Implant Therapy

Dental implants are small threaded titanium cylinders that replace lost or missing tooth roots. Implants are frequently an excellent option to replace a tooth or multiple teeth that were lost due to a variety of reasons. Dental implants are made of titanium and take advantage of a biological phenomena called osseointegration. Osseointegration allows bone to heal up against the titanium implant surface and anchor the dental implant firmly into the bone allowing a crown(cap) to be placed on top of the implant thereby replacing the lost or missing tooth.

Teeth are lost for a variety of reasons. The leading cause of tooth loss in the adult population is periodontal disease, a gum disease that causes the loss of the supporting bone around a tooth or teeth. Untreated this disease can lead to complete tooth loss. Another leading cause of tooth loss is cracking or fracturing of teeth. This can result from trauma to the teeth from an accident e.g. bicycling, car or sports-related accident. Some teeth that have had a lot of dental treatment e.g. root canals, crowns or posts and as a result have a reduced amount tooth structure are prone to cracking or splitting especially if a person grinds or clenches their teeth. Unfortunately, modern dentistry has very few treatments for cracked or split teeth other than removal and replacement.

The majority of dental implants are placed by dental specialists that have had years of training in surgery beyond dental school. These specialists are most often periodontists or oral surgeons, but some dental implants are placed by trained general dentists or specialist prosthodontists. Frequently the surgical specialist will place the dental implant and a general dentist or prosthodontist will place the implant post (abutment) and crown on top of it.

The placement of the dental implant is usually accomplished in a manner similar to regular dental treatments. A local anesthetic (lidocaine) is used to numb up the area of the mouth where the dental implant is planned to be placed. The procedure can take from one hour up to several hours depending on the number and complexity of placing the implants. During the procedure several x-rays are taken to verify that the implants are in the correct position and not impinging on other structures in the jaw. After the implants are placed, a few stitches are placed to close the area where the implants were placed. These usually dissolve on their own or are removed a few days later.

After the procedure, the patient usually rinses with an antiseptic mouthrinse twice a day and takes some over the counter or prescription pain medication. The area of the mouth where the implants were placed is usually sore for a few days and tender for about a week to 10 days. Sometimes antibiotics are also prescribed to be taken either starting a few days before the procedure or after the procedure.

As with any biological process, implants do not always attach to the bone successfully or completely and thus may require additional procedures or removal. The rate of successful integration of implants is between 95% - 98%, a very high success rate for a dental procedure. Much of this success is do to with advances in the technology of dental implant surfaces in the last 10 years and a better understanding of the factors critical to success. Two risk factors that reduce the chances of successful treatment are smoking and diabetes. Smoking, besides being bad for the lungs and vasculature, cause and contribute to a variety oral conditions such as periodontal disease.

Smokers tend to heal more slowly and develop more complications than non-smokers. Some implant specialists will not treat heavy smokers unless they agree to reduce or eliminate their habit and then only with the understanding that their dental implant treatment is riskier. Diabetics are also at increased risk of having implant complications. Uncontrolled diabetics need to control their blood sugar levels to normal or acceptable ranges before implant therapy can be contemplated. Well-controlled diabetics have almost the same rate of success as non-diabetics.

Occasionally, despite a healthy compliant patient and successful implant placement, the dental implant will not successfully integrate (bond) to the bone and needs to be removed. Usually, after an appropriate amount of healing time, implant placement is repeated.

Many options exist to replace lost teeth. When one or two teeth are missing the most common replacement methods are dental implants or bridges. Dental implants replace the lost roots and teeth, while bridges rely on the remaining adjacent teeth to serve as attachment points. Both of these treatments have their pros and cons. Bridges can usually be placed earlier after tooth loss and require less time to complete treatment. No surgery is required as in the case of dental implant placement. A bridge may be a good option if the adjacent teeth require crowns already. Bridges require more time to keep clean and healthy. Special floss and dental hygiene aids need to be used twice daily. Also, bridges require at least two teeth to be crowned, if the adjacent teeth are healthy with no fillings or just small fillings, these teeth will have to lose a significant amount of healthy tooth structure to accommodate the placement of a bridge.

Dental implants prolong the time to complete treatment. Typically it takes about three months before the dental implant is ready to have a post and crown placed on it. Additionally a surgical procedure is needed to place the implant. Dental implants are more like having the lost tooth back, as they need to be cared for in the same way as you care for your other teeth i.e. brushing and flossing. Also since dental implants are made of titanium they cannot get cavities, as is the case with teeth, crowns and bridges. The presence of the dental implant in the bone helps to preserve the bone of the jaw, which would otherwise be gradually lost once a tooth is removed in a 'use it or lose it' fashion.

In the event of complete tooth loss, many people have had to rely on dentures to replace their lost teeth for eating, speaking and smiling. While dentures in the upper jaw (maxilla) frequently work well due to the retention offered by the palate and shape of the upper jaw, lower dentures frequently are a much bigger problem. The lower jaw shape does not lend itself to holding the lower denture very securely and people find that their lower dentures move around when they eat or speak, not a situation conducive to having a pleasant dinner with friends. Since dentures use the gums as their support, denture wearers frequently find that the plastic portion of the denture rubs against the gums causing denture sores and irritation.

The placement of between 2 to 4 dental implants in the lower jaw can significantly increase the security and comfort of a lower denture. This procedure is widely considered as being the one intervention with the biggest potential to improve a denture wearer's quality of life. By placing more dental implants, typically 6-8 implants it may be possible to replace a denture completely, with teeth that are fixed completely to the jaw and do not need to be removed at night.

This solution while significantly more costly in both time and finances, can restore a smile that was previously lost for variety of reasons.
As with all medical and dental procedures, as both the knowledge and technology advances in a field, newer procedures are developed. Implant dentistry is no different. In recent years several innovative approaches have been taken. The placement of a dental implant immediately after the removal of a hopeless tooth can cut down the total treatment time and maintain the natural gum line allowing for a result in which it would be hard to see that anything happened at all. This 'immediate implant placement' procedure is not possible all the time, but frequently in the case of front teeth with minimal bone loss. Another procedure termed 'immediately loaded implants' goes one step further and seeks to place the crowns on the implants as soon as the implants are placed. This approach is very cutting edge and only attempted if perfect conditions exist.
When contemplating implant placement several factors are considered.

First and foremost the treatment aims to do no harm, so planning for proper implant positioning is vital. In the upper jaw the exact position of both the sinus and floor of the nose are important as well as how much bone is available to hold the dental implant. In the lower jaw the exact position of the inferior alveolar nerve, a nerve that provides feeling to the lower teeth and lips, is important because the dental implant should not impinge on this nerve or sensation in the lower jaw may be changed or lost. To have a good 'roadmap' of the jaw area where an implant is being considered, the implant surgeon will take a regular dental x-ray and may supplement it with more advanced radiographic imaging. This may include a panogram, tomogram or CAT scan of the area where dental implants are planned. As some of these radiographic studies are complex, a referral to an oral radiologist who specializes in the taking and interrupting of these images is common, especially if the situation is complex.