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Traditionally, if you were missing a tooth or if one needed to be extracted, the healthy teeth on either side of the missing tooth would be cut down and the whole thing replaced with a three-crown “bridge”.
Dental implants are the modern alternative. Instead of cutting down two perfectly healthy teeth, the practitioner inserts a dental post (dental implant) into the jawbone to replace your missing tooth root. This post becomes solidly fixed into your jaw (like a natural tooth root). Your general dentist then places a crown onto this artificial tooth root that looks, feels, and functions like your natural teeth.
Quite simply, dental implants are the most natural replacement for missing teeth.
The left photo shows a front tooth that broke off. The center x-ray and right photo show the broken tooth replaced with a dental implant and crown.
The top row: The left x-ray shows a root canal tooth that had a root fracture that lost bone due to the resulting infection. The tooth was extracted, a bone graft (socket preservation bone graft) was placed. The center photo and right x-ray were taken 4 months later showing dense bone fill.
The bottom row shows the implant placed and restored with a crown.
Replacing Several Missing Teeth
Dentures can cause bone loss, due to lack of stimulation.Traditionally, several missing teeth would have been replaced with a removable partial or full denture.
Dental Implant Supported Dentures are firmly anchored to the jawbone. This helps to prevent bone loss and causes them to feel much more like natural teeth.Dentures have to be taken out and soaked at night. During the day, they can also look unnatural and rub painfully. Dentures and partials make it difficult or impossible to eat certain foods.
Dental implants can now be used to anchor partial and full dentures. This prevents the slipping, irritation, and pain associated with “floating” partials and dentures. It also prevents the tedious removal of dentures for overnight soaking and cleaning. Dental implants also eliminate the need for dental adhesives. This allows you to enjoy eating the foods you previously avoided . With dental implants, your partials or dentures are firmly anchored to the jawbone, causing them to feel much more like natural teeth.
Natural tooth roots and dental implant posts are fixed firmly in your jawbone. When you chew, these tooth roots and posts stimulate the jawbone and prevent it from shrinking. You may have seen a person who looked prematurely old because their jawbone had shrunk after wearing floating dentures. Dental implants help preserve your jawbone and appearance.
The above left photo and right x-ray shows a patient with all the lower teeth missing.
The above left photo and right x-ray shows 6 dental implants placed.
The above photos show the implants restored with bridgework.
The Success Rate of Dental Implants
After their healing period, the success rate of dental implants is between 94% and 98%. If you are a non-smoker with good oral hygiene, the percentage is closer to 98%.
Does the Procedure Hurt?
It is often done under local anesthesia and patients generally experience little discomfort after the procedure. It is similar to having a simple tooth extraction.
 Professor P-I Branemark |
Discovered that the metal titanium fused directly to bone. The "father" of implant dentistry and modern orthopedic implant surgery. |
How Long Will Dental Implants Last?
Dental implants become fixed to the jawbone. Through the life span of a dental implant will vary with each patient, many have lasted for over 30 years. With good oral hygiene and regular cleanings, dental implants should last a lifetime. In contrast, the average life span of a traditional fixed bridge is between 10-15 years.
The first dental implants were placed in 1965 by Dr. P-I Branemark in Sweden, and are still functioning.
Bone Regeneration
A critical question in determining whether an implant can be placed is, “Is there enough bone to support the implant?” Fortunately, advanced bone regeneration techniques now make it possible to place many more implants than just 10 years ago.
This is an example of an area where the bone has receded horizontally from a tooth that was removed and not replaced. There is not enough bone present on the cheek side of the area to place an implant.
To re-build the missing bone, a bone graft was placed using Puros (processed by patented Tutoplast process) cancellous bone graft particulate (out of a jar from a bone bank), then was covered with a GoreTex barrier that had a moldable metal strut to keep the bone graft material in place, then sutured tightly closed. The area needs about 8 months to heal new, solid bone before an implant can be placed.
8 months after the ridge augmentation surgery there is solid bone and a dental implant was then placed.
This is 3 months after the implant was placed. Note how wide the ridge is compared to initially. Successful ridge augmentation with bone grafting made it possible to place a dental implant in an area that previously had an inadequate amount of bone to allow an implant to be placed.
Sinus Bone Grafting
Above the roots of the maxillary (upper) back teeth are the maxillary sinuses. The right and left maxillary sinuses are separate from each other, and are each about 15cc’s (3 tablespoons) of air space with a tissue lining of about 1mm in thickness called the Schneiderian membrane. At the upper portion of the maxillary sinuses, they drain into the other nasal sinuses thru an opening called an ostium.
When upper back teeth are removed, the floor of the maxillary sinus will actually grow downward, called maxillary sinus pneumatization. This can make placing dental implants impossible if there is no longer enough depth of bone for dental implant placement.
The photo on the top is of a "normal" sinus floor located just above the end of the upper back teeth roots. The photo on the bottom shows maxillary sinus pneumatization; that is the floor of the maxillary sinus actually moving downward. In order to be able to place a dental implant, there needs to be sufficient bone depth. If maxillary sinus pneumatization makes that difficult or impossible, it may be possible to do a bone graft to elevate the floor of the maxillary sinus back to where it used to be.
The above x-ray shows what happens when upper back teeth are out for many years. This x-ray shows what happens with enlargement of the maxillary sinus and resorption of the bone ridge when teeth are gone for decades.
Adding 1cc to 4cc of bone graft material to reduce 1 to 4cc of air space in a sinus with over 15cc’s of airspace does not effect normal sinus function. If you are prone to sinusitis before the maxillary bone graft, you still will be after it. If you are not, you still won’t be.
(Clinical Article: Maxillary sinus function after sinus lifts for the insertion of dental implants)There are 2 primary methods for accomplishing a maxillary sinus bone graft to facilitate dental implant placement, the osteotome sinus bone graft and the lateral window access sinus bone graft.
Osteotome sinus bone graft
If there is enough bone, at least 5mm of bone below the bottom of the sinus floor, to mechanically hold the dental implant in place temporarily on insertion, but not enough to hold it in for the long term, it may be possible to move the floor of the sinus up in this isolated area thru the drill hole made for placing the dental implant. With this method, it may be possible to add up to 3mm of bone depth for the implant. In this method, a hole is drilled in the jawbone to place the implant and is made right to the floor of the sinus. Then about 1cc of bone graft material is placed in the hole and a special tool (osteotome) is placed in the drill hole filled with bone and upward pressure is placed to push bone under the Schneiderian membrane (thick sinus tissue lining). Then an implant can be placed. At least 6 to 9 months are required to allow the bone graft to form new, solid bone. Then a crown can be placed on the dental implant.
The photo on the left is a situation where the floor of the maxillary sinus has dropped The middle photo shows the site is several millimeters short of the sufficient amount of bone needed for long-term dental implant placement. The photo on the right shows a dental implant placed with an osteotome sinus bone graft. Note the whitish halo around the bottom of the implant. That is the bone graft that was placed.
On the top row is a missing upper 1st molar
On the bottom row, the x-ray at the left shows a missing upper 1st molar with some pneuminazation (dropping) of the maxillary sinus floor. The middle x-ray shows that a 10mm length implant would protrude several millimeters into the maxillary sinus. The right x-ray shows the post-operative result. The osteotomy (drill hole for the implant) was made to the floor of the maxillary sinus, then the sinus lining (Schnederian membrane) was elevated, and a bone graft placed thru the osteotomy, then the dental implant was placed. Note the whitish halo around the bottom of the implant. That is the bone graft that was placed. 8 months later, the crown can be placed on the implant.Lateral Window (Cauldwell-Luc) sinus bone graft
If there is not enough bone depth, at least 5mm of bone below the sinus floor, then a different approach to graft bone is used. This is creating a window in the bone on the cheek side of the alveolar bone ridge to access to the maxillary sinus. Approximately 4cc’s of a bone graft material is mixed with platelet-rich plasma (we take about 20cc’s of your blood, the equivalent of 2 small tubes from a routine physical blood test, spin it in a centrifuge and mix it with the bone graft material and place it in the sinus to restore the bone level to it’s original state to allow dental implant(s) to be placed. After a 6 to 9 month wait to allow new bone to form solid, then dental implants can be placed.
Am I a Candidate for Dental Implants?
Dental implant treatment begins with an evaluation by your general dentist who will determine if you are a good candidate for this procedure. If he feels dental implants might be possible, he will send you to a periodontist for a placement evaluation.
For More Information
The following sites will provide you with more information on dental implants:
- Implant Innovation's Inc (3i)'s Patient Education Section
- American Academy of Periodontology Article:
Dental Implants: Teeth That Look and Feel Like Your Own
