Dental Implants

Whether missing one tooth or all their teeth, more and more people are replacing the loss with dental implants. Having a more natural feel than traditional bridges or dentures, most implant procedures involve placing metal anchors into the bone of the jaw, allowing the anchor and bone to fuse, placing an extension or abutment in the anchor, and fixing a prosthetic tooth, or crown, on the extension. After undergoing this multi-step process, many patients find they have a better feeling, better looking, and more stable solution to their tooth loss than more traditional dental reconstructive approaches.

However, the process of obtaining dental implants can be time-consuming, expensive, and success is not guaranteed. A patient considering this surgery should gather as much information as possible about the procedure and about the dentist who will be performing the procedure. This procedure outline will provide an introduction to dental implants and common risks and benefits of the procedure and can provide guidance as to more detailed questions to ask your dentist or oral surgeon.

What are the most common benefits of this surgery?

Replacing a lost tooth is vital to maintaining the overall health and function of the surrounding teeth. It helps avoid tooth migration and loss of structure. It is necessary to avoid loss of bone from the jaw in that area. Implants are an effective means of counteracting these problems. Implants are also very strong and provide a feel as close to a natural tooth as can be currently achieved. Further, implants reduce the impact of the lost tooth on surrounding teeth, as traditional bridge structures often require reduction (filing down) of the two adjacent teeth to hold the bridge in place with crowns. Implanting avoids such alterations to the surrounding teeth when replacing a lost tooth.

Implants, when replacing dentures, provide even more benefits. Dentures are notorious for slipping at the worst possible moments. Poorly fitting dentures can even affect diet, restricting food selections to easily chewed foods. Implants eliminate the possibility of slipping or pinching, and allow food of almost all types to be eaten (other than extremely hard foods such as chewing on ice, pits, or popcorn kernels, which is very bad for the implants and not good for natural teeth, either). In short, implants are the closest way to surgically restore a natural tooth to its original condition.

What will happen at the initial consultation?

At the first appointment, the dentist will examine your teeth and determine whether implants are the solution to your dental problems. Often, x-rays are necessary to discover the state of the jawbone, particularly if the teeth have been lost for some time. This information can be used to determine if implants would work for you and, if so, what particular type of implant that would be best for your situation.

How is the procedure performed?

Under local anesthesia, the first step for many implant procedures is the exposure of the bone where the implant is to be made. This is followed by placement of the implant into the exposed jawbone. Implants that are placed in the bone are called endosteal implants and are made of titanium or a titanium alloy because this metal does not adversely interact with biological tissue. After placement of the implant a cover screw is put in and the wound is closed with stitches and allowed to heal. In general, placements in the lower jaw need to heal about three months, while placements in the upper jaw need to heal about six months.

After healing, in a second surgical procedure, the implant is uncovered, the cover screw is removed and a healing abutment or a temporary crown is placed in the implant. Temporary crowns are generally used for esthetic reasons, when the implant is in a place that is visible. Both healing abutments and temporary crowns allow the tissue around the implant to be trained to grow around the final prosthetics tooth. After about two months the soft tissue will be healed to receive the final prosthetic tooth.

Impressions are taken to make a custom abutment that takes into account the shape of the neck of the implant. The prosthetic tooth is sometimes attached to a gold cylinder that can be screwed into the abutment or it can be directly cemented onto the abutment. This multi-stage process, where the two surgical procedures are separated by a lengthy healing time, has proven to provide excellent stability in the final implant. Single step surgical implants are available, but skipping the healing step often loses some stability of the final implant.

How long does the surgery take?

Surgery time will vary greatly depending on the number of implants. For each of the two visits, one implant, going very smoothly, will take a little over an hour. Time goes up proportionally from there.

Where will the procedure be performed?

The implant procedure generally occurs in the office of a dentist, oral surgeon or periodontist.

How much pain is there?

Local anesthesia avoids the pain that would be involved in the surgical procedures during implantation and uncovering of the implant fixture. Most patients state that implants involve less pain and discomfort than a tooth extraction.

What can a patient expect after the procedure?

Following surgery, there will probably be bleeding, controlled by biting down on some gauze. Swelling may be controlled using an ice pack. Gums are generally sore after both surgeries for seven to ten days. You may be given antibiotics to take during the period immediately following the surgery.

What is the recovery period like?

Many people have very mild soreness, bleeding, or swelling, which can be treated with first aid and over the counter medicines and can return to work the day after surgery.

In between the first and second surgery, there is a recovery period of three to six months while the implants associate with the bone. This growth of the bones around the titanium posts may induce a few weeks of soreness. This discomfort can usually be controlled using over the counter medicine.

It is very important during your recovery to practice scrupulous oral hygiene. Poor care, resulting in chronic swelling of gum tissue, is a major contributor to implant failure. You may need to see your dentist about four times a year to keep track of the implant health.

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What is the long-term outcome like for most people?

For most people, implants last between fifteen and twenty-five years. They may last significantly longer, but implantation is a new procedure and data has not been gathered. Between about 5 and about 10% of implants fail, but they often can be replaced with another implant attempt.

Ideal Candidate:

The primary consideration for the suitability of dental implants for a particular patient is the amount and condition of the bone in the area where the implant is to be placed. With the loss of a tooth, the area of the jaw without the tooth naturally undergoes resorption, or a thinning, of the bone in that area. The less bone available in which to place the implant, the greater chance of the implant not "taking" in the region. A common type of implant, called root form implants due to their similarity in shape to a tooth root, actually undergo a bonding with the surrounding bone called Osseo integration. Without enough healthy bone at the implant site, this process cannot occur and the implant will fail.

There are two solutions commonly used for highly resorbed bone in the area where the implant is to occur. The first is bone grafting. This involves undergoing a procedure that moves bone from one place in the body to another to enlarge the bone structure at the implant site. Often bone can be moved from one place in the mouth to another. Sometimes a graft from a donor or an animal or artificial bone can be used if bone from the patient is not available. Grafting usually is done four to eight months before the implant procedure, to allow the graft a chance to heal before it is disturbed with the implant process. A second solution is the use of subperiosteal implants that ride above the bone but beneath the gum. These types of implants are not placed in the bone. A CAT scan is commonly used to obtain a model of the bone structure and then the implant fixture is molded to precisely fit the bone model.

Other important information

A further consideration as to suitability for implants is the patient's general health, especially whether or not the patient smokes. Although the exact cause of the connection is not known, dentists hypothesize that the nicotine in the cigarettes, known to shut down blood vessels, interferes with the healing of the dental implants. Whatever the cause, heavy smokers are known to have a higher failure rate for implants than those who do not smoke. Other chronic conditions that affect healing, such as cardiovascular diseases, diabetes, and immunosupression can also increase the chance of implant rejection.

Risks and Limitations:

The greatest risk following the surgical procedures is that the implant will fail. For implants placed within the bone, most failures occur within the first year and then occur at a rate of less than one percent per year thereafter. Location of the implant can also predict the risk of failure. Implants in the back upper jaw fail most often, followed by the front upper jaw, the back lower jaw, and the most success seen in implant of the front lower jaw. Overall, the success rate for all implants runs from 90 to 95%. Most failed implants can be replaced with a second attempt.

Questions to ask:

1. What are the expected benefits of this procedure and what are the chances of me getting these benefits?

2. What are the expected risks of this procedure and what are the chances of me suffering from these risks?

3. What is your estimated cost of the procedure?

4. How many procedures like mine have you done previously and can I talk to any of these patients?

5. Is there an alternative treatment that I should consider as well?

6. How long will the procedure take and how many appointments are necessary?

7. What percentages of patients have had significant complications? (The dentist should disclose this information to you.)

8. Will you repeat or correct procedures if it does not meet agreed upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The dentist should provide you with his/her policy on this issue.)

9. What kind of longevity can I expect?

10. May I see "before and after" photos of recent patients? The dentist should provide many photos of recent patients.

11. Could I observe the exact procedure I am considering before I decide to have it done? (Either on videotape or ask to view one in real life.)

12. What should I expect after the procedure, in terms of soreness, what to watch for, and any limitations?

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified clinicians who are able to answer specific questions related to your situation.