DENTAL IMPLANTS

When considering replacing a missing tooth or several teeth, the following options are available:

  1. Dentures (a removable plate with false teeth)
  2. Bridge (Attaching a false tooth to an existing tooth)
  3. Dental Implants
  4. Leave it as a gap

Each treatment option has its advantages and disadvantages. In this page, we’ll be discussing Dental Implants.

A dental implant is a metal rod/screw, which is inserted into the jaw bone surgically to allow a false tooth (crown) or denture to be attached over it. It is considered to be the next best thing to a real tooth.

Dental Implants can be used in a wide variety of ways, but these are the most common:

  1. As replacement of a single tooth
  2. As attachments for retaining a denture

CONSULTATION AND INFORMATION GATHERING

During the initial consultation, several imaging investigations will be required to assess the existing quantity and quality of jaw bone, and the position of important vital structures (sinuses, blood vessels and nerves) around the implant area. These imaging investigations are usually:

  1. Orthopatomogram (OPG) – a large x-ray of your jaws
  2. Cone Beam CT – provides a 3 Dimensional image of the area

Your medical history will be checked to make sure you don’t have any medical conditions that may affect bleeding and healing. So it is important that you tell the operating dentist about these conditions, and any medications you are taking. (e.g. warfarin, bisphosphonates, etc…)

Impressions of your upper and lower jaw for study models will also be required for:

  1. Helping with the planning process,
  2. Fabrication of stents and guides to help with the implant placement,
  3. Making a temporary prosthesis to fill the gap during the healing process(temporary denture/bridge)

Once all the investigations, assessments and planning are done, you are ready for the procedure.

This is also when a price quote will be given.

*What is a prosthesis anyway? In medicine, a prosthesis is an artificial fabricated device to replace a missing body part (i.e. a missing tooth). Think Robocop and his full body metal prosthesis. In a dental sense, a prosthesis can be a crown, denture, bridge (all of which can be supported by dental implants.)

CONSTRUCTION OF STENTS AND TEMPORARY PROSTHESIS

Stent

In cases where 2 or more implants are placed at the same time, it is very important that the surgeon knows exactly where to place the implants in the mouth, and to place them parallel to each other. The stent helps with this.

Temporary Prosthesis

A temporary prosthesis (e.g. – temporary denture) maybe required for replacement of front teeth, while the implant settles under the gums and bone. Healing and bony integration usually takes about 3-6 months. The prosthesis acts as protection to prevent undue trauma or pressure on the implant during this healing period, and maintains the space between teeth. Besides, You wouldn’t want to be without a front tooth for 3 – 6 months right?

The stent and temporary prosthesis is not always required in every case.

PLACEMENT OF THE IMPLANTS

Once the temporary prosthesis and stent is ready, you will be ready for the dental implants. This can take an hour or more, depending on the number of implants placed, and if extra bone material is needed (if there isn’t enough bone surrounding the implant). The area will be numbed up, and the implants will need to be inserted surgically.

Most of the time, depending on how many implants are placed, you will be awake for the procedure, and numbed up in the area where the implants are inserted. The most you may feel is some vibration during the drilling and placement of the implant, very similar to having a filling done.

Once the implants are in, and the surgical area is stitched and closed over, the temporary prosthesis can be inserted. We now wait for 3-6 months for things to heal up. The implants will be stitched over by the gums, so you won’t see the implants as it heals.

*Not all cases need a temporary prothesis. If you don’t mind having a missing tooth while waiting, there is no need for a temporary one. Eg. replacing a molar back tooth.

**If you have an existing tooth which will needs to be removed and replaced by implants, there is a technique where an implant can be placed immediately after the extraction. The risk of failure is slightly higher in this case, but can be considered.

IMPRESSION FOR THE PERMANENT PROSTHESIS

After 3-6 months, the implants are checked that they are firmly in place, with no loosening or swelling or infection around the area. An x-ray may need to be taken at this point as well.

If all is well, the proper permanent prosthesis (crown, denture) is ready to be constructed. This will require another small surgical procedure to expose the tops of the implants for some more impressions.

*** This part of the procedure is a bit technical to explain. So just trust your dentist as he does the impressions. There will be a few attachments connect to the implant as he does this. It also depends on which prosthesis is being made.

If a denture is being made, you will need to go through the stages of making the denture first. (which can take a 3-4 extra visits)

After the impressions, a little screw-like abutment ‘thing’ will be placed over the implant. This time, the implants will not be covered completely by the gums. The gums will be stitched around the abutment, in preparation for the new prosthesis.

PLACEMENT OF THE PROSTHESIS

In a few weeks, when the permanent prosthesis (crown/denture) has been constructed, and tried in, it is either screwed, or cemented, or clipped on to the exposed implants.

Further adjustments will need to be made to the crown or denture, but the implant procedure is now complete.

REVIEWS

These appointments are very important to ensure the implants are successful. The reviews take place every 1, 3, 6, 12 months with possible x-rays, to check bone levels and its integration to the implants.

So there you have it. It is really difficult to talk about dental implants in its entirety in a small page. Very thick books have been written about it. But if you have further questions about it, feel free to ask your dentist.

Every procedure in dentistry have advantages, disadvantages and risks. Have a read below for some of them…

ADVANTAGES

  1. It is Permanent – unlike dentures which flop around, dental implants are integrated into the bone. This means you don’t need to take the implants out at night before you go to sleep.
  2. If you have full dentures, attaching them to dental implants will make them 100x more retentive
  3. High success rate –dental implants have a very high success rate of up to 95-98% and can last a very long time if done well and taken care of.
  4. No need to adjust or shave off existing teeth – unlike bridges, the implant stands independent of other teeth, which means no adjustments or attachments to other teeth

DISADVANTAGES

  1. Requires a surgical procedure – yes, in order integrate the implant to the jaw bone, it needs to be embedded into position by surgery
  2. Not immediate – depending on the position of the tooth, you may require an intermediate restoration while waiting for integration of implant
  3. Relatively more expensive than other options, however, as the technology becomes more available and improves, dental implants are getting more affordable.
  4. Takes time to integrate to the bone – round about 3-6 months, depending on which part of the jaw it is placed

GENERAL RISKS

  1. Bleeding, pain, swelling
  2. Non-healing surgical site
  3. Non-integration of implants to the bone
  4. Damage to important structures – nerves, sinus, existing teeth
  5. Peri implantitis – inflammation of the tissues around the implant
  6. SMOKING will ensure implants failure!
  7. Non Parallelism – when placing more than 1 implant for a full denture, the implants are placed parallel to each other. This is why accurate imaging and stents are made to help guide the implants in the right position and direction.