Mack McLaren and Chris Robinson- Implantology OUCOD 2015
A viable option for the replacement of missing, damaged, or
An implant is a small titanium screw or post that is
surgically placed into bone. The tissues of the bone
integrate with the implant as the healing process
After integration occurs implants act like the root of a
tooth. This allows for the foundation on which a
permanent restoration may be placed.
Implants may be used to replace a single tooth or
When a tooth is lost the bone that surrounds the tooth
begins to resorb or shrink. This may lead to drifting of the
surrounding teeth into the empty space.
Missing teeth may contribute to decay of the surrounding
teeth, gum disease, or issues with appearance.
Many people who are missing one or more front teeth are
conscientious of their smile.
Many people missing a back tooth may experience
difficulty or discomfort when eating.
Let’s look at some cases before and after treatment.
Several alternatives to dental implants are available.
Root canal therapy followed by a crown, fixed bridges,
traditional partial dentures, or complete dentures are
all possible alternative treatments.
These alternatives may come at a lower price.
However, each alternative also comes with some sort of
Teeth that suffer from an infection of the soft internal
tissues many times need a root canal. This process
voids the tooth of the vital tissues.
After treatment the tooth is non-vital. Non-vital teeth
tend to become brittle and are prone to fracture.
After treatment, many cases require that a crown to
provide structural support and provide an esthetic
restoration of the tooth.
The placement of a fixed bridge was the standard of
care for the replacement of a missing tooth/teeth for
A fixed bridge requires grinding on teeth adjacent to
the missing tooth. Each of these teeth act as an
anchor for the tooth that will replace the missing
Partial dentures are frequently used as a viable
treatment option when an individual is missing one or
more teeth on either the top or bottom arch.
This process involves slight reductions on multiple
teeth to create rests. Furthermore, some teeth may
need to be planed so that the partial denture can be
inserted and removed from the mouth.
Some patients are concerned with the esthetics of
partial dentures, especially the clasps that hold them
Dentures may promote the rate of bone resorption.
Complete or partial Dentures may cause abrasion of the
soft tissues of the mouth that cause sore spots.
Retention of a complete or partial denture, especially on
the lower arch, may prove difficult.
“Studies show that within five to seven years there is a
failure rate of up to 30% in teeth located next to a fixed
bridge or removable partial denture.1”
“Chewing efficiency of a denture is reduced to more than
half that of natural teeth.1”
Some patients may realize an interference with their
Full dentures are typically employed for people with no
teeth on a given arch (top or bottom).
Some patients notice a decrease in the quality of their
sense of taste because the maxillary denture covers the
full extent of the palate.
Improperly worn or maintained dentures may lead to
infection of the soft tissues of the mouth.
Several sets of dentures may be necessary over a life
time as the structure of the mouth changes due to
resorption of bone.
As previously mentioned, dental implants are made of
Titanium is an inert metal that has been used in the
field of medicine for many years. In the body it is
considered to be inert. Risk of rejection is very low.
However, it is important to note that rejection occurs
in about 3-8% of individuals.2
Your implant should have a serviceable life of many
years. However, after placement the implant must be
properly maintained by both yourself and your dentist.
Failure to do so may result in infection or loss of the
When considering implant therapy it is important to
note that the overall health of an individual is more
important than age. Good candidates will exhibit an
ability of the body to properly heal.
There are certain risk factors such as smoking,
diabetes, and poor oral hygiene that may prohibit the
placement of an implant.
A proper assessment of your systemic and oral health
should be performed by your dentist.
Prior to placement of an implant it may be necessary
to remove one or more teeth.
After a tooth has been extracted it may be necessary to
place a bone graft to provide an adequate amount of
bone to anchor the implant.
After an implant is placed it is typically best to cover it
with the gum tissue in that area and leave it
undisturbed for a period of several months.
Like with any dental restoration, the materials used have a
tremendous impact on the esthetics and resiliency of the
Materials used to make implant retained prosthetics include
metal, acrylic resin, and porcelain.
Metal and acrylic resin have characteristics that limit damage to
the natural teeth remaining in the mouth, while also making for
a durable prosthetic.
Porcelain best replicates the appearance of natural teeth, but
because of its hard, but brittle nature can easily damage natural
teeth or have pieces chip off of the prosthetic.
Choice of material is decided by the patient with the guidance of
the restorative dentist, but materials are not guaranteed.
Other material considerations include the screws or
cements that attach the prosthetic to the implant.
Some implants are retained by screws, which allow the
prosthetic to be placed and then removed. The screws are
covered by acrylic resin once the prosthetic is screwed into
place. In some cases, the screws can break or become
loose. Broken or loose screws can usually be replaced,
depending upon where the breakage occurs.
Cements can be used to adhere prosthetics to implants,
similarly to how crowns are attached to prepared natural
teeth. Use of cement does not allow easy removal of the
prosthetic and if excess cement is not properly removed, it
can cause a condition called peri implantitis, which can
cause failure of the implant.
Treatment options for the partially edentulous patient
can include implant retained crowns and bridges.
Single unit crowns require an implant for every tooth
being replaced. Implant retained bridges use one or
two implants to replace two to four teeth. Both
function and appearance are very much like having
natural teeth with these restorations.
Implants can replace a single
tooth or multiple teeth
Implant retained over denture.
These dentures are very similar to conventional
dentures. They are primarily supported by the jaw
bone and the gum tissue over the bone. Two to four
implants are used to help keep the denture in the most
ideal position, increasing patient comfort and
confidence as well as stability and retention.
Implant retained over dentures
can be used on either arch.
Hybrid prosthetics, also referred to as fixed removable
dentures, are another option for the completely edentulous
patient. These dentures are completely supported by the
implants, with no part of the prosthetic resting on the gum
tissue. They provide the best function and patient
satisfaction of any prosthesis. A minimum of four, and
preferably five, successfully integrated implants is
necessary to support a hybrid prosthesis. Because of the
additional implants needed, and the metal framework used
to build the denture, the cost of a hybrid is higher than for
an over denture. This prosthetic is not removable by the
patient. It is more difficult to keep clean, and thus requires
a high degree of commitment to oral hygiene.
In the process of placing your implant it may be
necessary reflect a small amount of gum tissue to gain
access to the bony tissues.
The surgeon will place a small pilot hole in the bony
tissue and then enlarge is in a slow sequential manner.
After the pilot hole has been established the surgeon
will place the implant.
The bone height and width must be enough to adequately
surround the implant after it is in the proper position.
Dental implants cannot be placed in areas where they will
damage or interfere with the major nerves of the face or
Diagnostic tests such as x-rays and cone beam CT
(computed tomography) scans provide the information
needed to determine if implants are viable and, if so, where
they should be placed.
In many cases, areas of inadequate bone height or width
can be supplemented by grafting procedures, which allow
implants to become a viable option.
The bone the implant is placed in must be an adequate
width and height.
In some cases your surgeon may need to modify the
boney structures to allow placement of an implant.
Modifications may include:
1.) Bone grafting
2.) Sinus lift (in the top arch toward the back)
3.) Other modifications of the hard or soft tissues
Sometimes there may not be adequate height or width
of the boney structures. In these types of cases it may
be necessary to add more bone to the implant site with
a bone graft.
This procedure will be completed by your surgeon.
Typically implant placement will be delayed to provide
enough time for the bone graft to integrate with your
In the illustration on the left inadequate height and width of the bone existed.
There must be enough boney structure to properly support and integrate with
your implant as in the illustration on the right.
Sometimes when dealing with a space in the top arch
towards the back it may be necessary to modify the
floor of your maxillary sinus to allow an adequate
depth of bone to place your implant in.
Once again this procedure will be completed by your
Sinus lifting and bone grafting may delay the
placement of your implant.
In the above illustration the floor of the maxillary sinus droops into the
space where an implant would need to be placed.
To resolve the issue a sinus lift was performed. This procedure
elevates the floor of the sinus out of the way of the implant.
During the same procedure a bone graft was placed to provide
adequate boney structure to support the implant.
The inferior alveolar nerve travels through the lower
jaw. It is provides sensory innervation to the lower
half of the face on each side.
Damage to this nerve may result in the loss of
sensation. It is important to note the location of the
IAN on each patient.
In many cases a CT scan will be performed to provide
specific information regarding this nerve.
In the above example a CT scan was used to note the location of the IAN
and plan the placement of the implants.
Proper maintenance of your implant will be essential to the
health of the surrounding hard and soft tissues as well as a
long life for your dental implant. This will require a team
effort between yourself, your dentist, and a dental
A proper oral healthcare program should be implemented
that consists of home care and professional care provided
at regular intervals.
Your dentist will assist you in developing an individualized
oral healthcare program designed specifically for you.
While your dentist can provide support you will have an
important role in this process, and you are ultimately
responsible for maintenance of your implant/prosthesis.
Regardless of the type of restoration that is placed you will
need to follow a regular home health care regimen.
Brush your teeth at least 2x per day.
It will be important to clean the in-between spaces as well.
This may be accomplished with a variety of aids such as:
1.) Tooth brush
2.) End tufted brushes
3.) Denture brushes
4.) Interproximal brushes
5.) Various types of floss
6.) Gauze or yarn
7.) Air flossers or water piks.
After placement of your implant(s) continue to brush your
teeth. Be sure to brush both the front and back sides of
After you have brushed your teeth be sure to clean the
in-between spaces. This may be accomplished with a
variety of methods.
You may use gauze if space allows
Dental floss can be used on implants
Interproximal brushes go in between
Dental floss between implant/teeth
Remove prosthesis from mouth and clean.
DO NOT use bleach or effervescent cleansers
as this may result in damage to your prosthesis
Use an appropriate denture cleanser as
recommended by your dentist.
Brush the tissues in the oral environment.
Clean the areas inaccessible with a brush with
one of the above mentioned aids.
A hybrid prosthesis is can only be removed by your
dentist. However, it is important to properly maintain
your prosthesis between visits.
Brush your hybrid prosthesis as
you would your original teeth.
After you have brushed clean under
the prosthesis. Many people use
dental floss, yarn, or gauze.
AT NOT TIME IS IT APPROPRIATE TO TOUCH
YOUR DENTAL IMPLANT WITH ANYTHING MADE
Your implant should only be cleaned with aids
recommended by your dentist.
Failure to follow proper cleaning guidelines may result
in damage to the finish on the exterior of the implant
thus leading to failure of the implant.
Failure to properly maintain your implant or prosthesis may
result in the accumulation of calculus, inflammation of the
gingival tissues, bacterial infections, and possibly even the loss
of your implant. The tissue should be coral pink, resilient, and
should not easily bleed.
Please monitor the area around your implant for swelling,
redness, plaque, bleeding, or any other changes.
Peri Implantitis is the inflammation of the tissues that
surround the implant and may indicate a problem.
Notice the red/puffy appearance of the gum tissue
around the implant.
Failure to properly cleanse your implant or prosthesis
may result in the accumulation of plaque.
As mentioned before, implants may come at a higher
price than the alternatives, but they may be the best
restorative option for you.
Implant surgery- $730.00
Implant Crown- $675.00
Implant Abutment $200.00
Bone Grafting- Price to be determined by surgeon
Expect to spend somewhere in the neighborhood of
Pricing for other options provided on a per case basis
due to unique needs of each patient.
Class notes from Implantology, Dentures I, RPD, FPD, Periodontology, and other courses as OUCOD
We would like specially thank Dr. Jacobsen and Mrs.
Miller from OUCOD for providing much of the
information in this presentation.
We would also like to thank Dr. Mullasseril, Dr.
Fairchild, Dr. Kessler, Dr. Keenan, Dr. Hasebe, Dr.
Keenan, Dr. Hall, Dr. Hornbuckle, Dr. Folks (of Miami,
Ok) and Dr. Williams (of Miami, Ok). Without their
guidance and input over the last three years this
project would not have been possible.