DENTAL IMPLANTS, THE COMPLETE PATIENT GUIDE

A dental implant is an artificial replacement for the root of your tooth. It screws into your jawbone and supports a fake tooth (crown). It has many benefits, but not everyone is a great fit for an implant.

Dental implants are installed surgically while your mouth is numbed with a local anesthetic. The surgery itself takes about?90 minutes, but the whole process might take as long as?6 to 12 months?because you usually need multiple dental appointments.

Dental implants are a highly debatable subject in dentistry. In later years, because of the ever-increasing demand for dental implants, implantology has experienced spectacular development and the technology continues to improve.

The industry has also focused on reducing treatment time and some implants can be placed immediately after tooth extraction as opposed to waiting six months after extraction.

In this article, we aim to offer you?a complete guide?that tries to deal with all the important aspects of dental implant treatments.

The guide is primarily intended for patients who are planning to have dental implants, but it may prove very useful to anyone searching for information on this topic.

Dental implants?can provide a natural-looking and natural-feeling replacement for a missing tooth that lasts for many years. However, they can be more expensive than the alternatives and may not be suitable for people who can’t undergo dental surgery.

outline

• What are dental implants?
• Why are dental implant restorations superior?
• Other important advantages
• Drawbacks
• Indications
• Contraindications

What are dental implants?

Dental implants are small threaded posts that replace missing teeth roots. Most dental implants are titanium, but some are ceramic. Both of these materials are safe and biocompatible (friendly to the tissues inside of your mouth).

Dental implants are metal devices that are surgically inserted into the jawbone in order to replace one or more missing teeth.

Normally, dental implants support a dental prosthesis such as a crown, bridge, or removable dentures but sometimes they may act as orthodontic anchors (in order to align and straighten teeth).

First, a?surgical procedure?is required to place the dental implant inside the jawbone. The basis for modern dental implants is a biological process called?osseointegration?where materials, such as titanium,?form an intimate bond to the bone. A variable amount of healing time is required for osseointegration (3 to 6 months).

After the healing time, an?abutment?is attached to the implant. The abutment will hold the?dental prosthesis?(crown, bridge, removable denture).

Why are dental implant restorations superior?

A lot of patients may wonder why they should choose dental implants (which entail a higher cost) over traditional dental restorations supported on natural teeth. The great advantage of a dental implant is that it replaces the missing tooth?in the most natural way possible. Dental implants "fuse" with the bone thanks to the biological process called osseointegration.

Thanks to this process, implant-supported prostheses offer a variety of advantages compared to conventional restorations. The main objective of any dental restoration is?the proper replacement of the missing teeth.

Teeth have 3 functions: Chewing, Aesthetics, and Pronunciation. When a dental restoration is designed, one of the main goals is to restore these functions as close as possible to natural teeth.

Let's compare implant restorations to traditional restoration in rehabilitating teeth's main

Patients suffering from tooth loss would do their best to replace their missing teeth as soon as possible. There is a plethora of options to do so, which can be divided into two main categories: dental implant-supported and traditional restorations. It’s important to consider your options carefully and go over the pros and cons with your dentist before committing to a restoration.

Why are dental implant restorations superior?

A lot of patients may wonder why they should choose dental implants (which entail a higher cost) over traditional dental restorations supported on natural teeth.

• The great advantage of a dental implant is that it replaces the missing tooth?in the most natural way possible. Dental implants "fuse" with the bone thanks to the biological process called osseointegration.
• Thanks to this process, implant-supported prostheses offer a variety of advantages compared to conventional restorations.
• The main objective of any dental restoration is?the proper replacement of the missing teeth.
• Teeth have 3 functions: Chewing, Aesthetics, and Pronunciation. When a dental restoration is designed, one of the main goals is to restore these functions as close as possible to natural teeth.

Let's compare implant restorations to traditional restoration in rehabilitating teeth's main function

Mastication or chewing process

• Mastication is the most important dental process. When restoration is designed, it is important to rehabilitate this process as closely as possible to natural teeth. When this goal is achieved, patients will adapt very quickly to the new restoration.
• When an implant-supported denture is manufactured, the chewing forces are passed to the surrounding bone just as?in the case of natural teeth?(see left image). Consequently, chewing comfort is excellent because dental implants function remarkably like natural teeth.
• By contrast, when a traditional denture is designed, some of the chewing forces are passed to the underneath gums as dentures usually rest exclusively on the gums. This is not the natural way, hence it takes longer to get used to a removable denture.

Aesthetics

• Restoring aesthetics is for many patients the most important goal. The general aesthetic of an implant-supported reconstruction is?great. A dental implant restores a lost tooth so that it looks, feels, fits, and functions almost like a natural tooth.

Phonation or pronunciation

• Normal speech can be disturbed when upper front teeth are missing (particularly incisors). It is well known that these teeth have an important role in some consonants' pronunciation.
• Adjusting to?traditional removable dentures?can mean struggling to pronounce everyday words, at least until mouth tissues adapt to the new situation (which can take several weeks). Not so with dental implants, which function almost like natural teeth.

Other important advantages

• Dental implants reduce the load on the remaining oral structures (teeth, gums, jawbone) by offering?independent support?and retention to crowns, bridges, and removable dentures.
• Dental implants preserve natural tooth tissue by avoiding the need?to prepare?adjacent teeth for conventional restorations (for example, a traditional?dental bridge).
• Tooth preparation involves permanently removing parts of the tooth's original structure, including portions that might still be healthy and structurally sound.

How do dental implants work?

A surgeon places a dental implant into your jaw during an?oral surgery?procedure. Once the implant heals, your dentist can place a crown on top. Depending on your oral health goals, your dentist can restore your implants with?crowns,?bridges,?or?dentures.

Who might need dental implants?

People who have one or more missing teeth can benefit from dental implants. You might need a dental implant if you have tooth loss due to:

• Cavities?(tooth decay).
• Tooth root fracture.
• Bruxism?(clenching or grinding your teeth).
• Gum disease.
• Facial injury.
• Congenitally missing teeth (you were born without certain teeth).

Indications

Dental implants are state-of-the-art tooth replacement systems. Dental implants can successfully restore?all forms?of?partial edentulism?(one or several teeth are missing) and?complete edentulism?(all teeth from a dental arch are missing).

Here are?some situations?when dental implants are strongly indicated:

The single-unit toothless gap with healthy adjacent teeth

• When a single tooth is missing, an implant-supported crown will preserve the adjacent natural teeth by avoiding the need to prepare them. If the toothless gap is restored with a traditional dental bridge, both adjacent teeth will have to be prepared.
• This operation involves permanently removing parts of the teeth's original structure, including portions that might still be healthy and structurally sound.

Partial edentulism with the back (posterior) tooth missing

• These conditions imply the absence of several posterior teeth (molars and/or premolars) on one or both sides of the dental arch (Kennedy class 1?or?Kennedy class 2).
• In these cases, traditional dental bridges (supported by natural teeth) are difficult to design because the back support tooth is missing. Removable partial dentures generally require the preparation of several teeth.
• Implant-supported prostheses, although entailing a higher cost, are highly indicated in these clinical situations.

Complete edentulism

• When all teeth are missing, the only traditional solution available is a?fully removable denture.
• Implant-supported prostheses (either fixed or removable) allow them to chew food better, speak more clearly and they have superior stability.

Other situations when dental implants may be indicated

• Patients who cannot tolerate a removable restoration (removable denture).
• Patients with high aesthetic and/or functional demands.

Contraindications

General contraindications

Absolute contraindications

• Some?serious general conditions?make anesthesia, surgical procedures and the overall placement are inadvisable.
• Heart diseases affecting the valves, recent infarcts, severe cardiac insufficiency, cardiomyopathy
• Active cancer, certain bone diseases (osteomalacia, Paget's disease, brittle bones syndrome, etc.)
• Certain immunological diseases, immunosuppressant treatments, clinical AIDS, awaiting an organ transplant
• Certain mental diseases
• Strongly irradiated jaw bones (radiotherapy treatment)
• Treatments of osteoporosis or some cancers by?bisphosphonate

Relative contraindications

1. Other situations will be evaluated on a case-by-case basis. Most often, dental implants can only be placed (with the greatest caution) after some preliminary treatments.

• Diabetes (particularly insulin-dependent)
• Angina pectoris (angina)
• Significant consumption of tobacco
• Certain mental diseases
• Certain auto-immune diseases
• Drug and alcohol dependency
• Pregnancy
• Important anatomical structures such as the maxillary sinus, the inferior alveolar nerve (located inside the mandible), have an abnormal position that can interfere with the dental implants.

Age

• Children: not before the jaw bones have stopped growing (in general 17-18 years).
• On the other hand, advanced age does not pose problems?if the patient's general condition is good.

Local contraindications

Some conditions or physiological changes, usually inside the mouth cavity, may temporarily prevent the placement of dental implants. Most of the time, these conditions can be remedied before the implants are inserted in the jawbone.

• There is insufficient bone to support the implants or bone structure is inadequate (due to some chronic infections or other conditions). To ensure a good prognosis, a dental implant?must be surrounded by healthy bone tissue.
• Adjunctive surgical procedures?have to be performed before the placement of dental implants. These procedures aim to increase the amount of bone, so more bone is available to support the implants.
• Some local diseases of the oral mucosa or alveolar bone can temporarily prevent the placement of dental implants until the conditions are treated.
• Hypersensitivity or other allergic reactions; rarely occurs.
• Poor oral hygiene.
• Bruxism or the involuntary grinding of the teeth.

When choosing a tooth replacement, consider the following factors:

The Effect on Your Oral Structure

• Implant-supported restorations have little to no effect on surrounding teeth, as they are held in place by the jaw itself. Dental implants are placed into the alveolar jaw bone, where they integrate with the bone material to create a sturdy base for your prosthetic. Fixed bridges, crowns, and implant-supported dentures all capitalize on this ability to preserve natural teeth.
• Bridges, a traditional restoration, rely on neighboring teeth for support. With traditional bridges, the teeth surrounding the gap in your smile need to be shaped for the placement of crowns that hold the replacement tooth. In this way, bridges provide you with a functional bite and an aesthetic restoration. Partial dentures utilize metal frames for support, which can wear on the teeth and soft tissues from continual touching.?

Healing Time before Initial Restoration

• While the initial placement of dental implants can sometimes occur on the same day as the extraction of a decayed or damaged tooth, the top prosthetic cannot be placed until the implant is fully healed and fused to the jaw. For patients with optimal gum health and jawbone density, the process from initial consultation to final restoration usually requires 4-6 months, though this can be lengthened if you also need periodontal treatment and bone grafting prior to the placement of your implant.
• Traditional restorations do not require the same amount of preparatory treatment before they can be placed. Provided the teeth that will be supporting fixed dental bridges or partial dentures do not require root canal therapy or other treatment, patients can expect to wait a few weeks to a month depending on the time it takes to fabricate your restoration.?

Long-Term Effects on Your Smile

• With proper care, implants are able to last a lifetime. The prosthetics used to balance your bite and complete your smile are subject to the wear of regular use but can be replaced using the same implant as support. Implants also provide the structural stability necessary to prevent jawbone resorption, protecting your facial structure, and your ability to comfortably chew and speak.?
• Traditional restorations prevent short-term changes in facial sagging but do not have the ability to stop bone loss. By applying pressure to the tops of the gums instead of stimulating the bone, patients with traditional prosthetics are more likely to experience jawbone health problems over the years, and a sunken facial appearance.?

structure of a dental implant restoration?

Most often, a dental implant restoration consists of 3 parts:

Dental implant?

- A surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, or removable denture.

• A surgical procedure is required to place the dental implant inside the jawbone. One or more implants may be required for a specific case.
• For example, when a single tooth is missing, a single implant will be positioned. If all teeth from a dental arch are missing, 4 to 8 implants may be required to support the restoration.

Dental implants come in a variety of shapes and sizes, so there is one to suit every clinical situation. An implant is actually an "artificial tooth root"; the implant surface is?ribbed?for better integration into bone tissue.

Implants are also?threaded; when they are screwed into the bone, they collect bone tissue so that the implant is as stable as possible when it integrates into the bone.

Some implants are molded as one piece with the crown; in this case, the type of the crown is pre-determined. More often, an abutment is attached to the implant after the healing period; this allows for more fine-tuning.

Abutment?

• - Implant abutments are artificial devices that are connected to dental implants after the healing process is over.
• The abutments are used to attach a crown, bridge, or removable denture to the implant fixtures.
• Prosthetic device?- Dental implants can support a large variety of prosthetic devices: dental crowns, dental bridges, and various types of implant-supported removable dentures.

Abutments?are manufactured in a range of sizes and shapes and are usually delivered by manufacturing companies along with the implants. From the various range of abutments, the ones that best fit the clinical case are selected.

Manufacturing materials

Implant abutments can be made from a variety of materials, such as titanium, surgical stainless steel, gold, and more recently, zirconium.

• Titanium abutments
• Titanium abutments are widely used due to the excellent properties of titanium alloys. They have very good strength and biocompatibility and can be used for any type of prosthetic restoration.
• Most clinicians feel more comfortable using a metal prosthetic abutment in the posterior molar areas, due to the increased masticatory forces present in these areas.

Zirconium abutments

• Zirconium abutments are more modern abutments, which are used to better complement the aesthetics of dental implant restoration.
• When all ceramics or zirconium restorations are planned, zirconium implant abutments provide a highly desirable option. When a zirconium abutment is used, the problem of matching the shade of adjacent teeth while hiding the dark color of the metal abutment is avoided.
• Moreover, in 2011, a one-piece zirconia implant (fixture and abutment) was introduced into the market.

Other materials

Besides titanium and zirconium, artificial abutments can be made of other materials: gold alloy, stainless steel, etc. Although indications are narrower, there are situations in which these may be successfully utilized.

Implant-supported prostheses

Dental implants can support a large variety of prosthetic devices. When planning for a type of implant-supported restoration, several factors are involved:

• The number and position of missing teeth
• The overall clinical conditions
• Aesthetic and functional demands
• Geographical location: different types of prostheses can be designed in various parts of the world
• Whether a patient can afford the designed solution
• The expertise and preferences of each practitioner

Dental crown

• An?implant-supported crown?is normally indicated when a single tooth is missing. However, it is possible to design adjacent single-unit crowns when several teeth are missing.
• The dental crowns can be made of porcelain fused with metal alloys (gold, titanium, base metals), zirconia, or all ceramics. The time of execution is relatively short and the prognosis is very good.

Dental bridge

• Many patients prefer fixed?implant-supported bridges?because they do not have to be removed for cleaning. Bridges are permanently secured to the implants either with dental cement or with lag screws. Large dental bridges supported by many implants can be quite expensive. It is not advisable to design dental bridges that are supported by both natural teeth and dental implants (with some exceptions). This could lead to the loosening of the implants (because of natural teeth' physiologic mobility) and failure.

The graphic above shows an implant in a bridge connection with a natural tooth. The movability of the tooth causes the chewing forces to act as a lever in the rigid implant situation.

It is also important to design enough implant units to adequately support the bridge. For example, if all teeth are missing and a fixed dental bridge is designed, at least 6 implants are required to support the bridgework.

Dentures

An?implant-supported denture?is a type of?overdenture?that is supported by and attached to implants. An implant-supported denture should be daily removed, to clean the denture and gum area.

Compared to a traditional denture (full denture) which rests exclusively on the gums, implant-supported dentures allow chewing food better, speaking more clearly, and providing better stability.

Removable dentures are designed when a large number (most of the time, all) of teeth are missing. When a removable denture is worn,?retainers?to hold the denture in place are attached to the implants and the denture.

Special retainers

Most often, the retainers are made of two components:

• A?male adapter?attached to the implant
• A?female adapter?is housed in the denture. This part will require periodic replacement.

There are various types of adapters designed to hold overdentures in place: the?ball-and-socket style retainer?(image above) and the?button-style adapter?are just two examples.

Another variation is when a cast bar of metal is secured to the implants. The complete denture then attaches to the bar with attachments allowing no movement of the denture (image below).

Orthodontic anchors

Dental implants can be used as orthodontic anchors in order to align teeth. Orthodontic implants are different from the ones used for prosthetics, as there is no osseointegration. Mini-implants provide absolute anchorage and they have revolutionized the field of orthodontics.

A note from Dr. Sultan Arif

Advantages and disadvantages of Dental Implants

Dental implants are one of the best and most convenient options for replacing missing teeth. Performed sometimes in just 1 appointment, the implant process generally yields successful results promoting a natural-looking smile, improved teeth functionality, and decreased chances of bone loss. If you are considering dental implants as a fixed (rather than removable) solution to replacing missing teeth, here are a few pros and cons you should consider:

Advantages of Dental Implants

• Dental implants can last a lifetime if taken properly care of. Unlike dentures, they generally do not need to be replaced after a certain amount of time.
• Dental bridges rely on neighboring teeth for support, whereas dental implants are fused into your jawbone. This protects your remaining teeth from damage or strain.
• Caring for dental implants is generally quite easy as you would practice the same oral care as you would for your normal teeth. This entails brushing, flossing, and regular dental visits.
• Implants look and function like real teeth, with no clicking noises or speaking and chewing difficulties that can occur with dentures.

Disadvantages of Dental Implants

• The dental implant procedure cannot always be completed within one appointment. Waiting for the actual implant to fuse with your jawbone can take a certain amount of time. During this time, a temporary tooth will be placed over the area.
• Implants require a certain volume and density of bone. Many patients require additional bone augmentation. Fortunately, bone augmentation techniques have become less invasive and less painful in recent years. Occasionally some patients are not suitable.
• Dental implants are a surgical procedure and although it is considered safe, complications cannot be ruled out. Risks include infection, nerve injuries or bleeding. Factors such as poor hygiene and smoking can increase your risk of infections.

Utmost care should be taken during the healing period, so here are a few rules to follow:

Take your medicine

• In the first few days following implant surgery, it’s vital that you take the medicine prescribed by your dentist. This will help to alleviate any pain and discomfort once the anesthetic has worn off.

Watch your diet

• Following surgery, it’s important that you stick to soft foods which do not require a lot of chewing. Foods such as yogurt, soup, eggs, and mashed potatoes are ideal. You can gradually introduce harder foods as your body heals but check with your dentist or surgeon first.

Take things easy

• It’s important to take things easy following oral surgery and not to try to do too much, too soon. Refrain from strenuous exercising until you are closer to being totally healed.

No smoking

• Smoking or the use of tobacco products affects the body’s ability to heal and will make the healing time far longer than usual. There’s also an increased risk of implant failure. To avoid complications, it’s best to give up smoking before the procedure and until healing is fully completed. In fact, wherever possible, we’d suggest you try and quit for good

Stay in touch

• During the healing period, you’ll be asked to visit your dentist for regular progress checks. It’s important that you keep all of these appointments and if you have any problems in between appointments, then please call the dentist right away to get your questions or concerns addressed. This will help prevent any complications during treatment and is important for a successful outcome.

Let’s look at the benefits and drawbacks of dental implants compared with other dental surgeries.