Dental implants are cylindrical metal (Titanium) devices that are placed within the bone in an area of missing teeth, which act essentially as replacement tooth roots, or as anchors for removable dentures. Dental implant placement is a team effort between an oral and maxillofacial surgeon and a restorative dentist. While the oral and maxillofacial surgeon performs the initial tooth extractions, and the actual implant surgery (and adjunctive bone grafting if necessary), the restorative dentist fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the implant process.
Following surgical placement of the implant fixture, a period of time from 3 – 6 months is necessary for the implants to attach to the bone. After this time, the dentist can then fabricate the tooth or bridge, which is then cemented or screwed to the implant fixture(s). In cases of multiple missing teeth, or in cases where the patient is missing all of their teeth and wears a complete denture, implants are often used to assist in securing removable dentures, which otherwise may be loose and uncomfortable. The implant placement procedure itself, usually results in minimal postoperative discomfort, and is normally performed under intravenous sedation, although in simple implant cases, local anesthesia may be all that is necessary.
Implants are very useful for a variety of situations where replacement of missing teeth is indicated, or to assist in retention of an unstable denture. The following are examples of the different situations in which dental implants may be beneficial.
One-Stage vs. Two-Stage Implants
When implants are placed in the bone, they need to be left unloaded (without any forces placed on the implant) so that they can attach to the bone. After the 3 – 6 months following placement of the implants when they are attaching (integrating) the implants can be weight bearing at that point, and can be restored.
Depending upon the quality of bone that is encountered at the time of implant placement, the implants are placed as either a one-stage or two-stage procedure. If the bone is found to be soft, the implant is buried under the gum tissue, so that we can be sure no forces are being placed on the implant during the healing phase. After the 3 – 6 months, a second minor procedure under local anesthesia is necessary to uncover the buried implant, and place a healing collar that comes up through the gums, allowing the gum tissue to heal around it, just like the gums will be surrounding the new tooth.
If the bone is found to be very solid, and it is felt that the minor forces that the implant will encounter in the mouth will most likely not prevent the implant from attaching to the bone, the surgery can be done as a one-stage procedure. With the one-stage procedure, the healing collar can be placed at the same time as the implant itself is placed, and therefore a second surgical procedure to uncover the implant is not necessary. During the healing phase, the small metal collar is visible in the mouth, but does not function as a regular tooth, and care has to be taken to avoid pressure on this metal collar. When the healing phase is complete, the patient can simply return directly to the restorative dentist for placement of the crown or prosthesis.
In recent years there has been increased interest in what is known as “Immediate Loading”, where a temporary tooth is placed on the implant on the same day that the implant is placed. A variation of this technique with placement of multiple implants that are restored with temporary teeth on the same day is known as “teeth in a day”, and has become increasingly popular in recent years.
The Different Ways in Which Implants Are Used
There are several ways of using implants:
- Replacement of Single Teeth
- Replacement of Multiple Teeth With Implant Retained Fixed Bridges
- Replacement of All of the Teeth
- Fixed-Detachable (Hybrid) Prosthesis
- Implants to Help Retain Removable Dentures
- Mini-Implants for Retaining Dentures
Why Select Dental Implants Over More Traditional Types Of Restorations?
There are several reasons why implants may be a better choice than traditional crowns, bridges or dentures.
When a tooth is lost and an empty space is left, the main method of placing a replacement tooth in this space was to trim down the teeth on either side of the space (often which were perfectly healthy teeth) and place a fixed (or cemented) bridge. The development of implants allowed to replace this missing tooth without having to modify the adjacent teeth at all.
For larger areas of missing teeth, dentists are now able to restore these areas without the need for removable dentures. In other cases where a removable appliance is still needed, implants can be used to anchor and secure these full or partial dentures, which makes them much more stable, and allows the patient to wear and function with their dentures comfortably without fear of embarrassment due to a loose or unstable prosthesis.
Are You A Candidate For Implants?
Implants are not applicable for every patient or every circumstance. If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If your mouth is not ideal for implants, there are often things that can be done to make the jaws more amenable to implant placement such as bone grafting, but there are still cases where due to anatomical or medical reasons, implants may not be recommended.
What Type Of Anesthesia Is Used?
For simple implant procedures, such as single tooth implants, this can often be accomplished under local anesthesia alone. For more complicated cases, especially those involving bone grafting, or if the patients is nervous or apprehensive, intravenous sedation can be used to make the surgical experience as smooth and easy as possible.
Cost of Dental Implants
How much does a dental implant cost?
This depends on a number of factors, and following a complete examination, treatment plan, and consultation with your restorative dentist, a complete treatment estimate will be provided for you.
Comparing the Long-Term Costs of Conventional Bridges and Dentures vs. Implants
While Bridges and Dentures may be less expensive at the outset, you should consider that both options sometimes have considerable continuing expenses.
Conventional fixed bridges require trimming down the neighboring abutment teeth. This can lead to eventual decay under the tooth-bridge interface, requiring replacement of the bridge years down the line. In a younger individual, this can mean replacement of the bridge (with possible loss of the abutment teeth and enlargement of the bridge) several times throughout the course of their lifetime.
Dentures cannot preserve the jaw bone the way dental implants can. The long term effect of wearing conventional dentures is that the underlying jawbone tends to shrink over time from the pressure of the denture. As this bone is resorbed, the jaw becomes smaller and thinner, leading to poorly fitting dentures, and repeated refitting and replacing the dentures to accommodate these changes.
Over a lifetime, dental implants can be the cost-effective as well as esthetic choice.