FAQ About Dental Implants
What are dental implants?
Dental implants replace missing teeth and are divided into three different parts. There is a metal post that replaces the root portion of the missing tooth, an abutment that connects the metal post and the crown, and a crown that is placed on top of the abutment. The posts are made of titanium, which is a metal that is compatible with human tissues. Titanium implants have been used for decades without any known ill effects. They can be used in both the lower jaw (mandible) and the upper jaw (maxilla). Dental implants are a unique reconstructive procedure to restore your natural smile. Your periodontist and/or dentist may have recommended dental implants for several reasons:
- Tooth loss due to disease (decay or periodontal disease)
- Root canal failure
- Cracked tooth
- Loss of a bridge
- Painful and/or loose dentures or partials
Your new teeth will look, feel and function as close as possible to your natural teeth. Clinical studies over 30 year periods have shown this procedure to be one of the most predictable in dentistry, with success rates as high as 95%.
When are dental implants needed?
Whenever teeth are missing or need to be removed, the advantages of dental implant fixtures will be discussed. We feel strongly that tooth structure and enamel should be preserved and left intact whenever possible. As a result, we advise patients to choose single-tooth implant replacements when appropriate. Please note that the pros and cons of procedures will always be reviewed with the patient, in order to establish the best treatment plan for each individual.
What advantages do implants give me?
- Dental implants can replace a single missing tooth. In this case using an implant would avoid drilling the adjacent teeth needed to support a permanently cemented bridge. This is often desirable when the abutment teeth do not have any fillings. The reason? Tooth enamel is precious. It cant be replaced once its drilled. The act of drilling, no matter how carefully its done, can still stress the tooths nerve. Sometimes this compromises the vitality of the pulp tissue and a root canal is needed. Another thing to consider is that as much as we would wish otherwise, dental crowns and bridges do not last forever. They can chip or break, and decay can form under the margins, necessitating replacements. When proper and regular maintenance is performed, a single dental implant reduces the need for extra crowns and future dental work.
- Dental implants can replace a removable partial denture. Unfortunately, removable bridges are not always as firm and kind to the tissues as we would like. Oftentimes they move around a bit and can even loosen the teeth they rest on, which are called abutments. In time, abutment teeth can become so loose that they may need to be removed. When this happens, a new, larger removable denture is needed. Removable dentures collect a lot of plaque and make cleaning around some teeth quite difficult. With implants these problems tend to be avoided, or at least minimized.
- Dental implants can better stabilize (anchor) an upper or lower denture, creating a greater sense of security. Also, the denture is often smaller than the one being replaced. Most people have enough bone remaining to have implants placed in their jaws. When theres not enough bone, we can re-build the jawbone through ridge augmentation to regenerate the amount needed to successfully have implants.
- Dental implants can be used in complex cases in order to avoid a denture if the patient still has some teeth left. These patients usually have existing bridges, a root canal has failed, a key abutment tooth has cracked, or their periodontal condition has worsened. With any of these conditions, a periodontist or dentist may suggest placing dental implants in strategic areas to avoid losing the remaining teeth and wearing removable dentures.
If I lost teeth due to periodontal disease, can I still have dental implants?
Definitely. Even when periodontal disease is present, most patients retain adequate amounts of bone for dental implants. In some instances where more bone is needed before placing implants, highly successful grafting procedures are available to regenerate the amount of bone needed. Once sufficient amounts of new bone have been regenerated, dental implants can be placed to support new dental prostheses.
But still, each mouth is different. How do you know I have enough bone for dental implants?
Dental x-rays and clinical exams help to determine if enough bone exists to place the dental implants. However, more information may be needed before making that determination. Dental CT scans provide the most accurate information as to how much bone is present in a jaw. Unlike dental x-rays that are two dimensional, CT scans view the jaw in three dimensions. This gives us a view of whats “inside” the jaw. Ultimately, the CT scans will provide information to know if you have enough bone for dental implants. We are proud to offer this service to patients in the convenience of our office.
Are there any possible side effects to implant placement?
Yes. When implants are needed toward the back of the jaw (in the premolar and molar area), there is a risk of injury to the mandibular nerve. This nerve runs through the length of the mandible (lower jaw), starting from behind the last tooth and exiting just behind the canine (or eye tooth).
How can I make certain the mandibular nerve is not in the way in my case?
Are there other anatomic areas of common concern when having implants placed?
Yes, the maxillary sinus. This is the large cavity in the area above the maxillary (upper) molars. It sits under the eyes, behind the cheekbones, and to the right and left of the nose. Its the space that fills with mucous when we have a cold. The reason the maxillary sinus is a concern during implant placement is that it is hollow. IT IS HOLLOW FOR EVERYONE! The area needs to be evaluated to see if there is enough jawbone remaining to support the implant.
Is there a way to grow more bone in the sinus so I can have an implant?
Yes. The procedure to grow more bone in the maxillary sinus is called a sinus lift. Placing a bone graft in this area is not difficult to do and generally yields excellent results. Once enough bone has grown, implants can be placed in an area that years ago was deemed an impossible site for dental implants.
Besides the mandibular nerve and the maxillary sinus, what else do I have to worry about when having dental implants placed?
Sometimes the bone is too narrow to hold an implant. When this is the case, we can perform a ridge augmentation to increase the width of the bone. Depending on the need, ridge augmentations can be performed simultaneously with the implant surgery, or months in advance of the procedure.
What about infections from dental implant surgery?
There is a slight risk of infection, however, following proper precautions can greatly reduce or even eliminate your odds of infection. After the implant surgery we will review appropriate post-operative instructions with you. These include, but are not limited to, the usage of antimicrobial mouth rinse, antibiotics, diet restrictions and appropriate oral hygiene care.
Can an implant be rejected?
Yes. Implants can be rejected, but not in the way we know “rejection” can occur in organ transplants, such as with kidneys and hearts. We know dental implants are compatible with human tissue. There are no known allergic reactions to commercially-pure, titanium implants, but failure can still occur. There are many contributing factors that may affect the success or failure of dental implants, such as smoking, systemic illnesses, uncontrolled diabetes, uncontrolled high blood pressure, poor oral hygiene care and oral bacteria contaminating implants. Before scheduling dental implant surgery, we conduct a thorough patient evaluation in our office. In addition, our highly trained staff ensures sterile conditions during implant procedures, from the way the implants and instruments are packaged and prepared to the hygienic conditions in the operatory.
How long does it take to replace my missing tooth?
The general rule of thumb is that when a metal post (implant) is placed in the mandible (lower jaw), the site will heal in 3-4 months, while the maxilla (upper jaw) takes 4-6 months. Once the healing is complete, the abutment and crown can be placed on the metal post (implant). Augmenting the bone, performing sinus lifts, needing jaw reconstruction, etc., will lengthen healing periods. Remember, healing times are related to human biology. It takes time for the body to heal. Healing can not be made to go any quicker than how we were intended to heal.
Is there a second surgical stage when getting implants?
Yes. The first stage is when the implants are placed in the jaw and the bone “attaches” or integrates to the implants. In a manner of speaking, the implant becomes part of your body. Months later, the periodontist performs a second surgical procedure where a tiny incision is made on top of the implant to place the “healing abutment”. Soon after this is done the dentist can begin making the desired restoration.
How successful are implants?
Implants placed by most periodontists or dental surgeons today have a high degree of success. In fact, they are close to 95% successful in the mandible (lower jaw) and 90% successful in the maxilla (upper jaw). These percentages may vary slightly from patient to patient, but as a rule, titanium implant dental fixtures are predictably successful.
If an implant fails, can another be placed in the same spot?
Usually, yes. If an implant fails the implant is removed, and if conditions are right, the site is prepared for another dental implant. Sometimes this can be done at the time the implant is removed. Other times, the periodontist or dental surgeon feels it is better to try again only after a prescribed healing period. Regardless of when an implant is placed in the site of a failure, it can still be successful.