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.”
Dental implants are a popular and effective restoration for lost teeth, if there’s enough bone present to support the implant. That might not be the case, however, because without the stimulation of the lost tooth, the bone may dissolve (resorb) over time. It’s possible, however, that you may need to re-grow bone in the back area of the upper jaw where your upper (maxillary) sinus is located.
Sinuses are air space cavities located throughout the skull. This feature allows your head to be light enough to be supported by your neck muscles. Inside each sinus is a membrane that lines your sinus cavities, nasal passages and other spaces. The maxillary sinus is located on each side of the face just below the eyes. Pyramidal in shape, the floor of the pyramid lies just above the upper back teeth.
A surgeon approaches the sinus through the mouth, with the objective of moving the sinus membrane up from the floor of the sinus. This is accomplished by placing bone-grafting material in the area. Over time the body uses the grafting material as a scaffold to produce new bone that then replaces the grafting material. The resulting new bone becomes the support for the implant.
If enough bone exists to stabilize an implant but not anchor it, then the surgeon can approach the sinus from the same opening that’s used for the intended implant site, insert the grafting material, and install the implant during the same procedure. If not, the surgeon creates a small “window” laterally over the teeth to access the sinus and insert the graft. The implant is installed a few months later after the new bone is created.
The procedure usually requires only a local anesthetic, although some patients may require additional sedation or anti-anxiety medication. After the surgery, you normally experience mild to moderate swelling and discomfort, about the same as having a tooth removed. All these symptoms can be managed with non-steroidal, anti-inflammatory pain medication and a decongestant for minor congestion in the sinus. We might also prescribe an antibiotic to help prevent infection.
Although this procedure adds another step and possibly more waiting time to implantation, it gives you an option you wouldn’t otherwise have — a life-like, effective replacement of your back teeth with dental implants.
If you would like more information on bone regeneration for 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 “Sinus Surgery.”
As dental implants increase in popularity, the surgical procedures to install them are becoming quite commonplace. Still, many people are nervous about this procedure, perhaps not really knowing what to expect. So if you're considering dental implants, here's a rundown of what happens before, during and after the procedure.
Dental implants are actually a tooth root replacement system. A post made of titanium is inserted into the jaw bone at the site of the missing tooth. Because of titanium's bone-friendly molecular structure bone cells naturally gravitate to its surface; over time the inserted post and bone will fuse. After a few weeks of this process, the post will be ready for a porcelain crown, bridge or overdenture to be attached to it.
Before the implant surgery you will undergo a complete dental exam. Everything is planned out in advance so that we know the exact location along the jaw to place the implants. In many cases we create a surgical template that can be used during surgery to identify these precise locations.
The procedure itself is painless for most patients, requiring only a local anesthesia. The procedure begins with small incisions in the gum tissue to allow us to see the precise point in the bone for the implant. We then create a small hole in the bone, using a drilling sequence of successive larger holes until we've achieved the best fit for the implant (during drilling you may experience a mild vibration). We then remove the implants from their sterile packaging, place them immediately into the drilled hole, then stitch the gum tissue back into place.
After surgery, most patients encounter only a mild level of discomfort for a day or two. This can be managed by prescription doses of common pain relievers like aspirin or ibuprofen, although we will use surgical strength ibuprofen. Rarely do we need to prescribe something stronger.
Once the implant fuses permanently with the bone, we then affix the final crown or other dental device in a painless procedure. This final step will give you back not only the use of your teeth, but a more appealing smile as well.
If you would like more information about dental implant surgery, 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 Surgery.”