Dental Implants

A Reason To Smile

By: Dr. Marc Lazare, DDS

The introduction of implant dentistry has laid the foundation for a new level of care and service that accomplishes today what was thought impossible only a few years ago. It is the most advanced therapy available to replace missing or lost teeth. Dental implants not only enable one to regain their confidence and psychologically be able to enjoy an active lifestyle, but they can improve your smile, help you to once again enjoy chewing all the foods you like, and help to restore your facial structure and youthful appearance.

What are dental implants ?

Implants are metal posts (usually titanium) that are surgically placed beneath your gums to act as artificial tooth roots once they have become integrated with the surrounding bone. These implants offer stable support to artificial teeth, whether in the form of a single crown, a fixed bridge or beneath a removable denture. A conventional fixed bridge still remains an excellent treatment option. However, many individuals who have lost or who will be losing a single tooth may be hesitant to grind down their intact adjacent teeth, especially when the adjacent teeth are free of cavities or restorations. For these individuals, a single tooth dental implant may be the ideal option.

Is everyone a candidate for implants?

As with any medical or dental procedure, the placement of implants may have a compromised success rate in certain individuals. Some of the reasons to exclude dental implants as a treatment option include: insufficient bone quantity, poor bone quality, inadequate amounts of space between your upper and lower teeth, vital anatomical structure in close proximity to the proposed implant site, unrealistic expectations about the esthetic outcome, or a still growing mouth and face.

Certain chronic diseases such as diabetes, osteoporosis or chronic sinus troubles can have the potential to interfere with the integration of bone to these implants. Individuals who smoke regularly will usually have a poorer prognosis for the implants in the long run. However with proper treatment planning, placement selection, and by utilizing the appropriate style of implant, the level of success has been tremendous. To find out if implants are the right choice for you, your dentist will need to evaluate your health history, take impressions of your mouth for planning models, and take the necessary dental x-rays. Your dentist will most likely refer you to have a CAT scan performed to help establish the quality and quantity of your bone, along with determining the best placement and the number of implants that will be required for long term success.

Different areas of the mouth typically have different qualities of bone. For example, the front segment of the lower jaw has the densest bone, while the back portion of the upper jaw usually has bone that is softer and more porous. if it is discovered that you do not have enough bone in certain areas, do not yet give up hope. Recent studies have proven that implants can be quite successful in bone that has been augmented by either natural or synthetic bone grafts. The degree to which new bone will form within the grafted site differs from one individual to another depending on the type of graft used and the overall health of the patient.

How do you care for implants?

The long term success of implants is, in part, determined by meticulous oral hygiene and regular dental visits. Although you cannot get cavities in implants or periodontal disease, it is possible to develop what is called peri-implantitis, which is inflammation of the tissues around the implants. To prevent this, keep brushing and flossing as you normally would your own teeth, and don’t forget to schedule your regular check-ups.

Are these implant procedures painful?

These procedures are performed without discomfort, under the utilization of local anesthesia or local anesthesia with I.V. Sedation. Occasionally general anesthesia may be used depending on the individual and their medical history. Post-operatively there may be mild to moderate discomfort and some swelling, but nothing that can’t be controlled with the assistance of an oral analgesic that your doctor will prescribe.

Single tooth immediate implants

Another topic to be of considerable interest for discussion is whether or not one is a candidate for placing a single tooth implant in a fresh extraction site (tooth socket). Dentists regularly wait for a period of 6 months after extracting a tooth before they place an implant. However, this delays treatment and may leave the residual bony ridge too thin for implant placement. A thin or resorbed bony ridge is of primary concern in areas where the esthetics of one’s smile is in jeopardy of being compromised. This compromised quantity of bone could lead to cosmetic defects such as the loss of the surrounding gum tissue.

It is believed that bone growth may actually be greatest after a tooth is removed. Single tooth immediate implant placement (according to a 1997 regeneration report in the Journal of Practical Periodontics and Aesthetic Dentistry) is indicated in the following cases: (1) teeth that are lost by trauma, (2) teeth that are condemned due to fracture, (3) residual baby teeth with root resorption, and (4) teeth with root canal failure.

The disadvantage of immediate placement is that placing an implant in a fresh extraction site does not provide optimum initial bone-to-implant contact. As a result, the usual waiting period for the implant to integrate with the bone may have to be extended by about 2 months. Depending on what implant system is used, this usual waiting period generally take anywhere from 2 to 6 months before the implant can be restored with a crown.

The immediate implant procedure has survived 10 years of clinical scrutiny and has a proven success rate that is close to those experienced in an intact toothless site. Keep in mind, however, that this procedure is not generic; it is only presently indicated for those individuals who satisfy the aforementioned criteria.

Final thoughts …

Implant dentistry and bone regeneration are among the recent miracles of modern medicine. Their impact on the field of dentistry ranks up there with the introduction of the local anesthetic Novocain (developed in 1904), and the air-driven turbine drill (introduced in1957). With adequate time and proper planning great things can now be accomplished.

If you are a candidate for implant dentistry (whether they are placed immediately after an extraction or not), do not rush the outcome of your dental treatment. It is a time consuming process, and cutting corners can compromise the esthetic results and the integration of the implant to your bone. Be patient, and allow your dentist to accomplish one miracle at a time.