Implants
Dental implants are artificial tooth roots placed in your jaw to hold a crown or bridge or denture in place. They are made of titanium which is a completely biocompatible metal and are placed inside the bone and osseointegrate with it.
Since recently if you missed a tooth, the traditional way to replace it is by fabricating a bridge. The bridge was placed on top of the teeth next to the one missing, after the removal of sound tooth structure in order to become abutments. Dental implants are much more tooth saving than traditional bridgework, since they do not rely on neighboring teeth for support.
Implant therapy starts with the surgical placement of implants inside the bone. The implants are left then to osseointegrate. Osseointegration is a process through which implants become one with the natural bone. After a healing period (ususally 2 to 6 months, depending on the case) the implants are ready to accept a final prosthetic crown, bridge or denture in way similar to the natural teeth. In the meantime a temporary crown or bridge is often given to patients for reasons of function or aesthetics. In some cases the implant can get the bridgework immediately after the surgical placement. This is called immediate loading of the implant and not all implants are candidate for such a process.
If you want to know more about dental implants, you can watch the following video:
The surgical placement of dental implants is a surgery that takes place at a properly equiped dental office under local anesthesia. During the surgery you will not feel any pain, since the area will be suffiently anesthetized. After surgery your doctor will prescribe pain killers and anti-inflammatory drugs that will take care any postoperative pain and discomfort. You will be swollen for the first couple of days after surgery. The swelling will start to go away after the third day post surgically and you should not worry about it. Swelling is part of normal healing. In some cases you might even bruise. Again this is something of no major concern, other than the aesthetic issue.
The implant surgery starts with an incision in the gums. A flap is raised and then with the aid of special rotary drills an opening is created in the bone that will host the implant. The incision is then sutured and the implant is either completely covered or sometimes a longer healing abutment is placed on top of the implant and part of it is left outside the gums. Whether the implant will be completely covered or not is a decision that the surgeon will take during surgery based on the quality of native bone. In case the implant is left to heal completely covered, a second surgery will be performed after some months (2 to 6 depending on the case) to uncover it.
Below there are two cases that demonstrate the area of the mouth before implants, the radiograph at the time of implant placement and the area of the mouth with the healing abutments on top of the implants.
After a certain period of healing (usually 2 to 4 months) the implant is ready to be restored.
The final implant restoration consists of a porcelain fused to metal crown and an intermediate part that connects the implant to the crown. This intermediate part is called final prosthetic abutment and it is screw retained inside the implant. The crown will sit on top of the prosthetic abutment and it can be cemented or again screw retained.
The sequence for the implant restoration is similar that followed for a tooth restoration. First an impression of the implant is taken using an impression coping specific to the implant. The impression is sent to to the lab and a metal framework is fabricated and then tested in the mouth. After that, porcelain is fused to the metal framework and once everything fits, the crown is placed on the abutment (either screw retained or cemented). The final crown will be a tooth that looks and feels as your own.
In certain cases the final restoration can be placed immediately after the surgical procedure. This is called immediate loading. Not all cases can be done like that. Ask you doctor if you are a candidate. In case you have to wait a couple of months before the final restoration is placed, a temporary restoration can be placed, so as you are not left without teeth, if you wish.
Below there is an example of two implants that were restored with two porcelain fused to metal crowns.
In many people the native bone is not sufficient for implants to be placed. The periodontist will be able to determine if you have enough bone. In most cases the decision is made with the help of a special radiograph that is called dental scan (cone bean computer tomography). In almost every case that there is lack of native bone, the bone can be augmented with specialized bone aumentation surgeries.
The bone augmentation is done with the aid of special membranes and bone grafts. The bone graft is either harvested from the actual patient or taken out of a bottle. In this case, it is completely safe and biocompatible and has approval by the national organization for medicines.
The implants can sometimes be placed simoultaneously with the bone augmentation procedure. If done seperately, you might need to wait an extra period of time (up to 6 months depending on the case) before you have your implants placed.
