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Oral Health Buzz

Implant Dentistry: A Guide

Dr. Pamela L. Alberto

Even though Americans can expect to retain their teeth longer, there are approximately 8 million people who are missing all of their teeth in the upper or lower jaw. Conventional partial dentures and dentures can be difficult to wear, making chewing a challenge. The discovery of implant technology and the birth of implant dentistry changed the way lost teeth were treated. Dental implants improve quality of life by improving the way we chew and smile. Patients who wear dentures can now get their teeth back with dental implants.

Discovery of Dental Implants

A Swedish research team lead by Dr. P.I. Branemark discovered that bone can bond with titanium. He called this bone-implant-interface 'osseointegration.' This was the beginning of implant dentistry. The success of dental implants is related to this discovery. In 1982, the team reported a 91 percent success rate in the lower jaw over 15 years. The success rates have improved to 96 percent. Most implants are titanium screws.

Factors in Dental Implant Placement

There are important factors in achieving success including atraumatic surgery with low-speed drills and the experience of the surgeon—doctors that place fewer than 50 implants per year have more complications. The patient has to have the right bone quality and content to initially stabilize the implant. Minimally, the patient needs to have at least 8mm of vertical height of bone and 6mm of width. If there is a lack of bone, there are many bone-grafting procedures that can be performed. We can use bone harvested from the patients' lower jaw or bone harvested from cadavers or bovine bone.

It is important for the doctor to perform a thorough medical history and clinical exam with the patient. There are some medical problems that make implants contraindicated, if the patient has brittle diabetes, liver disease, or a severe bleeding disorder, then they are not a candidate for implants.

The oral exam includes bone quantity and quality, the type of opposing dentition, and the type of tissue. Then a radiographic exam is performed, taking a panoramic film and 3D cone beam to plan the exact position the implants need to be placed.

After the proper examination, a surgical guide is made to be used during surgery to guide the placement of the implant. Usually antibiotics are given an hour prior to surgery. The surgery can be performed under local anesthesia or IV sedation.

An incision is made in the area of the missing teeth and a flap is opened up. Then, a preparation in the bone is made using various size drill bits in a low-speed handpiece. The preparation is made as long and as wide as the bone in the area. The implant placed is made of titanium with a roughened surface. The implant is screwed into the preparation. If part of the surface of the implant is not covered with bone, a bone graft must be placed. Then, the tissue flap is replaced and sutured in place. The implant must stay in place undisturbed for 4 to 6 months so osseointegration can take place. During the healing phase, the patient can still wear their partial or full denture. After the implant has integrated, the teeth can be placed.

The Beauty of Dental Implants

Maintaining your implants is very important for success. Implants can develop gingivitis and bone loss just like natural teeth, so they need to be flossed and brushed like natural teeth.

There are many offices advertising "teeth in a day" or "immediate load implants." This is not possible for all patients. The patient must have an abundance of very dense bone for this to be possible. The success of this procedure is less reliable since osseointegration has not taken place prior to placing teeth. It is important to see your dentist twice yearly so your implants can be checked and cleaned.

Dental implants are usually placed by oral and maxillofacial surgeons or periodontists, although some general dentists may take additional training to learn to place implants. The cost of dental implants ranges from $1,800 to $2,200. This does not include the cost of the crown or any additional bone grafting. Beware of implant clones—ask your doctor which implant you are receiving. You want an implant manufactured by a reputable company.

Implant dentistry improves the quality of life for anyone who is missing teeth and wearing dentures, allowing them to smile and chew with ease.

Most of my implant patients feel that implants have changed their life. They can now go to dinner with friends and order any food they want and chew it without worrying about their dentures shifting. One patient told me that every time she eats a steak since her implant, she asks God to bless me. This technology has changed peoples lives and changed the face of dentistry.

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