Dental Implants

WHAT ARE DENTAL IMPLANTS?
Dental implants are metal anchors placed in the jaw bone underneath the gum tissue to support artificial teeth where natural teeth are missing. Unlike other types of tooth replacements, such as removable dentures or fixed bridges that are cemented to remaining teeth, dental implants are actually placed ("implanted") into the jaw bone under the gum tissue.

These implants are usually made from a space-age metal called titanium, which is readily accepted by the body, and artificial teeth that look like natural teeth are then attached to the implants. Accepted by the American Dental Association, dental implants have been used for many years, and hundreds of thousands have been placed. Due to a phenomenon known as "osteointegration" meaning that bone actually attaches itself to the implant, these anchors provide a strong foundation that allows people with missing teeth to chew efficiently and comfortably.

Picture: Dental implants are tooth root substitutes which are surgically placed in the jaw bone and act as anchors to stabilize artificial teeth.

WHO NEEDS IMPLANTS?
Anyone who is missing teeth and can benefit from increased chewing efficiency and improved appearance or speech, is a candidate for dental implants. Implants can be the solution when it has become difficult or impossible to wear a removable denture. Portions of the jaw that are missing due to an accident, disease, or birth defect can often be reconstructed using implants.

You are a candidate for dental implants if:

you have enough jaw bone, and dense enough bone, to secure the implants
you do not have a disease or condition that interferes with proper healing after implant surgery (e.g. uncontrolled diabetes, or radiation/chemotherapy for treating cancer)

A discussion with your oral and maxillofacial surgeon and restorative dentist (the dentist who will make your new teeth) will determine if you are a candidate for dental implants. As a rule, age is not a barrier to implant treatment if you are in good health. In fact, thousands of people of all ages are turning to dental implants to replace a single missing tooth, several teeth, or all teeth.

TYPES OF IMPLANTS
Dental implants can be classified into three general categories: 1) endosteal, 2) subperiosteal, and 3) transosteal.

Endosteal implants are similar in shape to the root of a natural tooth, although some are shaped in the form of a blade. These implants serve as a replacement for the roots of missing teeth, and are placed directly into the jaw bone and become solidly anchored through a process called osteointegration. This process actually integrates the jaw bone into the implant during the healing phase, producing a very strong foundation for the artificial teeth that will be placed on the implants. Endosteal ("within bone") implants are the most common type of dental implants used today.

Subperiosteal or transosteal implants are less common, but may be recommended in special cases. Your dental team will choose the best implant for you.

Pictures above: Endosteal implants, which are similar in shape to the root of a natural tooth, are placed directly into the jaw bone. The examples in the photograph are shown at actual size.

STEPS IN OBTAINING DENTAL IMPLANTS
1. Examination/consultation
A thorough oral examination and medical consultation by the dental team responsible for implant treatment is necessary to determine if you are a candidate for dental implants. This team consists of your oral and maxillofacial surgeon, and your restorative dentist. Working as a team, the oral and maxillofacial surgeon places the implants and, after healing takes place, the restorative dentist designs and places the artificial teeth that are supported by the implants. During the examination, you will give a complete medical history. Be sure to give all information, including any health problems, allergies or medications you are taking. Your examination may include several types of x-rays to provide essential information about the jaw bone and its anatomy models of your jaws, and possibly certain blood tests. Based on the results of this examination, the dental team will discuss all aspects of your case with you. Together you will decide if dental implants are appropriate for you.

2. Preparing for Implant Surgery
Following are tips to help you prepare for your implant surgery appointment:

Clothing—Wear loose, comfortable clothing with sleeves that can be easily rolled up. If intravenous anesthesia or sedation will be administered, tight sleeves can make this difficult.

Transportation—Arrange to have someone accompany you to your surgical appointment and drive you home afterward. You may be drowsy for awhile after anesthesia, and driving yourself is unsafe.

Diet—If intravenous anesthesia or sedation will be administered, do not eat or drink for at least 6 hours prior to your surgery appointment.

Medications—Adhere to any medication schedule that is prescribed by your surgeon prior to surgery

Anesthesia—Modern anesthesia technology now makes it possible to perform even complex surgery in the dental office with little or no discomfort. During surgery one or more of the following is used to control pain and anxiety: local anesthesia that numbs the surgical area; nitrous oxide-oxygen (sometimes called "laughing gas") to relax you; intravenous sedation for relaxation; and general anesthesia that puts you to sleep. Your surgeon will fully explain the type of anesthesia that is most appropriate for your needs.

With the use of modern anesthesia technology complex surgery can be performed in the dental office with little or no discomfort.

3. Implant Surgery
The placement of endosteal dental implants requires two different surgical procedures. In "Stage 1" surgery the implants, or "fixtures’ are placed in the bone.

In "Stage 2" surgery which takes place after osteointegration is complete and the submerged implants are solidly anchored in bone, the fixtures are uncovered and special posts called "abutments" are attached to the implants.

These abutments project above the gum line into the mouth, and the final artificial teeth will be fitted onto them.

The portion of the implant that is fitted onto the abutment(s) and is visible in the mouth is called a prosthesis—they can be either of a "fixed" or "removable" type. A fixed implant prosthesis can involve a single tooth (top left) or several teeth (bottom left). A fixed prosthesis can only be removed by your dentist, but is designed to allow you to clean it. A removable prosthesis (right) is similar to a full denture and can be removed from your mouth for cleaning.

What to Expect During Surgery

Stage 1 Surgery
The first surgical procedure for endosteal implants involves placing the implants in the bone. This surgery can take place in the oral and maxillofacial surgeon’s office, or in a hospital setting. Local anesthesia with a mild sedative may be used, or in certain cases general anesthesia may be recommended.

After you are anesthetized, the surgeon will lift back the gum tissue to expose the bone and place one precisely measured hole in the bone where each implant will be inserted. The implant fixtures are inserted in the holes, then the gum tissue is replaced over the fixtures and sutures (stitches) are placed. The surgical procedure may take several hours if multiple implants are placed, and following surgery you will spend some time ‘‘in recovery" before going home. Osteointegration will begin taking place as healing progresses, and the fixtures should be firmly anchored by bone within four to six months.
	Stage 1 surgery involves placing the implant fixtures in the jaw bone.

Following Stage 1 Surgery
Immediately following surgery you may be asked to bite on some gauze to stop any bleeding, and an ice pack may be used during the first 24 hours to help reduce swelling. Expect some swelling in the area of the implant surgery for up to 72 hours following the procedure, as well as some discoloration of the skin and gums for a few days. Pain medication prescribed by your surgeon will help alleviate any discomfort, and you should be able to resume normal activities within a day or two. Your surgeon may also prescribe antibiotics. Expect some minor bleeding on the day of surgery but report excessive bleeding to your surgeon immediately. During this time a soft diet is recommended that doesn’t place undue stress on your new implants, and your surgeon will give you important instructions on how to clean your mouth. If you have been wearing a denture, the surgeon or restorative dentist may place a soft lining in it so you can wear it comfortably during the healing period or it may be necessary to leave it out for a short period of time. If spaces due to missing teeth must be filled in while healing takes place, temporary teeth that appear natural can be made. Sutures that were placed after surgery will either dissolve or you will return to your surgeon to have them removed.

Stage 2 Surgery
The second surgical procedure takes place after healing from Stage 1 surgery is completed. For endosteal implants which osteointegrate, healing usually takes 4-6 months. Areas of the mouth that undergo more chewing stress may require a longer healing period, perhaps up to eight months.

At the second surgical appointment, usually performed in the surgeon’s office using local anesthesia, the gum tissue is opened to expose the implant fixtures. The fixtures are examined to verify satisfactory osteointegration, then healing posts are attached to the fixtures. If sutures are placed, they will either dissolve or you will return to have them removed by your surgeon. This second stage of surgery is a relatively short procedure, and you can expect to return to normal activities within one or two days if not sooner.

In Stage 2 Surgery healing posts are attached to the implant fixtures.

Following Stage 2 Surgery
After returning home, eat a soft diet and follow your surgeon’s oral hygiene instructions. Expect some minor bleeding, but report excessive bleeding or swelling to your surgeon. You will return to your surgeon within a few days so that healing progress can be monitored, and if you wear a denture, it may be placed immediately or shortly after surgery This will be determined by your dentist on an individual basis. Ice packs applied to the face following surgery can help reduce swelling.

MAKING YOUR NEW TEETH
When your gum tissues have completely healed after Stage 2 surgery, you are ready to visit your restorative dentist and begin fabrication of your new artificial teeth. Your dentist will make impressions of your mouth, and bite registrations that record the way your jaws fit together, then the impressions are used to make models of your jaws and any remaining teeth. Your artificial teeth will be made based on these models. Your artificial teeth (called "restorations" or a "prosthesis") will be either removable, fixed, or a combination of both.

A removable prosthesis is similar to a conventional denture or partial denture, in that you can remove it from the mouth to clean it, but it has the advantage of being fastened to the implant abutments by clips, magnets or other devices. Artificial teeth and gum tissue are mounted on a metal framework, and the framework attaches to the implant abutments.

A fixed prosthesis can replace one tooth, several teeth, or even all of your teeth. The artificial teeth are screwed into the abutments, or cemented onto the abutments, and held firmly in place. If some natural teeth remain in the mouth, parts of the prosthesis may be connected to some of these teeth. A fixed prosthesis can only be removed by your dentist, and it is specially designed to allow you to clean it. If a fixed prosthesis is replacing many teeth, the artificial teeth will be mounted on a metal frame that must fit the implant abutments precisely Your restorative dentist may have you wear the prosthesis for a while to make sure it fits properly, before final attachment to the abutments.

It may take several appointments to complete your prosthesis, depending on the complexity of your case.

KNOWN RISKS AND COMPLICATIONS
Dental implant surgery has a high rate of success, but as with any surgical procedure, certain side effects or complications are possible. You should understand these before you consent to implant surgery Your surgeon will answer any questions you have about the following possible risks:

1. Swelling is a normal reaction to any surgical procedure and the amount of swelling depends on how extensive the surgery was. Normal swelling should peak within about 48 hours, then gradually subside. If swelling worsens after 48 hours, contact your surgeon.

2. Bruising occasionally develops in areas close to the surgical site. Any discoloration from bruising should disappear within a few days following surgery

3. Moderate pain is common for 24-48 hours following surgery, and pain medication may be required. If intense pain persists that cannot be relieved by prescribed pain medication, contact your surgeon.

4. Trismus, or stiffness of the jaw muscles, may be caused by swelling following surgery As the swelling decreases, trismus should disappear.

5. Infection is very rare following implant surgery but occasionally an infection can occur. If fever, persistent swelling! pain or pus develops following surgery, contact your surgeon immediately.

6. There is always a potential that an implant may fail. This can be caused by a number of factors, among them are rejection by the body or inadequate maintenance by the patient following surgery.

7. Injuries can potentially occur to adjacent teeth and roots, fillings or bridgework.

8. Loss or alteration of nerve sensation, resulting in numbness or a tingling sensation in the lower lip, tongue, cheek, chin, gums or teeth is rare but can occur if implants are placed in the lower jaw and a nearby nerve is irritated. Usually this is temporary, although in very rare cases it can be permanent. Every precaution is taken by your surgeon to avoid these nerves.

9. Sinus complications, such as drainage or pain (sinusitis), occasionally occur if implants are placed in the upper jaw and the sinuses become involved. This may or may not require further treatment, but any sinus symptoms should be reported to your surgeon.

10. Bleeding can be expected following any type of surgery, but it should be easily controlled and consist of occasional oozing during the first 24-48 hours. In the rare instance that bleeding is excessive or prolonged, contact your surgeon immediately.

11. TMJ (Jaw Joint) pain or abnormal function is rare following implant surgery, but this can occur. If it does, further treatment may be necessary.

12. Bone loss is rare, but may occur around the implant if proper hygiene is not maintained or if excessive stress is placed on the implant.

13. Jaw Fracture—In very rare cases the manipulations required for placement of the implants in the lower jaw can fracture the jawbone, particularly if the jaw is thin. X-rays will reveal the location of the fracture, and your oral and maxillofacial surgeon can treat the problem.

MAINTAINING YOUR IMPLANTS AND RESTORATIONS
Your surgeon and restorative dentist will schedule periodic check-up visits to make sure your jaws are healthy and the implants and prosthesis are functioning properly Just as important as regular professional care, however, is your own care of your implants and prosthesis. Following are guidelines for proper maintenance of your implants:

Practice meticulous home oral hygiene, following the instructions of your dentist and hygienist. Abutment posts, beneath the prosthesis, artificial teeth, and gum tissue must be kept clean. Home care aids such as special brushes and floss holders will help you accomplish this. If you do not keep your implants and prosthesis clean, your implants may fail.
Smoking and excessive alcohol consumption as well as chewing hard foods such as ice or hard candy may result in damage to your implants or cause them to fail.

While there is no guarantee of 100 percent success with dental implants, with careful planning by your surgeon and restorative dentist prior to surgery and proper maintenance by you, you can expect many years of use from your implants. In fact, current literature reports that 90 percent or more of implants have been successfully retained for up to 15-20 years. Thousands of people have rediscovered the joy of eating properly speaking clearly and laughing comfortably through the use of dental implants.

PAYMENT FOR SERVICES
If you have health insurance, make sure you read your medical and dental insurance policies or check with your insurance representative to determine if your plan will cover dental implant procedures before you begin treatment. Because dental implants often involve a team approach between the surgeon and the restorative dentist, obtain cost estimates from each one prior to treatment. Their fees are your responsibility regardless of how much your insurance may cover. Your dental office has its own financial policies, so be sure to discuss payment arrangements prior to treatment and make sure all parties fully understand these arrangements. Your surgeon, restorative dentist or their financial coordinators will be happy to answer any questions you have about fees and payment.