Dental implants have revolutionized dentistry in the last ten years. They provide a foundation for replacement of missing teeth that look, feel and function like natural teeth and are in many ways, better than the original teeth you were born with. The latest technological advancements have provided a replacement option that is very durable, strong and predictable. The person who has lost teeth regains the ability to eat virtually anything, knowing that teeth appear natural and that facial contours will be preserved. They are changing the way people live and patients with dental implants can smile with confidence.
What Are Dental Implants?
The implants themselves are small threaded titanium posts that are surgically placed into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes and are specially treated on the surface to facilitate direct attachment to bone. As the implant heals, the bone bonds intimately with the titanium surface (a process called osseointegration), creating a strong foundation for artificial teeth. A fully healed implant subsequently provides a strong, virtually indestructible base for artificial replacement teeth or anchors. Implants also help preserve facial structure, preventing bone deterioration that occurs when teeth are missing.
Consequences of Not Replacing of Missing Teeth
If there are missing teeth and gaps within the arch, there are a number of potential future complications that could occur. Generally, nature abhors a vacuum. Therefore, if there is a tooth missing, your other teeth could migrate in an attempt to fill that gap. The existing teeth on either side of the missing space would drift into the void. This would not be a bodily movement, but rather a tipping movement. The result would be teeth that are in a slanted position. This presents problems in hygiene and keeping the area clean, leading to accelerated tooth loss. The teeth in the opposing arch would also attempt to fill the missing space by over erupting. Consequently, the tooth would lose stability due to less bone support at the roots. Also, missing molars mean decreased chewing efficiency. Without distribution of forces, the remaining teeth will be overworked to bear the load normally designated for the missing tooth. This would again result in potential premature loss of teeth due to over usage.
Dental implants are a very permanent option for replacing teeth. They are also inert, and will not move in a growing patient, like natural teeth. Therefore, implants cannot be placed in patients that have not completed growth. Most girls complete growth at later teenage years and boys can have a growth spurt as late as 21. Although each patient is different, implant placement generally cannot occur in patients earlier than 16, except in extreme circumstances. Your surgeon will recommend the appropriate timing at your consult visit.
Dental implants can be utilized in three ways:
- Replacement of missing teeth
- Improving fit of dentures
- Temporary anchorage to move teeth with the assistance of braces (orthodontics)
Replacement Of Missing Teeth
When a tooth is removed, the root can be replaced as a titanium analog. This titanium “root” can be used to anchor a custom crown that will function like a new tooth. The titanium portion is underneath the gums, so it cannot be seen or felt. But the strength is far superior to the original root. The tooth is permanently attached to the titanium “root” and cannot be removed.
There are three components to an implant prosthesis: the fixture, the abutment and the crown.
The fixture (also referred to as the implant) is analogous to the tooth root. It is the foundation at the bone level, or the aforementioned titanium post that is placed into the jaw bone which forms the base that will eventually support the tooth. You will not be able to see the implant since it is submerged below the gums.
The crown is the visible portion of the tooth. It is the esthetic and functional component that will emerge from the gums. This portion of the prosthesis will be custom created by your dentist after the foundation (i.e. implant fixture) is fully healed and integrated with the bone. This process will occur between 3-6 months after the implant is placed.
The abutment is what connects the implant fixture to the crown. This component is also placed after the implant fixture is fully healed (again 3-6 months) and at the same time as the crown. Most of the time, the abutment is custom made by your dentist along with the crown. In certain circumstances, our surgeons will fabricate the abutment and your dentist will create the crown.
The Pre surgical Planning
Placing dental implants requires a lot of planning and preparation prior to the surgery. A slight error in angulations or depth of placement could cause difficulties later in fabricating the crown. Dr. Gill utilizes the newest techniques to ensure optimum results. Prior to the surgery, we will be taking additional 3-D radiographs specifically designed for implants and impressions, or molds, to duplicate your teeth in order to fabricate a surgical guiding stent. For more complex, full-arch reconstructions, a computer generated program will aid in placement and angulations of the implants so that any chance of complications will be minimized.
The Surgical Procedure
For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. The healing implants are re submerged beneath the gums, so there will be no teeth attached to the implants immediately after surgery. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to cautiously wear temporary dentures and eat a soft diet during this time. Majority of implant failures occur during this time, thus careful management of the wound is critical. After the surgery, most patients recover quickly within 2-3 days and experience minimal disruption in their daily routine.
After the implant has bonded to the jawbone, the second phase begins. Our doctors will uncover the implants and attach small cylinders that protrude through the gums and will act as a guide for the surrounding gums to heal around. These cylinders, called healing abutments, will be replaced when the permanent crowns are seated by your dentist.
When replacing a tooth in the visible esthetic areas, our surgeons will coordinate treatment with your restorative dentist regarding a temporary replacement during the healing period. We will make arrangements prior to your surgery visit to make sure you have an acceptable replacement for the missing tooth on a temporary basis while the implant heals.
Using the most recent advances in dental implant technology, there are select instances in which we are able to place implants at the same time as removal of the tooth, resulting in a fewer number of surgical procedures and quicker healing time. Your doctor has the experience and clinical acumen to determine whether he can predictably recommend this option for your case.
There are even situations where the implants can be placed at the same time as a tooth extraction and placing a temporary, non removable crown on the implant within 3-4 days – further minimizing the number of surgical procedures. Advances in dental implant technology have made it possible, in select cases, to extract teeth and place implants with temporary crowns at one visit.
Implants are a team effort between an oral surgeon and a restorative dentist. While Dr. Gill performs the actual implant surgery, initial tooth extractions, and bone grafting if necessary, your dentist fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.
Types Of Available Prosthesis (Teeth)
A single implant is used to replace each missing tooth – each prosthetic tooth attaches to its own implant.
A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. An implant supported bridge would utilize two or more anchor teeth that would support a gap to replace three, four or more missing teeth in a quadrant.
If all teeth are missing, a full arch reconstruction can be performed using multiple implants. Depending on the residual bone levels, full fixed arch reconstruction can be completed with four to six implants. In these cases, implants can be used to help anchor the dentures for improved fit (see below), or replace the denture altogether with a full set of teeth that are permanent and fixed. They can only be removed by your dentist.
Improving Fit Of Dentures
For many people, having dentures for a long period of time has caused resorption and atrophy (shrinking) of bone levels, resulting in dentures that have very poor fit. In cases of advanced resorption, no matter how well the denture is made, the anatomy does not allow a good fit. When chewing or speaking, the dentures can move and shift, causing poor function and speech. This problem is especially prevalent in the lower arch.
Using as little as two implants, our doctors can provide a foundation for overdentures, which are dentures with securing devices to keep the dentures from moving and shifting during function. These securing devices can come in the form of snaps, bars and clips. After the initial healing period (3-4 months), your dentist will fabricate the attachments to the underside of your dentures that can snap on to the implants. This will allow much improved function and form for your dentures.
Temporary Anchorage Devices (TADs)
These devices are temporary small diameter implants that aid your orthodontist in achieving your perfect smile faster and more predictably. When straightening your teeth, your orthodontist can utilize these temporary anchorage devices to prevent placing undue stress and pressure on other teeth while correcting your smile. The anchorage devices are strategically placed between your roots and removed after completion of orthodontics.
Your surgery can be performed with local anesthesia (“Novocaine” only) or asleep with I.V Sedation. When placing implants, a light sedation is recommended, but not required. If you have general anxiety for any type of dental procedure, you will find the sedation very soothing and stress-free. There will be times towards the end of the surgery where the anesthesia might need to be lightened when taking impressions and checking bite, but you will be asleep and comfortable when the actual implant is placed.
Advantages of dental implants
Once you learn about dental implants, you finally realize there is a way to dramatically improve you life through improved function and esthetics. When you lose several teeth – whether it’s a new situation or something you have lived with for years – chances are you have never become fully accustomed to losing such a vital part of yourself.
Dental implants can be your doorway to renewed self-confidence and peace of mind. It can open the door to a lifetime of renewed comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.
There are several advantages of implants over other conventional treatment:
1. Predictable. Using the newest and latest technology, implants have over 95% success rate
2. Durable. Implants last much longer than crowns, since decay under crowns and root fractures do not occur with implants like they do with natural teeth
3. Less sensitivity and pain. Implants are inert substances that have made a direct connection with bone. Therefore, hot/cold sensitivity and pressure sensitivity do not occur.
4. Less trauma to adjacent teeth. When planning for a bridge, the adjacent teeth have to be prepared and shaved down to accommodate a crown. Implants generally do not require any preparation of neighboring teeth.
Disadvantages of dental implants
1. Time. Compared to bridges, implants take longer, since it relies on your body to heal around the implant. From the time of tooth extraction, a bridge can take 4-8 weeks, but implants can take 3-9 months.
2. Cost. Implants require intricate, small, high-tech parts. Therefore, the lab and equipment costs are higher. However, Dr. Gill is able to make implants affordable at a cost comparable to bridges, since they perform a large number of implant surgeries.
3. Early failures. When implants fail, they fail early; they get rejected by the body’s immune system. This occurs 5% of the time (1 in 20). However, because of the high rate of success, any failed implant is always replaced at no additional cost.
Lip, chin and tongue numbness
Implants placed in the back part of the lower jaw have this inherent complication due to the proximity of the nerve that supplies sensory feeling to the lower lip, chin and tongue. If the implant is too close to the nerve, tingling and numbness can occur. The risk is dependent on the anatomy of the nerve and the amount of available bone above the nerve. Our doctors take special precautions with adequate preoperative planning with 3D imaging and surgical stents to minimize this complication
Implants placed in the back part of the upper jaw are commonly close to the floor of the sinus. Our 3D imaging allows us to determine the exact distance from the ridge to the floor, thus minimizing any complications of entry into the sinus. Furthermore, if the sinus is especially close, additional procedures to augment the deficiency can be performed at the time of implant surgery or as a separate procedure prior to implant placement.
Since the implant is a foreign body, there is a small chance that your body could reject it. The possibility of implant failure is approximately 5% (1 in 20). All failed implants are fully guaranteed and replaced at no additional cost after the bone has regenerated.
For jaws that have extensive resorption over time, placement of implants could further weaken the bone and theoretically could fracture. Fortunately, this extremely rare complication is only for exceptionally weak and resorbed jaws and not significant for routine cases.