Dental Implants

Overview

Implants in dentistry involve the surgical placement of the implant into bone and the implant becoming firmly fused or integrated with bone. Dental implants are used for the replacement of lost teeth, the securing of full dentures, as an anchor for orthodontic treatment (see Braces), or for the restoring of facial deformities, due to cancer, accidents or burns.

Dental Implants used for the replacement of teeth:

An actual laboratory constructed bridge on a lab model of an actual patient’s mouth

An actual laboratory constructed bridge on a lab model of an actual patient’s mouth

Dental implants involve three parts to the full replacement of the lost tooth. First is the implant itself; this is a surgical procedure that places the implant in bone. The goal is to get the titanium coated device to integrate or bond to the bone; integration takes time, approximately 3-6 months.

Once the implant is fully integrated in bone, the second step is to place the abutment. The abutment is seen above the gumline and it supports the crown. The abutment is usually screwed into the implant and the third and final step is the cementation of the Crown. The crown is not removable by the patient, but cemented much the same way it is cemented to an actual tooth. Implants can also support a Bridge or a Denture in the same manner.

Dental Implants used for the stabilization of dentures:

Sometimes over the course of a lifetime, teeth are prematurely lost and once teeth are lost, the jaw bone shrinks or resorbs. Gum disease (Periodontal Disease) also attacks bone causing tooth loss; the loss of the teeth causes the loss of bone and may make it difficult to hold dentures in place.


The placement of dental implants can help stabilize the denture and hold it more firmly in place. There are two ways the denture can be placed over the implant/implants: the denture can be screwed into the implant, making removal only possible by a dental professional or it can snap into place and be removable by the patient.

It should be noted that if there is not enough bone available to place the implant, further surgical procedures may be necessary before placing the dental implant. It may be necessary to do a bone graft and in the upper arch it may be necessary to lift the maxillary sinus called a ‘sinus lift’ .

Dental Implants used for orthodontic treatment:

Orthodontic treatment (see Braces) involves placing forces on certain teeth by anchoring appliances on other teeth, usually molars. In cases where there are no molars available (or other strong anchor teeth to use as anchors), dental implants can be placed to use as anchors. The dental implants are small and don’t fully fuse or integrate with bone and are easy to remove at the end of orthodontic treatment.

Dental Implants for the restoration of facial deformities:

When facial deformities occur due to disease or accidents, dental implants can be placed in facial bones to replace the lost facial structures. These procedures usually involve a team approach of the Prosthodontist (see Dental Specialties), ENT (ear, nose and throat) medical professionals, plastic surgeons, and others, depending on the situation.

Issues to consider for long-term success of dental implants:

There are a number of issues to consider when planning the placement of dental implants. Some of these include, but may not be limited to, the success or failure of dental implant placement:

  1. Heavy smokers, diabetic patients with uncontrolled blood sugar, and poor oral hygiene may preclude the long term success of dental implants. These patients are at a higher risk for Gum Disease (Periodontal Disease) which can cause implants to fail.
  2. Patients on biphosphonates (bone building drugs) may be at risk for long-term success of dental implants. The planning should consider both the type of drugs and the length of time the drug has been used.
  3. Placement of dental implants and the forces that will be required of the implant. The placement of the implant must properly distribute forces to prevent fracture of the crown, bridge or denture it supports, as well as the implant parts (the implant, abutment or screw). Inappropriate forces can cause bone loss around the implant, so bone density also plays a role in long-term success.
  4. Thickness of bone: both the vertical thickness (the height) and the horizontal thickness (the width) is a consideration to the placement of dental implants.

Risks involved in the placement of dental implants:

  1. infection following surgery
  2. excessive bleeding during surgery
  3. damage to nearby nerves, the sinus, blood vessels
  4. death of the flap of tissue that is opened to gain access to bone
  5. fracture of the implant, abutment or abutment screw
  6. failure of the implant to bond (integrate) with bone
  7. unacceptable esthetics due to gum or bone shrinkage around the restored implant due to a poor surgical outcome or poor oral hygiene

Implants have a high success rate when planning and home care before and after placement are optimal. The replacement of teeth with dental implants restores the ability to properly emulsify food and undoubtedly aids in better nutrition. Without a full dentition, a softer, less nutritious diet is consumed and quite possibly contributes to many of the diseases we see in our practices every day. Further, a healthy smile leads to higher self esteem and an overall higher feeling of well being.