Dental Implants

Beautiful Beginnings……

Regaining the ability and confidence to eat and speak again has a powerful influence on one’s life. The thrill of having the freedom to once again laugh, smile, eat, and kiss without worries is uplifting to one’s outlook and makes life more enjoyable.

What are Dental Implants?

The implants themselves are tiny titanium posts that are surgically placed into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. The bone bonds with the titanium (osteointegration), creating a strong foundation for supporting artificial teeth. Once the implant and jawbone heal, small extensions (abutments) are placed into the implant(s) which protrude through the gingiva. These abutments provide stable bases for the artificial replacement tooth crown(s). Dental implants can be thought of as mini-orthopedic implants. The materials from which the implant is made, the healing, and the bio-compatibility are all very similar to the much larger orthopedic hip or knee implants.  

Surgical Overview

There are two main surgical techniques for placing implants. Implants can be placed either using a single stage (implant abutment showing in the mouth) or a two stage (implant completely submerged under the gingiva) surgical technique.  As the different  names suggest, one is performed in one surgical step while the other requires a second surgery. There are even situations where the implants can be placed at the same time as a tooth extraction–further minimizing the number of surgical procedures.

One-Stage Procedure

In a one-stage procedure, a healing abutment is placed at the time of surgery. A healing abutment is a connector that extends from the implant in the bone into the mouth through the gum tissues. This surgical technique does not require a second surgical procedure to uncover the implant. Following a 3 to 6 month healing period in which the implant fuses to the bone, a crown is then placed on the implant, restoring the immediate appearance of a healthy, normal tooth. One-stage implant systems are generally used when the bone quality is good, guaranteeing good initial implant stability. They are also used when cosmetics is not a concern, such as the back areas of the mouth.

Under special conditions, an implant can be placed and a crown placed on top of it at the same time. However, this is a very special circumstance requiring ideal conditions and surgical experience as well as crown fabrication know-how. It is generally safer and wiser not to subject an implant to biting forces until it is fully healed and integrated with the supporting bone.

Two-Stage Procedure

A two-stage procedure is typically used for replacing teeth where there is no immediate need for a cosmetic solution and when more of a margin of safety is required. With this approach, the implant(s) are placed into the jawbone and the gum tissues cover them. They are not exposed to the mouth, but stay buried under the gingiva and are allowed to heal. Once healed, a second surgery is performed to attach an abutment for securing the crown in place. This approach is used when there is poorer bone quality or quantity. This may make it necessary to regenerate bone around the implant at the time of its placement. There may also be other health considerations dictating that a two-stage approach may be indicated.

Tooth (Teeth) in a Day

In some instances an implant can be placed and restored at the same appointment. This is very dependent on the bone present and the quality of the bone. Utilizing a computer generated surgical guide, an implant is placed in a very special manner which allows the restorative dentist to immediately place a custom restoration. This is very dependent on the initial strength and stability of the implant in the bone.

Tooth Extraction and Simultaneous Implant Placement

Occasionally a tooth can be removed and an implant placed at the same surgery. This may or may not allow the placement of a temporary restoration. More often the tooth is removed and implant is placed and buried. A removable temporary restoration is used during the healing of the implant. 

Mini implants

Mini implants are very small diameter implants that are sometimes used to stabilize a denture while standard implants are healing. These are generally removed at the end of the healing period for the standard implant. The denture is then modified to attach to the standard implants. 

What Types of Implant-Supported Prostheses are Available?

Single tooth – Replaces one missing tooth. Each prosthetic tooth attaches to its own implant. There are three components to this type of restoration: the titanium implant that fuses with the jawbone; the abutment, a transition piece that fits into the implant and extends into the mouth; and the crown which fits over the abutment and replaces the missing tooth.

Partial prosthesis (fixed or removable) – Replaces two or more missing teeth with a bridge. In some cases this can be removed by the patient and in other cases it is fixed to the abutment(s) and cannot be removed by the patient.

Removable complete prosthesis (over denture) – This replaces all of the teeth in your upper or lower jaw and is attached to either a bar supported by the implants or to friction grip abutments. This is removable by the patient.

Fixed implant complete prosthesis – This type of restoration can be placed by the dentist and removed by the dentist. In some cased the prosthesis appears very much like a conventional denture except it is held to the implants with screws. This is called a hybrid denture. The patient cannot remove this type of denture. The other is an all metal cast framework that attaches directly to the implants and has porcelain teeth. This also cannot be removed by the patient.

Why Dental Implants?

What are the Benefits of Dental Implants vs. Fixed Bridge?

• Closest thing to natural teeth. Dental implants look, feel, and function very much like natural teeth.
• Preserves healthy adjacent teeth. An implant eliminates the need to “grind” teeth down to support a bridge. Why sacrifice the structure of surrounding good teeth to bridge a space?
• Bone is maintained by the presence of implants. Bone loss occurs with the loss of teeth.
• Cost effective. Bridges may have recurrent decay resulting in them being replaced once, twice, or more over the course of a lifetime. Also, bridges require crowning adjacent teeth.
• Maintains your smile and youthful appearance.
• Can floss naturally between implant supported teeth.
• Improve confidence and self esteem.

 What are the Benefits of Dental Implants vs. a Removable Partial Denture?

• Preserves adjacent teeth. Removable Partial Dentures may contribute to the loss of adjacent teeth.
• Cost effective. Removable Partial Dentures will require maintenance and may require being replaced once, twice, or more over the course of a lifetime.
• Teeth are more stable.
• Greatly improved ability to chew food.
• Teeth are not removable.

What are the Benefits of Dental Implants vs. Conventional Dentures?

• Greatly improves ability to chew
• Improves ability to speak and smile with confidence
• Bone is maintained by the presence of implants. Bone loss occurs with the loss of teeth. Conventional Dentures may contribute to the loss of bone.
• No more denture adhesives.
• Palate is not covered. Upper dentures supported by implants generally do not cover the palate, so speaking is easier and foods taste much better.
• Eliminates unpleasant denture noise.
• Eliminates denture irritations and sores.
• Eliminates denture need for relines.

In short, your quality of life improves when you can eliminate the day-to-day frustrations and discomfort of ill-fitting dentures. With a sense of renewed self-confidence, many people rediscover the excitement of an active lifestyle shared with family and friends and the chance to speak clearly and comfortably. 

Will Grafting be Necessary Prior to Implant Placement?

This can be determined once the surgeon has the benefit of a radiographic and clinical exam. In the event there is insufficient bone to place the implant, one or both of the following procedures may be indicated:

Sinus Augmentation – A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.

Ridge Modification – Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or a bone substitute material to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

Dental Implants are a Combined Effort

Dental implants combine the best of modern science and technology, including a team approach. Your restorative dentist is the “quarterback” of the team. The team consists of you, the patient; your restorative dentist; and your oral surgeon. The surgeon performs the initial dental extraction(s), any bone augmentation and/or grafting, if indicated, and the actual implant placement surgery. The restorative dentist  places and adjusts the permanent prosthesis, i.e. crowns or dentures. The restorative dentist will also make any temporary prosthesis needed during the implant healing process.

A successful implant requires that all team members involved follow a careful plan of treatment. All members of the implant team will stay in close contact with each other to ensure everyone clearly understands what needs to be done to optimize the success of your treatment.

Are Dental Implants for You?

Whether you are a young, middle-aged, or mature adult, whether you need to replace one tooth, several teeth, or all your teeth, there is most likely a dental implant solution for you. The ideal candidate for dental implants is in good health, both physically and orally. With the exception of growing children, dental implants can be the solution of choice for people of all ages, even those with health concerns. Successful implants can still be achieved even with conditions such as the following:

• Existing Medical Conditions (including chronic diseases as high blood pressure and controlled diabetes)
• Gum Disease or Problem Teeth
• Currently Wearing Partials or Dentures
• Smokers
• Bone Loss
• Young Patients for Orthodontic Treatment. Implant placement in children is usually deferred until their jaw growth is complete. However, one exception is when implant placement is part of the orthodontic treatment plan.

How Successful are Dental Implants?

Success rates of dental implants vary, depending on where in the jaw the implants are placed, but, in general, dental implants have a success rate in the high 90’s percent. With proper care (see below), implants can last a lifetime.

Where will my Surgery be Performed?

Most implant procedures are performed in-office here at Kingwood Oral Surgery in a hospital-style operating suite, thus optimizing safety and convenience for the patient. Strict hospital standards for sterilization of all instrumentation is closely followed. Inpatient hospital implant surgery can be arranged for any patient, but is generally reserved for patients who have serious health problems who need special medical or anesthetic needs or for those who need extensive bone grafting from the hip or tibia.

What Type of Anesthesia is Used?

The majority of dental implants are placed in the dental office under intravenous sedation or general anesthesia and local anesthetic. The procedure can be comfortably completed with local anesthetic only in some instances.

Do Implants Need Special Care?

You will have invested significant amounts of time and resources in your implant(s), so it is important to protect them. Good oral hygiene is critical. Although a dental implant will never get tooth decay, like natural teeth, an implant is subject to inflammation and infection, called peri-implantitis, which is similar to periodontal disease.

Routine brushing, flossing, and use of an irrigating device and inter proximal brush is all that is recommended or needed to maintain a healthy implant. Regular visits to your dentist for cleaning are very important. In short, one cares for their implant(s) just as they would for their natural teeth.

Does Insurance Cover Implants?

Today, some dental insurance plans are covering the placement of dental implants. However, the annual reimbursement limit is still typically $1,500, an amount that hasn’t changed in multiple decades. Coverage under your medical plan may be possible. This depends on your insurance plan and/or cause of tooth loss.  Regardless of insurance coverage, many patients find dental implants a worthwhile investment in one’s health and well being.