Dental Implants

WHAT ARE DENTAL IMPLANTS?
Dental implants are biocompatible substitutes for lost natural teeth. They are devices for attaching artificial replacement teeth firmly to the bone. Implants can be used to support a single crown or as anchors for fixed bridges. fixed or removable partial or complete dentures.

WHAT ARE THE TYPES OF IMPLANTS?
There are basically two types of implants:
One type fits on top of the bone. This is called a subperiosteal implant and is custom designed for the patient's jaw.
The second type of implant is placed in the bone. This is called an endosteal implant. There are different sizes and shapes of endosteal implants. They may be shaped like cylinders, or screws or hollow baskets: some are long and thin. The choice of what implant is to be used depends on the quality and amount of available bone and the type of prosthesis or denture which will be supported by the implants. In some patients one or more implants might be used to replace single tooth, act as an anchors for a bridge, or as support for a full denture.

WHAT IS THE HISTORY OF DENTAL IMPLANTOLOGY?
Dental implantology goes back to the time of the early Egyptians. Modern oral implantology , as we know it today, dates back more than 30 - 40 years. Various implants have been used on or in the bone for over 50 years. The newer bone-integrated and biointegrated implants have been used with good success.
Implant academies and associations around the world have conducted long-term studies. In addition, participants at the Harvard School of Dental Medicine Conference on Dental Implants have endorsed dental implant techniques as safe and effective.
Recently, the American Dental Association has assigned insurance code numbers for implants and some insurance companies reimburse patients for implants and/or related procedures and prostheses. All of this activity stems from one central fact -- DENTAL IMPLANTS WORK.

HOW CAN DENTAL IMPLANTS HELP ME?

Dental Implants may offer solutions for the patient:

• who cannot chew comfortably and efficiently with conventional dentures,
• who has lost teeth and doesn't want removable partial dentures,
• who has lost a single tooth and wants a single tooth implants rather than a bridge appliance,
• who is now wearing a partial or full denture, and would prefer a fixed bridge or fixed-removable appliance.

AM I A CANDIDATE FOR DENTAL IMPLANTS?
Most patients who are healthy enough to undergo normal dental treatment and maintain good oral hygiene can have dental implants. Since general health conditions or structures of the mouth may prevent the use of an implant individual evaluation is necessary.

WHO MAKES UP THE IMPLANT "TEAM"?
The implant team is made up of the Oral and Maxillofacial Surgeon, the Restorative Dentist and the Laboratory Specialist.
The Oral and Maxillofacial Surgeon Is a highly trained specialist -- who has completed four comprehensive years of dental school plus at least three years of in-hospital surgical residency. 
The Restorative Dentist has the special skills required for the design and fabrication of the final crown, bridgework or denture. It is the restorative dentist's training that will provide you with a functioning and esthetic dental appliance.
The Laboratory Specialist has special knowledge about dental materials, denture and crown and bridge construction. His job is to fabricate in the laboratory what your dentist has designed for you.

WILL MY IMPLANT TEETH FUNCTION AS WELL AS MY ORIGINAL TEETH?
Nothing will function as well as natural teeth. However, implants function better than removable teeth. In most cases patients can eat without being aware of the implants. Most patients are happier with fixed teeth, a single tooth, or dentures that are supported by implants.

WHAT ARE THE RISKS OF SURGERY FOR DENTAL IMPLANTS?
Most of the possible complications associated with implant surgery are not serious. Other than the unlikely situation of a severe infection or fracture of the bone, most problems are easily reversed by medication, surgical intervention or removal of the implant. If the implant must be removed, it is often possible to replace it with another implant. Sometimes the implant can be placed in the same location, or it can be placed in another location.
All surgical procedures have certain risks. Although complications are unlikely, you should be aware of the following. Surgery on the lower jaw may incur a risk of damaging the nerve which controls sensation of the lower lip. If this nerve is damaged, there could be a loss of or change of feeling in the lower lip and chin. This change in feeling might involve tingling, itching, burning, feeling cold, feeling hot, or feeling partially or completely numb. Damage to the nerve Is not likely. If it does occur, the feeling will usually return gradually to its normal state within a few weeks to a few months. However, if the nerve it is possible that the resulting numbness could last for years or be permanent. Rarely. similar damage can occur to the nerve from the tongue.
Surgery on the upper jaw could result in nerve damage to the corner of the nose. The placement of implants on or in the upper jaw can result in perforations into, infections of, or problems with the nasal passages or the sinuses. Fortunately, such damage is rare. If it does occur, it will usually heal uneventfully, although treatment might require antibiotic therapy or surgical correction. If problems are allowed to develop around upper implants and are ignored by the patient, they may progress into the sinus and result in a condition requiring surgery, treatment and correction.
When an implant is placed near a tooth, it is possible that the tooth root may be damaged during bone preparation for the Implant. Such damage is extremely unlikely. If It should occur it is likely to heal, although it is possible that the damaged tooth would be lost or need root canal treatment.
Other surgical risks are bleeding, bruising, infections and swelling.

WHAT ARE THE RISKS OF DENTAL IMPLANTS?
Infection is a concern with dental Implants. Good oral hygiene can greatly reduce this risk. Some implants can cause additional stress on the bones in the jaw which can lead to loosening of the implant, failure and subsequent removal of the implant. If the implant fails due to bone deterioration and must be replaced with a conventional appliance, the patient may experience problems with retention because of associated bone loss.
Additional possible complications include discomfort, cosmetic problems, Implant breakdown and damage to adjacent teeth in the mouth. Fortunately, these problems are rare, especially with periodic checkups.

WHAT ARE THE CHANCES OF REJECTION OF THE IMPLANT?
The body does not reject a dental implant as it might a heart, lung or kidney. Although implants are more stable than removable dental appliances, bone and gum tissues do not attach to the implant as they normally do to a natural tooth root. Therefore, a dental Implant will not be as stable as a naturally healthy tooth.

HOW LONG WILL MY IMPLANT LAST?
Some implants are still functioning successfully after 25 years. For patients who have a history of trouble with their mouths and whose bone physiology around their roots have been a problem, the prognosis would be less optimistic than for patients who have had fewer dental health problems. Also, if there are many natural teeth remaining, the expected longevity of an implant is greater than if all the teeth are missing. As with any artificial replacement In the human body. no promises or guarantees can be made as to longevity of the implant or of the implant supported appliance.
IT IS IMPOSSIBLE TO KNOW HOW LONG ANY PARTICULAR IMPLANT WILL LAST AND THEREFORE IT IS IMPOSSIBLE TO PREDICT OR GUARANTEE SUCCESS.

WHAT CAUSES FAILURE OF DENTAL IMPLANTS?
Circumstances that may result in the failure of implants and the appliances they support are: local conditions, systemic conditions, and structural overload.
Local Problems: Bacteria can accumulate around a dental implant just as it can around a tooth. Bacteria can cause inflammation and infection of the gum and bone tissue. This can proceed to bone loss and loss of the implant. For long term success, implants must be kept meticulously clean. Other local damage can result from improper use of cleaning Instruments, grinding of the teeth, smoking, and/or excess use of alcohol.
Systemic Problems: Diabetes, metabolic bone disease, steroid therapy, HIV, problems with absorption of nutrients are but a few of the medical problems that may influence the success of implants. Any condition which prevents the body from repairing bone or other supporting tissue can result in the eventual loss of bone and gum support for the implant. Conditions such as osteoporosis, collagen diseases, drug use and addiction, or any debilitating disease can prevent the body from repairing itself. This does not necessarily mean that implants should not be used. Discussion with your physician is sometimes needed to determine whether any medical problems would prohibit implant treatment.
Structural Overload: When an implant supported fixed or removable dental appliance, such as a single crown, a bridge, or a denture is overloaded by chewing forces, something has to give. Most chewing forces are within the physiologic and\or mechanical tolerances of bone tissue that support teeth or implants. When the chewing forces are such that they exceed physiologic tolerances, as when the teeth are tightly clenched together or if not enough implant support anchors are placed to absorb chewing forces, bone tissue can be lost from around the implant.

ARE THERE PROBLEMS ASSOCIATED WITH SMOKING?
Smoking is extremely harmful to all oral tissues, especially when implants are present. Heat from smoking is retained in the metal. Irritants from smoking also effect the normal healing of the gum and bone tissues of the mouth. Smoking robs the bone and other tissues of vital nutrients and minerals needed for healing and maintaining the healthy bone connection to the implant. Smoking also decreases blood supply and oxygen to the gums and bone tissues that are next to the implant. To help keep the supporting bone and gum tissues healthy and able to resist infection, the implant patient should not smoke.  

CAN AN IMPLANT BE REPLACED?
Depending on the reason for its removal, an implant can often be replaced. After healing, if adequate bone is present and the gum tissue is adequate, a new implant can be inserted.

HOW LONG DOES TREATMENT TAKE?
A basic requirement of implant surgery is enough time for adequate healing. This is usually from three to six months. During this time the implants are usually under the gum tissue (occasionally they are above the gums). During this time the implant is healing in contact with the surrounding bone. A temporary appliance can usually be made which will be functional, comfortable and esthetic. This appliance may be used during the healing period.
After healing of the implant in the bone the prosthetic phase of treatment can be continued. In some cases this can take from a few weeks to a few months.

WHAT KIND OF FOLLOW-UP CARE IS NEEDED?

• Good oral hygiene. Your implants can fail for the same reasons that your natural teeth are lost. Poor oral hygiene is the greatest cause of implant failure. The build-up of dental plaque and debris around teeth and implants cause an increased concentration of bacteria and the destructive consequences of inflammation and infection. This will lead to swollen gums and loss of bone that is needed to support the implant. Excellent oral hygiene is necessary and vital to long-term success of the implant supported crown, bridge, fixed or removable dental appliances.
• Frequent visits to your dentist.  Frequent visits to your dentist are an important part of your commitment to success of your implant procedure. Your dentist and his staff will instruct you in the proper use of toothbrush and other oral hygiene aids. In the morning and before bedtime, you must brush and clean around the implants and the supported appliance. The dentist may also need to clean around the implant(s) and also check the health of the supporting bone tissues by examination and x-rays.