Dental Implant: What You Should Know
According to the American Academy of Implants Dentistry, at least 30 million people in the U.S are missing all their teeth in either one or both jaws. The statistics further revealed that 3 million people opted for implants in the start of the year with the number expected to rise by 500,000 as the year progresses. With such figures in mind, it would be correct to state that the future of dental implants is bright. Plus, being one of the most crucial patents in the history of dentistry, the dental implants have provided a solution that seconds none. Not only are they planned and designed to replace teeth in a perfect manner but they are also durable. Still, there are a lot of debates and misconceptions surrounding this procedure, reason why the following read seeks to educate and enlighten you on what dental implants are all about. Read on to have all your queries answered.
I. What are dental implants?
Although many options exist to replace a missing tooth, only one provides the look, feel and function of real teeth; dental implants. Traced back to 600 AD when teeth-like pieces of shells were hammered in to the jaw, dental implants have come a long way embracing the marvels of technology all the while allowing individuals to enjoy the joys of having a full set of healthy teeth. A dental implant is simply a prosthetic replacement for a missing tooth. The prosthetic replacement is made from titanium or titanium alloy, materials which are not only well tolerated by bone, but also has the unique ability of fusing with bone, a process known as Osseointegration. The dental implant consists of 3 parts; the implants device itself which is screwed directly into the bone, the abutment which is the piece that connects the overlying crown to the implant. It is worth noting that having a dental implant treatment is the only way to preserve and stimulate natural bone.
Types of dental implants
i) Subperiosteal (on the bone) – Just as the name suggests, this type of implants are placed on top of the jaw with the posts of the metal frameworks protruding through the gum to hold the prosthetic in place. More aptly referred to as a sub, this type of dental implant has been around for almost 50 years and works exceptionally well for patients with little or no jaw bone for additional conventional dental implants.
ii) Endosteal – This is the most popular type of dental implants and is placed within the jaw bone. They are usually shaped like cylinders and are either made of metal, ceramic material or metal covered with ceramic. Each implant will hold one or more prosthetic teeth. The Endosteal implant is most suited for patients who want an alternative to removable dentures or bridges.
iii) Transosteal – This implant passes through the bone. The implant is either designed as a U-shaped frame or a pin that passes through both the jawbone and the gum tissue in to the mouth. This technique is seldom used and only a few dentists recommend it to their patients.
iv) Mini Dental Implants (MDI) – Not all individuals are fit for standard dental implants; patients with bone issues such as inadequate jawbone structure are advised to go for MDIs. When the thickness of the bone is inadequate, fitting a conventional implant is not a good option. Just as the name suggest, these titanium implants have a smaller diameter compared to other implants. The implants are used to fix a small teeth, premolars or in cases where the teeth has to be fixed in a narrower area. The traditional implants are twice the size of MDIs. Basically, these implants have more or less the width of a toothpick. Traditional implants require 6-8 months to heal while MDIs have a very short recovery period. This is because the implants are minimally- invasive. Quick healing & miniscule amount of post-operation pain are the greatest hallmarks of the MDI surgery. Although these implants are very tiny, they are equally effective to anchor dentures.
II. What are the benefits of dental implants over other treatments?
1. Long term solution While tooth-supported dental bridges may only last for 5-7 years or even 10 years if properly taken care of, they will need to be replaced at some point. Dental implants on the other hand, are built to last, providing a lasting solution for a whole life time. However, take note that the endurance of your implant highly depends on regular proper care.
2. Do not require support from adjacent teeth Unlike bridges that rely on adjacent teeth for support, dental implants are held in place by the implant that was riveted in to the jaw bone, ensuring a strong and sturdy foundation.
3. Promote healthy bones Did you know that leaving empty spaces in your mouth after the loss of a tooth often leads to additional dental problems? In most cases, having an empty space in your mouth leads to deterioration of your jaw bone since it is not being used to support a tooth/teeth. Dental implants therefore provide the ultimate solution by preserving and stimulating your jaw bone thus stimulating bone growth and preventing bone loss.
4. It’s the next best thing to healthy natural teeth Unlike other dental treatments that may interfere with some of your daily activities such as eating, speaking and smiling; dental implants restore the natural look and feel of real tooth. What’s even better, is that other than looking and feeling real, the implants actually function just as well as a real tooth; dental implants are strong and stable.
5. Comfort As compared to removable dentures and bridges, dental implants essentially become part of your body. You therefore do not have to remove soaks or refix your prosthesis.
6. Peace of mind With dental implants, you never have to feel conscious about your smile looking different or worry that your dental implant will limit your ability to join in the fun. Simply put, dental implants let you and not your teeth run your life.
7. Retain your smile and natural face shape Your teeth account for your natural face shape, this means that losing a teeth or more alters your face shape and leaves it looking sunken and saggy. With dental implants however, your face’s shape stays intact preserving your unique features.
8. No cavities Cavities cannot occur on a replacement tooth or an implant restored crown meaning you can forget all about the excruciating pain that comes with tooth cavities. This however, doesn’t mean that your dental implants do not need care. You will be required to visit your dentist regularly, clean and care for your implants as well as your gums just as if you had natural teeth.
9. No speaking complications Dental treatments such as removable dentures present the problem of struggling to pronounce everyday words before you fully become adjusted to them. Dental implants however, which function much like natural teeth do not present such problems.
10. Eat what you want Dental implants do not harbor you from eating your favorite foods. In fact, you can indulge in whatever culinary experiences that takes your fancy just as though you have real natural teeth.
11. No funny or embarrassing sounds Anyone who has had dentures before understands the embarrassment of having to re-position them when you smile, speak, or kiss. Worse yet, the dentures will produce ‘clicking’ sounds when they shift limiting most of your oral activities. Dental implants do not present such difficulties as they are fixed in place and fused naturally to your jaw bone.
12. Predictable as compared to other teeth restoration methods Considered the most predictable treatment in tooth replacement and repair, dental implants hold a track record in reliability and long-term successful outcomes. In fact, studies prove dental implants to be more predictable than endodontic therapy and bridgework. Plus, scientifically, the success rate for dental implants has been reported as 98%.
III. Who needs dental implants?
Basically, if you have a missing tooth, then you are a suitable candidate for dental implants. However, you also need to be in good general and oral health. This means having adequate bone in your jaw, enough to support the implant. You also need to have healthy gums that are free of periodontal diseases. There is need to mention that even if you do not have enough bone in your jaw to support the implant, bone grafting or expansion procedures can be used to grow back the bone.
You can have dental implants if; – Several teeth are missing, implant supported bridge can replace them instead of using partial dentures and bridges – All teeth are missing; an implant-supported full bridge can be used instead of using dentures – A single tooth is missing, one crown and an implant can replace it instead of using a bridge Once you contact your dentist for a dental implant procedure, an oral exam will be scheduled for you.
The full mouth examination will determine whether you are a suitable candidate since untreated disease of gums or teeth can affect the success of your implant surgery. Plus, other risk factors such as excessive alcohol consumption and systemic diseases can also affect your suitability for a dental implant surgery. However, all these factors will be discussed when you attend for a consultation.
Factors that determine your candidacy for dental implants
i) Your oral health– In order to be a good candidate for implants, having good periodontal health is imperative. However, most patients will have gum diseases that most likely led to them losing a tooth. It is important to have such conditions treated before undergoing a dental implant surgery so as to prevent a case where the tissues surrounding the implant posts don’t heal properly.
ii) Smoking– Needless to say, smoking affects your body’s ability to heal itself. As you can imagine, this can pose problems when recovering from the implant surgery. And while smoking won’t automatically prevent you from getting an implant, it is always advised to inform your dentist so that proper measures can be taken to ensure the success of your dental implant surgery.
iii) Age factor– In most cases, dental implant surgery for children and teens is not advised. This is because they are still growing and so are their bones. Having dental implants will therefore be compromised by further growth as they grow in to adulthood. On the other hand however, you can never be too old for dental implants.
iv) General health– The fact that undergoing a dental implant surgery calls for the use of local anesthesia means that if you have a medical condition, the sedation could have dangerous effects on your health. Conditions such as diabetes, arthritis and high blood pressure will affect your candidacy. And although having such conditions does not eliminate you for dental implant surgery, it is important to inform your dentists to ensure that proper measures are put in place to secure your health and life as well.
IV. Are dental implants for me?
Any individual considering a dental implant surgery will;
> Have good oral and general health
> Be free from periodontal diseases
> Not smoke, or be willing to give up smoking during the Osseointegration period
> Have sufficiently dense bone tissue in jaw
> Be ready and willing to commit to a good oral hygiene regimen, healthy habits and routine post-surgery dental visits
So whether you have a missing tooth, loose tooth or fractured tooth, dental implants provide the best solution for everyone. However, in the case that you have been deemed not suitable for dental implants, your dentist will discuss alternative treatments that may work just as well.
V. How do dental implants work?
Dental implants are made of 3 parts;
1. A biocompatible titanium piece (dental implant) – The fixture or the implant is the part of the dental implant that is embedded in and becomes fused to your jaw bone. This is the artificial root that lies below the gum line and is made out of metal titanium. This part can be cylindrical, screw-shaped hollow or solid in design. For purposes of increasing the total surface area of the fixture (thus increasing the amount of fusion between the bone and implant) some manufacturers produce fixture portions that etched or grit-blasted so as to roughen up the surface. On the same line, manufactures also produce special fixture coatings such as hydroxyapatite which is thought to help in hastening the fusion process.
2. The abutment piece – This the part that lies at the gum line; it functions to support and secure the crown, denture or bridge that has been placed on it. This part is not screwed on the fixture until the Osseointegration process has taken place. Osseointegration simply refers to the process of the implant fixture fusing to your jaw bone.
3. A life like custom fabricated dental crown – This is the prosthetic tooth/teeth supported by the implant. The crown can either be screwed or cemented depending on how it has been designed. This part is custom made to match the natural appearance of your teeth.
The Implant Procedure
Whether or not all of your teeth are missing, the dental procedure is always the same. For example, if you have one missing lower tooth and are in excellent health condition, this is how the procedure would go like.
a) Implant site preparation In order to expose the bone area where the implant will be fused, the gum tissue is opened up. Once healthy bone material has been established a special drill is then used to create a suitable space for the implantation of the fixture. However, in the case that you have insufficient bone structure, bone grafting will be recommended.
b) Implant placement Following the preparation of the implant site, the implant is then placed after which the tissue is stitched. The stitches will be left in place for at least 7 days allowing enough time for healing after which they are removed. Note that the removal of the stitches is a painless procedure.
c) Healing The implant will then be given a period of 3-6 months for Osseointegration to take place. During this time of fusion, your dentist may place a temporary restoration on your implant owing to aesthetic and functional advantages.
d) Placing the implant’s permanent crown Once the healing period elapses, the implant can have its permanent dental prosthesis fabricated and placed. This can either be a dental bridge a crown or denture. In preparation for the placement of the custom made crown, the healing cap (screwed on to the implant at the time of placement) must first be removed and replaced with an appropriately shaped abutment that provides a nub for the attachment of the crown. Courtesy of improvements in technology, zirconium abutments are now available and can be attached to the implant post. This makes it possible for your new porcelain tooth to possess translucency properties just like a natural tooth. Also note that the implant surgery is carried out under local anesthesia so you will not experience any pain. When the sedation wears off however, you may experience some inflammation and tenderness; this can easily be controlled by painkillers.
VI. What are the risks and complications? Are dental implants safe?
As with every other medical procedure, having a dental implant surgery too has its own associated risks and complications. Listed below are some of the most commonly cited.
1. Dental implants are costly This is probably the greatest disadvantage cited by patients. And while the long term value offered by dental implants may cover up for the hefty price tag, insurance won’t pay for the full implant procedure making it even more costly for the majority of patients. However, a witty combination of insurance and financing can work to make dental implants affordable. For instance, individuals that are members of credit unions may qualify for a low-interest plan to pay for the procedure. Plus, reports from the National Association of Dental Plans confirm that some dental insurance providers offer limited coverage for dental implants.
2. Nerve damage A recent research was carried out by students from King’s College London Dental Institute and revealed that 1% of implant procedures carried out every year result in nerve injuries. This happens when the nerves that supply feeling to your lower jaws, lower teeth, bottom lip and gums are damaged. This often causes the patient experience temporary or sometimes permanent numbness or tingling. In some cases, pain is experienced. CT scans and x-rays can be used to help your dentist locate the position of your nerves and minimize or avoid the risk all together.
3. Side effects These are unwanted but mostly temporary effects of a procedure. Swelling and discomfort around the area of implantation is to be expected. Taking over the counter painkillers will be effective in dealing with such effects.
4. Loose implants In some cases, the jawbone fails to fuse properly with implant resulting in a loose implant. If such happens, your dentist will have to remove the failed implant and wait for the bone to heal before any attempt to fuse another implant.
5. Restoration replacement As effective and durable as dental implants may be, they will have to be replaced at some point. For instance, a porcelain bridge or crown on an implant may chip or break just as natural teeth without implants. Therefore, expect to replace fillings, bridges and crowns; they don’t last forever.
6. Bone loss Bone loss around the implant over the years is quite normal. However, if you lose too much bone, you will have to replace the implant. A clear indication that the original fabrication of your teeth and surgery are huge factors in ensuring the long-term health of dental implants.
7. Bone integration (Osseointegration) takes time Because bone heals slowly and a dental implant procedure requires the jaw bone to heal fully before placement of the crown, the whole process does take a long time. In the case that bone grafting is required; the treatment time would increase by a whole 3 months. Still, given the comfort and convenience that you get to enjoy with dental implants, you could say dental implants offer long-term benefits for a short-term sacrifice. Plus, bone naturally takes long to heal. However, over the years, dental implants like many other medical procedures have accumulated a small body of myths around them that sometimes taints the general perception of this effective and safe procedure.
Here are 3 of the most common dental implant myths;
Myth #1. Dental implants are painful This is not true, in fact, most patients who have undergone a dental implant surgery will attest to the fact that the whole procedure was actually easier than they expected. However, there are 3 factors that predict whether the procedure will work or not. For one the ease or difficulty of your situation will affect the amount of pain experienced. Second, your ability to heal will also determine the amount of pain experienced. And lastly, the skill and training of your dentist will also dictate whether you go through a smooth dental surgery procedure or a painful one.
Myth #2. Dental implants are expensive This is not true. In fact, compared to an average 3 tooth-bridge, the cost of a dental implant surgery is almost identical. This can be attributed to the fact that a dental bridge will need replacement every 7-15 years where as a dental implant will most likely never need replacement. What is even worse is the fact that the dental bridge costs just as much as the dental implant but causes irreversible damage to your adjacent teeth.
Myth #3. Dental implants take a long time This is not true, whereas a dental implant takes 2-4 months to heal; a dental bridge will take 3-6 weeks but will require replacements more often than the dental implant. Plus, there is the option of having a temporary crown so you don’t walk around with a missing tooth.
VII. How do I care for my dental implants?
Since you have invested a significant amount of time and money on your dental implant, it only stands to reason that proper care measures and cleaning regimens should be put in to place to ensure that investment is protected.
> Eat with caution Since dental implants are strong, you can eat almost any food. However, extreme actions such as cracking bones or trying to open packages with your teeth are not advised. Dental implants are just like any other investment; you need to take proper care of them.
> Avoid drinking extremely hot liquids Dental implants are made from metal, and as you know, metal retains heat more readily than soft human tissue. Therefore, if you drink extremely hot liquids, the implant will get heated up and retain heat long enough to burn the layer of tissue surrounding the implant. If consumption of hot liquids is repeated the damage may ultimately lead to the damage of the dental implant. If the liquid is too hot for the touch then you should not drink it.
> Do not consume hot and cold foods simultaneously The crown of a dental implant is made from porcelain. And porcelain just like glass expands when heated and contracts when cooled. Therefore, if you do happen to consume extremely hot and cold foods simultaneously, chances are the crown will crack leading to a chipped crown.
> Avoid using vibrating electric toothbrushes When using a vibrating tooth brush, the internal screw on your dental implant will be unscrewed causing the crown to become loose. In order to fix a loose crown, you’ll need to have the crown replaced at a significant cost.
> Avoid flossing around the implant Unlike natural teeth which are attached to the teeth by the periodontal ligament, a very strong ligament that also has nerves; a dental implant is only attached to the gums by a peri-implant seal. This seal is weak and inadequately supplied by nerves meaning if your floss vigorously around the implant chances are you will damage the seal allowing bacteria to fester and access the bone. This can eventually lead to bone damage and loss of the implant.
> Keep regular dental maintenance appointments Dentists advise to have your implants checked at least once per year with cleaning intervals of between 4-6 months. This way, any arising problems can be dealt with at an earlier stage instead of waiting until it becomes uncontrollable.
> Let your dentist or whoever is cleaning your teeth know that you have dental implants Since dental implants look much like real teeth, your hygienist may not be able to differentiate or even realize that you have dental implants and thus use regular cleaning instruments. Implants call for different cleaning instruments that do not scour the surface of the teeth. On the same line, your implants should never be cleaned by vibrating or ultra-sonic instruments for reasons mentioned earlier.
> Consistent dental hygiene Without gentle flossing and regularly brushing your teeth, infections can easily develop around the dental implants. Furthermore, studies show patients who floss, brush and schedule regular dental appointments to have their dental implants lasting longer.
> Quit smoking Smoking poses the greatest risk for implant-related complications. This means anyone looking to have a dental implant surgery should consider quitting the habit.
How do I find affordable and high quality dental implants?
– Have a talk with your dentist While you may be eager to get your smile back it is not advisable to run off to the nearest dental facility whenever you think you are ready, instead, consider discussing your options for treatments and needs. Not only will this be beneficial to your dental health, but it also goes a long way in helping you save on the total cost.
– Understand how dental implants will benefit you It is no secret that dental implant surgeries can cost a fortune, however, the several advantages offered by this procedure quite measure up to expenses.
– Ask for treatments that might be able to make the procedure cheaper Not to say that this will hugely affect the costs involved but options such as phased treatment and payment plans might make it easier to fit your dental implant surgery costs in your budget.
What are my Dental Implants Options?
Single Tooth Dental Implant
When only a single tooth is missing or damaged, it can be replaced by a dental implant and crown. This is often considered a preferable alternative to extensive bridgework, which requires dentists to drill or file the surrounding teeth to support the cement bridge. Since a dental implant mimics the functions of a real tooth, it also tends to last longer and do less long-term damage to your mouth replacing the root and preventing bone decay sometimes experienced with bridges and other procedures.
A crown is a replica tooth designed to perform the same function as the tooth and also blend in with the rest of teeth. A dental implant consists of both the crown and the base. The base is fixed to the bone through the gum. Since the base has to be firmly fixed to the gum and is intended to last for a very long time, it often requires several surgeries to fully put into place. First, a surgery is done to remove the damaged tooth and to prepare the area for the implant. After this, the implant base is fixed to the jaw.
The implant has to be fixed in gums where the original roots of the tooth were. This may take several months since the jaw and gums must be accustomed to the implant without any signs of infection or complications. Once the base has bonded to the jaw, another preparatory surgery is performed to add an extension to the base. The crown is carefully fitted on the extension until it is tight against the gum and fits well with the natural teeth.
Multiple Teeth Dental Implants
If you have lost several teeth, implant-supported bridges can replace them. The bridge contains all the teeth in one piece and is anchored on dental implants. First, the implants are installed. This is normally done in one session. A temporary bridge is also fixed to help you function normally after leaving the dentist. The implants have to integrate with the jawbone before the permanent bridge is attached. This is normally done 1-2 months after the implants have been installed. This time varies depending on the teeth affected and aesthetical needs. After this, a new bridge is installed.
The bridge will handle all the pressure that your strong, natural teeth did. The other option of replacing multiple missing teeth is replacing each tooth with an individual implant. However, this process is best if the missing teeth are not adjacent. If the missing teeth are adjacent, then the fixed-bridge implant is the best solution.
Full-Arch Dental Implant Replacement
Full-arch is implants created to hold one whole set of dentures’ for the entire jaw bone. Basically, these implants are just like those used for partial teeth replacement. The only difference is that the number of implants may vary depending on the patient’s bone condition and shape of the mouth. Careful diagnosis of such implants together with an intensive study is necessary. This helps to plan and also coordinate the entire procedure before full arch implants are installed.
The dentist may do some X-rays and possible CT scans to determine the actual amount of bone you have available for the implants to anchor to. Two types of implants are commonly used during this procedure; a bar-retained implant and ball-retained implant. A bar-retained implant features a thin metal bar attached to several implants placed in the jawbone.
The attachments are fitted to the bar, the denture, or both. The denture is then placed over the bar and is securely attached. With a ball-retained implant, each jawbone-embedded implant features a ball-shaped metal stud that fits into an attachment on the denture. The balls go into the sockets, securing the denture to the jawbone. In certain cases, the denture contains the attachment and the implant features the sockets. After the implants are placed, the healing process takes a few weeks.
However, a full arch of implants can now be connected to a temporary fixed bridge in a process called immediate loading. Once the implants are placed, they start receiving load from the chewing forces of the patient. This process requires extensive professional planning and coordination. Since dental implants are fixed to the jawbone, it’s essential that you have high jawbone density and quality. Patients with gum disease are advised to treat this problem before undergoing the procedure. In case of inadequate jawbone, bone augmentation is required.
This is the process of increasing the mass and volume of the bone recommended. In areas where the bone has diminished due to resorption, bone augmentation ensures more bone volume to support the tooth replacement process. Basically, bone augmentation is a term that describes a variety of procedure used to build bone so that dental implants can be placed.
The procedure typically involves grafting (adding) bone or bone-like materials to the jaw. This graft can be your own bone or can be a processed bone obtained from a cadaver. Choosing your own bone for a bone-graft is an excellent choice. This will most likely come from your chin or ramus (back part of your jaw). If the dentist cannot get enough bone from these areas, he/she may need to get the bone from your hip or shin bone instead. The hip is considered to a better source because it can provide a large amount of bone.
However, bone taken from the hip requires a hospital stay. If you don’t want a bone removed from your body, then a dentist can use materials made from the bone of human cadavers or cows. Synthetic materials are also used for this purpose.
After the grafting process, the patient has to wait for some few months for the graft material to fuse with the existing one. Processed grafting materials can either cause the surrounding bone to grow into the graft or cause the cells around the graft to change into bone. A graft from your own bone transplants the bone cells or a block of bone that fuses to the jaw. Apart from bone grafting, several different procedures can be used for bone augmentation.
One procedure is called sinus lift or elevation. This process increases the height of your upper jaw by filling part of your maxillary sinus (area above your jaw on either side of the nose above the back teeth) with a bone. Other bone augmentation procedures include ridge expansion and distraction osteogenesis. All these procedures are very effective but your dentist will only choose one depending on the types, location and the number of implants used. No matter how your teeth got lost, whether it was an accident or lack of dental hygiene, always visit your dentist for help. He/she will advice you on the best way to replace your missing tooth or teeth.
How much do dental implants cost?
The cost for dental implant procedure is determined by a number of factors, they include;
1. Bone density – As mentioned earlier, implants heavily rely on bone function. Therefore, if you have experienced bone loss, you will need to perform a bone graft before the implant procedure. This will be billed separately.
2. Quality of the implant – Depending on the number of teeth that you want to replace, the cost of the dental implant surgery will vary accordingly. The more implants needed the more you are going to spend. Together with the quality and quantity of the implants, you will also need to consider, time taken to check your mouth, find an ideal location for the implant and check for bone loss.
3. Sinus lift – In cases where you are looking to replace teeth with dental implants in the upper molar and premolar, a sinus lift will be needed before the dental implant procedure. This too, will be billed separately.
4. Procedure – There are a variety of dental implant procedures that meet different needs and budgets. For instance, single dental implants will be priced differently as compared to implant supported dentures.
5. Tooth extractions – There are cases where two or more teeth need to be removed before the dental implant procedure kicks off. This raises the cost of your treatment plan.
6. Gum disease – As mentioned earlier, most of the patients who require dental implants often have gum diseases. In such cases, the gums must be treated first to avoid compromising the success of the dental implant surgery. The treatment of the gum disease will increase the total cost of the procedure. Lastly, keep in mind that there are a number of competitive and demographic forces within the dental industry that often discourage competition in terms of price, however, this doesn’t mean that you can’t get a more affordable option if you shop around.
Given the fact that approximately 70% of adults between the age of 35 to 44 lack at least one tooth and that 25% of the population older than 74 has no teeth at all, it is quite obvious that the demand for dental implants will experience a cataclysmic growth over the coming years. Be a part of the statistics; increase your confidence and smile your way through life with dental implants.