Patient Services



INFORMATION ABOUT IMPLANTS

What is an implant?
An implant is an artificial means of anchoring something very securely to the bone of the jaws or face. This “something” can be a tooth; a bridge of just teeth; a denture; or a bridge of teeth and gums, sometimes called a hybrid denture, or a fixed-removable denture. In all of the previous mentioned cases, the implant acts as an artificial root for a tooth or teeth. Implants can also anchor a maxillo-facial prosthesis, such as an artificial nose, eye, or ear. In short, an implant holds in a missing part of the body.

Why is an implant necessary?
Implants help to anchor artifical replacement teeth for teeth that have been lost and sometimes anchor artificial prosthetic devices that replace missing bone, gum tissue, and teeth. Implant retained artificial teeth are currently the most natural and comfortable way to replace natural teeth that is available. With proper planning and expert surgical, restorative, and laboratory services, the result is a tooth or teeth replacement that looks and feels like natural teeth.

What are implants made of?
Implants are made from titanium or titanium alloy. Often the surface is treated to enhance the bond to the bone. There are hundreds of types of implants manufactured throughout the world. Some have strict quality control on their manufacture and some do not. Some have research on which to base their claims of success, and some do not. In my practice, I limit my choice of implants to the two that I feel are the best on the market, which have a long and proven history, have tight control of their manufacturing process, have research to support their claims, have ongoing research to improve the product, and have features which have a biological basis to integrate (heal) faster after placement, and have a stronger bond to the bone.

What are the success rate of implants?
On average, implants are about 99% successful in the lower jaw, and 97% successful in the upper jaw in a non-smoker. Smoking will significantly decrease the success rate. Other factors which may decrease the success rate are:

1. Lack of adequate bone or poor quality bone.
2. Very heavy musculature.
3. Lack of “guidance” of the upper front 6 teeth. This means that they don’t overlap in the proper way. The dentist can tell you if this is a problem or potential problem.
4. Uncontrolled diabetes.
5. Lack of keratinized tissue (gums) surrounding the implant. This can almost always be fixed by surgical preparation of the implant site, either at the time of implant placement, or as a separate procedure before the implant is placed.

How are implants placed?
Implants are placed surgically into the jawbone. A hole is drilled into the bone and the implant is screwed into the hole. This process can take as little as 5 minutes, and is usually done with local anesthetic. There is usually very little post-operative discomfort. In some cases bone grafting may need to be done, either at the time of implant placement, or prior to implant placement. Pre-placement grafting will require additional healing time. After the implant is placed, there will be a healing period, called integration. Once integrated, a tooth or teeth, or prosthetic device can be attached to the implant or implants.

What takes place during implant placement?
Prior to the surgical placement, elaborate planning is done. Models of the teeth are mounted on an articulator to check the bite. A wax replacement for the missing tooth or teeth is made on a plaster model of the jaw. Using this, a radiographic and surgical stent is constructed. Using the radiographic stent, a cat scan (CBCT) is obtained of the area and the surgery is planned digitally on the computer. On the day of the surgery, sterile drapes are placed over your face and body to isolate the area. A local anesthetic or a general anesthetic is administered. This preparatory phase will take 30-45 minutes. A device is placed on the remaining teeth to guide a surgical drill. A small hole is drilled and checked for accuracy, and then it is enlarged a little bit at a time until the proper size for the implant is achieved. The implant is then screwed into place and a cover screw is placed over the top to keep food from getting inside. Generally, the actual surgical process will take about 5 minutes or less per implant. A temporary replacement is placed if the area shows when smiling. This will take an extra 10-45 minutes.

What are the alternatives to implants?
When implants are not used, replacement teeth either have to be anchored by remaining teeth or, if no teeth are left, rest on the gum tissue. Use of other teeth to support and anchor replacement teeth puts extra pressure and strain on those teeth, since they are supporting more force than they are designed for. Replacements are usually either done with a bridge that is permanently attached to adjacent teeth (fixed bridge), or a replacement that can be taken in and out of the mouth (removable bridge or removable partial denture). Regardless of which of these are done, if any component part, or tooth which supports or anchors the device fails, repair may be possible or the whole appliance may need to be remade. If all of the teeth are missing, the replacement is called a removable denture. Of course, one alternative is to do nothing. However, this choice will often result in additional bone loss, and worsening of whatever situation is creating the need for the implant in the first place, making future implant placement more difficult.

Other Frequently Asked Questions and Answers about implants
1. Q. Can an implant be placed on the same appointment that a tooth is removed?
A. Yes, but not always. This is called “immediate placement”. Whether the implant can be immediately placed depends on the amount and quality of the bone. If enough bone is present, and the implant is tight when first placed, it can be left in place. If there has been too much bone loss, or the implant is loose after being screwed into place, it may need to be removed and bone grafting may need to be done. This is usually decided at the time of implant placement surgery. Bone grafting will require a waiting period of about 2-3 months for the bone to grow before the implant can be placed.

2. Q. Can the replacement tooth be placed on the implant the same day it is put in?
A. Yes, but not always. If a tooth is extracted, and an implant immediately placed (see above), sometimes a temporary restoration can also be placed at the same time. This is called “immediate loading.” It depends, as above, on the quality and quantity of the bone, and whether the implant is solid (resistant to being moved) when placed. The same is true for an implant placed into a site where the bone has already healed. The quality and quantity of bone, the load expected on the implant, and whether the implant is secure when placed will guide the surgeon as to whether the implant can be expected to withstand having a tooth immediately placed on it (immediately loaded). In general, multiple implants in a row can withstand immediate placement and immediate loading better than a single implant. Immediate placement and immediate loading MAY decrease the success predictability slightly.

3. Q. Why shouldn’t I go to Mexico or India and have my implants placed?
A. There are hundreds of implants currently on the market manufactured all over the world. They all look similar. However, small changes in design have led to vast improvements in the predictability and longevity of implants. Only a handful of implants have undergone rigorous testing. Implants used in this practice are in that group and have been extensively researched, have proven track records of decades of use, and have strict quality control and packaging guidelines. The skill of the surgeon and the restorative dentist will influence the final outcome. We work only with specialists who are highly trained in implantology. We work closely with the surgeon to be as sure as possible that the implant will be placed correctly to have an excellent restorative result. In addition, the fit and design of the crown or other restoration will have an effect on the longevity of the implant restoration. We use only skilled and experienced laboratory technicians to accomplish this, and only highly precious metals (high noble metals) to make the final restorations. This is not likely to be the case in Latin America or in third world countries overseas. The expertise of the specialists, restorative dentists, and laboratory technician; the cost of precious metals used in the construction of the restorations; the cost of high quality, highly researched, and highly regulated dental implant devices used in the U.S.; and the cost of expert laboratory support, all add to the cost of the final restoration. These things are impossible for anyone to determine in clinics or offices in other countries. Even in the U.S., many offices will not reach this high level of service. Finally, a poorly placed implant can mutilate the jawbone and correction of the mutilation can be difficult and expensive, or impossible.

4. Q. Is there much pain in having an implant placed?
A. No. The implant placement is essentially painless, and the actual placement itself only takes a few minutes.

5. Q. What is the recuperation time after having an implant placed?
A. Generally, you will need to be on a soft diet for a day or two. You can
usually return to your normal activities on the following day. You should refrain from active sports activities for at least a few days.