There are several factors, which can limit conventional prosthodontic treatment and therefore may indicate the need for implant therapy. A knowledge of these factors serve as a foundation for the diagnosis and treatment planning of your needs.
Am I a candidate for dental implants?
Generally speaking, if you have lost teeth, you are a candidate for dental implants. It is important that you are in good health, however, as there are some conditions and diseases that can affect whether dental implants are right for you. For example, uncontrolled diabetes, cancer, radiation to the jaws, smoking, alcoholism, or uncontrolled periodontal (gum) disease may affect whether dental implants will fuse to your bone. It is important to let your dental surgeon know all about your medical status (past and present) together with all medications you are taking, whether prescribed, alternative (herbal) or over-the-counter.
Researches have shown that 80% to 97% of implants succeed depending on their health status and how the methods of studies were done.
Patients who have or had Chemotherapy for cancer have 25% of implants fail when they have implants placed under hyperbaric oxygen or HBO chamber. Smokers have 11% implants fail. Increasing researches have shown that success rates are much higher in smokers if patients stop smoking 4 weeks before and 8 weeks after implant surgery.
Where and how implants are placed requires a detailed assessment of your overall stomato-gnathic system (“stoma” – mouth; “gnathic” – jaws), within which the teeth function. This will necessitate compiling records that include study models of your mouth and bite, and specialized radiographs (x-rays), which may include 3D scans known as computerized tomograms (CT scans).
Planning with the help of computer imaging ensures that dental implants can be placed in exactly the right position in the bone.
How and why is bone loss(t) when teeth are lost?
Bones need stimulation to maintain its form and density. In the case of alveolar (sac-like) bone that surrounds and supports teeth, the necessary stimulation comes from the teeth themselves. When a tooth is lost, the lack of stimulation causes loss of alveolar bone. There is a 25% decrease in width of bone during the first year after tooth loss and an overall decrease in height over the next few years.
The more teeth loss, the more function loss. This leads to some particularly serious aesthetic and functional problems, particularly in people who have lost all of their teeth. However, it doesn’t stop there. After alveolar bone is lost, the bone beneath it, basal bone — the jawbone proper — also begins to resorb (melt away).
How can bone be preserved or re-grown to support dental implants?
Grafting bone into the extraction sockets at the time of tooth loss or removal can help preserve bone volume needed for implant placement. Surgical techniques are also available to regenerate (re-grow) bone that has been lost, to provide the necessary bone substance for anchoring implants. In fact, a primary reason to consider dental implants to replace missing teeth is the maintenance of jawbone.
Bone needs stimulation to stay healthy. Because dental implants fuse to the bone, they stabilize it and prevent further bone loss. Resorption is a normal and inevitable process in which bone is lost when it is no longer supporting or connected to teeth. Only dental implants can stop this process and preserve the bone.
How to place / who places implants?
It takes a dental team to assess and plan dental implant placement and restoration — the fabrication of the crowns, bridgework or dentures that attach the implants atop and are visible in your mouth.
The dental team consists of the following important specialists:
1. The general restorative dentist or a prosthodontist. This doctor plans and places the tooth/ teeth or fixed or removable implant supported dentures.
2. The surgeon, who is either a general dentist, a periodontist, or an oral surgeon. This doctor has advanced training in implant surgery and prosthetic placement.
3. The lab technician. This specialist builds up the crowns, bridges, or dentures that attach atop the implants which are visible in the mouth.
Dr. ChauLong Nguyen has extensive knowledge and training in planning and placing dental implants and prosthetics with the highest and latest technologies such as Digital X-rays, Cone Beam Computer Tomography (CBCT) scan and software to plan surgery and create surgical guide for complicated case or Computer Guided surgery, computerized anesthetic delivery system, CEREC 3 D making teeth in one visit.
Her patients prefer to have her as a surgeon and the restorative doctor because they have more accurate and precise final results as well as they save time, energy, and costs.
Many times she would recommend for a second or third opinion so patients can make a well educated and informed decision.
Placing dental implants requires a surgical procedure in which precision channels are created in the jawbone, often using a surgical guide. The implants are then fitted into the sites so that they are in intimate contact with the bone. They generally require two to six months to fuse to the bone before they can have tooth restorations attached to them to complete the process.
After implant is placed, Dr. Nguyen will need to see you for follow up in 1 week, 2 weeks, 4 weeks, 3 months, and six months some times 8 months in the highly esthetic place.
After the new tooth/ crown has been cemented or screwed in, you need to have regular cleaning and check ups at 3 or 6 months, depending on your oral hygiene status.
What are the options for implant tooth replacement?
Single Tooth Replacement: Immediately (at the same time an implant is placed) or after a period of healing, an abutment is attached to the implant. This is a device that “abuts” or joins the implant to a tooth form called a crown, which replaces the tooth part you see in the mouth. It will hold a custom-made crown that the dental laboratory will fabricate and match to your existing teeth. The custom crown is cemented or screwed onto the abutment to permanently keep it in place. Once the crown is in place, it should be indistinguishable from your natural teeth.
Fixed Multiple Tooth Replacement: As with single tooth replacement, temporary healing caps or abutments may be placed on multiple implants until the healing phase is complete. After healing, permanent abutments are attached to the implants. They can attach to custom-made crowns or bridgework that a dental laboratory will fabricate to match your existing teeth. In the final step, the custom bridge, which will replace multiple teeth, is cemented or screwed onto the abutments. The teeth are replaced without disturbing the healthy teeth next to them, and bone loss is halted.
Removable Implant – Supported Tooth Replacement: If all of your lower teeth are missing, depending on the design of the removable restoration, two to six implants may be used to support a lower denture. If all of your upper teeth are missing, a minimum of four implants may be used to support an upper denture. Removable dentures are often used to replace extensive tooth, bone and gum-tissue loss, thus providing support for the facial skeleton, lip and cheeks. A new denture can have attachments that snap or clip it into place on the implants or a custom made, milled bar can be fabricated to create additional strength and support for the restoration. Design variations are often related to your bone density and number of implants present; your dentist will discuss these options during your consultation. A significant advantage of a removable denture is facilitating the cleaning of the dental implants.
How do implant tooth replacements differ from teeth?
Natural teeth and dental implants may look the same, feel the same, and even function in a similar way, but they are very different. The most important differences are in the way they attach to the surrounding bone, their response to dental disease, their maintenance, and repair.
Teeth attach to the surrounding bone by a periodontal ligament (“peri” – around; “dont” – tooth) made up of collagen fibers that join into the tooth on one side and bone on the other. Dental implants fuse directly to the bone.
The gum tissues also attach to the root of a tooth with collagen fibers as described above. However, gum tissues can only stick to the surface of dental implants.
Teeth are susceptible to dental decay as well as the need for root canal therapy; dental implants are metal and do not decay or need root canal. Teeth may also be susceptible to periodontal (gum) disease, while dental implants may be susceptible to peri-implantitis, an inflammatory response to bacterial biofilm of the tissues surrounding the implant, which can result in disintegration of the bone to the implant.
What type of maintenance do dental implants require?
Implant crowns and other prosthetic (false) tooth replacements are made to be remarkably failsafe systems. They are removable and replaceable (only by your dentist), so that if damage or wear necessitates replacement, this can be accomplished without affecting the implant(s) or attachment to the bone.
Nevertheless, implants do require maintenance. It is important to practice good daily oral hygiene, including brushing and flossing to control bacterial biofilm. It is also important to see your dentist and dental hygienist. Special instruments are necessary to clean dental implants that will not damage their metal surface beneath the gum tissues. Your dentist will need to monitor your implants to make sure the integrity of the osseointegration is stable, and that the implant crowns, bridgework or dentures are functioning adequately.