Overview

For almost a hundred years dentistry has tried, with limited success, to find a way to replace missing teeth with artificial teeth that attach to the jawbone. Since the 1980s, the science and art of dental implantology continues to be refined and improved into a highly predictable procedure.Today, hundreds of thousands of patients have dental implants placed each year. In fact, the replacement of missing teeth by dental implant is becoming an emerging standard of care versus alternative approaches.

Implants are titanium posts that are placed in the bone to serve as the replacement for the root portion of a missing natural tooth. The implant is biocompatible with human tissue, and in three decades of use there have been no known foreign body reactions. After allowing time for the jawbone to bond to the surface of the implant (osseointegration), am abutment is attached to the implant. This portion (i.e. the abutment) exits the gum and a crown or other restoration is placed on the post. The final restoration is similar to a crown on a natural tooth, and is not removable. It feels and functions as a normal tooth. This ability to add a tooth where it is needed has changed the way dentistry is practiced.

Implants can be used to hold single crowns, or multiple crowns and bridges. However, connecting natural teeth and implants with bridges is generally not advised.

In addition to holding crowns, implants can be used to support partial dentures and “overlay” dentures, where the appliance is supported by implants but can be removed.

There are many benefits to using dental implants. When teeth are lost, ongoing shrinkage of the jawbone occurs, which can cause the face to look older. This shrinkage can also make adequate fit of a partial or full denture difficult. Placing implants can slow or stop this process. Dental implants look, feel, and function like natural teeth, and offer a tremendous improvement in comfort, speech, eating, and convenience over conventional partial and full dentures.

Implant Replacement for Single Teeth

While a single tooth can be replaced with a removable appliance, the look, function, and convenience of a non-removable/fixed tooth replacement strategy are generally superior. In the past this could only be accomplished with a tooth supported bridge, where the teeth on either side of the missing tooth are crowned, with the replacement tooth connected to the crowns.

A fixed bridge supported on natural teeth is an excellent restoration, but many people would prefer not to have to “prepare”, or cut down, the adjacent healthy teeth. Today, implants have become so predictable they are often recommended in place of a bridge to replace single missing teeth.

The advantages of implants over bridges include:

  • Prevent further bone atrophy (Shrinkage).
  • It is not necessary to drill down the adjacent natural teeth to make crowns.
  • The teeth remain separate, making cleaning (flossing) easier and usually improving the long-term prognosis for the adjacent natural teeth.
  • If a bridge fails, the entire bridge must be removed. Implants are stand-alone.
  • Implants cannot decay; the main reason for bridge failure.
  • Implants never require root canal therapy because they are not susceptible to tooth decay.

Implant Replacement for Multiple Teeth

Implants can be used to support multiple teeth, or bridges. They are very useful when the natural teeth are not strong enough to support a bridge, or when there are no teeth available to which a bridge can be connected. In these cases, implants offer the only solution for a permanent restoration, and an alternative to a removable appliance.

Implant Supported Partial and Full Dentures

Conventional full dentures, particularly lower dentures, are often loose, and offer only marginal chewing ability. Because they exert a continual pressure on the bone, they also tend to cause further jaw bone loss over time. This makes the stability of conventional dentures more problematic and can contribute to malnourishment and even depression. Implants are are fantastic solution, and offer remarkable support for removable appliances. In fact, implants were originally developed primarily to help the millions of people with ill-functioning dentures.

The advantages of an implant supported removable appliance include:

  • More secure retention and fit of appliance, improving function and comfort
  • Less stress on any remaining natural teeth holding the appliance
  • Reduction or elimination of bone shrinkage where implants placed

Implant Placement

Implant placement is surprisingly easy, and generally there is little more than “aspirin pain” post-operatively. This is because the bone that receives the implant has no nerve endings, and the only minor discomfort is the incision in the gum. The implants are checked regularly after placement to follow healing. It takes 2-4 months for the implants to integrate (bond) with the jawbone, at which time the post is placed. The last phase is placement of the final crown or appliance. (See Implant Treatment Outline).

Patient Selection

Implant placement is surprisingly easy, and generally there is little more than “aspirin pain” post-operatively. This is because the bone that receives the implant has no nerve endings, and the only minor discomfort is the incision in the gum. The implants are checked regularly after placement to follow healing. It takes 2-4 months for the implants to integrate (bond) with the jawbone, at which time the post is placed. The last phase is placement of the final crown or appliance. If insufficient bone exists, we now have the ability to increase the amount of bone with ridge augmentation procedures. In the upper arch, the proximity of the sinus may reduce the amount of bone available. Sinus lift procedures can add bone to the floor of the sinus, allowing for implant placement.

Risks of Implant Placement

As with any surgical procedure, there are risks involved with implants. The greatest single concern with implant placement is impingement on the mandibular nerve, which is found in the lower back jaw. Damaging this nerve can cause a permanent numbness of that side of the lower lip. By carefully evaluating the position of the nerve with a CBCT, the risk of injury is very small and seldom occurs.
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Another complication of implant placement is implant failure. Implants can fail either early (during the initial healing) or late (after they have been in use). Early failure is an unusual occurrence, with most studies reporting that 96-100% of the implants have successful initial healing. Often, the reason for early failure is unknown, but it may be due to infection or trauma. Late failure is very dependent on the patient. Things like poor brushing habits, smoking, or poor oral health increase the risk of implant failure. It is very important to keep your implant clean (just like your teeth) and to see your dentist and periodontist on a regular basis for checkups.

Implants can successfully be placed in adults of any age, although certain health problems may contraindicate their use. We will help determine if you are a candidate for dental implants after a careful review of your dental and medical history as well as clinical and imaging examination.

Platelet Rich Plasma/Platelet Concentrate/Platelet Rich Fibrin

The use of your own body’s growth factors has been scientifically proven to accelerate and enhance your own body’s normal healing processes. These growth factors are contained in cells known as platelets which are found in blood and are responsible for causing clotting to occur. Platelet Rich Fibrin is a procedure we commonly perform in conjunction with bone grafting surgery in areas that are being prepared for the placement of dental implants. While a normal concentration of platelets circulating in your blood is about 200,000 per microliter, the platelet rich plasma process produces a platelet count in excess of 2 million platelets per microliter. This increases the amount of growth factors that can be delivered to the area being reconstructed by 4-5 fold, significantly stimulating the wound healing process which ultimately results in an accelerated and overall improved quality of bone healing.

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For definitions on medical terminology click here.

Please feel free to ask us if there is anything you have questions on: office@periodontalmedicine.org