Dental Implants
What are Dental Implants?
In the last 30 years, teeth replacements have come a long way. Today, Dental Implants are a standard treatment protocol for replacing missing natural teeth. In most instances, Dental Implants are the strongest tooth replacement option available and is unparalleled by any other prosthetic tooth restoration treatment. They can withstand greater bite pressures than dentures and thus do not limit a patient’s chewing ability. One of the primary objectives of opting for Dental Implants is to obtain the same form and function as that of your natural teeth. Every dentist agrees that nothing can completely replace a healthy set of natural and clean teeth. However, when the loss of a tooth is inevitable; Dental Implant is the next best thing.
A dental implant is an artificial, titanium “root” which is placed into the jawbone and provides a permanent solution for replacing teeth. Dental implants offer an effective long-term solution for people suffering from missing teeth and other chronic dental problems. Unlike dentures and bridges, Dental implants are now considered the gold standard of care for replacing missing teeth. This is because they fit, feel and function like natural teeth.
There is a 98% success rate for Dental implants in healthy individuals and there is a 95% success rate for the survival of Dental implants even after 10 years in place. On the other hand, dentures start to lose their ability to work properly within the first 5 years in function.
How do Natural Teeth and Dental Implants differ?
Natural teeth are held by ligaments (periodontal ligament) that attach their roots into the gum and jawbone and therefore are allowed some form of movement. Dental implants are supported by a different means. They are fixed in place and form an intimate bond, via the process of “osseointegration”, with your jawbone and should not move at all. So in some contexts, your dental implant could be stronger and withstand more pressure than your natural teeth.
Why is it important to fix a missing tooth?
Missing teeth can have a severe impact on your daily life. It has an impact on your general health, appearance and self-esteem. The following is a list of the possible consequences of not replacing missing teeth:
- Change of facial structure: Your jaw is designed to operate with 28 teeth and so the surrounding teeth begin to drift into an empty space even if one tooth is out of the equation. The structure of your teeth defines your facial structure and lip profile. When teeth and bone volume are lost, the shape of your face is altered. This is predominantly because roots of the teeth that are missing form an integral part of your bone and facial structure. Hence, tooth loss can result in parts of the face appearing to be sunken in, causing asymmetry, thinning lips due to poor tooth support and an increase in fine lines/wrinkles.
Generally, the longer you wait after a tooth is extracted, the more bone volume will be lost and the more expensive and difficult it becomes to get teeth replaced.
- Loss of jaw bone: Jaw bone mass is preserved through biting and chewing. The area where your tooth stood will fail to receive the same amount of stimulation and will begin to disappear (a process known as resorption) if you are missing a tooth. The image below illustrates this process.
- The Domino Effect: The loss of a permanent teeth leads to a whole host of other problems if it is not replaced in a timely manner. The following x-ray image offers a perfect explanation.
- A missing lower tooth allows the opposing upper tooth to start growing down into the new empty space.
- Movement/Tipping of adjacent teeth into this space.
As teeth move, they lose contact with their neighbours and new spaces are created. - Increased food and plaque accumulation cause cavities and pockets to form under gums.
- Bone where tooth was removed begins to shrink resulting in decreased tooth support and gum disease.
- Nutritional effects: As remaining teeth do not have opposing teeth to bite down on to, missing teeth leads to the inability to chew food properly. When food is not chewed properly and mixed with enzymes in your saliva that prepare food for your stomach, your digestive system is unable to break the food down. Unchewed food has a major impact on your digestive processes, causing a reduced absorption of micronutrients and can lead to malnutrition.
- Speech problems: Many people do not realize that missing teeth can affect your speech as certain words are not able to be pronounced correctly. This can cause confidence issues.
- Psychological Effects: We all know that a smile is one of the defining features of many individuals. Losing a tooth is a traumatic experience. Various studies have shown that there is a strong correlation between tooth loss and negative consequences. According to the survey conducted by the Academy of General Dentistry, 86% listed social embarrassment as a highly impactful problem associated with missing teeth. The study also indicated that nearly 50% of patients with tooth loss have less social involvement than those with a complete smile. People often avoid smiling when they are without a complete set of teeth.
If you are suffering from tooth loss, it is essential for you to ensure that there is tooth replacement as soon as possible.
An Overview of the Implant Process
Assessment and Treatment Planning
Every patient is different and therefore treatment planning always begins with a detailed assessment. The initial steps involve history taking, examination, and special tests.
Crucial to this process is the examination of hard and soft tissue.
Hard tissue assessment includes evaluation of:
- the quality and quantity of bone through imaging,
- the surrounding teeth,
- individual patient factors (medical conditions, infection, and smoking) that may affect bone healing,
- bone-related pathology.
Soft tissue assessment includes investigation of:
- the history of periodontal diseases or the health of the gums,
- the smile line dimensions
- how the treatment will have an impact on the patients smile aesthetics.
Prior to placing a dental implant, a CT scan is normally taken to assess the final dimensional position, space requirements, and local anatomical structures surrounding the area of concern. Dental casts and photographs of your mouth may also be required.
Once a medical history is thoroughly evaluated and necessary information from a proper diagnosis is acquired, an appropriate treatment plan is formulated. One of the best pathways to succeed is by visualizing the optimal result and then from here, to plan backwards. This method allows us to put the most appropriate treatment plan forward to achieve the ideal result and set more realistic expectations
Tooth Removal:
Dental implant surgery involves several stages. Firstly, the teeth that cannot be saved are removed if they are not missing already. Generally, after tooth extraction the area is left to heal for 3 months prior to placing a dental implant.
In some instances, after removing teeth a bone graft is done straight away. A bone graft involves filling an extraction socket with bone substitute in order to preserve the socket dimensions and prevent further bone loss in the site of the extracted tooth. It allows the socket to heal while eliminating shrinkage of the area and collapsing of gum tissue. The bone graft is usually given 3-9 months to heal and results in a better foundation to place a future dental implant.
In many instances, a bone graft is unable to performed following tooth removal due to reasons such as existing infection in the area. In such cases, following tooth extraction, 8-16 weeks is typically needed for the natural bone to grow and fill the socket.
Implant Surgery Procedure:
During this part of the procedure an incision is made into the gum to expose the underlying bone, so that a titanium fixture (dental implant) can be inserted into the space of your missing tooth
In most cases, the bone grafting procedure is carried out during this stage- simultaneous to placement of the dental implant. Bone grafts may be minor or more complicated when there is greater bone deficiency. Generally, there is prolonged swelling of the area associated with bone grafting. We will advise the appropriate aftercare regime and medication to keep you comfortable following the procedure.
It is also important to mention that a dental implant can sometimes be placed simultaneous to the removal of your natural tooth. This procedure is known as having an ‘immediate implant’ and requires a certain criterion to have been met for greater predictability.
Pre-Operative Image
This image shows a lack of bone height at the floor of the sinus, where implants need to be positioned.
Post-Operative Image
This image shows bone grafted at the floor of the sinus to increase the bone height in order to secure dental implants. This procedure is commonly known as a ‘maxillary sinus lift’
As shown in this image, in cases when the bone width is too small, a bone graft may be carried out to restore the ridge structure. This is usually left to heal and integrate for 3-9months prior to dental implant placement. This is to ensure the implant is placed with greater initial stability.
Post-Surgery Healing:
Immediately following dental implant surgery, it is common for the jaw and gums to feel sore and tender. Additionally, patients may also experience some swelling or bruising. To assist with this, we may prescribe pain medication and a course of antibiotics. We also recommend home care such as rinsing your mouth with salted water and using an antiseptic mouthwash or antiseptic gel for the next few weeks (e.g. Curasept or Savacol). During this stage of initial recovery, crunchy, hard foods and foods with kernels and seeds should be avoided as these can irritate the gums and lodge between the implant and gum tissue. Avoiding highly seasoned, spicy and acidic foods also aids in a quicker recovery time. Over the next few weeks, pain and swelling would gradually reduce as the jawbone heals around the dental implant in the osseointegration process. This process can take four months or more.
Dental Implant Healing Phase:
As previously mentioned, the healing phase of a dental implant is scientifically known as osseointegration. During this process, your natural bone grows around the implant and accepts the new ‘foreign object’ as a part of your jawbone. Healing time can take up to 4-6 months. The healing period and the rate of implant integration may depend on factors such your general and dental health, the amount of bone grafting carried out, the quality of the bone in the area of concern and your medical status (including any medications).
While the implant heals, patients have the option to wear a replacement temporary tooth to ensure they are not left with a gap, especially in the aesthetic zone. The tooth may be in a form of a denture, a temporary bridge, temporary tooth attached to your implant or a customized clear retainer that fits over your teeth and carries an artificial plastic tooth. The most ideal solution will be utilized for every patient to suit their immediate needs.
Temporary Dentures
Temporary Tooth held by a clear stent
Once healing and the osseointegration process is completed, the dental implant is exposed, and a healing abutment is installed into the implant (see figure below).
The restorative phase/prosthetic phase
The restorative/prosthetic phase begins once the implant is well integrated.
Once your dental implant has had sufficient healing time, we can then attach the artificial tooth on top, completing the full implant retained restoration. Dentists require an equal amount of technical expertise as the surgical phase while restoring an implant due to biomechanical considerations, especially when multiple teeth are to be restored. Our aim is to work towards restoring the aesthetics of the smile, the functional bite (occlusion), and the structural integrity of the teeth to evenly distribute the forces of the implants.
Some of the steps involved in the restorative phase include:
- Removing any temporary restorations if in place. In some situations, they can be reused during the time of manufacturing the final prosthesis.
- Testing the degree of osseointegration – Special devices are used to look for any clinical movement of the implant. The presence of pain, swelling and infection are some of the criteria to be considered prior to placement of the restoration on the implant. Clinical tests are combined with dental radiography which determines the degree of bone formation around a dental implant.
- Attaching the implant crown – Once the healing process is completed and it has been confirmed that the implant is integrated, then artificial teeth are connected to the dental implant. Once the implant-crown is back from the dental laboratory, the fitting of the prosthesis into the implant is checked and necessary adjustments are made. Assessment of the prosthesis is made based on the shape, size, colour, gum profile and general appearance.
Call us or book online for a consultation with one our highly trained dentists about Dental Implants.
