Dental implants aren’t a modern luxury. History taught us that this is a common misconception. The first evidence of dental implants dates back to around 600 AD. X-rays taken of Mayan remains show bone growth around shells used to replace missing teeth in the lower jaw. From the 1500's through the 1800s, experiments were done with transplanting teeth.
The teeth to be implanted were usually obtained from underprivileged people or from "grave-robbers". The early 20th century saw the use of different types of metals to determine which was the most "biocompatible".
As the 1900’s progressed, dentists and surgeons experimented with not only implant design but also with placement and restorations.
Mid-century America produced the first sub-periosteal implant, as well as the first implant textbook to allow the expansion of implant knowledge.
Today, dental implants are a common, well-studied and accepted form of tooth replacement.
For most people the loss of a tooth or several teeth can have many repercussions. Teeth may be lost due to a variety of factors including gum disease, fracture, abscess, facial trauma or cavities.
The loss of one or many teeth may lead to any of the following problems:
- Esthetics – tooth loss affects the appearance of a smile, causing embarrassment or self-consciousness. The cheeks or facial features may appear sunken in when multiple or all teeth are missing.
- Function – Losing teeth affects the ability to chew and speak. Certain sounds such as "S" or "Th" may be difficult to say when teeth are missing. Chewing hard, crunchy or fibrous food may damage the gums and food may become lodged in spaces.
- Stress – when a tooth or teeth are lost, the remaining teeth absorb the forces. When a tooth is under more stress than it should be, it may shift, loosen or crack.
- Bite Changes – Over time, teeth will unevenly shift and drift to fill in the spaces. The result of the shifted teeth is an imbalanced bite that leads to premature wear, cracking and possible further tooth loss.
- Bone loss – the pressure of the teeth stimulates the jawbone. When there are no teeth to put force on the bone, the result is a shrinking of the bone. Over time, bone will become thinner and lower. Eventually, it may not be strong enough to support an implant or a denture comfortably.
If you have a missing tooth, today there are a variety of options to choose from to help improve your smile. Fixed dental bridges, removable dentures or dental implants may be chosen to replace missing teeth. Each one of these options has it pros and cons.
Most people choose dental implants for their longevity and esthetics. Dental Implants are most often made of titanium. The titanium is medical grade, similar to the metal used in joint replacements. The implants are placed subgingivally (below the gum) and into the bone. They mimic the root of a tooth.
Over time (usually 4-6 months), the bone of the jaw grows around the implants and locks the implants into place. This process is called osseointegration. Following successful osseointegration the implants are ready to be restored.
Fortunately, there are several implant restoration options to maintain a healthy, functioning smile. Dental implants may be used in many ways from replacing a single tooth to full mouth rehabilitation:
- Single Tooth – A single implant replaces a single missing tooth. A single crown is placed on top of the implant.
- Multiple Teeth – Multiple implants may be placed and a fixed bridge may be attached to them
- All teeth – Multiple implants may be placed and a fixed or removable denture is made. The implants firmly hold the prosthesis in place allowing you to chew more food than was possible with dentures alone. It also eliminates the worry of dentures moving or falling out when speaking.
Dental implants have a very high success rate (close to 98%) and with proper care and maintenance, they can last a lifetime.
Which patients are candidates for implants?
The majority of patients choose dental implants because they are more durable and they do not want to cut down adjacent teeth, as would be necessary with a fixed dental bridge. Patients who are candidates for implants:
- are in good general health and see a medical doctor regularly for check ups
- are in good oral health and have a mouth free from gum disease
- want to improve the tightness and stability of their dentures without adhesive
- want to improve esthetics, speaking and eating
- do not want to cut down natural teeth to support a fixed bridge
Not everyone is a candidate to receive dental implants. Patients with poor bone structure or not enough supporting bone may not have jaws strong enough to hold the implants. In many cases bone grafting or a procedure called a sinus lift may be performed to shape and rebuild the bone. However, in more severe cases there may be too little bone to rebuild.
Patients with certain medical conditions such as uncontrolled diabetes or osteoporosis may not be able to have dental implants. Additionally, smokers may have a greater chance of implant failure or delayed healing.
The Dental Team
Once a patient has made the decision to have dental implants and is determined to be a good candidate, a dental team will work together to ensure the best outcome is obtained.
Treatment planning and record taking are essential steps to allow a seamless surgery and restoration. X-rays and cone beam (CT), models, wax-ups and surgical stents may be utilized as well.
Oral Surgeons, Periodontists and some General Dentists may perform the implant surgery, placing the implants into the bone. Most patients tolerate surgery well.
The surgery begins with anesthesia, either local (Novocain) or sedation. The dentist may use a guide to place the implant in the optimal position. The implant is drilled into the bone and tightened. Sutures are placed so as to cover the implant with the gum. Sometimes a temporary tooth is placed with a denture or temporary crown.
When healing is successful and complete (usually 4-6 months), a second minor surgery is necessary to expose the implant. A minor incision is created and a healing cap is placed on the implant. The gum is closed around the cap but leaves the cap exposed. Once this has healed (usually in a couple weeks), a Prosthodontist or General Dentist will continue the process and provide the final prosthesis.
In a typical single implant case, the implant is restored in two possible ways:
- Cement-retained – a part called an abutment is screwed to the implant. It sticks out of the gum and a crown/tooth is cemented to the abutment
- Screw-retained – a crown is screwed directly to the implant, eliminating the cement.
Depending on the case and the doctor's preference, the dentist may choose either one of these options. Both cement and screw retained implants are designed to give the patient many years of use of their new tooth.
A removable denture held in place with implants is called an overdenture. If implants are placed to hold a removable denture in place, abutments are placed on the implants, just as they would for cement-retained crowns. Rather than crowns going over the abutments, attachments are placed inside the denture.
These attachments engage the abutments and usually allow the overdenture to "snap" into place. This provides greater retention and less movement of the denture, making it easier to speak and eat. The most common place for an overdenture is the lower jaw, however upper overdentures are advantageous as well.
Having an overdenture on the upper jaw allows the palate (roof of mouth) to be exposed rather than covered by the denture. When the palate is not covered by the denture, the mouth can feel more. Patients may notice they can speak more freely and taste their food better.
Although dental implants cannot get cavities, they are susceptible to infection and gum disease. Proper home care is necessary to ensure the gum and bone around the implants remain healthy.
Patients with implants should brush and floss around their implants and see their dentist regularly for maintenance and observation. The dentist or hygienist will clean around the implants, measure that the gum is still tight and no infection is present and ensure that all parts are working properly.
In the past, dental insurance did not cover the cost of implants. In more recent years, some dental insurances have begun covering a portion of the cost of implants and implant crowns.
Given the fact that implants can last a lifetime, they are more cost effective than fixed bridges or removable dentures that need to be replaced after several years of use.
If you are missing any of your natural teeth, a dental implant can be a permanent solution to fixing your smile.
Please call us at (203) 377-9300 to schedule an appointment.