If a tooth cannot be saved, whether it be due to fracture of the root or too much missing tooth structure, a dental implant is a good option for replacement. We are experienced and skilled in extraction, grafting and dental implant procedures, when indicated, to help you and your restorative dentist replace a hopeless or missing tooth with a healthy, functional implant-retained crown.
Dental implants are designed to provide a foundation for replacement teeth that look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. The implants are small titanium posts, which are placed into the jawbone where teeth are missing. The bone bonds with the titanium (a process called osseointegration), creating a strong foundation for artificial teeth. In addition, dental implants can help preserve facial structure, preventing the bone deterioration, which occurs when teeth are missing. They can also help to keep adjacent teeth from shifting.
The implant consultation consists of periodontal evaluation to determine if the surrounding gums and teeth are healthy and evaluation of the bone for the future implant. If the tooth that requires extraction is still present, an evaluation of the surrounding bone will be completed. If the tooth is missing a 3-dimensional radiograph (Cone Beam CT) will be needed to assess the amount of bone present. After the evaluation, we will discuss the findings with you and explain if any treatment is needed. This is a good time to ask any questions you may have about the evaluation, findings, or anything else regarding your oral health. After treatment recommendations are established, our staff will present a treatment plan with financial information. After this, they will work with you to set up an appointment. We will then write a letter to your general dentist to discuss recommendations for treatment.
Dental implants are metal anchors, which act as tooth root substitutes. They are surgically placed into the jawbone. Small posts are then attached to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.
For most patients, the placement of dental implants involves two surgical procedures. First, the implant, which looks like a screw is placed into your jaw. Over the next few months, the implant and bone are allowed to bond together to form an anchor for your artificial teeth. During this time, a temporary tooth replacement can be worn.
After the implant has bonded to the jawbone, the second phase begins. The surgeon will uncover the implant and attach a small healing collar or a healing abutment. You then return to your general dentist, and an impression must be taken. Then posts or attachments can be connected to the implants. The replacement teeth are then made over the posts or attachments. The entire procedure usually takes six months. Most patients do not experience any disruption in their daily life. For more information on dental implants and care for your teeth following a dental implant, please click here.
A procedure called “socket preservation” is sometimes needed to preserve bone and minimize bone loss adjacent to a tooth that has been removed. The technique involves filling the socket with bone (and a membrane if needed) and allowing the bone to heal for approximately 3 months before implant placement.
“Ridge modification” may be needed if you don’t have enough bone to support an implant. This bone loss could be caused by periodontal disease, wearing dentures, injury, remodeling of the bone due to tooth loss, or trauma. During this procedure, bone is added where needed to ensure a proper foundation for implants. Your bone usually needs six months of healing time before placing implants.
“Sinus augmentation” may be needed to place implants in the upper back jaw, where your bone is very close to your sinus. In this procedure, the sinus floor is raised so there is more room for new bone to grow to provide a proper foundation for implants. This procedure can be completed at the same time as implant placement in some cases, but may need to be done separately if minimal bone height is present. If a separate procedure must be completed, six months of healing is required prior to implant placement. There are two ways to complete a sinus augmentation depending on the amount of native bone present. Your situation will be assessed so that we can find the best option for your situation.
Replacing a single tooth can be achieved with a conventional bridge or an implant retained crown.
The conventional fixed partial denture (fixed bridge) requires that your general dentist shaves down two or more adjacent teeth and places a 3-unit 1 piece bridge over the teeth, filling the space. Placing a bridge on natural teeth increases the functional forces that are placed upon them and makes the use of floss between the teeth more difficult. Conventional bridges may need to be replaced if the supporting teeth develop cavities or periodontal disease. In a certain percentage of instances while preparing the adjacent teeth for crowns (i.e. drilling down a tooth), the preparatory procedure will cause the nerve of the tooth to die and require root canal treatment to eliminate infection of the nerve.
An implant single-tooth restoration avoids the need to shave down (drill) the adjacent teeth and is a free-standing restoration not connected to any of the other teeth. The implant tooth can be flossed and brushed just like a natural tooth. An implant is placed in the position of the missing tooth. When the implant is stable and ready for loading, an abutment can be attached to the implant that will connect the final crown to the implant. An impression is made to record the contours of the abutment or the position of the implant top. The crown is then fabricated and fixed in place using cement or screws. An implant crown is not susceptible to cavities but may develop complications if oral hygiene is not maintained. The implant restoration should be routinely evaluated in time intervals that are determined by the conditions of the remaining natural teeth and the implant.
Replacing multiple teeth can be achieved with a multiple single-tooth implant restoration, with implant fixed partial dentures (implant bridges), with a removable partial denture (RPD), or with a conventional fixed partial denture (FPD).
The missing teeth may be replaced with multiple single-tooth implant restorations (described under replacing single teeth), or with implant fixed partial dentures (implant bridges). Implant bridges replace the support lost as a result of missing teeth, avoid the need to drill the adjacent teeth and do not require an implant for every missing tooth. The space, gum tissue and underlying bone must be appropriate to place the dental implants.
Implants are placed in strategic positions to replace the missing teeth. When the implants are stable and ready for loading, abutments can be attached to the implants that will connect the final bridge (prosthesis) to the implants. An impression is made recording the contours of the abutments or the position of the implant tops. The implant bridge is then fabricated and retained in place using cement or screws.
An implant bridge is not susceptible to cavities but may develop complications if oral hygiene is not maintained. This implant restoration should be routinely evaluated - the time interval dependent upon the conditions of the remaining natural teeth and the implant bridge. Restorations using porcelain may be susceptible to a low incidence of porcelain fracture. Patients with large functional forces, including bruxism, may require stronger metal chewing surfaces.
Replacement with a conventional removable partial denture (RPD) is indicated for patients who can accept having a restoration that is NOT permanently fastened. This restoration should be removed on a daily basis by the patient for oral hygiene access to the remaining natural teeth and the prosthesis. The RPD is made up of a metal framework, denture teeth and acrylic. Some patients may not like the appearance of the clasps (metal arms) that engage the remaining teeth to retain the prosthesis, the display of portions of the metal framework, the denture teeth and acrylic. Replacement of worn denture teeth, as well as relining the prosthesis to maintain proper adaptation to the gums, is usually necessary over time.
The major advantages of an RPD are minimal preparations of the adjacent teeth (significantly less than a bridge), replacement of missing teeth, cosmetic replacement of the lost volume of gum and bone, reduced expense and easier access for oral hygiene. With an appropriate design, an RPD may be modified to add any teeth that may require removal in the future.
Replacement with a conventional fixed partial denture (FPD) or bridge requires reduction of two or more adjacent teeth to make crowns that will be connected to each other with a false (prosthetic) tooth suspended between them. A fixed bridge increases the functional forces placed upon the supporting teeth and complicates the use of floss between the teeth. The number of natural teeth that require reduction is dependent upon many factors which include the number and span of the missing teeth, the location in the jaw, and the condition of the involved teeth themselves. Conventional bridges may need to be replaced if the supporting teeth develop cavities or periodontal disease.
If you are missing, or need to remove all teeth in one or both jaws, implants may allow you to have a fixed full-arch bridge fabricated as well.
As an alternative to wearing a full denture (if there is adequate bone or bone augmentation procedures can be performed to grow sufficient bone) multiple implants can be placed across the jawbone to provide support for a fixed bridge. This procedure is similar to those described for single or multiple implants but requires careful diagnosis, planning and coordination before treatment begins. This attention to detail will ensure that an appropriate number of implants can safely be placed in positions that will allow your dentist to fabricate a bridge which will meet your needs and expectations.
The number of implants necessary for a full-arch fixed bridge varies depending on your particular anatomy, the opposing teeth, the type of bridge you want to have placed and the number of teeth you want or need to replace with the prosthesis. A full arch of implants can be placed when you are already missing all teeth in one of your jaws.
If you have teeth remaining, they may need to be removed as a first step before implant surgery can proceed, or sometimes the teeth may be extracted and implants placed immediately after the teeth have been removed. If there are teeth remaining, you may be able to have a temporary fixed-bridge made by your dentist to help transition from your own teeth to implants. In this scenario (while the implants are healing), the temporary bridge stays in place which allows chewing, speaking and smiling - all without having to wear a removable denture. If it is not possible to retain enough teeth to support a fixed bridge while the implants are healing, then you may need to wear a removable denture temporarily.
Usually, you will be advised by your dentist to refrain from wearing the denture for a period of time (customarily two weeks) after the implants have been placed. This allows the gums to heal without being disturbed. In recent years, we have learned that it is often possible to place a full arch of implants and connect them to a fixed bridge (usually temporary) in what is known as immediate loading - which means the implants are receiving "load" from chewing forces as soon as they are placed.
This newer procedure is highly successful but there are certain requirements for its success. This technique requires careful planning and coordination by your dentist and surgeon and as with all treatment, you should discuss all of your options and alternatives with your dentist and decide together which may be the best and most appropriate for you.
An implant overdenture fits over a dental implant with various types of attachments that provide you with excellent stability and retention of your complete dentures. The implant overdenture is a full denture used to replace the teeth in a full-arch where all the teeth are missing. The denture can "snap" into place to afford you more comfort, and improved chewing ability.
Pre-surgical prosthodontic planning for implant overdentures begins with diagnostic impressions for recording jaw relation and diagnosing possible dentures. These impressions help to determine the correct positioning of the teeth on the new dentures as well as to confirm the optimal location for each implant. They are also used to assure correct appearance and bite. Frequently, a template is produced from the diagnostic impression that is provided to the surgeon for guidance during implant placement surgery.
Most often, an upper overdenture will require placement of more implants than a lower overdenture due to the different nature of the anatomy of the upper and lower jaws. It may also be possible to fabricate an upper denture without a palate (roof of the mouth), which may be a more comfortable option for some patients.
The specific need for an implant overdenture can vary and the decision for this treatment option should be made with your restorative dentist. Many patients can benefit from the facial support provided by the extensions of the complete denture design.