Modern dental implants have been used for over 40 years by dentists throughout the world. They are made of surgical level titanium and offers a permanent solution for one or more missing teeth. Titanium is also used in other medical applications, including hip and knee implants. The properties of titanium allow the bones of the human body to integrate to the surface. This process is known as osseointegration.
A natural tooth consists of a root and a crown. If you compare natural teeth to implant-supported replacement teeth, you’ll see they have the same basic parts. Both have a crown (the visible part used to chew food). Both have a root that holds the tooth securely under the gum and is anchored into the jaw. When you lose a tooth, you lose both the root and the crown. To replace the tooth, the surgeon first replaces the root with a small dental implant.
Dental implants are designed to provide a foundation for replacement teeth that look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. In addition, dental implants can help preserve facial structure, preventing the bone deterioration which occurs when teeth are missing.
Time is allowed for the bone to heal and grow around the dental implant, usually 3 to 6 months. The bone bonds with the titanium, creating a strong foundation for artificial teeth. A support post (abutment) is then placed on the implant and a new replacement tooth (crown) is placed on top of the abutment. In many cases, a temporary replacement tooth can be attached to the implant immediately after it is placed.
If all of your teeth are missing, a variety of treatment options are available to support the replacement teeth. You can have multiple crowns joined together and fixed to dental implants. Or even have a full denture clip onto implants for better grip.
Sometimes, there may be an inadequate bone for implant placement if your tooth was removed many years ago and your bone is extremely thin. In this case, a bone graft can be placed next to the thin bone and allowed to heal for up to six(6) months. After the graft has fused to your pre-existing bone, the implant will then be placed. Bone grafting is usually a relatively comfortable office procedure. Many different bone-grafting materials are available, including your own bone.
Just like LASIK eye surgery, dental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life.
Overview of Implant Placement
The Surgical Procedure
The procedure to place an implant takes 30 to 60 minutes for one implant and only 2 to 3 hours for multiple implants. The number of appointments and time required vary from patient to patient. The surgeon will bring great precision and attention to the details of your case.
Prior to surgery, you may receive antibiotics and pain-control medications for greater comfort. A local anesthetic will be administered to numb the area where the implant will be placed.
When you are comfortable, the surgeon makes a small incision in the gum tissue to reveal the bone, creates space using special instruments, and gently inserts the titanium implant. The top of this implant is often visible through the gum. Sometimes it is better in the early stages of healing to have the implant covered by the gum tissue.
The Healing Phase
Now the healing begins. The length of time varies from person to person, depending upon the quality and quantity of bone. In some cases, implants may be restored immediately after they are placed. The surgeon will advise you on follow-up care and timing. After the initial phase of healing, the surgeon places an abutment (support post) or a healing cap onto the implant during a brief follow-up visit. This allows gum tissue to mature and provides access to the implant.
Occasionally, impressions are made at the time the implant is placed. This enables the crown to be ready when the implants have healed. How long your mouth needs to heal is determined by a variety of factors. Follow-up care (one to four appointments) is usually needed to ensure that your mouth is healing well and to determine when you are ready for the restorative phase of your treatment.
It may be beneficial to perform a soft tissue graft to obtain stronger, more easily cleaned and natural appearing gum tissue in the area around the implant. This process involves moving a small amount of gum tissue from one part of your mouth to the area around the implant. Most often, it is a brief and relatively comfortable procedure.
Whether it’s one tooth or all of your teeth that are being replaced, your dentist will complete the restoration by fitting the replacement tooth (crown) to the dental implant.
When Are Dental Implants Placed?
Implants are often placed several months after extraction. At times, an implant may be placed immediately after extraction of a tooth. This may involve a little more risk, but it simplifies the process—you won’t have to wait for another appointment to place the implant. When infection or other problems with the bone are present, immediate implant placement is not the best treatment.
If your tooth has been missing for some time, the adjacent support bone is likely to grow thinner and shrink. This occurs because the root of the natural tooth has to be present to stimulate the bone. As much as one-third of your jaw’s thickness can be lost in the year following tooth extraction. If you are missing enough bone, you may benefit from having additional bone grafted into the area. This ensures the implant will be adequately supported when it is placed in the jaw.
How Many Implants Do I Need?
Most frequently, one implant per missing tooth is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants.
Missing All Lower Teeth
Although many patients have no problem wearing an upper denture, some people find it difficult to wear and eat with lower dentures. Several implant-supported replacement options are available if you are missing all of your lower teeth.
Ball Attachment Denture
One option is to have two implants placed in your lower jaw and a denture made that snaps onto these implants. This option allows your lower denture to be more stable while chewing than without implants. However, there will still be the movement of your lower denture, and sore spots will occur if any food particles, especially seeds, are caught under it. As with all removable replacement teeth, you still will need periodic appointments for denture adjustment.
Bar Attachment Denture
Another option involves placing four to six implants, depending on your jaw size or shape, into your lower jaw. After healing is complete, the implants are connected with a custom-made support bar. Your denture will be made with special internal retention clips that attach onto the support bar, enabling the denture to snap firmly into place. This is called an “overdenture.” The advantage of this option is that it is much more stable than the first option and allows very little denture movement. Your denture is still removable for easy cleaning and maintenance.
Screw Retained Denture
A third option involves placing five or more implants in your jaw and attaching a permanent denture. Your denture is held in place by screws or clasps that secure it to the support posts or bar. It doesn’t touch the gum tissue, which allows you to clean under the denture without removing it. This denture will replace all your missing lower teeth and will not be removed except at maintenance visits. Although cleaning under your denture without removing it is more time consuming and requires more dexterity, many patients who want a permanent denture prefer this option.
Individual Implants
The final option is to have all your teeth individually replaced so that they will appear to be growing out of your gum tissue and will most closely resemble the appearance of your natural teeth. This option usually requires eight or more implants. Separate abutments or support posts for each one of these implants will be made and crowns for each missing tooth will be placed. The teeth are often joined together for sinus grafting to replace bone height strength and support. Overall, this is the most costly option, because it requires the most implants and individual replacement tooth fabrication. Your replacement options may also be limited by the current size and shape of your jawbone.
What If I’m Missing All Of My Upper Teeth?
A similar range of treatment options is also available for your upper jaw. However, because the bone is not as hard as that in the lower jaw, people often need more implants to support their new replacement teeth. Depending upon the number of implants to be placed, it may be possible to eliminate the need for covering the roof of your mouth with a complete denture. This option allows you to fully taste your food and gives you a better sense of its temperature. Your denture will feel more natural. You will still have a removable denture, which makes cleaning the support bar and denture much easier.
Implant Retained Upper Denture
Depending upon the number of implants to be placed, it may be possible to eliminate the need for covering the roof of your mouth with a complete denture. This option allows you to fully taste your food and gives you a better sense of its temperature. Your denture will feel more natural. You will still have a removable denture, which makes cleaning the support bar and denture much easier.
Individual Upper Implants
If you want a restoration that is similar to your natural teeth and therefore not removable, you probably will need eight to ten individual implants placed. This is followed after healing by the placement of the abutments and new replacement crowns.
After Placement Of Dental Implants (Post-op)
Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.
Bleeding
Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues, please call for further instructions.
Swelling
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag, or a plastic bag, or towel filled with ice on the cheek in the area of surgery. Apply the ice continuously, as often as possible, for the first 36 hours.
Diet
Drink plenty of fluids. Avoid hot liquids or food. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed.
Pain
You should begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one to two Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol. Ibuprofen bought over the counter comes in 200 mg tablets. Two to three tablets may be taken every three to four hours as needed for pain. For severe pain, the prescribed medication should be taken as directed. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
Antibiotics
Be sure to take the prescribed antibiotics as directed to help prevent infection.
Oral Hygiene
Good oral hygiene is essential to good healing. The night of surgery, use the prescribed Peridex Oral Rinse before bed. The day after surgery, the Peridex should be used twice daily, after breakfast and before bed. Be sure to rinse for at least 30 seconds then spit it out. Warm salt-water rinses (one teaspoon of salt in a cup of warm water) should be used at least four to five times a day, as well, especially after meals. Brushing your teeth with the healing abutments is not a problem. Be gentle initially when brushing the surgical areas.
Activity
Keep physical activities to a minimum immediately following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.
Wearing Your Prosthesis
Partial dentures, flippers, or full dentures should not be used immediately after surgery and for at least seven days, unless otherwise specified by your dentist.