Replacing Missing Teeth with Dental Implants
The best way to describe a dental implant is to compare it to a real tooth. A natural tooth consists of a root and crown. The part of the tooth that you can see is called the crown. Beneath the crown and hidden below the gums is the root, which anchors the tooth to the jawbone. When you lose a tooth, you lose both the root and the crown. To replace a tooth, we first have to replace the root. Essentially, a dental implant functions as a brand new root. This titanium root is fitted into a socket that we create in your jaw, replacing the lost root of your natural tooth. Once an implant has been placed into the jaw, the bone around the implant will need to heal for 3 to 6 months. The time required depends on how dense and sturdy the bone is. When the initial phase of healing is completed, a tapered support post called an abutment will be secured to the top of the implant. The new crown will be secured to this abutment.
Whether just one or all of your teeth are missing, several treatment options using dental implants are available. We hope this web site helps you understand the general treatment options available to you. Your particular circumstances and treatment needs are unique. In consultation, we can focus on the specifics of your problem and help you decide what’s best.
The Team Approach to Dental Implant Restorations It’s impossible for a dentist to be an expert on every condition and a master of every possible treatment involved in dentistry. Dr. Stout’s board certified training in oral and maxillofacial surgery has allowed him to become highly skilled at the surgical aspects of dental implant treatment and to perform these procedures at the very highest level. Your restoring dentist (general dentist or prosthodontist) provides treatment in restoring the implanted roots. This involves making the attachments and crowns that will be placed permanently on the implants after healing of the implants is complete. As a team, both Dr. Stout and your restoring dentist will work closely together to plan and carry out a successful treatment for you.
How Are Dental Implants Placed?
An implant can be placed where the missing tooth was located about 5 months after a tooth is removed. When a tooth is removed, if the bony socket walls are intact, your body will grow new bone to refill the empty socket. Sometimes bone graft material is placed in the socket to assist this process.
The implant placement surgery is done in our office surgery center with the aid of sedation anesthesia. It takes about an hour for one implant and 2 hours or longer for multiple implants. The placement of implants consists of several steps. First, we’ll attach heart and breathing safety monitors, and you will receive sedating medication. Once you’re comfortably asleep, we’ll also administer local anesthetic to the areas where the implants will be placed. A small incision is made into the gum tissue revealing the bone into which the implants will be placed. Using special instruments, a socket is carefully created in the bone. The implanted root is placed in the socket and rotated into a firm and ideal position. Sutures are used to close the wounds, and you will awaken from the sedation rather quickly. Pain-relieving medications and antibiotics are usually given, and the recovery is surprisingly mild.
Once the implant is inserted into the bone, treatment is completed in one of two ways. In the traditional two-stage approach, the site is left undisturbed to allow the implant to heal for 3 to 6 months. Then a second surgery called an uncovering surgery will be performed, typically with just local anesthetic to numb the gum tissue. In this procedure, the gum is opened and the top of the implant located. A temporary healing cap is attached to the top of the implant and the gum tissue is sutured around the healing cap, which now remains exposed. Gums need to heal for 2 to 4 weeks after this procedure before impressions can be taken and the final crown can be made. This is called a two-stage approach and is appropriate in most aesthetic areas such as the front teeth.
An alternative approach is called the single-stage approach in which the healing cap is connected at the same time the implant is placed into the socket in the bone. The gum tissue is then sutured around but not over the top of the healing cap, just as in the uncovering surgery. The one-step approach makes it possible to avoid a second surgical procedure and often speeds up the treatment time to complete the restorations. This approach is commonly used in posterior areas of the mouth.
Once the surgical procedures have been completed and the implanted root has healed a sufficient period of time, the surgical phase of your treatment is completed and the restorative phase begins. Your restoring dentist will take impressions of the implant position and record the color and shape of your natural teeth. With this information, your dentist will work very closely with the laboratory technician to fabricate a restored tooth or that is functionally sturdy and esthetically pleasing.
Most of the time, one implant is placed for each missing tooth root. If several adjacent teeth are missing, two or more implants are used to create an implant supported bridge. The number of appointments and amount of time required for restorations depends on the number of teeth to be replaced. For a simple restoration, as few as two appointments are needed for the restorative phase. More extensive restorations may require additional appointments.
Replacing Lost Bone Support
Like natural teeth, dental implants require a sufficient amount of sturdy bone to support the implant. When a healthy tooth is present, the tooth itself actually stimulates the surrounding jawbone to maintain the strength of the bone. Once the stimulation of the tooth root is gone, the bone starts to shrink away or atrophy, leaving the jaw bone too narrow to accommodate an implant. As much as one-third of your jaw’s thickness can be lost in the year following tooth extraction.
Replacing All the Teeth in a Jaw
If you are missing all the teeth in one or both jaws, you may consider a number of treatment options using dental implants. Although a few patients have little difficult wearing an upper denture, most find it difficult to wear lower dentures because they are so often loose or uncomfortable. Placing implants to restore chewing function is very common in this situation, even for patients in their 70's and 80's. Poor general health and smoking are significant negatives, but all other patients can be excellent candidates.
For restoring a jaw missing all the teeth, the first option is to have 2 or 4 implants placed in your jaw and a modified denture called an overdenture made that snaps onto these implants. This allows your denture to be more stable while speaking and chewing than it could ever be without implants. This is a very common solution for the lower jaw.
A second option involves placing four to six implants in the jaw. After healing is complete, the implants are connected with a custom made support bar. Your denture will be made with special retention clips inside that attach onto the support bar allowing the denture to snap firmly in place. Since the denture does not actually rest on the moveable gums at all, this option is more stable than the first option. Your denture will still be removable for easy cleaning and maintenance. When this technique is used on the upper jaw, it is generally possible to avoid covering the roof of your mouth with the denture. This will allow you to better taste your food and to better sense food temperature. Your denture will also feel much more natural.
Frequently Asked Questions about Dental Implants
How long will the implants last?
Implants last a long time. Long term studies show about a 95 percent success rate, which compares favorably with other areas in the body that receive implant placement such as hips or knees. The success rate actually varies depending on the location within the mouth. The lower jaw has a slightly better success rate than the upper and the front teeth better than back teeth.
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What can I use for teeth while the implants are healing?
Many options are available to allow you to have teeth during this time and these options are tailored to your specific needs. For a single tooth, a temporary removable tooth such as a flipper or even a temporary cemented bridge can be made. If all your teeth are missing we can usually modify your present complete denture or make you a new temporary denture to wear during the healing phase. These dentures can typically be worn right after the implant surgery.
How do I clean my implants?
As with natural teeth, it is important that you clean implant supported restorations regularly with a toothbrush, floss and other recommended aids. You should also visit your restoring dentist at least twice each year for hygiene and maintenance.
Am I a good candidate?
In general, if your are motivated to obtain the benefits of dental implants, you are probably an excellent candidate. This is true even if you don’t consider your age or general health to be ideal. Smoking, poor oral hygiene (with a poor prospect for improvement) or very poor general health are concerns that can be discussed at consultation.
Several circumstances that do not disqualify you or make you a poor candidate are advancing age (We find no correlation between age and implant success.) A history of prior smoking, or well controlled systemic diseases like high blood pressure or diabetes, arthritis, or even osteoporosis.
What are the potential problems?
The risks of dental implant surgery are similar to that of extraction of teeth, but the recovery is usually milder. Most of our patients feel that the recovery from implant procedures was more comfortable than it was for the extractions. We always prescribe medications to keep you comfortable after the surgery.
If a dental implant fails to heal properly or loosens after a period of time, it is removed in the same manner that a tooth is extracted. After the site heals, another implant can usually be replaced. Grafted bone can fail to heal properly with the recipient site and rarely requires revision. Occasionally, we do touch up surgery to improve the gums surrounding the implant.
Serious complications are extremely remote and the potential is related to your general health. Dr. Stout will review your health carefully and discuss any possibility for serious complications.
What do these services cost?
Once you are familiar with your treatment options, we will give you an estimate of all the expenses involved in placing and restoring your dental implants. Since dental implant treatment involves procedures performed by Dr. Stout and by your restoring dentist, you should be careful to make sure that you have an accurate estimate from both doctors who will be involved in your care. The cost for your surgical phase of treatment includes placement of the implant itself plus any bone and gum tissue grafting that are needed. The treatment done by your restoring dentist will include fees for abutments and the crowns, dentures, and retention clips or devices. You should also become informed of any fees for the temporary restoration and for future periodic maintenance such as hygiene visits, tissue conditioners, and occasional repairs.
Most dental insurance plans do not cover implant surgical procedures but may cover the restorative treatments. However, medical insurance will often cover treatment to replace teeth that were lost due to accidents or tumors. We will assist you in estimating what your actual costs will be after we evaluate your insurance coverage.
How do I get started?
We invite you to call our office at (805) 981-8144 for an initial consultation and exam so that we can discuss your needs and discuss possible treatment solutions. All patients are welcome. We do not require a written or verbal referral from your restorative dentist in order for you to meet with us for consultation. We look forward to the opportunity to answer any questions you have and help you decide if dental implant treatment is right for you.
