Dental implants are one of the options available for replacement of missing teeth. Dental implants have been in use since 1965. They consist of a metal base, usually titanium, which is surgically placed in the jaw bone, an abutment and a crown. An implant may be screw-shaped or cylindrical-shaped with a slightly roughened surface.
The presence of a natural tooth root stimulates the surrounding bone to continually produce new bone. When a tooth is lost, the bone that had supported it will be resorbed back into the body because it no longer has the stimulation. Once implanted into the jaw, the implant acts like one of your natural teeth. It will have similar stability; strength and ability to stimulate new bone formation. This ability to stimulate new bone growth is important in contributing to the stability of the implant. During healing, the new bone will grow around the implant (osseointegration), anchoring the implant in place.
There are two types of implants – endosteal and periosteal. The endosteal implant is the most common. It is implanted within the bone of the jaw itself. A periosteal implant may be used if the bone is less than ideal to support an implant. The periosteal implant is placed on the top of the bone.
Step One: Diagnosis
After receiving a recommendation of implants, you must be evaluated to see if you are a good candidate for implants by a periodontist or oral surgeon. It is important that you be in good overall health and oral health. You must also have the appropriate amount and quality of jaw bone present. How is this assessed? You would begin by having a panoral radiograph taken with a small metal ball. A panoral is an X-ray taken of your head, which shows the bones of your face from the eyes to the chin, on a flat film. Small metal balls are placed in the area of the planned implant as a reference point before the X-ray is taken. This will show how much bone and indicate its density in place, in the area of the implant.
In certain circumstances, a panoral film may not present enough information, and, a CAT scan may be required. This scan will give more detailed information of the bone and the location of structures such as sinuses.
Step Two: Surgical placement of implant
Once it is determined that the bone quality and quantity is sufficient, an appointment can be made to start the surgical procedure. An incision is made in the area in which the implant is to be placed. Several measurements are taken during the surgery to ensure successful placement. A small starter entry hole is made with a dental instrument and the implant screw is inserted to a specific depth. A small healing cap is put over the top of the implant screw. The tissue is sutured back in place and the area is allowed to heal. The healing phase of this stage is 3-6 months, depending on the individual’s rate of healing. The bone has to have time to grow and mature around the implant.
One question many people have is whether or not the implants will hurt. You will be given a local anesthetic possibly in conjunction with a sedative during surgery and a pain medication for after surgery. When asked, most people say the discomfort was slight and not as bad as they thought it would be.
Step Three: Uncovery and placement of abutment
In most cases, further surgery is not necessary. The abutment, or mid-stage of the implant, is placed on top of the implant. After the healing of the implant is complete, the patient will have to have another surgical procedure to uncover the implant and remove the healing cap. At this surgery, the abutment is placed on the top of the implant. The abutment is the part that will be above the gum line and will hold the new crown.
Step Four: Placement of prosthetic crown
After the abutment is placed on the implant, an impression is needed to provide information to make the new crown. The patient's dentist makes the crown. The patient may require several appointments prior to final placement of the crown.
A patient’s age is not necessarily a factor in whether or not he/she is a candidate for implants. It is more important that the patient be in good general health and oral health. Successful implants not only depend upon proper placement, but also patient compliance. It is important that the patient pay close attention to homecare, proper brushing and flossing. Without daily removal of the plaque buildup, the implant may fail due to infection. Regular check-ups with your dental professional are also necessary.
Implants may be done for one tooth, several teeth or they may act as anchors for a full denture. For full or partial dentures a few key implants may be placed. The denture is manufactured to have a method to snap down over the implants. The dentures will be very stable and usually the patient will not have the sore spots that may occur with new conventional dentures.
There may be individual circumstances that will require additional treatments with a patient’s implant procedure. If the quantity of bone present or the quality of the bone is not adequate, a procedure called ridge augmentation may be required. As the name suggests, if the bony ridge that supported the teeth is not thick or dense enough, a surgical procedure that adds additional bone will be needed. The bone growth process may take up to six months before the patient can begin any implant procedure.
In the upper arch, the floor of the maxillary sinus may be too close to the tooth roots of the back upper teeth. In order to correct this, a sinus lift procedure is done which will raise a part of the sinus and try to grow new bone where needed. Again, you may need up to a year for this new bone to heal and mature. Some of the newest implants may be placed at the same time as a sinus lift in some individuals.
How long do implants last? There have been implants in place for more than 30 years that are still functioning. However, patients with newer versions of implants have been followed for up to 20 years and the implants are still functional.
The fee for the implants varies with the number of implants placed and the additional procedures required. It is best to get a fee estimate from all the professionals involved. Until recently, implants have not been covered under most dental insurances. Currently, there are a limited number of companies that will cover a portion of implants. The patient can always call their own company and ask what is covered under an individual policy for implants.
For additional information, please call Dr. Reidy’s office.
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