Dental Implants: Replacing a Single Tooth

What are your choices when you lose all of your teeth in the lower arch due to periodontal disease, fracture or deep decay? Tooth replacement options include implant-supported tooth replacement, fixed (cemented) bridgework or removable partial dentures.

Dental Implants are the most progressive and natural option in tooth replacement. State-of-the-art technology provides predictable, comfortable, and esthetic results allowing high quality eating, speaking and smiling. An increased confidence accompanies an improved quality of life. Currently most dental implant systems available are designed around the concepts developed several years ago by researcher Dr. P.I. Bränemark click here to read "Dental Implants: An Historical Look at Tooth Replacement"). These implant systems are placed into the jawbone, allowed to integrate with living bone, and then used to anchor tooth replacements. Most are screw-shaped with internal openings that allow teeth to be attached. Most systems are made with a roughened titanium surface to increase implant surface area and improve bone integration, and increase chances for success in bone with poor density. This implant surface is growing in popularity as research shows improved success rates. Some dentists use an implant surface coated with chemicals as research shows this can improve the speed and quantity of connection of the implant to bone.

Benefits Of Implant Dentistry

1. Implants are the most natural option.
2. Plaque control around implants is similar to natural teeth.
3. Implants do not decay.
4. Implants are not sensitive to temperature changes.
5. Implants help to preserve, strengthen and prevent atrophy or shrinkage of bone.
6. Implants can be used to support a variety of tooth replacement options.
7. Implants have high success rates.
8. Implant-supported tooth replacements are stable and allow for chewing apples and other substantial foods.
9. In the unlikely event an implant must be removed, bone loss is minimal and similar to that of an extracted tooth.
10. Teeth on implants can be unscrewed and modified if changes occur to neighboring teeth.

Challenges to Implant Dentistry

1. Surgery is required to place the implant into the jawbone.
2. Implant dentistry requires more time.
3. Often, a second procedure is required to expose the integrated implant.
4. Not all implants work, although most systems have success rates over 95%.
5. Implants are usually more expensive than other options for the short term.

Implant Treatment: The Process

1. Review the patient's medical & dental history.
2. Comprehensive oral, dental, and bite examination.
3. Complete set of dental x-rays.
4. Consult with the patient.
5. Consult with the surgeon.
6. Fabricate an acrylic implant template to guide the proper placement of the implants.
7. A CT scan formatted for implant examination is frequently used.
8. Implants are placed into the lower jawbone.
9. Two to four months of healing are needed to allow the implants to heal directly against the bone. The integration of the implants is required for successful long-term function.
10. The implants may require a second procedure to be exposed from under the gums.
11. After a short healing period, the restorative dentist can register impressions of the implants.
12. The laboratory manufactures the tooth replacements to fit on the implants. Precision components are used for stability and health for the implants.
13. The dentist delivers the tooth replacements.
14. Proper oral hygiene and regular hygiene visits should be performed to preserve health around teeth and implants.

Who Is Not A Good Candidate For Implants?

Patients with poor wound healing, poor resistance to infections and poorly controlled diabetes should find alternatives to dental implants. Patients also need enough bone to provide stable support to the implants and withstand chewing. Patients may be more easily treated with alternative dental options, such as fixed bridgework or dentures (see below) in select situations.

FIXED BRIDGEWORK requires the preparation or grinding down of teeth on either side of the missing tooth. The dentist then takes impressions of these teeth. While the patient wears a temporary tooth replacement, a laboratory will fabricate the bridge to be cemented onto the prepared teeth. The result is generally very esthetic and comfortable, and completed in a month or less. However, fixed bridges require more involved plaque control (flossing under the bridge) and require the irreversible alteration of neighboring teeth. Fixed bridges also generally require teeth on either side of the missing tooth. Therefore, when a back tooth has been extracted, fixed bridges are not a popular option.

REMOVABLE PARTIAL DENTURES can replace one tooth or several teeth. This is usually the least expensive option. However, most clinicians agree that partial dentures are the least desired option in tooth replacement. They clasp onto remaining teeth with a friction fit. The design of the partial often acts as a slow extraction device to the teeth it clasps. Bone under partial dentures will more often atrophy or shrink with time. Partial dentures can be depressed onto unsupported gums and create unhealthy forces on the supporting teeth. Partials can become loose and food can pack underneath their acrylic base. This can be painful and require immediate removal and cleaning after meals. Many patients have a difficult time adjusting to the bar or plate that connects the clasps of the partial. Unfortunately, this is hard to predict and many partial dentures spend their life in nightstand drawers.