Dental Implants - What are they?
Dental Implants are a very misunderstood segment of Dentistry. It now accounts for the largest growing procedure in the dental field and is recognized as the standard of care for tooth replacement.
Implants have been around for many years. People have always sought out ways to incorporate foreign materials into the jaw to aid in chewing and esthetics. Archaeologists have recovered jawbones showing the skills of these predecessors to our modern day Implantologists.
It was in the 1970’s that Dental Implants really began to take off. During his years in Dental School Dr. Daar was fortunate to work with these first brands of Implants and saw the benefits of tooth replacement by this technique.
One significant innovation was the usage of Titanium as the main component of the implant. Like a hip implant, knee implant, etch titanium was found to be compatible with the human tissues and did not cause a foreign body response leading to rejection. This is the material utilized in most of modern day implants. Another advantage now is that in the past implants were basically pounded or tapped into the bone. Newer techniques allow them to be screwed into place in most situations.
The implant screws are made in several designs by numerous manufacturers and share common elements. If it is a reputable company the type of implant does not matter. It’s the technique and technician placing them. Jus like a screw in wood, we need good wood or bone to place the implant. Often, we must place extra bone (such as when a tooth is extracted) to create an ideal implant site. Once it is placed, unlike a screw in wood, the bone surrounding it grows onto the implant surface making it a permanent fixture.
Here are a few examples:
As you can see there are some differences in thread design and shape. Its all personal preference. Any of them can get the job done. With regards to the procedure we can discuss a single tooth replacement with an implant and crown. Let’s go over a case where the tooth is already missing.
We first listen to the patient to see what their expectations and needs are. Then using the necessary technology, we evaluate the potential site for the implant.
Often a panoramic x-ray is all that is necessary to determine the placement site, implant size, and implant length. We had performed the extraction and were familiar with the bone density width and available length.
Often the situation is not so clear cut and we utilize the latest in scanning technology to determine implant placement. We can choose the exact brand, length and width of implant, and superimpose it on the scan for perfect placement in the mouth.
We go through the patient’s medical history and plan accordingly. Most people are candidates for Dental Implants. However certain factors such as smoking, poor hygiene, and osteoporosis make the prognosis less positive. Patient undergoing radiation therapy and chemotherapy have limited growth of new bone, and we must find a time in their treatment that will give us a positive outcome.
After we have determined that a patient is a good candidate for Dental Implants we go through the treatment plan explaining the procedure:
We always premedicate patients with antibiotics. We are introducing something into the body and we wish to avoid post operative complications. Since there are no pain fibers in the bone we can generally place an implant by numbing out the gums with local anesthetic (a shot). We realize however that many patients have reasonable fears of Dentistry and we treat everyone as an individual. Other options for anxiety control are:
Nitrous Oxide- aka laughing gas
Conscious sedation- combination Nitrous Oxide and Ant anxiety pill
And in rare occasions I V sedation
Most of our patients have no problem going through the procedure without being sedated.
Post operatively we find Advil or Motrin handles most discomfort.
Once we numb the patient out we determine the location of the implant site and often can make a simple punch in the gums to access the bone. We then drill a pilot hole and take a picture to make sure we are aligned correctly and not near any anatomy such as nerves, other teeth, or sinuses.
The site is minimal and requires no stiches later on. As you can see there is minimal surgery and little bleeding. The implant is then screwed in. Its not always this easy, but this is what we strive for.
Several months later an impression is taken with the healing cap removed. There is no surgery at this time , and no need for shots of local anesthetic. A crown is made to fit the implant and implant post we fabricate, and it is placed several weeks later.
We match the shade color, shape, and bite so that it feels, functions, and looks just like the patients’ natural tooth.