What is a Dental Implant?
An implant is a man-made replacement for natural teeth. A surgeon places metal anchors in the jaw bone underneath the gum tissue where natural teeth are missing. When the implant has become solid, the dentist will mount natural-looking artificial teeth on the metal implants. These non-removable teeth are more secure than other forms of dental restoration, such as removable dentures or fixed bridges. There are several types of dental implants, of which the doctor will select the most suited to the patient’s needs. The doctor will take an x-ray to evaluate the amount of bone remaining, models of the mouth to determine space available, and a thorough examination to decide which type of implant would benefit the patient most.
Dental implants are accepted by the American Dental Association. Hundreds of thousands of dental implants have been placed, and they have been in use for many years. The implants are made from titanium, a metal readily accepted by the body. In fact, thanks to a phenomenon known as “osseointegration,” the bone of the jaw actually attaches itself to the implant over time, providing a strong foundation that allows people with missing teeth to chew as efficiently and comfortably as if the teeth were natural.
YOUR NATURAL TEETH
Your own natural teeth in a healthy, well-maintained condition are the best you can possibly have. There is nothing else which compares with them. It is, therefore, in the best interest of your health and well being to do anything you can to keep your teeth for as long as possible. With good care and frequent check-ups you can accomplish this goal.
SUPPLEMENTING YOUR NATURAL TEETH
When a tooth is lost it is best to replace the tooth with a non-removable replacement replacement as promptly as possible. When you lose your teeth, you gradually lose the bone that supported them. As this bone disappears, problems with other teeth nearby and a lack of support for dentures, partials and bridges increase. These problems include pain, mobility, lack of retention for prosthetics, sharp, painful ridges, mobile gum tissue and sore spots. The tongue enlarges to accommodate spaces of missing teeth. With tooth loss, a five-fold decrease in function occurs and the diet shifts to softer foods. Also, when the bone is lost numbness to the lower lip or even the possibility of fracture of the jaw rises. Since the bone is deteriorating, it will spread and deteriorate around healthy teeth and ultimately cause the loss of those teeth. The progression will affect the ability to provide the same treatment in the later stages of bone loss than if treatment had been started earlier in the process. It’s much better to replace a tooth BEFORE all of the side effects begin. By waiting, you risk the possibility of not being able to provide the same, simple type of treatment that would have been possible earlier.
Who is a candidate for implants?
Anyone who is missing one or more of their teeth and can benefit from increased chewing efficiency, improved appearance, and improved speech may be a candidate. Implants can be the solution when it has become difficult or impossible to wear a removable denture. Portions of the jaw that are missing due to an accident, disease, or birth defect can often be reconstructed using implants. Age is generally not a barrier if the candidate is in good health.
You are a candidate for dental implants if:
Your jaw bone is thick enough and dense enough to secure an implant. However, if there is already some bone loss, it is sometimes possible to graft more bone onto the jaw to create a more ideal site for the implants.
You do not have a disease or condition that interferes with proper healing after implant surgery, e.g. uncontrolled diabetes or radiation/chemotherapy for treating cancer.
If one or a few of the teeth are missing, implants in conjunction with a crown or bridge can replace those teeth and function as normal teeth without losing more bone or be subject to decay. If all or most of your teeth are missing, then implants may be placed to anchor a loose denture. Ultimately, a consultation with a dentist who is knowledgeable regarding these procedures can help determine your needs.
When a tooth is lost it is best to replace the tooth with a non-removable replacement as promptly as possible. When you lose your teeth, you gradually lose the bone that supported them. As this bone disappears, problems with other teeth nearby and a lack of support for dentures, partials, and bridges increase. These problems include pain, mobility, lack of retention for prosthetics, sharp, painful ridges, mobile gum tissue and sore spots. The tongue enlarges to accommodate spaces of missing teeth. With tooth loss, a five-fold decrease in function occurs and the diet shifts to softer foods. Also, when the bone is lost, numbness to the lower lip or even the possibility of fracture of the jaw rises. Since the bone is deteriorating, it will spread and deteriorate around healthyteeth and ultimately cause the loss of those teeth. The progression will affect the ability to provide the same treatment in the later stages of bone loss than if treatment had been started earlier in the process. It’s much better to replace a tooth before all of the side effects begin. By waiting,you risk the possibility of not being able to provide the same, simple type of treatment that would have been possible earlier.
Is there discomfort involved?
Just with any surgery, there can be some discomfort; however, local anesthetic is used to eliminate any discomfort. Intravenous sedation and general anesthesia are also available for those patients who prefer to not be aware of the procedure. The doctor will prescribe medications to ease any discomfort that may occur. Special care will be taken to stay in contact with you after the surgery to be sure that you remain comfortable.
How long does it take?
To complete treatment it may take as little as six weeks, up to six months. Treatment time varies depending on each individual set of circumstances. It should be understood that patients’ quality and quantity of bone could dictate the length of the entire procedure to ensure its success. However, your dentist can provide you with temporary teeth during this time frame. The temporary prosthesis must NOT rest directly on the implants. This means that arrangements must be made to see your dentist immediately after surgery to adjust your prosthesis. Throughout the healing period your dentist must see you on a regular basis to ensure that the implants are not inadvertently loaded. It is wise not to wear prostheses for 1-2 weeks after the surgery and to be on a full liquid diet. If this is not feasible, arrangements can be made to discuss this with your dentist and surgeon.
The placement of endosteal dental implants (by far the most common type of implant) may require two different surgical procedures/stages, or can be done in one. In “Stage I” surgery, the implants are placed in the bone. A few months later, when the osseointegration process is complete and the bone of the jaw has solidly attached itself to the submerged implants, the second procedure takes place. In “Stage II” surgery, the soft tissue covering the tops of the implants is opened up and special posts called “abutments” are attached to the implants. These abutments project above the gumline and into the mouth, and the final artificial teeth will be fitted onto them. One-stage implants may be placed that only require one surgery. By eliminating a second surgery, time and expenses are saved.
Where do I begin?
During the initial consultation, a clinical and x-ray evaluation is performed to see if you are a candidate both from a surgical and medical standpoint. At this visit, the patient is shown the various types of dental prosthesis available on implants, and a brief overview of implant dentistry is given. All available options are discussed, along with the benefits, risks and complications of each. Your physician and dentist are involved in the decision making process.
Should the patient wish to pursue implants as an option, an appointment is made for a work-up. This would involve obtaining various records- study models of the upper and lower jaws, photographs, additional x-rays, etc.; additional consultations with other clinicians may be necessary. At times it is necessary to fabricate a radiographic stent that may be used to take additional x-rays or a Dent-a-scan (A 3-D CT Scan with a measuring grid performed at an outside facility), which would further enable us to measure the bone available for placement of implants. After comprehensive treatment planning has taken place, the patient is presented with the various options available. Often additional soft tissue and hard tissue procedures may be necessary on a case by case basis.
Once the decision making process involving all parties has taken place, the surgery may be scheduled. Depending on the case, this may be performed under local anesthesia, intravenous sedation, or general anesthesia. Prescriptiondrugs would be dispensed and sometimes taken before the surgery. A surgical template may be fabricated by the restorative dentist or surgeon prior to the case that is used intra-operatively as a drill guide. Arrangements are made with the patient’s restorative dentist to adjust the existing transitional prosthesis, before or after the surgery, or to provide a different transitional prosthesis.
During the procedure (intra-operatively):
- You will be given local anesthetic and possibly some sedation, depending on what you and the doctor decide is best for you.
- After you are numb, the doctor will slightly expose your jawbone and drill one or more precisely measured holes. Very gentle, low-speed drilling and extensive irrigation with sterile water will be used to minimize trauma.
- The surgeon will place the implants in your jawbone, and suture the gum tissues closed to cover the implants. The implants should integrate with the bone within 3-6 months, depending on the site. (One-stage implants may only need 6-12 weeks to osseointegrate.)
- Surgical adjuncts may be used such as bone grafts or membranes to further assure stability.
After the surgery (post-operatively):
- An ice pack will be given to you to hold to the outside of your face, reducing swelling.
- You will be given gauze to bite on, to minimize gum swelling and bleeding.
- You will be given instructions to go over carefully on how to care for yourself.
- It is MOST important not to have any pressure on the implant surgical site.
Following Stage I Surgery:
Immediately following surgery you may be asked to bite on some gauze to stop any bleeding, and an ice pack may be used during the first 24 hours to help reduce swelling. Expect some swelling in the area of the implant surgery for up to 72 hours following the procedure, as well as some discoloration of the skin and gums for a few days. Prescribed pain medication will help alleviate any discomfort, and you should be able to resume normal activities within 3-5 days. Expect some minor bleeding on the day of surgery (up to 24-48 hours following surgery), but report excessive bleeding to your surgeon immediately. During this time, a no-chew diet is recommended to avoid placing stress on the new implants, and you will be given instructions on how to clean your mouth. If you have been wearing a denture, the surgeon or your dentist may reamout the appliance and eventually place a soft lining in it so you can wear it comfortably during the healing period. It may be necessary to leave it out for a short period of time. If spaces due to missing teeth must be filled in while healing takes place, temporary teeth that appear natural can be made. Sutures that were placed after surgery will either dissolve or you will return to have them removed.
Stage II Surgery:
The second procedure takes place after the jaw has fully healed from the Stage I surgery, and involves placing titanium posts on top of implants, called abutments.
- We will have followed your case carefully throughout the months following Stage I surgery. At appropriate intervals, we will take an x-ray to check for integration.
- Usually local anesthesia is sufficient for this stage. It usually takes less time than the first, however each case is different. IV Sedation/General Anesthesia is required for more extensive cases.
- Call your restorative dentist to inform them of your appointment. It is advisable to make an appointment immediately following the surgery toadjust the prosthesis for acomfortable fit. They will let you know when they want to see you in their office to take the impression for the final prosthesis.
During the procedure:
- When the local anesthetic takes effect, the surgeon makes an incision to expose the tops of the implants.
- All the excess tissue and bone are cleaned away from the fixtures.
- The surgeon confirms that all implants have successfully osseointegrated (become solid with your jaw bone).
- Titanium posts, called temporary abutments or healing caps, are screwed into the implants, and stitches are placed.
After the procedure:
- Sometimes your old denture can be fitted with a soft liner to fit over your abutments, or your prosthesis can be hollowed out to fit over the abutments. This is usually done by your dentist.
- After the gums have healed (usually 2-3 weeks), your dentist will be able to commence fabrication of your prosthesis. In some cases, more time is given for soft tissue healing. Temporary abutments or healing caps are eventually replaced by permanent abutments and the final implant prosthesis. In anterior anesthetic cases, a temporary crown may be worn over the implant up to 8-12 months for soft tissue sculpting to take place before fabrication of the final prosthesis. Please inquire about the Atlantis system.
Restoration (Stage III):
When your gum tissues have completely healed following Stage II surgery, you are ready to visit your restorative dentist and begin fabrication of your new artificial teeth.
How your new teeth are created:
- Your restorative dentist takes impressions (molds of your mouth) and bite registrations (imprints of the way your jaws fit together). These are used to fabricate a model of your jaw and any remaining teeth as well as the final abutments themselves. Abutments are the metal posts that screw into the implant and are exposed above the level of blue.First, temporary abutments or healing caps are placed at Stage I for one-stage implants and at stage II for two-stage implants. Following soft tissue healing, permanent abutments are fabricated to act as the base for the permanent implant prosthesis.
- From this model, your dentist has a dental lab create your prosthesis (artificial replacement tooth or teeth).
- To ensure the best fit, your dentist will need to see you several times. This fitting process can take a few months. During this time you can continue to wear your old denture, partial, or false tooth.
- To ensure the best fit, a trial set of teeth is carefully set in wax for a fitting or “try-in.” Then your final prosthesis is made and fitted onto a cast metal framework.
Different types of prostheses that are available:
- An individual crown or bridge can be constructed from porcelain or composite plastic and screwed or cemented onto the final abutment(s).
- A bar can be made to connect two or more implants, with a clip within the denture providing retention. This is called an implant overdonture.
- Prostheses can be removable or fixed, or you can use a combination of both. You, your surgeon, and your dentist can discuss these and decided which is best for you. It will depend on the placement and affordability.
Maintenance (Stage IV):
Dental Implants need special care to keep them clean and trouble free. Much of the success depends on keeping each abutment post clean and plaque-free. Just like natural teeth, you should clean your dentures, both the posts and the prosthesis, after every meal.
- Removable: You should brush the inside and the outside of a removable prosthesis. Then brush around the gums and abutments with the prosthesis removed.
- Fixed: Brush a fixed prosthesis thoroughly, as you would natural teeth.
- You may want to use a cordless electric toothbrush, such as Rotadent, Braun Oral B, or Sonicare. These are very effective in cleaning in and around the implants.
- You may want to use an interdental brush. Make sure it has a nylon-coated center wire to avoid scratching the soft metal surface of the abutment posts.
- Oral irrigators are also effective in reducing plaque accumulation around natural teeth and implants.
- You need to floss more than ever before. You may be asked to use a special floss to clean around your gums, posts, and teeth.
- Floss around the abutment posts of a removable prosthesis with your teeth removed.
- You may need the help of a floss threader. Floss threaders help you introduce the floss under bridges and bars so these areas can be easily cleaned.
- You may need a special wide floss for additional help in cleaning your implants, called “superfloss.”
Special cleaning aids:
- A lighted, magnified mirror will help you see your abutment posts more clearly.
- Full frame reading glasses are available without prescription at your pharmacy to give you the close-up vision you may need.
Bruxism Night Guard:
When you have your final prosthesis, we will take an impression to make you a night guard. This is a piece of plastic that is molded to fit your teeth securely. It can be worn at night while you are sleeping to guard you from bruxing (grinding) your teeth or even daytime clenching. This motion can cause harm to your implants.
Dental Hygiene visits:
Dental cleanings should be performed by your dental hygienist / restorative dentist every 3-4 months.
Oral Surgery Recall:
The patient should present this to our oral and Mmaxillofacial surgery office for clinical and panoramic evaluation on a yearly basis.
Is there a chance of rejection?
The body does not reject a dental implant, as it might a soft tissue transplant, such as a lung, heart, or kidney. This does not mean that an implant cannot fail, but it would be due to other factors, such as improper force on the implant or other conditions (i.e. smoking) or existing diseases of the patient. Dental implants are made of titanium that is totally biocompatible (compatible with body tissues) and actually integrates with the surrounding bone and becomes part ofyour body. Titanium is also being used more and more in the medical field to replace body parts.
Is there any risk involved?
Dental implant surgery has a high rate of success, but as with any surgical procedure, some side effects or complications are possible. You should understand these before you consent to implant surgery. We will be happy to answer any of your questions about the following possible risks:
Swelling is a normal reaction to any surgical procedure and the amount of swelling depends on how extensive the surgery was. Normal swelling should peak within about 48 hours, then gradually subside. If swelling worsens after 48 hours, please contact us.
Brushing occasionally develops in areas close to the surgical site. Any discoloration from bruising should disappear within a few days following surgery. In order to obtain water-tight closure, the surgical sites are completely closed. This can lead to a back-up of blood that can cause discoloration of the skin, which can appear up to a week after surgery and last up to two weeks. You may swab witch hazel to help disperse this discoloration.
Moderate pain is common for 24-48 hours following surgery, and pain medication may be required. It is often advised to take the non-steroidal anti-inflammatory pain killer for the first 3 days to block the pain mediators, whether you think you need it or not. If intense pain persists that cannot be relieved by your prescribed pain medication, please contact us. Different families of pain killers are available, so if one family doesn’t work, another may and will be called in for you.
Trismus, or stiffness of the jaw muscles may be caused by swelling following surgery. As the swelling decreases, trismus should disappear.
Infection is extremely rare following implant surgery, but occasionally an infection can occur. If fever, persistent swelling/pain or pus develop following surgery, please contact us immediately.
Implant failure- There is always the potential that an implant may fail. This may be caused by a number of factors, but is usually due to inadequate maintenance following surgery.
Injuries can potentially occur to adjacent teeth and roots, fillings or bridgework.
Loss or alteration of nerve sensation, resulting in numbness or a tingling sensation in the lower lip, tongue, cheek, chin, gums, or teeth, and/or lack of taste, is rare but can occur if implants are placed in the lower jaw and a nearby nerve is irritated. Usually this is temporary, although in very rare cases it can be permanent. Every precaution is taken to avoid these nerves.
Sinus complications, such as drainage or pain (sinusitis), occasionally occur if implants are placed in the upper jaw and the sinuses become involved. This may or may not require further treatment, but please contact us if any sinus symptoms occur. Sinus precautions are listed under Antrum/Sinus Instructions.
Bleeding should be expected following any type of surgery, but it should be easily controlled and consist of occasional oozing during the first 24-48 hours. In the rare instance that bleeding is excessive or prolonged, please contact us.
TMJ (jaw joint) pain or abnormal function is rare following implant surgery, but this can occur. If it does, further treatment may be necessary. Conservative therapy, consisting of soft diet, no gum chewing, nonsteroidal anti-inflammatories, warm moist soaks to affected join or muscles, etc., may be instituted immediately.
Bone loss is rare, but may occur around the implant if proper hygiene is not maintained or if excessive stress is placed on the implant.
Jaw fracture– In very rare cases, the manipulations required for placement of the implants in the lower jaw can fracture the jawbone, particularly if the jaw is thin. X-rays will reveal the location of the fracture, and the problem can be treated.
How long could one expect to be off from work?
This is advised on a case by case basis. For a single implant, we generally recommend the day of and the day following surgery, that no strenuous exercise is done for that week following surgery. The amount of swelling and/or bruising may be related to the amount of surgery performed and the healing capacity of the patient. The amount of time required is an individual decision and may be discussed at the treatment planning phase. A full month implant reconstruction case should plan on taking approximately one week off from work.
Maintaining implants and restorations
Once your implants are in place, you will schedule periodic check-up visits with us and with your restorative dentist to make sure your jaws are healthy and the implants and prosthesis are functioning properly. Just as important as regular professional care, however, is your own care of your implants and prosthesis.
If you do not keep your implants and prosthesis clean, your implants may fail. Therefore, practice meticulous home oral hygiene, following the instructions of your dentist and hygienist. Abutment posts, beneath the prosthesis, artificial teeth, and gum tissue must all be kept clean. Home care aids such as special brushes and floss holders will help you accomplish this. You should maintain a hygiene visit every 3-4 months with your dentist. ANY LOOSENESS OF YOUR ABUTMENTS AND/OR PROSTHESIS SHOULD BE CONSIDERED A TRUE EMERGENCY AND YOU MUST BE SEEN IMMEDIATELY!! Otherwise, undue forces will be transmitted to the underlying implants that could cause them to fail.
Smoking and excessive alcohol consumption, as well as chewing hard foods such as ice or hard candy, may result in damage to your implants or cause them to fail.
While there is no guarantee of 100 percent success with dental implants, with careful planning by your surgeon and restorative dentist prior to surgery, and proper maintenance from you, you can expect many years of use from your implants. In fact, more than 90 percent of implants have been successfully retained for up to 15-20 years. Thousands of people have rediscovered the joy of eating properly, speaking clearly, and laughing comfortably through the use of dental implants.
A thorough oral examination and medical consultation by the dental team responsible for implant treatment is necessary to determine if you are a candidate for dental implants. This team consists of your oral and maxillofacial surgeon, your restorative dentist, and you. The oral and maxillofacial surgeon will place the implants and, after healing takesplace, the restorative dentist designs and places the artificial teeth that are supported by the implants.
During the examination, you will give a complete medical history. Be sure to give all information, including any health problems, allergies, or medications you are taking. Your examination may include several types of x-rays to provide essential information about the jaw bone and its anatomy, models of your jaws, and possibly blood tests. Based on the results of this examination, the dental team will discuss all aspects of yourcase with you. Together you will decide if dental implants are appropriate for you. If they are, you will be informed about the various choices of prosthetics available to you. In order to meet your needs and goals, however, often the implant team (patient, surgeon, dentist) will not know what the final prosthetic will be until the implant is uncovered and its success is determined.
Is it expensive?
The procedure can involve a significant investment, and fees can be determined after the x-rays, models, records, and a clinical examination are completed, along with your treatment plan from your dentist.
What will my insurance pay?
Although portions of the procedures involved may be covered, the implant itself is not a covered benefit under the majority of insurance contracts. We are, however, persistent in doing the best we possibly can in obtaining benefits for our patients from their medical and dental insurance. To date, No Fault, Worker’s Compensation, and a handful of private insurance companies have reimbursed for implant dentistry. Occasionally, medical and/or dental companies may reimburse if it is trauma related or medically necessary (i.e. cancer), or for a congenitally missing tooth (missing from birth). Sometimes sinus lift and/or bone grafting procedures may be a covered benefit under the patient’s medical policy.
There is no way that we can guarantee anything which goes into the mouth and which is under the control of the individual patient. We can only tell you that we will strive to place the implant(s) properly, provide you with the information you need to help care for your implant(s) at home, and will be available for regular periodic follow-up appointments to evaluate your continued dental health. We will do everything we can to make the implant(s) succeed but you will have to make the same commitment. If you do not “keep your end of the bargain,” the implant(s) will likely fail. Also, you must return to our office and the restorative dentist’s office at regular intervals for examination and service according to ourrecommendations (i.e. every three months for cleanings). If you do not do this, difficulties may arise, resulting in the loss of the implant(s).
Our office will do our utmost to make your implant dentistry a pleasant and rewarding experience, now and for years to come.