Dr Benley George
A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants may be an option for people who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.Like tooth roots, dental implants are secured in the jawbone and are not visible once surgically placed. They are used to secure crowns (the parts of teeth seen in the mouth), bridgework or dentures by a variety of means. They are made of titanium, which is lightweight, strong and biocompatible, which means that it is not rejected by the body. Dental implants have the highest success rate of any implanted surgical device.Titanium’s special property of fusing to bone, called osseointegration, is the biological basis of dental implant success. That’s because when teeth are lost, the bone that supported those teeth is lost too. Placing dental implants stabilizes bone, preventing its loss. Along with replacing lost teeth, implants help maintain the jawbone’s shape and density. This means they also support the facial skeleton and, indirectly, the soft tissue structures — gum tissues, cheeks and lips. Dental implants help you eat, chew, smile, talk and look completely natural. This functionality imparts social, psychological and physical well-being. Today dental implants are the best choice for replacement of teeth.
Types of dental implants
- Endosteal (in the bone): This is the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth. This type of implant is generally used as an alternative for patients with bridges or removable dentures.
- Subperiosteal (on the bone): These are placed on top of the jaw with the metal framework’s posts protruding through the gum to hold the prosthesis. These types of implants are used for patients who are unable to wear conventional dentures and who have minimal bone height.
Indication
The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.
Contraindications
Dental implants are not indicated in the following patients with;
- Heart diseases affecting the valves (valvulopathy)
- Recent infarcts
- Severe cardiac insufficiency, cardiomyopathy
- Active cancer, certain bone diseases (osteomalacia, Paget’s disease, brittle bones syndrome, etc.),
- Certain immunological diseases, immunosuppressant treatments, clinical AIDS, awaiting an organ transplant
- Certain mental diseases
- Strongly irradiated jaw bones (radiotherapy treatment)
- Treatments of osteoporosis or some cancers by bisphosphonates
- Children: not before the jaw bones have stopped growing (in general 17-18 years).
Examination
Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Initially a dentist will take x-rays of your jaw, paying special attention to the area which will be treated. A general review of these x-rays will allow the dentist to carefully inspect for any additional teeth or areas in the bone that require treatment (whether for implants or otherwise). Many dentists will use a panoramic radiograph, which shows all of the upper and lower jaws’ bones and teeth, to diagnose other dental and bone pathology. These can also be used to assess the height of available bone and the relation and position of other anatomic structures – all considered as part of the overall analysis for implants.
CT Scan
The most accurate form of x-ray imaging currently available is the CT scan, commonly known as a CAT scan. Medical CT scanners are often used by dentists to diagnose, analyse and devise treatment plans for implant surgery so you may be referred to a radiologist during the diagnosis process.
There are other types of CT scanners known as Cone Beam CT scanners (CBCT) that can provide similar images and can be converted to the many commonly used software programs available for analysis by your dentist. CBCT scanners use significantly less radiation. Both types of CT scanners provide very detailed, three-dimensional images that can accurately measure the height and width of available bone, as well as locate the nearby anatomic structures (such as the maxillary sinuses and mandibular nerves) that the surgeon must be mindful of during surgery.
Other diagnostic studies are required to properly proceed with implant treatment. A full periodontal examination is required to determine if gum disease is present and, if so, devise an effective treatment plan. A complete tooth-by-tooth examination is also necessary to identify and properly treat any active cavities or other dental pathology.
Dental impressions are needed at various points of treatment to assess the status of your bite and proceed with proper restoration of the implant(s) in coordination with the rest of your entire dentition. Photographs may also be used to help plan your treatment as well as record your progress.
Replacement of lost tooth using implants
Single Tooth Replacement:Immediately (at the same time an implant is placed) or after a period of healing, an abutment is attached to the implant. This is a device that “abuts” or joins the implant to a tooth form called a crown, which replaces the tooth part you see in the mouth. It will hold a custom-made crown that the dental laboratory will fabricate and match to your existing teeth. The custom crown is cemented or screwed onto the abutment to permanently keep it in place. Once the crown is in place, it should be indistinguishable from your natural teeth.
Fixed Multiple Tooth Replacement: As with single tooth replacement, temporary healing caps or abutments may be placed on multiple implants until the healing phase is complete. After healing, permanent abutments are attached to the implants. They can attach to custom-made crowns or bridgework that a dental laboratory will fabricate to match your existing teeth. In the final step, the custom bridge, which will replace multiple teeth, is cemented or screwed onto the abutments. The teeth have been replaced without disturbing the healthy teeth next to them, and bone loss has been halted.
Removable Implant-Supported Tooth Replacement: If all of your lower teeth are missing, depending on the design of the removable restoration, two to six implants may be used to support a lower denture. If all of your upper teeth are missing, a minimum of four implants may be used to support an upper denture. Removable dentures are often used to replace extensive tooth, bone and gum-tissue loss, thus providing support for the facial skeleton, lip and cheeks. A new denture can have attachments that snap or clip it into place on the implants or a custom made, milled bar can be fabricated to create additional strength and support for the restoration. Design variations are often related to your bone density and number of implants present; your dentist will discuss these options during your consultation. A significant advantage of a removable denture is facilitating the cleaning of the dental implants.
Steps in Implant placement
First, the implant, which looks like a screw or cylinder, is placed into your jaw. Over the next two to six months, the implant and the bone are allowed to bond together to form an anchor for your artificial tooth. During this time, a temporary tooth replacement option can be worn over the implant site.
Often, a second step of the procedure is necessary to uncover the implant and attach an extension. This temporary healing cap completes the foundation on which your new tooth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached.
Finally, a replacement tooth called a crown will be created for you by your dentist and attached to a small metal post, called an abutment. After a short time, you will experience restored confidence in your smile and your ability to chew and speak. Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth.
Every case is different, and some of these steps can be combined when conditions permit. Your dental professional will work with you to determine the best treatment plan.
Maintenance of Implants
Oral Hygiene
Proper care of your implants is important to their continued function and good health. While they are not subject to cavities as our natural teeth are, they can develop gum inflammation, and even infection and bone loss if not properly maintained. Whereas localized inflammation and infection around your teeth is known as periodontal disease, a similar process can occur around implants and is known as peri-implantitis. Routine tooth brushing and flossing of teeth should be done to maintain a good oral hygiene.
Dental Check-ups
Your “new teeth” will require periodic checking by your dentist to ensure the surrounding gums and bone are maintained and healthy. This also requires periodic x-rays to evaluate the level of bone around your implants. The dental restorations attached to your implants will also require periodic checking by your dentist to verify that they are secure and functioning properly.
It is not uncommon for the screws that attach your restoration to the actual implants or abutments to loosen from time to time. This usually entails simply removing the dental restoration, cleaning it and replacing it with new or re-tightened screws. Similarly, if your dental restoration is cemented to the underlying implant, they may also loosen periodically. If this happens, your dentist will need to remove the restoration, clean it, ensure that it is fitting as designed and re-cement it to the implant. While these are minor complications, however inconvenient, they should not be ignored. Allowing the restoration to remain in place when it is not properly attached to the implant can create more significant problems.
Implant crowns and other prosthetic (false) tooth replacements are made to be remarkably failsafe systems. They are removable and replaceable (only by your dentist), so that if damage or wear necessitates replacement, this can be accomplished without affecting the implant or attachment to the bone.
Nevertheless, implants do require maintenance. It is important to practice good daily oral hygiene, including brushing and flossing to control bacterial biofilm. It is also important to see your dentist and dental hygienist. Special instruments are necessary to clean dental implants that will not damage their metal surface beneath the gum tissues. Your dentist will need to monitor your implants to make sure the integrity of the osseointegration is stable, and that the implant crowns, bridgework or dentures are functioning adequately.
Benefits of implants
Next best thing to healthy, natural teeth.Strong and stable, a dental implant restores a lost tooth so that it looks, feels, fits and functions like a natural tooth. Other options can lead to bone deterioration, and may interfere with eating, smiling, speaking and other activities of everyday life.
Dental implants are a long-term solution. Traditional, tooth-supported dental bridges only last five to seven years, and with proper care often more than 10 years, but at some point they may need to be replaced. While dental implants may need periodic adjustments, they can last a lifetime when properly placed and cared for over time.
Enjoy life without worrying about your teeth- No need to stay home or feel uncomfortable in public, embarrassed because your smile looks different, or worrying that missing teeth will limit your ability to join in the fun or that removable dentures or tooth-supported replacement teeth will loosen or fall out when you talk, eat or laugh. Teeth restored with dental implants are teeth that let you, not your teeth, lead your life.
Retain your natural face shape, and smile. A face without teeth can sag and appear sunken and sad. Dental implants allow you to maintain the natural shape of your face and smile.
Leaving empty spaces in your mouth after losing one or more teeth can lead to additional health issues, such as the loss and deterioration of some of your jawbone. When it is not being used to support a natural tooth, the jawbone deteriorates, losing its strength and firmness. Dental implants are the only dental restoration option that preserves and stimulates natural bone, actually helping to stimulate bone growth and prevent bone loss.
Dental implants allow you to keep your teeth where they belong – in your mouth. And no more worrying that your dentures might slip or fall out. Brush, floss and care for teeth that have been replaced using dental implants exactly the way you would natural teeth – in your mouth.
Adjusting to removable dentures can mean struggling to pronounce everyday words. Not so with dental implants, which function like natural teeth.
Taste and enjoy the foods you love without hesitation. You can bite naturally, eat virtually anything you want and, unlike removable dentures that can feel uncomfortable, you can experience the full taste of the food you eat with dental implants, too.
Cavities can’t occur in an implant-restored crown, or replacement tooth; however, you will need to visit your dentist as scheduled and clean and care for it and your gums and mouth every day, the same as you would if it were a natural tooth.
Dentures may slip when you eat, talk, smile, laugh, kiss, yawn or cough, so that you have to “reposition” them back into place in the mouth. Dental implants are fixed in place and fuse naturally with your jawbone.
Protect your healthy teeth. Placing a tooth-supported bridge requires grinding away the teeth on one or both sides of the missing tooth or teeth – thereby damaging healthy teeth to restore those that are missing. The modified healthy teeth are attached to, and support, the bridge. Dental implants go in the jawbone, in the spot where your missing tooth root was, without impacting healthy teeth. They also help prevent healthy, adjacent teeth from shifting as they would if an empty space were left for an extended period of time.
More predictable than other repair and restoration methods. Dental implant treatment has a track record of reliable, long-term successful outcomes and is often considered “more predictable” than other treatments to repair or replace missing teeth, including bridgework, removable appliances and retreatment of failing root canal therapy.
Success rate of dental implants
Despite decades of clinical and scientific research, dental implants do not have a 100% success rate. However, the success rates have improved dramatically since the introduction of dental implant surgery and the dental profession can proudly report success rates well above 90% for most implant patients. Similarly, long-term success rates are in the high 90% range and are likewise improving. Dental implants have brought up a great revolution in dental care which has resulted in an equivalent replacement for a lost tooth.
