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DENTAL IMPLANTS

INTRODUCTION:
 		  
Dental implants are metal “posts” that are inserted surgically into the jawbone and are used to anchor a single tooth, several teeth or a mouthful of teeth. As the accompanying illustration shows, the typical dental implant for the replacement of a single tooth consists of three separate pieces, each fulfilling a unique role in the process. The actual implant is usually a titanium post that your surgeon places into the jawbone. Over the next two to six months, the implant will safely fuse with the bone to form a secure, immovable base upon which the two other components, the abutment and the prosthesis or crown, will be placed. The abutment attaches to the portion of the implant that sits above the gumline. It forms a platform for the crown, which is carefully molded and positioned on the abutment by a prosthodontist or restorative dentist.
In general, the crown is not added until the implant and jawbone have fused. There are some cases, however, particularly in situation where there is an aesthetic concern, when a temporary crown may be placed on the abutment at the time of the surgery. Your surgeon and/or dentist can tell you if this procedure is right for you.

 
WHO NEEDS DENTAL IMPLANTS?
 
With the general exception of growing children, dental implants can improve the quality of life for almost everyone who is missing one or more teeth. People of all ages can benefit from dental implants. Many surgeons can point to patients in their 80s and 90s who have been successfully treated with dental implants. Additionally, individuals with existing medical conditions or other health concerns, including the following are generally good candidates for implants:

Medical Conditions: If you can have routine dental treatment, you can usually have an implant placed. While precautions are advisable for certain conditions, even patients with such chronic illnesses as high blood pressure and diabetes are generally successful candidates for implant placement.
 
Gum Disease or Problem Teeth: Almost all implants have been placed with high success rates in patients who have lost their teeth to periodontal (gum) disease or decay.

Currently Wearing Partial or Full Dentures: Dental implants can replace fixed bridges or removable dentures, or they can be used to stabilize and secure removable dentures, making them much more comfortable to wear.

Bone Loss: Bone loss is not uncommon for people who have lost teeth or had periodontal disease. Oral and maxillofacial surgeons are trained and experienced in grafting bone to safely and securely place the dental implant.

Children: Implant tooth replacement in children is usually deferred because their jawbones are still growing and the implant, a fixed entity, will not grow with the bone. There are exceptions, however, and some children, such as those undergoing orthodontic procedures, may be candidates for dental implants. Your family dentist or orthodontist will help you determine whether dental implants are right for your child.


BENEFITS OF DENTAL IMPLANTS:

If you are unfamiliar with dental implants or maybe thought they were similar to traditional fixed bridges and removable dentures, you may be surprised by their unique quality of life benefits. Not only do dental implants look, feel and perform like your healthy, natural teeth, they help protect your oral health by reducing the bone loss that often accompanies the use of conventional dentures that rest on the gum line. Dental implants enable you to eat and enjoy the foods you crave without restriction and allow you to speak clearly and confidently without embarrassing clicking noises or slipping dentures.

Implants Aid in the Prevention of Bone Loss: The density of the jawbone is preserved and maintained by the presence of your natural teeth. When one or more teeth are lost through gum disease, tooth decay, and accident or other incident, the bone thins and weakens over time. In the area of missing teeth, both fixed bridges and removable dentures rest on top of the gum line and do nothing to maintain or preserve the jawbone. As bone loss occurs, the fixed bridge or removable denture no longer fits properly. Patients with fixed bridges may encounter hygiene problems commonly associated with these prostheses, while patients with removable dentures may be bothered by clicking noises and slipping dentures. Dental implants, however, are placed in and fuse with the jawbone to form a lasting bond that maintains and preserves bone density in the same manner as healthy, natural teeth.
 


 
Avoid Injury to Adjacent Teeth: Until the advent of dental implants, a fixed bridge was the conventional solution for replacing a single missing tooth. Unfortunately, a fixed bridge designed to replaced on tooth actually impacts three teeth; the tooth being replaced and the teeth on either side, which are used to anchor the bridge. These adjacent teeth must be cut down so the bridge may be securely cemented. Because the dental implant is fused with the jawbone, it is unnecessary to involve healthy adjacent teeth.

Lifestyle Benefits: Insecure fit, difficult eating favorite foods and an artificial appearance often cause patients who wear removable dentures or fixed bridges to complain that the appliances make them look and feel older than their actual age. By contrast, natural looking, long-lasting dental implants are usually indistinguishable from natural teeth and provide patients with more self-assurance and confidence.


TREATMENT OPTIONS TO REPLACE MISSING TEETH:

The dental implant procedure is a team effort that includes the patient; the oral and maxillofacial surgeon, who surgically places the implant; and the restorative dentist, who creates and places the crown after the site has healed and coordinates the various aspects of the procedure.

The process begins when the patient visits the restorative dentist to discuss treatment options for a broken, missing or soon to be extracted tooth. General the patient has several options:

Do Nothing: This is the poorest choice as teeth behind a missing tooth may eventually drift into the unfilled space and periodontal disease may develop. Over time there may be bone loss in the area of the missing tooth.
 

Fixed Bridge: A fixed bridge may require the cutting down of adjacent, healthy teeth that may, or may not, need to be restored in the future. Bone loss and recurrent decay may occur under the fixed bridge since there is no actual tooth in place to maintain the area. Further, there may be future costs to replace the bridge once, twice or more often during the patient’s lifetime. In general, a fixed bridge must be replaced every seven to 15 years.

Removable Partial Denture: A removable partial denture, may contribute to the loss of adjacent teeth and the loss of bone density. Studies show that within five to seven years, there is a failure rate of about 30% in teeth located next to a removable partial denture. As with fixed bridges, removable partial dentures need to be replaced every seven to 15 years.
 
Dental Implants: Of all the options open to the patient, dental implants are frequently the best treatment option and the solution of choice for replacing missing teeth. Implants do not impact adjacent teeth or lead to bone loss. In general, dental implants seldom need replacement once they have fused with the bone.


UNDERSTANDING THE SURGERY:

On the day of the implant procedure, your oral and maxillofacial surgeon will surgically place the posts or implants in the jawbone. The placement of the dental implants may be done in one or two stages.

In “Stage One,” the implants are placed in the jawbone. After you are anesthetized, your oral and maxillofacial surgeon will make an incision in the gum tissue and place one precisely measured hole in the bone where each implant will be inserted. The implants are inserted in the holes, the gum tissue is repositioned over or around the implants and sutures (stitches) are placed. Depending on your situation, your oral and maxillofacial surgeon may place healing abutments that will minimally protrude through the gum tissue. In special cases, prosthetic abutments may be placed along with provisional, or temporary crows. The time required for implant surgery may vary. Following surgery, you may spend some time “in recovery” before you are allowed to go home.

In “Stage Two,” which takes place after osseointegration is complete, the implant is uncovered and a special cap, called a healing abutment, is attached to the implant. After the gum tissue has adequate time to heal, the healing abutments are removed. Prosthetic abutments are placed on the implants and the restorative dentist takes impressions for the final crown or prosthesis. In most cases, stages on and two can be accomplished in a single appointment.
 

         

 
KNOWN RISKS AND COMPLICATIONS:

In general, dental implant surgery has a 95% success rate, but as with any surgical procedure, certain side effects or complications are possible. You should be aware of these before your dental implant surgery. Your oral and maxillofacial surgeon will answer any questions you have about the following possible risks:

1. Swelling: is a normal reaction to any surgical procedure. The amount of swelling depends on the extent of the surgery. Normal swelling should peak within 48 to 72 hours, and then gradually subside. If swelling worsens after 72 hours, contact your oral and maxillofacial surgeon.

2. Bruising occasionally develops in areas close to the surgical site. Any discoloration from bruising should disappear within several days following surgery.

3. Mild to moderate discomfort may be experienced for 24-72 hours following surgery, and pain medication may be required. If intense pain persists that cannot be relived by prescribed pain medication, please contact your surgeon.

4. Trismus: Stiffness of the jaw muscles, may be caused by swelling following surgery. As the swelling decreases, trismus should disappear.

5. Infections: this is very rare following implant surgery, but occasionally and infection may occur. If fever, persistent swelling, pain or drainage develops following surgery, contact your surgeon immediately.

6. Implant failure: this is also a rare complication and may be caused by a number of factors, including the failure of the implant to fuse with the bone, inadequate cleaning or maintenance by the patient, too much mechanical stress on the implant or by smoking tobacco or excessive alcohol consumption.

7. Injuries to adjacent teeth, roots or bridgework.

8. Loss or alteration of nerve sensation: This can result in numbness or a tingling sensation in the lower lip, tongue, cheek, chin, gums or teeth is rare but can occur if implants are placed in the lower jaw and a nearby nerve is irritated. Typically this is temporary, although in very rare case it can be permanent.

9. Sinus complications: Drainage, pain (sinusitis), may rarely occur if implants are placed in the upper jaw adjacent to the sinus. This may or may not require further treatment, by any sinus symptoms should be reported to your oral and maxillofacial surgeon.

10. Bleeding may occur 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, contact your oral and maxillofacial surgeon immediately.

11. TMJ pain: This is rare following implant surgery, but may occur. If it does, further treatment may be necessary.

12. Bone loss: This is rare but may occur around the implant if proper hygiene is not maintained or if excessive stress is placed on the implant.

13. Jaw fracture: In very rare cases, placement of implants in the lower jaw may temporarily weaken the jaw bone, resulting in a fracture, particularly if the jaw is thin. X-rays will reveal the location of the fracture.


WHAT TO EXPECT AFTER THE 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. There may be some swelling and discoloration of the skin in the area of the implant surgery. Medications prescribed by your oral and maxillofacial surgeon will help alleviate any discomfort, and you should be able to resume normal activities within three to five days. Your surgeon may also prescribe antibiotics. Expect some minor bleeding on the day of the surgery, but report excessive bleeding to your surgeon immediately.

During this time your oral and maxillofacial surgeon may recommend you follow a soft diet that doesn’t place undue stress on your new implants. He will also give you important instructions for cleaning your mouth. If you have been wearing a denture, the surgeon or restorative dentist may place a soft lining in it so you can wear it comfortably during the healing period, or it may be necessary to leave it out for a short period of time. If spaces left by missing teeth must be filled while healing takes place, temporary teeth that appear natural can be made. Sutures placed during surgery will either dissolve or you will need to return to your oral and maxillofacial surgeon to have them removed.

Over the next few months, the dental implants will fuse with the jawbone through the osseointergration process. In general, no crowns or prostheses will be attached to the implants during this period. However, in certain instances a temporary crown may be placed on the implant while osseointergration is taking place. Your oral and maxillofacial surgeon will let you know if you are a candidate for this procedure.


THE FINAL RESTORATION OR PROSTHESES:
 
After the implant has fused with the jawbone and your gum tissues have completely healed, you are ready to visit your restorative dentist who will begin fabricating your new artificial teeth. The restorative dentist will take impressions of your mouth and bite registration that record the way your jaws fit together. These will be used to make models of your jaws and any remaining teeth. Your artificial teeth will be created based on these models. Artificial teeth, called “restorations” or “prostheses,” are either removable, fixed, or a combination of both.
 
   
A removable prosthesis is similar to conventional or partial dentures. Artificial teeth and gum tissue are mounted on a metal framework, which attaches to the implant abutments. Like conventional dentures, they can be removed form the mouth for cleaning, but your new removable prosthesis has the advantage of being fastened to the implant abutments by clips, magnets or other devices that hold them firmly in place, making them unable to slip or click.
 
A fixed prosthesis can replace one tooth, several teeth, or even all of your teeth. The artificial teeth are attached to the abutments and held firmly in place either with screws or cement. Your restorative dentist may have you wear the prosthesis for a while to make sure it fits properly before final attachment to the abutments. Depending on the complexity of your case, it may take several appointments to complete your prosthesis.


Regardless of the type of prosthesis you are receiving, your restorative dentist will utilize extreme care and aesthetic techniques that will result in a final product that looks, feel and performs like your healthy, natural teeth. This is truly something to smile about.

 
MAINTAINING YOUR IMPLANTS OR RESTORATIONS:

Your oral and maxillofacial surgeon and restorative dentist will schedule periodic check-up visits to make sure your jaws are healthy and the implants and prostheses are functioning properly. Just as important as regular professional care, however, is your personal care.

To ensure many years of service from your dental implants, practice meticulous oral hygiene according to the instructions provided by your dentist and hygienist. Abutment posts, beneath the prosthesis, artificial teeth, and gum tissue must be kept clean. Home care aids, such as special brushes and floss holders, will help you accomplish this. If you do not keep your implants and prostheses clean, you implants may fail.


THE NEW YOU:
 
While there is no guarantee of 100% success, with careful planning by your surgeon and restorative dentist prior to surgery, and proper self-maintenance, you can expect many years of use from your dental implants. In fact, current literature reports that the vast majority of implants placed 20 or more years ago are still in service and functioning normally today. Thousands of people have rediscovered the joy of eating properly, speaking clearly and laughing comfortably through the use of dental implants.

The information provided above is for educational purposes only.  Individual results may vary.  A personal consultation with your plastic surgeon is the best way to gain information about your particular complaint, and about potential treatment options to address the same.