You may be considering dental implants for a lot of reasons: durability, functionality and imperviousness to decay. But perhaps the winning reason is how they will make you look — their life-like quality can restore a smile marred by missing or disfigured teeth. Achieving that result, though, requires your dental team to determine beforehand the state of your bone and gums, and treat any conditions that would interfere with the final result.
The first area to look at is the amount of bone available to support the implant. An adequate amount is necessary not only to stabilize the implant, but to also ensure proper placement needed to achieve the best “smile” result. Your specialist, then, will take steps to protect available bone during procedures, or even aid in building up the bone structure by inserting grafting materials that encourage new bone growth.
The degree of bone volume in adjacent natural teeth is also important because it can greatly affect the health of the papillae. This is the triangular-shaped gum tissue that occurs between each tooth that gives normal teeth their arched appearance. Insufficient bone in these areas could cause the papillae not to regenerate properly around the implant site, which creates unsightly dark spaces in the gum tissue known as “black hole disease.”
We must next consider the quality and health of your gum tissue. Patients whose gum tissue tends to be thin face difficulties during cosmetic surgical procedures; their thinner tissues are also more prone for objects behind them to be visible, including metal or other crown materials.
Our aim is an implant crown emerging from the surrounding gum tissue just as a natural tooth would. To achieve this requires knowing first what we have to work with regarding your bone and gums, and to address any issues that are problematic. One aid in this process is to affix a temporary “prototype” crown on the implant to wear while the permanent crown is manufactured. This allows you to “test-drive” the new look, and make adjustments in the final product regarding color and materials.
Accounting for all these factors — and then making adjustments along the way — will help ensure the final crown meets your expectations for function and appearance.
If you would like more information on the fabrication of implant crowns, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Matching Teeth & Implants.”
Normally, teeth erupt and grow in a symmetrical alignment: on the top palate, for example, the two central incisors take center stage; on either side are the lateral incisors, and then beside these the canines (cuspids).
But what happens when teeth don’t grow in? The result can be a smile that just doesn’t quite look right; more importantly, normal function is impaired because the person can’t grasp and chew food correctly.
These missing teeth are the result of a congenital (“from birth”) defect. It’s estimated that almost a quarter of all people are missing one or more wisdom teeth, and more than 5% are missing one or more second premolars or upper lateral incisors.
In a normal arch (the upper or lower set of teeth), each tooth type performs a particular role during eating. A missing tooth causes the remaining teeth to compensate, but beyond their capacity. The remaining teeth also tend to move to fill in any gaps left by the missing teeth, as when the eye teeth move toward the central incisors in the absence of the lateral incisors. This puts them out of position, so they can’t cover (“occlude”) their counterparts on the other arch and grasp food properly.
To improve the smile and restore proper chewing function it’s necessary to first move these “out of position” teeth to their correct position through orthodontics. We would then fill the gaps that result with life-like restorations (preferably dental implants with crowns) that resemble the type of tooth that should be there.
The restoration needs to be timed carefully, especially for young patients whose jaw structure has not fully developed. If implants are installed before the jaw’s full maturity (usually late teens or early twenties), the implant crowns may not appear to be the right length as the jawbone continues to grow. Since bone growth depends on the normal pressures exerted by the teeth, there may also be insufficient bone mass in the gap area to support a dental implant. Growing bone with bone-grafting material may be necessary before installing implants.
The total process could take many months or even years, depending on age and other conditions. In the end, though, the results can be astounding — better function and a vibrant, new smile.
If you would like more information on developmental problems with teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Permanent Teeth Don’t Grow.”
There’s no doubt dental implants are an effective choice for restoring both the form and function of missing teeth. But although they aren’t susceptible to tooth decay as with natural teeth, the bone and gum tissues that surround them are. Implants, therefore, require the same cleaning and maintenance as natural teeth.
A dental implant is actually a root replacement, a titanium post surgically imbedded in the jawbone. Because titanium is osteophilic (“bone-loving”), bone will naturally grow around it, making the implant more secure over time. Atop the implant is an abutment to which an artificial crown, the visible portion of the implant, is attached. The abutment is surrounded and supported by connective fibers within the gum tissue that hold the tissue against the implant surface.
This attachment differs significantly from natural teeth’s attachment to the jawbone, which attach to a tooth’s root through the periodontal ligament. The tiny fibers of the ligament hold teeth in place; its elasticity allows for tiny adjustments in a tooth’s position in response to changes in other teeth and bone. The ligament is also rich in blood supply that enriches the area with nutrients and provides resources to fight and resist infection.
An implant doesn’t have this same degree of defense against infection. Without proper hygiene, a layer of bacterial plaque known as biofilm can develop on the crown surface of both natural teeth and restorations. In addition, an infectious condition specific to implants known as peri-implantitis can set in the gum tissues surrounding the implant. This can lead to bone loss (sometimes very rapid) and eventual loss of the implant.
Although your daily hygiene won’t require special toothbrushes or other devices for implant cleaning, your professional cleanings will. The metal instruments (known as curettes) used to clean natural teeth could damage implant surfaces. The hygienist will use devices made of plastic or resin rather than metal, and nylon or plastic sheaths or tips on ultrasonic equipment that are specially designed for implant cleaning.
While maintaining dental implants requires diligence on both your part and ours, implants remain an effective, long-term choice for dental restoration. In fact, some studies indicate upwards of 95% success rate. Proper hygiene will greatly increase your chances for many years of service from your implants.
If you would like more information on properly maintaining your dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implant Maintenance.”
Dental implants have quickly become the restoration of choice for two basic reasons: they effectively restore the lost function of missing teeth and simultaneously rejuvenate the smile with their life-like appearance.
Achieving a life-like appearance, however, isn’t always a simple matter. A restoration in what we dentists call the “Smile Zone” (the upper front area that displays both teeth and the gum line when you smile) requires careful planning and technique to ensure they appear as life-like as possible.
Our first concern is whether there’s enough bone to fully anchor an implant. Bone is a living, dynamic tissue that goes through cycles of dissolving (resorption) and growth. The normal forces of biting and chewing transmit through healthy teeth and stimulate growth in the bone. When the teeth are missing and no longer transmit this pressure, the bone will eventually resorb only and not grow.
Adjacent teeth could also be affected with bone loss if the extraction was difficult and a bone graft was not placed into the extraction socket to preserve bone. This not only puts adjacent teeth at risk of gum and bone loss but can also have implications for the final smile appearance. This bone also supports the triangular tissue between teeth known as papillae which give teeth their arched appearance. If the bone isn’t adequate, there’s less hope that the papillae will regenerate.
With these concerns it’s very important to consider how the implant and crown emerges from the gums in the Smile Zone. Recent developments in implant design are helping in this regard. The design change of the top of the implant re-orients the gum tissues in relation to the implant from vertical to horizontal, which dentists call “platform switching.” This provides greater stabilization where bone mass is limited, and helps create a more aesthetically pleasing result. There are also other techniques, such as surgical tissue grafting of the papillae that can further enhance the final appearance.
Although creating a natural, life-like appearance in the Smile Zone is difficult, it’s not impossible. It’s important first to undergo a complete dental examination and profile, where we can advise you on your best options to achieve a beautiful smile.
If you would like more information on the relation of implants to the aesthetics of your smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Implant Aesthetics.”
Lose a baby tooth when you're a young kid, no big deal — you'll grow another. Lose a permanent one and there's cause for concern. For one thing, tooth loss is often a symptom of an underlying oral health problem, such as tooth decay or gum disease, so it's important to identify the cause and treat it to prevent it from progressing. It is equally important to replace the tooth — not simply for the immediate impact it can have on your smile or bite, but for long-term function, esthetics and the health of the bone that supports your teeth.
The primary options for tooth replacement are fixed bridgework and dental implants. Both result in esthetically pleasing outcomes; the main difference is how each is attached. With a bridge, the replacement tooth, referred to as a “pontic,” uses the two natural teeth on either side of the gap — referred to as “abutments” — for support. The pontic is sandwiched between two other crowns, which fit over and are bonded or cemented to the teeth on either side of the gap. To ensure the companion crowns fit properly, the enamel must be removed from each abutment.
Placing dental implants, by contrast, involves working only on the affected area. The “implant” is actually a small titanium rod with spiraling threads just like a miniature screw that is carefully inserted into the jawbone as though it were a natural root. The replacement tooth, a customized crown, is secured to the end portion of the implant by way of an intermediary referred to as an abutment, which firmly anchors it in place.
Both bridges and implants are natural looking, functional, predictable, and reliable. Each has its advantages and disadvantages, and based on your oral health, one may be more appropriate than the other.
If you would like more information on tooth loss and replacement, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “The Hidden Consequences of Losing Teeth” and “Dental Implants vs. Bridgework.”