body "converts" the donor bone into your natural bone, thereby rebuilding your resorbed jawbone.
- Xenografts are harvested from animals. The animal bone, most commonly bovine (cow), is specially processed to make it biocompatible and sterile. It acts like a "filler" which in time your body will replace with natural bone. After this replacement process is complete dental implants may be placed to support teeth.
- Alloplastic grafts are inert, man made synthetic materials. The modern artificial joint replacement procedure uses metal alloplastic grafts. For bone replacement a man made material that mimics natural bone is used. Most often this a form of calcium phosphate. Depending on how it is made, it may be "resorbable" or "non-resorbable". That is, your body may or may not replace the alloplastic graft with your natural bone. In those cases where it is not replaced it acts as a lattice or scaffold upon which natural bone is built. In either case, the end result is to create enough bone for the placement of dental implants.
Modern bone grafting techniques can be nothing short of a miracle for those needing bone replacement. Should your doctor recommend this treatment you will be given further information on the type, location and amount of graft needed.
FREQUENTLY ASKED QUESTIONS
Are implants always successful?
Modern implant techniques have been in use since the 1950's. Improvements in procedures and materials have given implants a ten year average success rate of 93 percent or better. This enviable success rate is improving every year!
Can failed implants be replaced?
In the unlikely event an implant fails it can usually be replaced by another. In fact, most patients wouldn't have it any other way!
Is everyone a candidate for implant treatment?
In general, anyone healthy enough to undergo routine tooth extraction or oral surgery is probably able to receive an implant. There are some health conditions that warrant special consideration. Certain chronic diseases, heavy smoking or alcohol abuse may contraindicate implant treatment. After careful evaluation of your health history, your dentist will alert you to any conditions that may effect your treatment. Remember, age is not a factor.
Will others know I have dental implants?
Today's implant treatment enables you to have your new teeth look, feel and function like your own. Even though others will be unaware you have dental implants, many patients are so pleased they tell everyone they know. Dental implants offer some of the finest restorative results possible in modern dentistry.
How long does complete treatment take?
Depending of the type of implant and replacement teeth selected, the total time can be as little as a few weeks to six or more months. If bone grafting is necessary, further time may be needed. Your dentist will discuss your options with you and advise you of the time requirements.
Will I need to be hospitalized?
Most implant procedures are performed in the dental office under local anesthesia. Although, some patients may desire pre-medication or IV sedation to control apprehension. Hospitalization may be necessary for complex surgical procedures or general health reasons.
Is there pain or discomfort?
Many patients report implant surgery less troublesome than having teeth removed. With modern anesthesia and close attention to post operative care you can expect minimal discomfort.
What Can I Expect After Treatment?
As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply!
After treatment, your periodontist will work closely with you and your dentist to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.
Will I be without replacement teeth at any time?
Immediately following surgery you may be instructed not to wear replacement teeth in the surgical area. If required, this period is usually short, and temporary teeth are soon provided so you can quickly "get on" with your life.
How much does implant treatment cost?
The cost of implant treatment depends upon the number and type of implants placed and the type of replacement teeth needed. For example, replacement of a single tooth with implant treatment costs about as much as a dental bridge. The bridge necessitates "cutting down" adjacent teeth for crowns. Implant treatment does not. More complex treatment, such as bone grafting, will add to the cost. The cost can vary in different countries, so it's is best to consult your dentist. The improvement in your self confidence, comfort, eating habits and appearence will make dental implant treatment one of the best investments you've ever made!
Are implant supported teeth as strong as my natural teeth?
Yes. Research shows that in many cases implants are actually stronger then natural teeth. Compared to removable teeth, studies show implant supported teeth have 100 percent or better chewing efficiency. Dental implants can make it possible for you to enjoy your favorite foods, improve your nutrition and your appearance!
LOOK GOOD, FEEL GOOD
There is a certain feeling each of us has when we look into the mirror and feel really confident about our appearance. It "sets the mood" for our day or social function. Simply stated, our personal confidence can dramatically effect our lives.
Unfortunately, missing teeth, medically known as edentulism, keeps many people from "feeling their best". Edentulism not only effects your self confidence, but also has a dramatic impact on the quality of your life. Edentulism:
- may limit your choice of foods and therefore your nutrition and general health.
- can make you feel isolated either socially or on the job.
- can effect relationships with loved ones.
- can place stress on the remaining teeth requiring them to "do more work". This can lead to further tooth loss.
- leads to bone loss making the "fitting' of traditional dentures difficult or mpossible.
For years the best solutions for missing teeth were bridges, partial or full dentures.
Partial Dentures: When several teeth are missing, a removable partial denture may provide the support needed to fill in the spaces. Partial dentures usually attach to natural teeth with unsightly clasps and hooks. These very obvious attachments can cause undue stress on the existing natural teeth and promote tooth decay.
Full Dentures: Some people can wear full dentures without fit problems, but it is not uncommon for a denture wearer to live with pain and irritation of the gums or have difficulty eating or speaking. Many denture wearers are anxious about whether or not their denture is going to slip and cause embarrassment.
Fixed Bridges: Removable teeth, no matter how well made, do not feel or function like natural teeth. Historically fixed bridges came as close as possible to the feel of natural teeth. However, this necessitates "cutting down" and crowning natural healthy teeth to support the bridge.
Advantages of Dental Implants Over Dentures or a Bridge
Every way you look at it, dental implants are a better solution to the problem of missing teeth.
- Esthetic. Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth.
- Tooth-saving. Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!
- Confidence. Dental implants will allow you to once again speak and eat with comfort and confidence! They are secure and offer freedom from the irksome clicks and wobbles of dentures. They'll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues.
- Reliable. The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement.
There's another price to pay for edentulism. When teeth are removed, Mother Nature assumes there is no need for the bone that supported the teeth. After all, that is the primary job of your jawbone. Over time the bone slowly, yet progressively diminishes. In fact the upper and lower jawbone get smaller or shrink. This process, called resorption, occurs at a more rapid rate if all teeth in the jaw are missing. But, it also occurs when just some of the teeth are missing. If left untreated, the loss of jaw bone can progress so far that a denture will no longer stay in place no matter how much sticky adhesive is used.
DENTAL IMPLANTS ... THE NATURAL SOLUTION
For centuries man has endeavored to find a more natural replacement for missing teeth. Modern, space age materials have allowed that quest to become a reality. Todays dental implant is possible because of these materials combined with years of research and clinical trials. The dental implant is truly the most natural solution for missing teeth.
But what exactly is a dental implant? There are basically two types of implants. Those that sit on top of the jaw bone, but under the gums, and those that fit into the jawbone similar to the root of a natural tooth. Each type offers solid, non-mobile support for replacement teeth which act and feel like natural teeth. Since both types are attached to your jawbone they can provide distinct advantages over traditional methods of replacing missing teeth.
- Implants restore proper chewing function and so you can enjoy foods previously too "difficult" to eat.
- You feel confident that your replacement teeth won't move or loosen.
- You regain the closest thing to the look, feel and function of your natural teeth.
- Throw away those gooey adhesives.
- Forget about unsightly partial denture clasps which place damaging pressure on remaining natural teeth.
- Eliminate irritated and painful gums.
- Improve your speech by eliminating or reducing the "fullness" of full or partial dentures.
- Replace missing teeth with the look and feel of natural teeth without having to "cut down" healthy teeth.
- Dental implants help stop the progressive bone loss and shrinkage of your jawbone by "mimicking" the roots of natural teeth.
- Dental implants are clinically proven with a success rate in excess of 90%.
Clearly dental implants are one of the finest treatment options dentistry has to offer. With their ability to improve the quality of your life and health it's easy to understand why they have become the accepted alternative to traditional methods of replacing missing teeth.
TREATMENT PROCEDURES
This procedure is a team effort between you, your dentist and your periodontist. Your periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs.
Replacing a Single Tooth
If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.
What are the advantages of a single-tooth implant over a bridge?
A dental implant provides several advantages over other tooth replacement options. In addition to looking and functioning like a natural tooth, a dental implant replaces a single tooth without sacrificing the health of neighboring teeth. The other common treatment for the loss of a single tooth, a tooth-supported fixed bridge, requires that adjacent teeth be ground down to support the cemented bridge.
Because a dental implant will replace your tooth root, the bone is better preserved. With a bridge, some of the bone that previously surrounded the tooth begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.
In the long term, a single implant can be more esthetic and easier to keep clean than a bridge. Gums can recede around a bridge, leaving a visible defect when the metal base or collar of the bridge becomes exposed. Resorbed bone beneath the bridge can lead to an unattractive smile. And, the cement holding the bridge in place can wash out, allowing bacteria to decay the teeth that anchor the bridge.
How will the implant be placed?
First, the implant, which looks like a screw or cylinder, is placed into your jaw. Over the next two to six months, the implant and the bone are allowed to bond together to form an anchor for your artificial tooth. During this time, a temporary tooth replacement option can be worn over the implant site.
Often, a second step of the procedure is necessary to uncover the implant and attach an extension. This small metal post, called an abutment, completes the foundation on which your new tooth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you.
Finally, a replacement tooth called a crown will be created for you by your dentist and attached to the abutment. After a short time, you will experience restored confidence in your smile and your ability to chew and speak. Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.
Replacing Several Teeth
If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
What are the advantages of implant-supported bridges over fixed bridges or removable partial dentures?
Dental implants provide several advantages over other teeth replacement options. In addition to looking and functioning like natural teeth, implant-supported bridges replace teeth without support from adjacent natural teeth. Other common treatments for the loss of several teeth, such as fixed bridges or removable partial dentures, are dependent on support from adjacent teeth.
In addition, because implant-supported bridges will replace some of your tooth roots, your bone is better preserved. With a fixed bridge or removable partial denture, the bone that previously surrounded the tooth root may begin to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.
In the long term, implants are esthetic, functional and comfortable. Gums and bone can recede around a fixed bridge or removable partial denture, leaving a visible defect. Resorbed bone beneath bridges or removable partial dentures can lead to a collapsed, unattractive smile. The cement holding bridges in place can wash out, allowing bacteria to decay teeth that anchor the bridge. In addition, removable partial dentures can move around in the mouth and reduce your ability to eat certain foods.
How will the implants be placed?
First, implants, which looks like screws or cylinders, are placed into your jaw. Over the next two to six months, the implants and the bone are allowed to bond together to form anchors. During this time, a temporary teeth replacement option can be worn over the implant sites.
Often, a second step of the procedure is necessary to uncover the implants and attach extensions. These small metal posts, called abutments, complete the foundation on which your new teeth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you.
Finally, replacement teeth, or bridges, will be created for you by your dentist and attached to the abutments. After a short time, you will experience restored confidence in your smile and your ability to chew and speak.
Replacing All of Your Teeth
If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
What are the advantages of implant-supported full bridges and implant-supported dentures over conventional dentures?
Dental implants provide several advantages over other teeth replacement options. In addition to looking and functioning like natural teeth, implant-supported full bridges or dentures are designed to be long lasting. Implant-supported full bridges and dentures also are more comfortable and stable than conventional dentures, allowing you to retain a more natural biting and chewing capacity.
In addition, because implant-supported full bridges and dentures will replace some of your tooth roots, your bone is better preserved. With conventional dentures, the bone that previously surrounded the tooth roots begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.
In the long term, implants can be more esthetic and easier to maintain than conventional dentures. The loss of bone that accompanies conventional dentures leads to recession of the jawbone and a collapsed, unattractive smile. Conventional dentures make it difficult to eat certain foods.
How will the implants be placed?
First, implants, which looks like screws or cylinders, are placed into your jaw. Then, over the next two to six months, the implants and the bone are allowed to bond together to form anchors for your artificial teeth. During this time, a temporary teeth replacement option can be worn over the implant sites.
Often, a second step of the procedure is necessary to uncover the implants and attach extensions. These small metal posts, called abutments, along with various connecting devices that allow multiple crowns to attach to the implants, complete the foundation on which your new teeth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you.
Depending upon the number of implants placed, the connecting device that will hold your new teeth can be tightened down on the implant, or it may be a clipped to a bar or a round ball anchor to which a denture snaps on and off.
Finally, full bridges or full dentures will be created for you and attached to your implants or the connecting device. After a short time, you will experience restored confidence in your smile and your ability to chew and speak.
Sinus Augmentation
A key to implant success is the quantity and quality of the bone where the implant is to be placed.
The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. If you've lost bone in that area due to reasons such as periodontal disease or tooth loss, you may be left without enough bone to place implants.
Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. Several techniques can be used to raise the sinus and allow for new bone to form. In one common technique, an incision is made to expose the bone. Then a small circle is cut into the bone. This bony piece is lifted into the sinus cavity, much like a trap door, and the space underneath is filled with bone graft material. Your periodontist can explain your options for graft materials, which can regenerate lost bone and tissue.
Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. After the implants are placed, an additional healing period is required. In some cases, the implant can be placed at the same time the sinus is augmented.
Sinus augmentation has been shown to greatly increase your chances for successful implants that can last for years to come. Many patients experience minimal discomfort during this procedure.
Ridge Modification
A key to implant success is the amount and quality of the bone where the implant is to be placed.
Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. This defect may have been caused by periodontal disease, wearing dentures, developmental defects, injury or trauma. Not only does this deformity cause problems in placing the implant, it can also cause an unattractive indentation in the jaw line near the missing teeth that may be difficult to clean and maintain.
To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Your periodontist can tell you about your options for graft materials, which can help to regenerate lost bone and tissue.
Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to 12 months before implants can be placed. In some cases, the implant can be placed at the same time the ridge is modified.
Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come. Ridge modification can enhance your restorative success both esthetically and functionally.
