In 1952, orthopedic surgeon PI Branemark tried to remove a titanium cylinder he had placed in a rabbit femur during a study. He couldn’t do it.The bone had grown to the surface of the titanium. Eureka! Osseointegration was discovered! He then put on his thinking cap and went to work. In 1965, Dr. Branemark placed his first implant into a living human patient. Ta-da!! The birth of modern day implants.
Over the last fifty years, improvements in design, surgical and restorative technique, and materials have made implants the most predictable way to restore missing teeth! Today’s implants can potentially last a lifetime and the ways they are being used are growing each year.
What are Dental Implants?
An implant is a root replacement. Sounds simple, because it really is. A titanium post is placed into the bone, where osseointegration–bone connection–occurs. The total process for this bone healing takes about four months. Then, a replacement tooth can be built upon the titanium root for a beautiful, long-lasting restoration.
What are the Advantages of Dental Implants?
Implants offer a natural look and feel unmatched by other restorations. But that’s not the only advantage. Traditional bridges and partials rely on the surrounding teeth for support. Over time, the increased workload can cause wear and damage to the overworked teeth. implants are not attached to the natural teeth and support the load themselves. In the case of a single tooth replacement, they can be treated exactly like a natural tooth, allowing for easy flossing and cleaning of the implant.
Did you know that once a tooth is lost, the bone that once supported it starts to disappear? Without the tooth root to stimulate it, the bone slowly thins and shortens. Placing an implant stops this process, as it acts just like a tooth root and stimulates the bone.
What Can an Implant Do?
One of the biggest benefits to implants is their versatility. An implant can be used to replace
- A single tooth
- Multiple teeth
- An entire arch
But implants can also
- Anchor partial and full dentures
- Aid in orthodontics
Who Can Have Implants?
With the advances made in implant technology, almost everyone can have an implant. Your surgeon will discuss your medical history and risk factors that pertain to you. Risk factors for implant placement include
- Gum Disease
- History of Smoking
- Smoking constricts vessels and diminishes blood flow, which affects healing.
- Bone Levels
- There must be enough bone to house the implant
- Vital Structures
- Location of nerves and sinuses
- Medical Conditions
- Uncontrolled diabetes
- Irradiated bone
How Do I Know if I am a Candidate for Implants?
Almost everyone can have an implant, but there are considerations. A Cone Beam CT can be used to how much bone is present at the implant site and whether the implant site is close to vital structures such as sinuses or nerve.
What Happens if I Don’t have Enough Bone?
Don’t worry! In most cases, bone grafting can be done.
What is Bone Grafting?
Bone grafting is taking bone and applying it to a site. The bone may come from another place in your body, more commonly, from sterile cadaver bone. Bone grafting can be done in different ways. Sometimes, at the time the tooth is extracted, some bone is packed into the socket to help preserve the bone there. The cadaver bone in the socket serves as a kind of matrix that allows your own bone to fill in.
What is a Sinus Lift?
Sometimes, the implant site may be close to the sinus cavity. In this case, a sinus lift with a bone graft may be needed. It sounds a lot worse than it is. The roots of the upper teeth back sit below the maxillary sinus. If there isn’t enough bone, it is possible that the implant would penetrate the sinus cavity. In this case, a sinus lift and graft would need to be done. The area is exposed and the sinus is gently lifted up using an instrument. Then bone is packed beneath it to hold the implant. Many times, this is performed with just local anesthesia.
How Long Do Bone Grafts and Sinus Lifts Take to Heal?
Complete healing for bone grafts is about 4 months for most people. Sometimes, grafts can be done at the time of the implant placement. Your surgeon will discuss your options.
How is an Implant Placed?
Once the Cone Beam CT or other imaging is done, your case will be planned. Planning may include a surgical guide for placement. Then, it is time for surgery. Your surgeon will discuss options for anesthesia. Implants can be placed with local anesthesia, the numbing injection used for all routine dental work, or under IV sedation.
What Should I Expect the Day of Surgery?
The surgical experience can vary based on
- Whether additional procedures are performed
- Sinus lifts
- Location of implant
- Type of Anesthesia
As an example, though, let’s look at the case of a single implant placed under local anesthesia. You will be given injections to make you very numb. A small incision is made where the implant will go and a series of drills will be used to prepare the bone for the implant. Remember, the bone itself doesn’t have feeling. So, while “drilling a hole in your bone” sounds daunting, the actual experience is quick and painless. The implant is then placed in the bone. It really is that simple. A screw or a healing abutment will be placed on the implant and if stitches are necessary, they will be placed. Most appointments last about an hour.
You can expect
- Numbing injections to get you comfortable
- Vibrations during the placement
I bet you were expecting a longer list. Most people who receive implants report little to no post-operative pain! Depending on which method is used, you may leave with a few stitches or a healing abutment, which is a small flat cylinder that screws into the implant to allow your tissue to heal in the proper contours.
What Should I Expect After Implant Placement?
Most people report little to no pain after implant placement. However, it is a surgery and certain precautions should be observed. Your surgeon or dentist will go over post-operative instructions and give you a written set of guidelines.
Healing is uneventful for most people, however normal post-operative conditions may occur
- Mild swelling/bruising
- Oozing bleeding
When Can I Get my Permanent Tooth?
The healing period is about four months for most people. Once your surgeon or dentist gives the go-ahead, you are ready to get your permanent tooth! Making a tooth for a single implant is generally very straightforward and simple procedure.
There are three parts to an implant restoration:
- Implant – titanium root replacement placed in bone
- Abutment – screws into the implant. Acts as a tooth that has been prepared for a crown.
- Crown – The tooth shaped restoration that you see in your mouth.
Here’s what to expect:
There are generally two visits to get your final crown.
- Healing abutment is removed if present
- Impression coping is placed
- Impression is taken
- Healing cap is replaced
Sometimes the implant remains covered at the time of surgery and is uncovered at a later date.
The impressions will be sent to a lab where a crown will be fabricated. Once your crown is ready
At this appointment, your crown will be tried in, an x-ray will be taken to ensure proper fit, and the tooth will be placed permanently.
How Should I Care for my Implant?
Now that your implant has been placed, you can care for it just like a natural tooth! It will be need to be kept very clean to ensure good gum health. Maintain your routine visits and call your dentist right away if you notice
- Implant feeling loose
- Bad Taste
Can Implants Fail?
The success rate for implants is very high, but failures can and do occur. Depending on what caused the failure and how much bone was destroyed, another implant may be able to be placed.
Some Causes for failure
- Failure of implant to osseointegrate
- Inadequate bone density
- Damage to tissue
- Peri-Implantitis (Infection of the implant)
- Causes bone loss and possible loss of implant
- Caused by bacteria
- Can be caused by excess of dental cement under gum
- Tissue Damage
- Implant is a failure if it is placed too near or into nerve causing pain
- Putting the implant into function too early or improperly
- Your Biology
- Some patients bodies won’t allow them to integrate
- Faulty implant
What do I do if My Implant Fails?
Fortunately, failure rates for implants are very low at around 5%. The best outcomes happen when the failure is detected early. Keep regular appointments and report anything unusual. In the event that your implant fails–don’t panic. With today’s technology, it is sometimes possible to save a failing implant. When the implant can’t be saved, a new one may be able to be placed, although not always. The area will need to heal and may need to be grafted.
Questions? Your dental team is well trained to answer all your implant questions!