What is a Dental Implant? A dental implant is often the best replacement option for missing teeth. The implant is an artificial tooth root that replaces the root or roots of a missing natural tooth. Once the implant is secured in the jaw bone, it is not visible and can be used to support a crown, a bridge, or a denture. Dental implants are an option for people who have lost a tooth or teeth due to decay, periodontal disease, or trauma. Implants can also be used for orthodontic tooth movement.


What are Dental Implants made of? Dental implants are made of titanium, a metal, which is strong, lightweight, and biocompatible. Therefore, the implant will not be rejected by the body. In fact, the implant actually fuses to the surrounding bone through a process called "osseointegration". When osseointegration occurs, the implant will not move or slip and the implant becomes a very strong foundation on which to place a crown, bridge, or removable prosthesis. Titanium is also used in artificial hips and knees. It has been reported that the success rate of dental implants is among the highest of any implanted surgical device.

What Types of Tooth Replacement Options Are There?

• Fixed Single Tooth Prosthesis. When a single tooth is lost, a single implant is used to replace the root of the missing tooth. An abutment which protrudes from the gums is then attached to the implant with a screw. Finally, a crown that looks and feels like a natural tooth is fabricated and cemented or screwed onto the abutment. The crown is not removed for cleaning or during sleep.


• Fixed Multiple Tooth Prosthesis. When three or more teeth in a row are lost, they can be replaced in a couple different ways. One way is to place an implant for each missing tooth and restore them in the manner described for the Fixed Single Tooth Prosthesis. As an option, two or more implants can sometimes be placed and then restored with a custom cemented or screw-retained bridge. The bridge is not removable.


• Removable Prosthesis. This type of prosthesis closely resembles a conventional removable denture. However, unlike a conventional denture which rests on the patient's gums, this prosthesis rests completely on the implants and is held securely in place. This is a good option for a patient missing all of the teeth in the upper or lower arch because it is more affordable than the "Fixed" options and because it is more comfortable and secure than a conventional denture. This type of prosthesis is also a good choice for the patient that cannot tolerate having the entire roof of the mouth covered. Furthermore, cleaning the implants is much easier with a removable prosthesis. A few different Removable options exist:



1. "Locator" or Ball-Retained. Both of these prostheses are connected to implants by male-female type attachments. A male or female attachment is connected to each implant and the opposite attachment is housed inside the denture. As the denture is placed on the implants, the male and female attachments are fit together. Two or more implants can be utilized for this prosthesis.


2. Bar-Retained. With this type of prosthesis, a cast bar or precision-milled bar is attached to all of the implants for additional strength and support of the restoration. The bar follows the curvature of the jawbone and sits above the gums. Locators may be applied or clips can be placed inside the prosthesis that attach to the bar when the prosthesis is placed over it. Two or more implants can also be used for this prosthesis.

3. Hybrid. A hybrid, or fixed-detachable prosthesis, is a combination of an implant-supported removable denture and a fixed bridge. With this solution, usually four to six implants are placed and a removable prosthesis is screwed into the implants which cannot be taken out by the patient. Only the dentist can remove this prosthesis.

4. "All-On-Four" or "Teeth-in-a-Day". This surgical/restorative technique was developed in Europe in the 1990's and is quickly emerging in the United States at this time. In this technique, implants are placed and when possible, a screw-retained prosthesis is attached to them the same day. The need for the patient to wear an interim removable denture during the healing phase is thereby eliminated. Unique to this technique is that the implants that are placed in the back of the mouth are angled forward. The benefits of this are that important anatomical structures can be avoided, longer implants can be used resulting in a more secure implant, and bone grafts can also be eliminated. As is the case with the hybrid prosthesis, this prosthesis cannot be removed by the patient.
   

What Advantages do Dental Implants offer? Implants offer many advantages, including:

• Improved Appearance. When a natural tooth is lost, some of the bone that supported the tooth is lost as well. Placing an implant in this space helps to stabilize the bone through osseointegration, preventing its loss. By preventing bone loss, the implant helps to maintain the jawbone's shape. The gums, cheeks and lips are therefore supported as well and a natural looking smile is preserved.
• Improved Speech. Many denture wearers have difficulty with speech due to the bulk of denture resin material. Dentures may also slip during function making speech difficult. Dental implants provide anchorage for your new prosthesis so that it will not slip.
• Improved Comfort. Conventional dentures and partial dentures rest on teeth and gum tissue. Implant- supported prostheses gain support from the implants thereby reducing the load to remaining teeth and gums. In turn, denture sore spots that typically occur with conventional dentures are eliminated.
• Improved Chewing Ability. Conventional dentures move away from the gums or slide during chewing which makes eating difficult. Denture adhesives are often used to keep the dentures from moving. Implant-retained prostheses are stable, allowing you to eat with confidence and without pain or the need for adhesives.
• Improved Self-Esteem. Dentures can make a person look and feel older than they really are. Dental implants can help you chew, speak, smile and look completely natural. This functionality imparts physical, social and psychological well-being as well as a renewed self-confidence.
• Improved Oral Health. When tooth-supported bridges are made to replace missing teeth, the natural teeth that support the bridge must be "cut down" so that crowns can be made for them. Once the bridge is in use, flossing becomes more difficult because all of the crowns of the bridge are attached to each other. Further decay or periodontal (gum) disease of the supporting teeth may lead to the replacement or total loss of the bridge. Alternatively, when implants are used to replace missing teeth, adjacent teeth are not cut down thereby preserving natural tooth structure. Because the implants are not natural, they cannot decay.
• Maintenance of Jawbone Volume and Density. Jawbone needs stimulation to maintain its volume and density. It gets this stimulation when we chew. When a tooth is lost, the lack of stimulation from chewing causes a loss of bone. A 25% loss of bone at an extraction site is possible in the first year following tooth loss. More bone may be lost in subsequent years. The more teeth are lost, the more function is lost. This can lead to aesthetic and functional problems for the patient. Bone needs stimulation to stay healthy. Because implants fuse to bone, they stabilize it and prevent further bone loss. Therefore, implants must be considered as a primary replacement of missing teeth.
• Longevity. Dental Implants now have a very high overall success rate. With proper oral hygiene, many implants will last a lifetime.

Are there any Disadvantages to having Dental Implants placed? The disadvantages to implant placement are few. They include:

• Surgery. An in-office surgical procedure is necessary for implant placement. A healing period is usually necessary before a crown, bridge, or removable prosthesis can be made.
• Cost. Dental implant procedures may incur an increase in cost when compared to conventional dentistry.
• Mechanical Failure. The fracture of abutment screws or the loosening of screws can occur. As is the case with tooth-supported crowns and bridges, the fracture of porcelain can also occur. The reported occurrence of these failures is less than 5%.

Are You a Candidate for Dental Implants? A proper diagnosis must be made before an implant can be placed. The best candidate for an implant is in good general and oral health. There must be healthy gums and an adequate amount of bone to support the implant. The patient must also be committed to good oral hygiene and regular dental visits. Implant placement in children is usually deferred until jaw growth is complete unless the implant is part of the orthodontic treatment plan.

Are there any Contraindications to having a Dental Implant placed? Behaviors such as heavy drinking and smoking can affect the success of an implant. Bruxism (tooth grinding or clenching) may not only reduce the prognosis for successful implant treatment initially but for the life of the patient as well. A custom made bruxism appliance worn at bedtime can help minimize the forces of bruxism.

There are also certain diseases and conditions that can affect whether dental implants may be right for you. For example, uncontrolled diabetes, heart disease, cancer, or radiation therapy to the head or neck may affect the fusion of the implant to the bone. Patients with these conditions need to be evaluated on an individual basis. Implants are contraindicated in patients who take intravenous bisphosphonates for breast cancer.

What is Involved in Getting a Dental Implant? A dental team plans the implant placement and restoration. This dental team consists of a surgeon who places the implants, a restorative dentist such as Dr. Mika who plans and places the restorations in the patient's mouth, and a dental laboratory technician who fabricates the restorations. All members of the team remain in close contact with each other during the case to assure optimum results. The first step in the process is the development of an individualized treatment plan that addresses your specific needs such as how many teeth you will need replaced. Prior to surgery, detailed radiographs will be taken. A CT scan may also be obtained to help plan the proper placement of the implants with a high degree of predictability. The dental team will determine what type of prosthesis will be fabricated followed by the number of implants, their length and diameter. A surgical stent with pre-drilled holes is sometimes fabricated to assist in implant placement.
How are Dental Implants Placed? Precision channels are first prepared in the jawbone into which the implants will be placed. The implant remains in intimate contact with the bone during healing. As the bone heals, the implant and bone fuse in a process called osseointegration and the implant becomes securely anchored to the bone.

How Successful is Dental Implant Surgery? Many studies have been conducted to determine the success rate for dental implants and most recent studies report success rates above 90%. Success is related to many factors including operator skill, the replacement tooth's purpose and position in the jaw, the quality and quantity of bone at the site, and the patient's general health, oral health, and oral hygiene.

Are There Any Risks Involved with Implant Surgery? As is the case with any dental surgery, there are some risks involved which include: Infection, injury to surrounding teeth or blood vessels, nerve damage, and sinus problems. After surgery, bruising and minor bleeding may be experienced and you can expect some swelling and pain at the implant site. Your surgeon will prescribe the appropriate pain medications to keep you comfortable.

When can Tooth Replacements be Placed on the Implants? After a hopeless natural tooth is removed, the jawbone is prepared for surgery which may involve bone grafting. Although some implants can be placed at the time of an extraction, three to four months of healing is usually required before an implant can be placed. After implant placement, it usually takes another three to six months for healing before a final tooth restoration can be placed. During these healing phases, a temporary denture can be made and placed for appearance. In certain cases, an implant and a restoration can be placed at the same time in a procedure called "Immediate Loading". In these cases, a temporary tooth is placed that cannot bite against an opposing tooth. This avoids forces on the implant while it osseointegrates with the bone. After osseointegration, a permanent tooth replacement is then placed that is capable of chewing.

When is Bone Grafting Necessary? For a successful implant procedure, there needs to be bone in the jaw that is both thick enough and strong enough to support an implant against the powerful forces of chewing as well as the forces of parafunction (grinding and clenching habits). Placing bone grafts at the time of tooth extraction can help maintain the bone volume necessary for implants.

Deformities in the upper and lower jaw can leave you with an inadequate amount of bone in which to place dental implants. These defects can be filled with bone graft material to build up the jawbone or ridge. Ridge modification can not only improve appearance but also improve the chances for successful implants.

The upper posterior jaw is one of the most difficult areas to place implants due to insufficient quantity and quality of bone and because of the proximity of the maxillary sinus. A sinus augmentation procedure can raise the sinus floor and develop more bone for the placement of implants. Without an adequate amount of bone volume or density, an implant procedure would surely fail due to loss of supporting bone (resorption).

What can cause a Dental Implant to Fail? The failure of an implant usually occurs when the implant does not fuse, or osseointegrate with the bone. If the implant does not fuse to the bone sufficiently, it is removed and the procedure can be done again at a later date. The risk of failure increases if the patient has any of the contraindications to implant placement discussed above. A condition called peri-implantitis may also develop. This is an inflammatory condition in the gums and bone around the implant which may result in bone loss and loss of the implant. Peri-implantitis is usually associated with a chronic infection and is seen most frequently in heavy smokers, diabetics, and in patients with poor oral hygiene.

How are Implants Maintained? Poor oral hygiene is one of the main reasons why some implants fail. Because implants are metal, they cannot decay. However, they are susceptible to peri-implantitis which is an inflammatory response to the buildup of bacterial biofilm that can result in the loss of the implant. Dental Implants do require maintenance and must be cared for just like natural teeth. Excellent oral hygiene including brushing and flossing is a necessity as are regular dental check-ups. At your check-up appointment, your hygienist will clean your tooth replacements as well as the implant parts. Dr. Mika will make sure your implants are stable and your tooth replacements are functioning properly.

Does Insurance Cover the Cost of Dental Implants? More and more insurance companies are helping to cover the cost of implants. Coverage varies from company to company and even between different plans within the same company. Dr. Mika's staff will help you to determine your level of coverage.