What is it?
An implant is a titanium or zirconia post that is surgically inserted into the jawbone that is used to support a prosthesis – either a crown, bridge, partial, or denture in an effort to restore chewing function, distribute biting forces, and esthetics.
When do we need them?
Single tooth replacement – when a single tooth is missing or needs to be extracted due to damage or decay. This option restores the function and appearance without affecting adjacent healthy teeth.
Multiple teeth replacement – When several teeth are missing and or need to be extracted. Implants can support multiple crowns or bridges to restore function and esthetics.
Full Arch fixed replacement – When all the teeth are missing or need to be extracted – full arch replacements can be supported by multiple implants, offering a stable and durable solution.
Dentures and partial dentures – Implants can support dentures or partial dentures when there is improper tissue or tooth support to help retain the prosthesis. When the tissue and or lack bone support for a denture leads to the inability to properly retain a denture (no ridge, frenulum attachments, muscle functions, etc) or if a patient wants to decrease the size of the denture (remove the palatal seal required for suction in a traditional denture) which can improve a patient’s ability to taste. Implants can be used to support partial dentures to aid in retention due to lack of enough teeth for support, or if the teeth themselves lack stability to support a partial due to extent of decay or periodontal involvement.
What are the implications?
Long-Term Solution: Dental implants provide a durable and long-lasting solution compared to other tooth replacement options such as dentures and bridges. Dental implants can last 10–30 years on average, and depending on your age when you get one, they could last the rest of your life.
Improved Oral Function: Implants function like natural teeth, allowing for better chewing and speaking compared to removable options.
Bone Health: Dental implants help prevent bone loss in the jaw, which occurs when teeth are missing and not replaced.
Aesthetic Benefits: Implants look and feel like natural teeth, which can enhance appearance and boost self-confidence.
Maintenance: Implants require similar care to natural teeth, including regular brushing, flossing, and dental check-ups and are easier to maintain that dental bridges.
Cost: Dental implants can be expensive and are often not covered by insurance, although they are cost-effective in the long term due to their durability.
What are some of the contraindications?
Insufficient Bone Density: Patients with inadequate jawbone density or volume may not be good candidates for implants unless bone grafting procedures are performed.
Chronic Diseases: Certain chronic conditions such as uncontrolled diabetes, cardiovascular diseases, and immune system disorders can affect the success of dental implants.
Gum Disease: Active periodontal disease needs to be treated before implants can be placed, as it can compromise the implant's stability and ability for the body to integrate to the implant.
Smoking: Smoking can impair healing and increase the risk of implant failure. Smokers are generally advised to quit before undergoing implant surgery.
Bruxism: Implants, in contrast to tooth roots, do not have a periodontal ligament (the natural shock absorber of teeth). Implants fuse to the bone when they integrate and do not move at all so Patients who grind or clench their teeth (bruxism) may exert excessive pressure on the implants, leading to potential fracture and/or failure. This is why it is important to utilize a night guard when we have dental implants.
Age: While there is no upper age limit for implants, younger patients whose jaws are still developing are not suitable candidates until their growth is complete.
Medications: Certain medications, such as bisphosphonates (used to treat osteoporosis), can interfere with bone healing and implant integration. Medical consultation in conjunction with OMFS may be needed in some of these cases.
Radiation Therapy: Patients who have undergone radiation therapy to the head or neck region may have a higher risk of implant failure due to compromised bone healing.
What to expect?
Pre-Surgical Considerations
Comprehensive Assessment: A thorough evaluation, including medical history, dental examination, and imaging studies (such as X-rays, CT scans, and intraoral 3D imaging), is essential to determine candidacy for implants.
Treatment Planning: A detailed treatment plan will be developed, outlining the surgical procedure, timeline, and any preparatory treatments (e.g., bone grafting).
Informed Consent: Patients should be fully informed about the potential risks, benefits, and alternatives to dental implants to make an educated decision.
Surgical guide fabrication: Once we have determined there is sufficient bone volume (height and width), a surgical guide will be fabricated to ensure necessary precision of placement. A guide seats over existing teeth as supports or over a dental arch (tissue or bone) when we do not have enough existing teeth and guides the surgery to take the guesswork out of placement. Implants placed with guides are precise and improve the overall success dramatically. Guide fabrication typically takes 1 week. In our office we do not place implants without guides.
Surgery:
Depending on the number of implants being placed, surgery can take anywhere from 30 minutes to 3 hours. The arch or area will be numbed/ anesthesia will be placed. Soft tissue punch or a flap will be opened to expose the area of implant placement. The surgical guide will be seated and the osteotomy (preparation of the bone to accept the implant) will be performed. Often x-rays will be taken to verify the area. Implant will be placed and stability measured in newtons. In some cases grafting may be needed around the implant in conjunction with a membrane and/or sutures to aid in the healing process.
Post-op CT is taken to ensure placement location.
Antibiotics will be prescribed to help prevent infection during the initial healing phase.
Post-Surgical Care
1-week post-ops are indicated in all implant placements
Healing Time: Adequate time for osseointegration (the process by which the implant fuses with the bone) is necessary, typically 3-6 months before the final restoration is placed. A type of digital tuning fork is utilized to measure osseointegration (bone healing to the implant) and gives us the green light to move forward with restoration or if we need additional time to heal (yellow/red).
Many times prior to being able to take a final impression for a crown or bridge, healing abutments need to be placed over the implant to contour the tissue for best long term success and esthetic result.
Follow-Up Appointments: Regular follow-up visits are essential to monitor the implant's integration and address any complications promptly.
Oral Hygiene: Maintaining excellent oral hygiene is crucial to prevent infection and ensure the long-term success of the implant.
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