A NewBeginningwithDentalImplants A Guide to Understanding Your Treatment Options
Why Should I Replace What Are My ToothMy Missing Teeth? Replacement Options?Usually, when you lose a tooth, it is best for your oral If you are missing one or more teeth and choose tohealth to have it replaced. Missing teeth can affect have it or them replaced, several treatment optionsyour “bite” as well as your ability to speak and chew. are available.Their loss can increase the burden on your remaining A ‘flipper’ is a removable plastic tooth that isteeth and can cause muscle pain in your jaws and inexpensive but fragile and temporary.headaches. And of course, losing a tooth can affect A cast partial denture also is removable but isyour appearance. precision cast in metal for longer service life. Wire The good news is that, most of the time, replacing clips help hold it in place.a missing tooth is not an emergency. You have time to A fixed bridge is cemented into place usingconsider what replacement option is best for you and crowns or “caps” on the teeth adjacent to the opento make an informed decision. This booklet discusses space for support. Crown placement usually requiresyour general treatment options. removing or reducing the outer layer of the tooth. In some cases, a ‘Maryland’ bridge, a fixed bridge that does not need crowns, is glued onto the back of the teeth adjacent to the space so that minimal tooth structure is removed. Complete dentures or ‘plates’ are the traditional solution for people who have lost all their teeth in one or both jaws. The success of a complete denture depends upon the individual’s jaw size and shape, his or her oral habits, and his or her adaptability. Some people adapt well to dentures, while others are not able to adapt. Dental implants can be used to provide supportExtraction site of upper front tooth. for the replacement of one tooth or all of an indivi- dual’s teeth. After years of research and clinical trials, we can now provide this option in addition to the traditional treatments just described. Implant-sup- ported teeth can be cemented, screw-retained, or removable and can be made attractive, stable, and comfortable for almost any patient.Missing front tooth.Implant supported replacement tooth.
Flipper (removable). Fixed Bridge (cemented in place).Cast partial denture (removable). Maryland Bridge (cemented in place).Lower complete dentureAny other replacement options will be discussedwith you before treatment begins. Implant supported replacement tooth.
Are Dental ImplantsAn Option For Me?If you are considering dental implants, your mouthwill be examined thoroughly and your dental andmedical history will be reviewed to ensure that dentalimplants are appropriate for you. Dental x-rays and,frequently, panoramic (or complete) x-rays of yourjaws will be taken to evaluate your jawbone and todetermine if it will accommodate implants. Occasion-ally, more detailed information is required and can beprovided by special x-rays. They will help determineif additional tests or procedures are needed to placeyour implants properly. taken. Frequently panoramic x-rays of your jaw are taken. What Is A Dental Implant? The best way to describe a dental im- plant is to compare it to a real tooth. A natural tooth consists of a root and a crown. The part of the tooth that you see and eat with is called the crown. Beneath the crown is the root, which anchors the tooth through the gum tissue to the jawbone. When you lose a tooth, you lose both the root and the crown. To replace a tooth, we first have to replace the root. Essentially, a dental implant is a new root. This titanium root is fitted into a socket that we create in your jaw, replacing the lost root of your natural tooth. Dental implants come in various shapes and sizes and have different types of surfaces. The actual implant selection will depend on a variety of factors related to your specific treatment needs and the most appropriate one(s) will be used. Once an implant has been placed in the jaw, the bone around the implant will need to heal for up to six months, depending upon how hard the bone is. When this initial phase of healing is completed, a sup- port post called an abutment will be placed on the im-A thorough examination of your mouth is required. plant itself and then a new crown will be placed on top. If all of your teeth are missing, a variety of treatment options are available to support the replacement teeth.
How Are DentalImplants Placed?Usually, the office procedure to place a dental implanttakes about an hour for one implant and no morethan two or three hours for multiple implants. Theplacement process consists of the following steps:• If indicated, you will be given medication suchas antibiotics prior to the surgery. You may be offeredsedation with nitrous oxide (“laughing gas”) or intra-venous medications. Then, a local anesthetic will beadministered to numb the areas where the implant(s)will be placed.• After you are comfortable, a small incision ismade into the gum tissue, revealing the bone intowhich the implant will be placed.• Using special instruments, a socket is createdcarefully, avoiding damage to the bone.• The titanium implant is then inserted intothe socket.• Finally, if necessary, sutures will be used. Once the implant is inserted, it is completed inone of two ways: First, the gum tissue will be closed(or sutured) over the implant, allowing the implantto heal for up to six months. Then a second procedure,called “uncovering surgery,” will be performed aftera local anesthetic has been used to numb the gumtissue. Next, the gum is moved out of the way, theimplant located, and a healing cap placed into it. Thegum tissue is then sutured around the healing cap.Generally, after two to four weeks, you will return tohave the healing cap removed, the abutment (or sup-port post) placed, and impressions made in order forthe final crown (replacement tooth) to be fabricated.This is called a “two-stage” or “two-step” approachto implant placement and is the more traditional After you lose a tooth, we generally allow theapproach. For more aesthetically important areas, extraction site to heal. The implant is then placedwe may ask that you wait up to 12 weeks to begin the into the mature site.final restorative process. During this time, you will befitted with temporary teeth. Occasionally, impressionsare made at the time the implant is placed in order tohave a crown ready when the implants have healed. After the implant is placed, the area will need toheal for as long as six months. How long your mouthwill need to heal will be determined by a variety offactors. Follow-up care (one to four appointments)is usually needed to ensure that your mouth is healingwell and to determine when you are ready for the re-storative phase of your treatment.
When Are The Implants Placed? Approximately three months after the tooth is re- moved, the implant is placed where the missing tooth was located. Once a tooth is removed, if your socket walls of bone are intact and fairly thick, your body will grow new bone to replace or refill the empty socket. Your socket will usually be completely filled in with bone by the time you are ready for placement of your implant (about three monthsHealing cap in place. later). Occasionally, it is possible to take out the tooth and place the implant at the same time. This may in- An alternative approach is called the “single- volve a little more risk, but it simplifies the process—stage” or “one-step approach,” in which a healing cap you won’t have to wait three months for the bone tois added at the same time as the implant is placed refill the socket. Again, there are times when this isand the gum tissue is sutured around it. If the entire appropriate and other times (when infection or otherprocess occurs during one step, a second surgery to problems with the bone are present) when immediateplace the healing cap is unnecessary. Because only one implant placement is not the best treatment.surgical appointment usually is all that is needed, If your tooth has been missing for some time, theboth patients and doctors often prefer this approach. adjacent bone is likely to grow thinner because theHowever, it is not always the best method for placing root of the tooth itself has stimulated the bone. Onceimplants. We will use the most appropriate approach the tooth root is removed, the bone loses this stimula-to meet your particular needs. tion and starts to disappear. As much as one third of On occasion, it may be necessary to perform a your jaw’s thickness can be lost in the year following“soft tissue graft” to obtain stronger, more easily tooth extraction. If you are missing quite a bit of bone,cleaned and natural appearing “gum” tissue in the you may need to have additional bone grafted into thearea around the implant. This process involves mov- area so that the implant will be supported adequatelying a small amount of gum tissue from one part of when it is placed.your mouth to the area around the implant. Most of-ten, it is a brief and relatively comfortable procedure.Original bone and tooth relationship. Bone loss occurs over time.
Do I Have Enough Bone?Again, if after tooth extraction the walls of the socketare very thick, they will usually fill with bone in threemonths. However, if the walls of your socket are verythin (such as in your upper and lower front teeth),then this type of healing will not be as predictable. Af-ter waiting three months for the bone to fill in, youmay have only a very thin ridge of bone. Sometimes, abone graft is placed at the time of tooth extraction tohelp your body fill in the socket with bone. This stepwill maintain the width or volume of bone you willneed for implant placement. It is most commonly per-formed on thin-walled extraction sockets, especiallyin such visible areas as the front of the mouth. If your tooth was removed many years ago, thenyour bony ridge may be extremely thin and you maynot have enough bone left for implant placement. Inthis case, a bone graft can be placed next to the thinbone and allowed to heal for three to nine months.After the graft has fused to your pre-existing bone,the ridge will be re-entered and the implant placed.Usually bone grafting is a relatively comfortableprocedure. Many different bone-grafting materials Sinus grafting to replace bone height.are available, including your own bone. You also may need bone grafting if the sinuscavities in your upper jaw are very large or very low tion. During this procedure, the membrane that linesand extend into the tooth-bearing areas. This often the sinus will be located and elevated. Bone will beoccurs when teeth in the back of a person’s upper jaw added to restore the bone height and ensure that den-have been removed many years before, and the tal implants of an adequate length can be placed. Thisamount of bone available for implant placement is procedure often can be performed at the time of im-thus limited. This condition requires what is called a plant placement.“sinus grafting procedure.” Most often, it is performedin the office with local anesthesia and perhaps seda-Bone width restored with bone grafting. Implant and replacement tooth in place.
How Many Implants A second option involves placing four to six im- plants, depending on your jaw size or shape, into yourDo I Need? lower jaw. After healing is complete, the implants are connected with a custom-made support bar. YourMost frequently, one implant per missing tooth is denture will be made with special retention clips in-placed. Because many of the larger teeth in the back side that attach onto the support bar, allowing theof your jaws have two or three roots, the most com- denture to snap firmly into place. This is called anmon approach is to replace missing back teeth with “overdenture.” The advantage of this option is that itlarger implants or more than one implant per tooth, is much more stable than the first option, allowingespecially if there has been moderate bone loss or if very little denture movement. Your denture still willthere is evidence of excessive biting force. be removable for easy cleaning and maintenance. A third option involves placing five or more im- plants in your jaw and attaching a permanent denture. Your denture is held in place by screws or clasps that secure it to the support posts or bar. It doesn’t touch the gum tissue, which allows you to clean under the denture without removing it. This denture will replace all your missing lower teeth and will not be removed except at maintenance visits. Although cleaning under your denture without removing it is more time con- suming and requires more dexterity, many patients who want a permanent denture prefer this option. The final option is to have all your teeth individu- ally replaced so that they will appear to be growing out of your gum tissue and will most closely resemble3 Implants Replace 2 Lower Molars.What If I’m Missing All OfThe Teeth In My Lower Jaw?If you are missing all of the teeth in your lower jaw,you may consider a number of treatment options.Although many patients have no problem wearingan upper denture, some find it difficult to wear lowerdentures. The first option is to have two implants placedin your lower jaw and a denture made that snaps ontothese implants. This option allows your lower dentureto be more stable while chewing than without implants.This is a viable option if your jaw’s support ridge is bigenough. There will still be movement of your lowerdenture, however, and you can still get sore spots ifany food particles, especially seeds, are caught under it.As with all removable replacement teeth, you still will Custon made support bar and specialized lowerneed periodic appointments for denture adjustment. denture with retention clips.
the appearance of your natural teeth. This option What Can I Use For Teeth Whileusually requires eight or more implants. Separateabutments or support posts for each one of these The Implants Are Healing?implants will be made and crowns for each missingtooth will be placed. The teeth are then frequently Many options are available, and they are tailored tojoined together for strength and support. Overall, your specific needs. If you need a replacement tooththis is the most costly option, because (among other while the implants are healing, temporary removablereasons) it requires the most implants. In addition, teeth or a temporary bridge can be made. If all youryour options may be limited by the current size and teeth are missing, we can usually modify your presentshape of your jawbone complete denture or make you new temporary den- ture. If you would prefer nonremovable teeth during the healing phase, temporary transitional implantsWhat If I’m Missing usually can be placed along with the permanent im- plants, and temporary teeth may be made and in-All Of My Upper Teeth? serted the same day.A similar range of treatment options is also availablefor your upper jaw. However, because the bone is notas hard as that in the lower jaw, people often need What Are Themore implants to support their replacement teeth. Potential Problems? Although it is natural to be concerned about the pain that may be caused by these procedures, most patients do not experience severe or significant postoperative pain. Pain medication and antibiotics will be prescribed for you to make your recovery as easy as possible. Occasionally, some people develop postoperative infections that require additional anti- biotic treatment. In addition, there is a chance that the nerve in the lower jaw, which provides sensation to your lower lip and chin, may be affected. If you are missing quite a lot of bone, it might be difficult to place an implant without infringing on the nerveImplant Supported Upper Denture. space. Although we take great care to avoid this nerve, occasionally it is irritated during the procedure resulting in numbness or tingling in your lip, chin, Depending upon the number of implants to be or tongue. And although this numbness will usuallyplaced, it may be possible to eliminate the need for resolve, it can be permanent. If you notify us of post-covering the roof of your mouth with the denture. operative numbness as soon as possible, it will allowThis option will allow you to better taste your food us to manage your care in the most appropriate way.and to better sense food temperature, and it will makeyour denture feel more natural. You will still have a re-movable denture, which makes cleaning the supportbar and denture much easier. If you want a restorationthat is similar to your natural teeth and therefore notremovable, you probably will need eight to ten im-plants placed. This is followed after healing by theplacement of the abutments and crowns. Relationship of nerve to lower teeth.
How Long Will rary replacement teeth are used during this phase. Information we obtain at the time of implant place-The Implants Last? ment will help us to determine what is the most ap- propriate approach for you.Implants last a long time. Of patients who were miss- The dental work required to complete your treat-ing all of their teeth, long-term studies (more than 30 ment is complex. It is, however, considered more com-years) show an 80 to 90 percent success rate. For pa- fortable and more pleasant than conventional dentaltients missing one or several teeth, six-year studies care. Frequently, most of the work can be done with-show a success rate of greater than 90 percent, which out using even local anesthesia.compares favorably with other areas in the body that Your restorative treatment begins with special-receive implant replacement (such as hips or knees). ized impressions that allow us to produce a replica ofHowever, if one of your dental implants either doesn’t your mouth and implants. We will also make “bite”heal properly or loosens after a period of time, you records so that we see the relationship of your uppermay need to have it removed. After the site heals (or and lower jaws. With this information, we will makeon occasion at the time of removal), another implant the abutments (support posts) that attach your re-usually can be placed. placement teeth to your implants. Various types of abutments exist. Frequently, we can use “off the shelf ” abutments. Other times, custom abutments must beWhat Happens After The made of gold or a tooth-colored ceramic material. As you can imagine, these custom-made abutments addImplants Have Healed? to the cost and treatment time involved. Which abut- ment to use is a decision that often cannot be madeIn most cases, after four to six months of healing, your until after healing is complete and impressions havejawbone is firmly fused to the implants. The restorative been made.phase of your treatment, when your missing teeth are The number of appointments and the amountactually replaced, is now ready to begin. Depending of time required for each appointment is different foron a variety of factors, it may be possible to begin the each patient. No two cases are exactly the same andrestorative phase of your treatment earlier in certain regardless of the number of teeth replaced, thecases immediately after implant placement. We will work must be completed with great precision andreview the most appropriate treatment sequence and attention to detail. If you are having only a few teethtiming for your particular situation. replaced, there as few as three short appointments In some cases, depending on the density or hard- may be required. Between appointments, we will needness of your bone, it is helpful to increase gradually time to complete the necessary lab work to make yourthe work on your implants. Various types of tempo- replacement teeth. If your final restoration is a removable denture, you will need to come to as many as five office ap- pointments (although it may be fewer) over the fol- lowing several months. During these appointments, we will perform a series of impressions, bites and adjustments in order to make your new teeth as well as the custom support bars, snaps, magnets, or clips that will secure your teeth to the implants. During this period we will make every effort to make certain you have comfortable temporary replacement teeth. In general, once your implants are placed, you can expect your treatment to be completed anywhere from two to 12 months. For these reasons, it is diffi- cult for us to tell you exactly how much the restorative phase of your treatment will cost, although you should receive a reasonable estimate of costs . It also is diffi-A number of short appointments are needed to cult to give you a specific timeframe for completion ofcomplete your treatment after the implants have your treatment until after the implants are ready forhealed. restoration.
How Do I Clean My Implants? another dentist provides the temporary teeth and re- stores the dental implants after healing is complete. In this case, both doctors are involved in planning yourAs with natural teeth, it is important that you clean im- dental treatment. Also, depending upon a variety ofplant-supported restorations regularly with tooth- factors, different dental specialists will help with yourbrushes, floss and any other recommended aids. You dental care.also should visit your dentist several times each yearfor hygiene and maintenance. As with regular denturesand other tooth replacements, your implants and theirassociated components are subject to wear and tear and What Do Theseeventually will need repair, including clip replacement, Services Cost?relines, screw tightening, and other adjustments. Before treatment begins, every effort will be made to give you an accurate estimate of all the expenses in- volved in placing and restoring your dental implants. This includes the implant placement itself plus any bone and soft tissue grafting procedures that are needed. In many cases, there is an initial charge for the diagnostic work-up, including study models, x-rays, and the fabrication of a surgical template to ensure the best possible result. You also will be charged for the abutment or support post(s), plus the crown, dentures, or anything else that will be placed over the implants, including temporary restorations, as well as for periodic maintenance such as hygiene visits, tissueA variety of toothbrushes and floss are availableto help you clean your implants. conditioners, denture relines and other repairs. We will try to assist you in estimating what your actual payments will be after we evaluate your insur- ance coverage or other third party payments, if any.Will One Doctor Your ultimate restorative choice should be guided by your sense of what is best for you based on the infor-Do Everything? mation we have provided you. You also should con- sider the financial impact of each treatment optionIn some situations, your dental implants can beplaced and restored in the same office. At other times, as some insurance companies provide no or limitedone dentist places the implant(s) and performs any coverage. If different doctors are involved, they willother necessary additional surgical procedures while charge you separately for their services. Each patient is unique, and it is not possible for us to discuss every option and every contingency for treatment outcome. This booklet is intended to help you understand the general treatment options available to you. If your specific treatment options are not clear, please contact us. We will be happy to answer any questions you have about your dental care.