Dental implants are a great way to predictably restore a missing tooth. If you are missing one or more teeth and would like something to replace the missing space, implants may be an option. Advances within the past 30+ years have enabled implants to be placed predictablly and successfully. With a ~80% success rate, they have become a popular and effective method to replace missing teeth, and are arguably one of the biggest advances in dentistry.
Dental implants are indicated when:
-You are missing one tooth and you do not want a bridge; with a bridge, the tooth in front and back of the missing space requires crowns (abutments) to attach the missing tooth to (pontic). With an implant, the teeth adjacent to the missing space is left untouched.
-Your dentures do not fit properly or are not comfortable. If you find your dentures are loose, a mini dental implant (MDI) may help. Compared to the traditional dental implant, the MDI has a much thinner diameter and is less invasive. A mini dental implant has a thin small circular head that allows the denture to snap and connect to the implant. The result is a firm fitting stable implant over-denture that is no longer loose.
- Smoking: A debatable contraindication, but it is believed that since smoking inhibits blood flow to tissues, this may inhibit healing and prevent full osseointegration.
- Uncontrolled diabetes: With Type II diabetes, if uncontrolled, impairs implant healing due to the body’s poor blood flow and circulation.
- Bruxism: Also known as tooth grinding or clenching, this parafunctional habit also delays healing. Dental implants do not have a periodontal ligament liketheir natural tooth counterparts to cushion occlusal forces. Heavy grinding may cause little movements within the implant, increasing likelihood of failure. Your dentist may decide to have you wear a nightguard to help alleviate this trauma.
- Oral bisphosphonate (ie. Fosamax and Boniva): A highly debatable topic, it is thought that bisphosphonates, especially IV induced, cause osetonecrosis (death of bone). The American Dental ASsociation has various articles and studies on this controversial phenomenon.
- Anatomy: For implants on the lower jaw, particular attention needs to be placed on the location of the mental foramen (MF) and inferior alevolar nerve (IAN); for the upper jaw, the maxillary sinus level. If the MF and IAN are disturbed during surgey, it may cause merve damage via prolonged numbness (parathesia) or painful numbness(dysesthesia).
- If the maxillary sinus is invaded, prolonged sinus issues may result. Your dentist or surgeon may elect to do a sinus lift prior the implant surgery. With upper teeth, especially the roots of the molars and premolars, they may be in very close relation to the maxillary sinus. Because sometimes this sinus level is low, an implant may actually pierce the sinus space. With a sinus lift, the maxilla’s sinus floor is “lifted” or pushed higher up and then filled with extra bone. This procedure allows the implant to osseointegrate within the extra bone substance, and also prevents the sinus from being invaded.
WHAT IS A DENTAL IMPLANT
Implants are composed of a surgical grade titanium that is biocompatible with the jaw bone. The exterior surfaces of the implant may be modified by adding plasma or etched to increase surface area and to enhance and promote osseointegration.
Unlike natural teeth implants do not have a periodontal ligament, hence the feeling may be different from natural teeth.
A dental implant is essentialy a screw that is surgically placed in either jaw and serves as an anchor for a new post and crown. Most implants placed today are a “root-form” which means it serves asa replacement of the root. Because of the high success rate of dental implants, they are generally a good replacement option of a natural tooth.
An implant procedure has 3 general stages:
- The dental surgeon or general dentist surgically places the implant in the jaw bone with a precision drill, and is typically aided with a surgical stent. A panoramic x-ray and/or a CT ( cone beam computed tomography ) scan is typically done to evaluate bone density and location of adjacent nerve and blood vessels. If necessary, the surgeon may place a tissue and/or bone graft to ensure there is sufficient bone to hold the implant in place. If an implant is placed near the front where the smile line is critical, the surgeon will determine if a tissue graft is necessary to make sure there is enough gingival tissue. A collar, or healing cap, is then placed over the head of the implant to ensure the gum tissue to heal properly.
- After the implant is placed, there is a typical wait time of 3-6 months to allow the implant to heal and for it to osseointegrate with the jaw bone. The titanium is fully biocompatible, permitting bone to grow around and onto the implant.
- When the surgeon has deemed the implant fully osseointegrated, the collar or healing cap is removed, an impression is taken and sent to the dental lab to fabricate an abutment and crown. An abutment is a “fence post” that is screwed within the immplant itself. The final crown is then attached onto the abutment via screw or cement.