Dental Implants

Pick up most magazines or newspapers these days and you’re likely to see an ad about dental implants. And with the advent of “implant centers” in major metropolitan areas, television ads are now delivering the message that an implant center, with everything conveniently offered under one roof, is the state-of-the-art choice for dental implant treatment. Some even extol the virtues of getting your new “Teeth In A Day!” Bombarded with so many different messages about dental implants, how does the consumer make the right decisions?

While this kind of marketing distorts the limits of our current research and knowledge, this new end of the spectrum may not necessarily end in a rainbow. This important and controversial topic will be covered in two parts. A clear understanding of the increasing options available for implant treatment is a good place to start together with alternative replacements for missing teeth and their economic impact. This first part will also educate you about the problems associated with tooth loss and why implants are considered the state-of-the-art tooth replacement system.

In part two, we’ll discuss who are the most suitable and experienced dental professionals to place implants. We will discuss the why, when and where to make your implant choices including how to navigate through the implant marketing hype.

Dental Implants: The Optimal Tooth Replacement

Let’s begin by taking a look at what makes implants the most optimal tooth replacement system today. An implant connection to the bone is different than how a tooth connects to the bone but it performs the same function. Dental implants act as substitute tooth roots in a unique way.

Implants actually stabilize bone and prevent the inevitable bone loss that occurs when teeth are lost. Commercially pure titanium, of which almost all current implant surfaces are made, has the unique property of being “osteophilic” (osseo-bone, philic – loving), thus joining biochemically to bone. Osseo-integration (osseo – bone, integrate – to join or fuse with) was discovered quite by chance and has revolutionized dentistry. The fusion is almost like a pillar in concrete, allowing no movement at all. Stresses of biting forces are transmitted directly through implants to the bone — which they allow for very well. They provide virtually the same function as natural teeth roots, including stimulating the bone, thereby stabilizing it and preventing its loss.

Consequences of Tooth Loss — Believe It or Not, It’s All About Bone

The bone that encases the teeth known as “alveolar” bone, (from alveolus – sac, an extension of the jaw bone), is the special bone that surrounds and supports the teeth. It develops with the teeth as they erupt into the mouth, accompanies the teeth in life and is lost when the teeth are removed. As one famous scientist put it, “Alveolar bone is like any other bone in the body, it just lives more dangerously,” said Dr. Harry Sicher.

When teeth are lost or removed the alveolar bone, which is fragile in structure like an ice cream cone, “resorbs” or melts away. What complicates matters is the “pattern” of resorption or the melting away process. Where the bone is thinnest, it resorbs more quickly. This is particularly true for the upper front teeth where bone, gum and even the lips can appear to cave in or collapse. The dental literature indicates that 79% of the population has a smile line that will not cover these types of “defects.” This is very noticeable when smiling and many people become quite self-conscious about their appearance as a result.

It Ain’t Necessarily So!

Bone resorption always occurs naturally when teeth are lost, unless measures are taken to prevent it. We are fortunate to live in an era when this melting away process can be compensated for by grafting techniques — which can work well in experienced hands. Although bone can now be restored by grafting techniques, it’s preferable and easier to prevent its loss from occurring. Bone maintained in both sufficient volume and position will allow for proper implant positioning, which in turn will stabilize the bone and prevent further resorption. The desired end result — completely natural looking teeth.

Keys to Implant Success

In the hands of an experienced “team,” implants placed surgically in the right position not only allow for the fabrication of implant-crowns that look natural, but also function properly and are maintainable — indistinguishable from real teeth. In the wrong position or without proper forethought implants can create a nightmare for the restorative dentist and dental technician who make the crowns.

Implant placement and positioning is dependant upon adequate bone volume and density, which are therefore critical to success. In experienced hands, implants are extremely successful. Documented research and clinical studies indicate success rates of over 95% — which is higher than any other tooth replacement option. Even in areas of low bone density success is quite common. Once integrated and functional, implant restorations can last a lifetime.

Success from Concept to Design

The concept and design of implants has been very well researched and tested. Implant tooth replacement systems often comprise separate and interconnecting units, which can allow the crown components to be removed and replaced if the need arises.

Once an implant is placed in the bone time must be allowed for the osseo-integration (bone fusion) process to take place, usually between two to four months. One of the primary reasons for early implant failure is “loading” them with biting forces too early. Only in carefully controlled circumstances where stability of the implant(s) can be assured, is it possible to place implant crowns early, with any degree of predictable success. The “Teeth In A Day” concept is somewhat misleading, because the crowns placed on the implants are functional, but most often temporary in nature. This is more commonly effective in the lower front jaw where the bone is denser and implants can be splinted (joined) to crowns atop the implants assuring their initial stability. It is a little less predictable in the upper jaw and for single tooth replacement, but still possible in the right hands and circumstances.

Traditional Tooth Replacement — Not So Traditional Any More

Dental implants are a relative “new kid on the block” for replacing missing teeth, but how do they really compare to other more traditional systems?

Removable options — Past methods of removable tooth replacement have included plastic “flippers” (non-precision, simple, temporary in nature and relatively inexpensive) and precision made metal based partial dentures, which are more expensive. Both can replace individual or groups of teeth. A fundamental problem with removable prostheses (replacements) is that for stability they rest on the teeth and gums tending to cause further problems all related inevitably to their design. These include tooth decay and periodontal (gum) disease and hastening the loss of bone and teeth through pressure transmitted through the gums upon which they rest. They constitute short term options with documented studies indicating that removable partial dentures are replaced about every 5 years.

For total tooth replacement whether in the upper or lower jaw full dentures (plates) have been the only option. Since they are kept in only by pressing on the gum tissues they transmit force to the underlying bone which accelerates its loss even more quickly. They also compromise the facial structures. As they continue to collapse, full dentures must be relined (made thicker) to compensate for additional bone loss and facial sagging. They also become particularly problematic in the lower jaw where there is no palate for suction and in addition tongue forces tend to destabilize them.

Non-removable options — Fixed bridges are non-removable prostheses (tooth replacements) which are attached to the natural teeth. They act by joining other teeth together with a false tooth or teeth between them “bridging” the gap. But the biggest disadvantage; these “abutment” or adjoining teeth are cut down into small peg shapes which compromises their long term health. As well as carrying the additional load of the missing teeth they replace, they become more prone to bacterial plaque accumulation, decay, root canal problems and periodontal (gum) disease. Bridges do not have a long life span therefore they will eventually need to be replaced. Studies indicate that bridges are only 67% successful at 15 years.

Benefits of Dental Implant Treatment

  1. Enhanced quality of life
  2. Integrity of the facial structures is preserved
  3. The smile is restored as close as possible to its natural state
  4. Long term health of adjacent teeth is not compromised
  5. Replacement teeth that look, feel and function like natural teeth
  6. Increased stability
  7. Improved health due to improved nutrition and proper digestion
  8. Renewed self-confidence
  9. Improved appearance
  10. Improved ability to taste foods
  11. Increased convenience of hygiene and maintenance

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