1. Introduction
Dental technology has come a long way in recent years to offer patients better alternatives to traditional metal braces. Today, we have the ability to offer patients the straight, beautiful smile they desire. Forget the costly receding gum lines, the decalcification from the braces or the root canals from the brackets. Let’s do it the right way, from start to finish. Many people spend their entire lives covering their mouths when they laugh, smile or talk. They feel stuck because they do not want to wear adult metal braces for years or they are currently in a profession that requires them to maintain a professional appearance. While using porcelain veneers to cover up the problem may seem like a quick fix, it will only make things worse in the long run. Using the Mac Veneers technique combined with Sure Smile TM aligners we can correct the alignment of your teeth as well as offer you a whiter, broader smile. With our new virtual imaging technology, you will see the end result before you even begin!
2. Understanding Dental Implants
There are many types of implants available, and developing technologies mean that new techniques are becoming available all the time. Generally, we can describe dental implants as being either conventional or immediate, and either one-stage or two-stage. Conventional implants involve a two-stage process, with the fixture being placed in a first surgery and uncovered for a second stage of treatment at a later date. Immediate implants involve placing the fixture at the same time as the extraction of the tooth. One and two-stage is a description of whether the fixture is buried under the gum at the first stage of surgery. The choice of implant type depends on many factors and varies from case to case. Step-by-step instructions for each treatment will be explained to you if implants are indicated.
Dental implants are a predictable and versatile way for dentists to replace missing teeth. Perhaps the main advantage of an implant is that it avoids placing a denture or ruining an adjacent tooth. By replacing a missing tooth with an implant, the adjacent teeth are not compromised, which is often not the case with replacement using a conventional bridge. Implants can be used to provide support for a variety of dental prostheses, including crowns, bridges, and dentures. There are very few instances where implants cannot be used to restore a patient’s natural smile.
Dental implants in dental ideal are the standard of care for most cases of teeth replacement. An implant is a small fixture made of biocompatible metal, which is placed in the jawbone and acts as a replacement for the root of a missing tooth. In general, implants are used to support a crown, bridge, or denture.
2.1. Benefits of Dental Implants
There are several benefits to dental implants over other forms of treatment to replace missing teeth. Longevity. When properly placed and cared for, dental implants can last a lifetime. They are composed of titanium, which is a biocompatible material used in many structural medical applications. Dental implant technology has been around for several decades and is a predictable form of treatment. Adjacent teeth are not compromised in any way. Placement of a dental bridge requires the cutting down of teeth adjacent to the missing tooth/teeth. Since a dental implant replaces single teeth, there is no need to involve adjacent teeth. With a partial denture, metal clasps are often required to hold the prosthesis in place and can be damaging to abutment teeth. All connections and attachments for an implant-retained prosthesis are contained within the mouth and do not involve or damage surrounding teeth. Preservation of bone. Bone is maintained through the principle of “form follows function.” Teeth are supported by surrounding bone. When tooth structure is lost, surrounding bone is resorbed away. This is why people who are missing all of their teeth and wearing complete dentures have a “sunken in” facial appearance. This also affects denture support and stability. The presence of dental implants preserves bone by providing the necessary stimulation and stability for bone to remain in its present form. Implants are the only form of tooth replacement that simulates natural tooth structure and thus prevent bone resorption.
2.2. Types of Dental Implants
In certain cases where there is a single tooth missing, it is possible for a permanent crown to be placed on the implant. This has a high cosmetic success rate and in many cases can last the lifetime of the patient. If the patient has several teeth missing, it is possible to do a partial bridge or full bridge, which is a permanent solution and has a high success rate of both function and durability. In some cases, the more traditional methods of tooth replacement such as crowns and dentures may still be viable options.
The artificial teeth are created and fitted to the part of the implant that protrudes from the gums. These artificial teeth are usually either cemented and screwed into the implant or held in place by friction. The type of teeth will vary based on the patient’s specific needs, and the dentist or oral surgeon will determine the best course of action.
The final step is the placement of the artificial tooth or teeth. This step is of great benefit to the patient because it does not involve off-site treatment and it is usually simple and quick. This step involves taking an impression of the mouth and a bite, and then making the tooth or teeth. This corrective phase can range from taking one to three months, but the majority of the time is spent waiting for the gum to heal around the placement site. This helps to create a more natural appearance as the tooth is embedded in the alveolus and will not shift as with other treatments such as dentures.
During the second step, the implant is placed. The implant is placed and then the area is often left to heal for a few months. During this time, the implant will osseointegrate or adhere to the bone.
This step involves an initial examination, x-rays, and impressions molds of the patient’s teeth and jaw. The specialist may elect to perform a CT scan of the patient’s mouth. This step is very similar to the initial steps in other dental procedures.
Once it is determined that a dental implant is beneficial to you, several steps follow in the process. Typically, the first step is a consultation and review of treatment options. The procedure can vary in complexity, but many times it is very simple. It is often possible to complete the first step of placement of the implant in one session. Many have reported that having an implant placed was less painful than having a tooth removed. Some reported that it was no more painful than having other dental treatments such as a filling or a root canal.
3. The Importance of Choosing the Right Implant Dentist
Finding a dentist that is board certified by the American Board of Implantology/Implant Dentistry (ABOI/ID) is important. These dentists have met criteria for education and experience and demonstrate a high level of knowledge and expertise in implant dentistry. They have been proven to have the essential qualifications, knowledge, and expertise to provide quality implant care. ABOI/ID Diplomates have shown by examination a knowledgeable and experienced approach to implant dentistry. Board-certified dentists often set higher standards for themselves and provide superior care for their patients. Always make sure that the dentist has a permit and certification to practice implant dentistry. Start by asking the dental receptionist or scheduling coordinator. This will save you the trouble down the road. Ideally, finding a dentist that effectively allots ample time for furthering his knowledge and expertise is suitable. Dr. Oates suggests finding out if the dentist teaches, writes articles and books, has a referral network with other dentists and specialists, and utilizes plans that are at the forefront of technology (such as CAD/CAM imaging and robotic implant surgery). Ask the dentist what societies he/she is a member of and what continuing education courses they have taken recently.
In making decisions dental decisions related to implant dentists, pinpointing the right choice may seem like a daunting task. However, your patience and time spent will soon enough pay off. The process is very crucial. Here are some guidelines about how to choose an implant dentist.
3.1. Qualifications and Experience
Qualifications to look for include a dental or post-graduate degree from a reputable university. Although education from a top university does not always ensure skill, it is, however, an indicator that your dentist has the essential training required for implant dentistry. Experience is crucial when it comes to any health-related procedure. A dentist who is well-practiced in implant dentistry will be able to quickly identify and solve potential complications. This decreases the likelihood of a procedure taking longer than expected and costly return visits. High patient satisfaction is another indicator that a dentist excels in their field. Ask your dentist about their success rate. A good dentist will keep records of their successful cases which can be reviewed by potential patients.
When it comes to your health and appearance, you deserve the best. This rule applies in every regard, even when it comes to maintaining your oral health by choosing an implant dentist. An experienced, qualified dentist with extensive knowledge in implant dentistry is essential for achieving optimal results.
3.2. Patient Testimonials
Testimonials are one of the most important factors in selecting any products or services. As you look for the right implant dentist, you should seek out the advice and experiences of patients who have received treatment from the dentist you are considering. Implant dentistry is a field that is still in its infancy. The many different choices and options available to replace missing teeth can be very confusing. Although the dentists qualifications, training and experience are all important factors, what most patients want to know is “how is this going to help me?” or “what are my chances of a successful outcome?” Only another patient can truly understand what you are going through and it is these people who can offer the most insight and advice regarding whether or not implant dentistry is a good option for you and whether a particular dentist is the right one to carry out the treatment. Remember that every patient is different and a particular experience or result does not guarantee that you will have the same. However, it is reassuring to see that other patients have been satisfied with their treatment.
3.3. Advanced Technology and Techniques
Along with the integration of 3D imaging, there have been vast improvements regarding the material and surface of the implants themselves. Studies have shown that certain characteristics to an implant such as its shape, roughness, and composition of materials can have a profound effect on how bone will heal around it. This will ultimately affect the success and stability of the implant in the long run. Implant companies are now able to manipulate these characteristics to optimize the way in which bone will heal around an implant, ultimately providing the patient with a better outcome. With the well-being of his patients always in mind, Dr. Lee has done his best to stay current with the recent research and developments in the field so that he may provide the best treatment possible.
Dental implants are now considered the standard of care for missing teeth. Conventional methods of replacing missing teeth such as bridges and dentures often compromise adjacent teeth and bear a lower long-term success rate. Dental implants, on the other hand, are more predictable in both their prognosis and the long-term satisfaction they give to patients who choose this modality of treatment. The development and integration of 3D dental imaging has greatly improved not only the diagnostic capabilities for the patient but also the precision at which an implant can be placed. With the patient in mind, Dr. Lee has found this to be an invaluable tool for added predictability in the outcome of the treatment. Through the use of a Cone Beam Computed Tomography (CBCT) scan, a 3D image can be obtained, visualizing vital structures, pathology, bone quality, and quantity, enabling Dr. Lee to have a better understanding of the case and therefore decreasing the risk of complication. A surgical guide can then be fabricated to ensure precise implant placement. This not only avoids any guesswork on the location of the implant but also avoids any additional incisions or flap reflection, thus decreasing the postoperative discomfort and the possibility of complications. With the patient’s comfort in mind, it is procedures like these that represent how far dentistry has come in improving patient care.
As implant dentistry constantly grows, methods and techniques have become more and more complicated. Just as advancements in other medical fields have greatly improved patient care, the field of implant dentistry is no exception. Dr. Lee’s commitment to providing the best possible outcome for his patients has led him to integrate the latest technological advancements into his practice. Such advancements enable Dr. Lee to be more efficient and effective, providing the patient with a more predictable outcome.
4. Initial Consultation and Evaluation
Dr. Lee will conduct a complete review of your dental and medical history. Certain medical conditions can prevent successful implant treatment. For this reason, Dr. Lee needs to know if you are being treated or monitored for any medical condition. These conditions may include cardiovascular disease, diabetes, pregnancy, or cancer. Other considerations include psychiatric medications and substance abuse. All of these conditions or medications require special treatment planning or precautions. If Dr. Lee determines that implant treatment is not for you, he will refer you back to your general dentist for an alternative restoration. A referral to another healthcare provider is rare, but it is done in the patient’s best interest.
Your consultation includes a thorough examination of your teeth, gums, bite, and oral structures. You will be provided an evaluation of your oral health and a proposed treatment plan to address your needs.
Dr. Lee spends time with each patient, discussing his or her concerns and goals for treatment. He is honest and candid, explaining the pros and cons of all treatment options. Thanks to advances in dental technology, you can even see a dramatic simulation of your post-treatment smile!
4.1. Comprehensive Examination
A comprehensive examination evaluates the health and condition of the entire oral cavity. There are many factors that contribute to the breakdown of teeth, signs and symptoms of diseases, and conditions of dental work; often times these are not apparent to the patient. This type of examination is also valuable in detecting any signs or symptoms of oral cancer or other systemic conditions that manifest in the oral cavity. Since Dr. Basti was also seeking to enhance his smile and overall appearance, another valuable tool used in his examination was the aesthetic evaluation guideline. This guideline helps to diagnose the condition of a patient’s smile and clearly document what changes are necessary to achieve the desired cosmetic outcome. In conjunction with the examination Dr. Dang also made comprehensive digital dental photography and imaging. This is the process of taking high quality digital photos and intraoral images of the current condition of a patient’s teeth, and making computer generated simulations to predict the desired treatment outcome. These photos are valuable for both the patient and dentist to use as a visual aid and to thoroughly compare before and after results. This is an effective communication tool to ensure that the patient’s desired outcome is met.
After meeting with Dr. Basti for our free consultation to discuss his extreme smile makeover, Dr. Basti decided to do a comprehensive examination as well as extensive digital photography and imaging. Dr. Basti had several missing teeth, his remaining teeth were discolored, and there were signs of severe wear on his teeth. Dr. Basti’s level of decay and breakdown made him a candidate for a full mouth reconstruction. A significant amount of his teeth were removed and replaced with implants. Implants are the superior choice for tooth replacement because they are permanent, retentive, and serve as replacement for both the tooth and the root. Dr. Dang determined that the major cause of wear on Dr. Basti’s teeth was from a bad bite. This was something that clearly needed to be addressed in his reconstruction. Establishing a correct bite and increasing vertical dimension were goals that Dr. Dang set to avoid any future problems in these areas. An in-depth consultation and thorough examination is extremely beneficial when a patient is seeking comprehensive dental work.
4.2. X-rays and Digital Imaging
Radiographic examination is a crucial part of the diagnostic phase. It provides information that is not visible to the naked eye. This type of information allows for comprehensive treatment planning and aids in the process of determining an accurate prognosis. Digital x-rays are faster and more efficient than traditional film x-rays. They emit 80% less radiation, which makes them safer for the patient. The x-rays are taken and instantly appear on a computer screen with the use of a sensor. This large image is easily visible and can be manipulated to aid in the detection of things such as cavities. It also provides a more detailed print of the hard tissue in the mouth. Digital imaging refers to any image that is produced from a computer. In the dental world, digital imaging most commonly refers to taking photographs inside the mouth. This is a fast and non-intrusive way of obtaining images that are valuable in assessing a patient’s smile. These images can show the existing condition of the teeth, the types of fillings that are in place, and areas of potential concern. This is important information in prosthodontics where the goal is to achieve an optimal aesthetic result and maintaining or improving the health of the teeth in the process.
4.3. Treatment Planning
After completing the evaluation, Dr. Basti will determine the best treatment option or options for you. For some, this may start with another consultation, and for others, we may proceed directly to scheduling your treatment. Usually, the treatment options have a range of time and fees. This can be overwhelming for some, and in that case, Dr. Basti will take extra time to clarify all options and allow you to make the best choice for your own personalized treatment plan. The comprehensive examination helps to prevent any oversights or miscalculations in diagnosis that could compromise the quality of treatment. The information that we obtain from the comprehensive examination, combined with our regular care for our long-term patients, allows Dr. Basti to make the best decisions for each patient’s individualized treatment. We believe this is the key to our reputation for high-quality care.
5. Preparing for Dental Implant Surgery
Maintaining proper oral hygiene is crucial. You should brush and floss normally before the surgery. A germicidal mouth rinse prior to and after the surgery will be helpful in preventing infection. On the day of your surgery, do not rinse your mouth vigorously, spit, or touch the surgical area. **_Please use the prescribed Peridex Oral Rinse the evening of surgery, and then every day for 7-10 days._** This will help decrease the bacterial count to aid in healing. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, **_especially after meals._** Brush your teeth and the healing abutments. Be gentle initially with brushing the surgical areas. You may begin using a water pik the next day and we will show you how to best use that. This will help decrease the bacterial count to aid in healing. Warm salt water rinses (teaspoon of salt in a cup of warm water) should be used at least 4-5 times a day, **_especially after meals._** Brush your teeth and the healing abutments. Be gentle initially with brushing the surgical areas. You may begin using a water pik the next day and we will show you how to best use that.
Before your implant surgery on whatever tooth, there are some steps that will help your surgery and healing process go as smoothly as possible. Please confirm you have a responsible adult who will be present before your surgery, drive you home afterwards, and can be reached for any questions or emergencies that may arise.
5.1. Oral Hygiene Instructions
Remember that your oral hygiene has a significant impact on the success of your surgery. It is important to keep your mouth as clean as possible. Failure to keep your mouth clean can result in infection at the surgery site, and can minimize the chances of a successful surgery. Depending on the severity of the implant or the amount of surgery required, your doctor may modify these instructions to suit your specific needs.
Denture wearers: You may not wear a denture for the first 24 hours. After the first 24 hours, you may wear the denture as a “flipper” during the first 2 weeks. Make sure to clean the denture after the surgery.
Brushing: Do not brush teeth on the day of surgery. The day after surgery you may begin brushing your teeth, being very gentle around the surgery site for 2 weeks.
Avoid rinsing your mouth for the day of surgery. The day after surgery, rinse mouth gently with warm salt water (1/2 teaspoon of salt in a cup of warm water) 3 times a day (especially after meals). Continue rinsing until you are fully healed.
5.2. Dietary Restrictions
By avoiding these types of food and drink, you will ensure a smoother healing process with less pain and fewer complications. This short-term sacrifice will pay off in the long run.
Foods heavy in oils and fats should also be avoided, as they too can cause pain in the surgery areas. Hot liquids and food should be a no-no as well, due to the fact that they dilate the blood vessels and can cause more bleeding.
During the initial healing period, you should not drink through a straw or consume any carbonated beverages. It is recommended that you do not drink alcohol for the first week. These activities create suction in the mouth which may dislodge the blood clot in the surgery area, or the sutures. Alcoholic drinks, being acidic, can cause pain to the surgical sites and interfere with healing.
Within the first few days after surgery, you should avoid hot and spicy foods. These can cause pain and bleeding. Also, avoid foods with small seeds (like those in tomatoes) as they can lodge in the surgery area. Unfortunately, small berries (strawberries, raspberries, etc.) are also harmful for this reason as well. High citrus foods such as oranges and lemons should be avoided as well, due to their acidic content. These can also cause pain and delay the healing process by increasing the chance of infection.
Stay away from foods which may cause problems in surgery areas. Some of these foods are listed here. Try to follow these instructions for 2-5 days after surgery. Then, as the dental implants are placed and stabilized more firmly, you can slowly return to a normal diet.
5.3. Medication Guidelines
Relaxing Medications If you are using Valium or a similar type of medication, discontinue its usage for 24 hours prior to surgery. Again, taking this medication with a small amount of food can decrease the chance of upset stomach or nausea.
Pain Medications Avoid taking any narcotics if possible. If you undergo IV anesthesia with the surgery, usually 2-4 Advil or Ibuprofen will suffice. If this is inadequate and you need to change to a stronger medication, remember to take it with a small amount of food. This can help to decrease the chance of upset stomach and/or nausea. Eating yogurt or pudding with your pill is usually sufficient. Plan to only take pain medication at night as it can make you drowsy and impair cognitive function.
Antibiotics Start taking an antibiotic (usually Amoxicillin 500mg) the day prior to surgery. It should be continued for 7-10 days postoperatively. If you are allergic to this medication please contact our office.
The success of your implant depends greatly on keeping your mouth clean during the healing time. Medications prescribed by your physician prior to surgery should be discussed prior to surgery. Generally, you should take the last dose of your preoperative medication no later than 1 hour prior to surgery. All other narcotics, sedatives or anxiety medication purchased from California cosmetic dentist or an oral surgeon should be taken according to the instructions on the bottle with a small sip of water. It is imperative that you do not exceed the dose which impairs your ability to function cognitively. If this occurs, you may be sent home and your surgery rescheduled.
6. Dental Implant Surgery
Recovery and Post-Operative Care After the implant procedure, the doctor will give you aftercare instructions. These instructions may include some or all of the following items: using a prescription mouth rinse twice daily, avoiding the surgical site when brushing and flossing for one week, eating a diet of soft foods and cold foods for approximately one week, taking an antibiotic, and using an ice pack to minimize swelling. You will also be given a date to return for a follow-up visit to ensure proper healing and function of the implant. This visit is essential to the long-term success of the treatment. You will also need to adhere to a maintenance schedule of cleaning and examination to ensure the health of your new implant.
Implant Placement Procedure Today, dental implants are the standard of care for the replacement of one or more missing teeth. After more than three decades of use, the success rate is well established; therefore, implants are now considered a predictable and proven treatment option. If a tooth requires extraction, an implant can often be placed immediately following the extraction. It is important to replace a missing tooth as soon as possible to prevent bone loss in the jaw, and in most cases, it is advantageous to use an implant.
Anesthesia Options The majority of dental implants and bone graft can be performed in the office under local anesthesia, IV sedation, or general anesthesia. Oral sedation can be utilized as it is simple, high in success with little risk, and very cost-effective compared to other anesthesia options. Local anesthesia, very common in dentistry, is usually sufficient for straightforward procedures. Your doctor will discuss the anesthesia options with you during your treatment planning phase to ensure your comfort during the procedure.
6.1. Anesthesia Options
General anesthesia: General anesthesia is defined as a controlled state of unconsciousness accompanied by a partial or complete loss of protective reflexes. The patient cannot be aroused even by painful stimuli. This can be accomplished with a variety of drugs and techniques. General anesthesia is rarely indicated for dental implant surgery. It can be used in the case of a patient who is extremely apprehensive and unable to cooperate, mentally handicapped, physically compromised or disabled. It is more commonly used for extensive procedures involving multiple surgeries or the entire dental arch. If indicated, it is safe when administered by an anesthesia or oral surgery specialist in an office or hospital setting. Because of the post-operative grogginess or sleepiness, the necessity for a driver and the increase in cost, this modality is far less convenient for the patient and is therefore used as a last resort when other forms of sedation are inadequate.
Conscious sedation: The simplicity and predictability of dental implant surgery makes it an ideal candidate for conscious sedation. This can be any technique that alters the patient’s state of consciousness without general anesthesia and analgesia. The spectrum of sedation ranges from minimal sedation where the patient is awake but relaxed, to moderate sedation where the patient may not remember much of the procedure and may slur his words, to deep sedation where the patient is on the edge of consciousness but can still be aroused and general anesthesia where the patient is not arousable. Most commonly an anti-anxiety agent (Valium, Halcion, Xanax) and nitrous oxide (laughing gas) is used to achieve minimal to moderate sedation. This allows the patient to drive himself to and from the appointment and have a relatively clear head several hours after the completion of the surgery. Higher doses of oral sedatives or intravenous drugs can put the patient in a deeper state of sedation without the need for general anesthesia.
Local anesthesia: A local anesthetic that is in the form of an injection is commonly used during dental implant surgery. Often times, a numbing medication (Novocain) is applied to both the surface and the inside of mouth and jaw tissues rendering them insensitive. Teeth are simply inconvenient to anesthetize because the crowns and roots have sensory nerves that connect to the jaw nerves through very tiny openings in the skull. The close proximity of the sensory nerves in the jaw to the roots of the upper molars make numbness of these teeth easier to attain. Once the cheek, lips or tongue are anesthetized, the implant surgery is similar to extraction, although it is more complex because it involves cutting and sometimes sewing the gum tissues.
6.2. Implant Placement Procedure
Tooth replacement has been made more advanced, quicker, and efficient with the use of dental implants. Step one involves an incision in the site where the implant will be placed. Multiple incisions may be made to facilitate a guided surgery if required. Step two involves the placement of the implant into the prepared site. Step three involves the closure of the site to allow for healing. Healing time varies depending on the location and type of implant placed. Bone grafts or implants placed into extraction sites typically require more time for healing. Healing time may range from a few weeks to a few months. Step four involves the uncovering of the implant by re-entering the site. Some implants do not require this step as they are placed in a one-stage procedure. Step five involves taking an impression of the implant 4-6 weeks following the uncovering. This impression will guide the fabrication of the crown. Step six will be the final placement of a temporary or permanent restoration.
The placement of dental implants today involves a number of steps and products. The first step generally includes an assessment of your current dental condition. A great deal of records will need to be gathered at this appointment to plan out your treatment. The following steps will describe what takes place during an “implant placement.” Additional minor procedures may be required in order to facilitate the placement of your implant. These procedures may include, but are not limited to, bone grafting or a sinus lift.
6.3. Recovery and Post-Operative Care
Bleeding that is excessive is uncommon. If it occurs, place a gauze pad over the area and apply pressure. If you are unable to control the bleeding, call your dentist. Heavy rinsing can cause increased bleeding, so rinse gently with warm salty water. During the first 24 hours following surgery, do not rinse your mouth out as it may wash away the blood clot which is forming. This is an essential part of the healing process, protecting the bone from infection and debris. Dry socket is a common complication which can occur 3-4 days after the surgery. It causes a throbbing pain at the surgery site, and leaves a bad taste in the mouth. It occurs when the blood clot is lost and the bone becomes exposed. To prevent dry socket, avoid smoking and vigorous rinsing of the mouth. Usually dry socket is accompanied by an infection, in which case, antibiotics may be recommended. This will resolve the problem if done early enough.
The recovery and post-operative care stages of dental implant surgery are critical to the overall success of the procedure. It is important to follow all instructions given by the dentist to ensure the best possible healing and therefore the best possible outcome. Discomfort after the surgery is normal. It is usually treated with a painkiller such as Tylenol or Ibuprofen and should begin to subside within 24 hours. Should you have prolonged or severe pain in the area of the surgery, swelling, or the occurrence of a reaction to the medication, contact your oral surgeon or dentist immediately.
7. Osseointegration and Healing Process
Content provided by Steven Fong, DMD, CFAO, MAFO, MSBE, MHT. Formation of healthy tissue and bone by maintaining or increasing the metabolic activity in the area of missing teeth through the controlled movement of the implanted teeth.
Most patients can continue their normal routines soon after their implant treatments, with just a few modifications. A small amount of bleeding, swelling, and discomfort is normal. If any of these postoperative problems persist, please call our office for further instruction. Take medications as prescribed. Be sure to keep all food and beverages away from the surgical site. Avoid actions that may force air into the mouth, such as drinking from a straw and playing a wind instrument. Get plenty of rest and avoid excessive physical exertion. It is important to clean your mouth as best as you can – you may brush your teeth as normal but be very gentle around the surgical site. A saltwater rinse (one teaspoon of salt in a cup of warm water) can help to keep the surgical area clean. Try rinsing after meals. And remember, it’s important to maintain a balanced diet. You may be accustomed to follow-up appointments to ensure the health of your implants and monitor the healing process. Oftentimes, the dentist will need to remove stitches. The surgical site will begin to heal within a few days. Nutrition can have a big impact on the speed and quality of the healing process. Erratic eating or overconsumption of sugary foods can interfere with the immune system function, impairing the healing process.
7.1. Bone Integration
Bone integration is the adherence of osteobone on the surface of the titanium implant. The bone will grow to establish a firm hold on the implant to provide retention and support for the implant. The healing process for osseointegration can take up to several months, in certain cases, two to three. It is room which is also one of the more critical stages in successful mean treatment. During this time, the patient is without a tooth in the esthetic zone and great care must be exercised not to disturb the site. Placing an immediate implant or a temporary abutment and crown can create micromovement on the implant which is detrimental to the process. Measures must be taken to avoid such situations and to protect the site. Often a custom healing abutment is fabricated to prevent foreign debris from entering the site. This is usually done with a temporary abutment on the non-esthetic teeth and case specific precautions must be taken. In all cases, a temporary tooth or appliance to replace the missing tooth must not exert any pressure on the implant. This can be achieved by a variety of means, discuss this with your periodontist to determine the best course of action. Measures to best protect the site and optimize the conditions of treatment will be determined on a case-by-case basis.
7.2. Temporary Restorations
Temporary restorations are used to mimic the shape and form of the final restoration, but not the details. They are usually made of acrylic and are meant to last several months. Some patients do not require an interim step of this nature. This is especially true in areas of the mouth that are not highly visible (posterior areas). The decision to use or not use a provisional restoration is based on the specific needs of the patient. In complex cases, it may be prudent to construct a long-term provisional in order to test the aesthetics, form, and function of the final restoration. This can be especially useful if there is any question as to the ability of the soft tissue to heal in a manner that will allow the restoration to be successful. This is often the case in areas of high esthetic concern in the anterior segment. During the visit when the final impression is made, your dentist will guide you as to whether or not a provisional restoration is needed.
7.3. Follow-up Appointments
At the appointment following surgery (3-10 days), the surgical site is examined to confirm that there has been no postoperative swelling or infection. The sutures are removed. An x-ray is usually taken at this appointment to ensure that there are no untoward problems. This x-ray will serve as a baseline for the second stage surgery. Further appointments every 2-6 weeks will be made to examine the progress of the integration process. The amount of time these appointments will consume depends on how quickly the x-ray shows the position between the implant and the bone to be in excess of that required. Minimum of 4 weeks prior to uncovering the implant on the mandible and 6 weeks on the maxilla, an appointment is made to take a second x-ray used to compare against the baseline taken immediately after the implants were placed. The purpose of this appointment and x-ray is to ensure that osseointegration is occurring with the implants and to confirm that delayed or immediate loading of the implant would be successful.
8. Final Restoration and Prosthesis
Dental implants and the resulting connection of the final restoration can only be successful if periodontal disease is controlled and the implants and other supporting structures are maintained. The most important aspect in maintenance is meticulous oral hygiene. This is a joint effort between the patient, the restorative dentist, and the periodontist. Following this, it is important to develop an occlusal scheme that is as passive as possible on the implants to protect them from mechanical overload. This will reduce the effective forces applied to the implants and reduce the likelihood of detrimental force distribution. With the development of more advanced bone grafting materials and surgical techniques, we can now offer implants to a wider array of patients. However, monitoring patients with a history of heavy smoking and/or heavy alcohol consumption should be particularly vigilant as they have a very high risk of peri-implantitis. While biological complications remain the main cause of implant loss, mechanical complications such as a fracture of the implant itself or fracture of the restoration are also a consideration, and steps can be taken to decrease the risk or maintain the restoration should such an unfortunate event occur. Overall, long-term success is highly achievable with the maintenance of a well-controlled implant and restoration and implementation of all the factors that have contributed to the advancement of implant dentistry in recent years.
8.1. Customized Dental Crowns
Individually fitted, custom fabricated teeth. The crown is the part of the tooth which is visible in the mouth. It is the part that is usually replaced when a tooth is badly broken down and a routine filling is not strong enough. Imagine how good it would be to have your broken tooth restored back to its natural strength and appearance. A custom made crown can achieve this and in some cases it is the best option for a natural looking result. Crowns are made in a variety of materials and your dentist will discuss the most suitable for your tooth. Usually, porcelain crowns are matched to the shade of your existing teeth. A crown is prepared for teeth that have lost a fair amount of structure and fillings cannot be used. The crowns are strong and functional and will improve your overall aesthetics.
8.2. Dental Bridges and Dentures
Enclosed permanent restorations include abutment crowns and bridgework. A dental bridge is a fabricated tooth (or teeth) that is supported by neighboring teeth. It is a series of conjoined crowns which serve to fill in a missing tooth space. There are several different types of bridges, varying in stability, application, and material. The precise name and type of bridge can be described by your dentist. The support teeth are prepared in a similar manner to crown abutments. The pontic is built into the bridge and is any artificial tooth used to fill in a missing tooth space. Varying materials can be used for bridges. The best suited bridge for your particular case is dependent upon the patient’s occlusion (bite), the position of the teeth, and function of the restoration. Construction of a bridge is very similar to that of a c-shaped crown for partial coverage. Multiple appointments are required for bridge and abutment preparation, recording, and final placement. A temporary bridge can be placed at a patient’s preference. Permanent bridges more closely resemble natural teeth and should restore function and aesthetics for many years when properly maintained. Complete dentures can be either tooth supported or implant supported. A tooth-supported denture is held in place by gripping to natural teeth via several of the aforementioned attachments, and a partial coverage crown on a natural tooth. The most stable and effective solution to complete dentures would be replacement of the missing teeth with implant-supported crowns and a removable implant-supported denture fabricated with one of the previously described attachments.
9. Maintaining Your Dental Implants
Good oral hygiene is essential to maintaining your dental implants. Using a soft toothbrush, specifically a Curaprox, is advisable because hard toothbrushes have been known to scratch the surface of your natural teeth and the porcelain on your implants. The bristles on these types of toothbrushes are much softer and still effective. Interdental brushes are recommended for cleaning areas that cannot be reached by a toothbrush. They are designed to remove plaque from between the teeth and around the gum margin. It is highly recommended to use a water irrigation device which is a product aimed to clean the debris from in between the teeth and under the gum line using a high pressure water jet. In addition to the water jet, a mouthwash containing antibacterial agents can be used to reduce the amount of bacteria in the mouth. The occurrence of plaque and calculus can lead to many problems so removing it is essential. Calculus can only be removed by a dentist or hygienist so it is highly important to monitor the buildup of plaque to prevent calculus forming.
9.1. Oral Hygiene Practices
To maintain your dental implants, diligent oral hygiene is necessary. Implants can accumulate plaque and tartar just as easily as natural teeth can. Therefore, it is very important to clean your implants on a regular basis. You should clean them after meals and before going to bed to prevent food from getting trapped where the implant emerges from the gums. If using a manual toothbrush causes too much abrasion on the abutment or implant, a Sonicare brush is often a great choice. It is important to avoid abrasive materials and always make sure to clean all exposed sides of the implant. A Waterpik and any type of floss is essential for cleaning food and plaque from in between the teeth. An oral irrigation device (often referred to as a Waterpik) is a small, handheld device that shoots water in a steady or pulsating stream. This device is great for cleaning around implants and teeth. Also, rubber tip stimulators and other periodontal stimulators are effective at cleaning implants and preventing gum disease around them. These should be used a few times per week. Finally, antimicrobial rinses may be prescribed by your dentist to help control the bacteria that can cause periodontal disease. Always avoid tobacco products as they are known to cause failure of dental implants and overall, the key to maintaining your dental implants is to prevent plaque buildup.
9.2. Regular Dental Check-ups
What is the importance of x-rays during my regular dental check-up? X-rays can help your dental professional to see if you have any cavities in between your teeth. Your dental professional will also check for any bone loss, and to determine the size of the bone, and to see if there is any damage to the bone. Microscopic analysis of any bone loss is the best way to detect periodontal disease, a disease that causes tooth loss. X-rays can also help your dental professional to check the condition of your tooth roots and the bones surrounding them. Any other abnormalities such as cysts, abscesses, tumors, or extra or impacted teeth, can also be detected by x-ray.
What happens during a regular check-up? Check-ups are very thorough and are focused on prevention of dental problems. Your dental professional will evaluate your overall health and oral hygiene, the risk of tooth decay, root decay, and gum or bone disease. Your dental professional will evaluate your need for tooth restoration or tooth replacement, and check your bite and jaw for problems. Finally, your dental professional will conduct an oral cancer examination. During the course of your regular check-up, your dentist will clean your teeth and check for any cavities or gum disease.
A regular dental check-up is important because it helps to keep your teeth and gums healthy. You should have a regular dental visit at least every 6 months or as recommended by your dental professional.
9.3. Lifestyle Recommendations
Ways that you can maintain your dental implants include: – Diet – Be cautious with your new teeth when eating hard foods. Just as with natural teeth, avoid chewing on ice or hard candy. When chewing sticky foods, make sure to brush your teeth afterwards. This will also reduce the amount of plaque on your teeth. – Avoid using your teeth to bite open things – This is a common way to damage teeth and dental implants. Use your hands, or scissors to avoid damaging your teeth. – Smoking – This has been linked to higher failure rates with dental implants than in non-smokers. This is due to a few reasons. One is that smoking can weaken the bone structure in your mouth. Another is there is an increased rate of periodontal disease with smokers. Finally, smoking can cause a higher level of plaque and bacteria on the dental implants. – Teeth Grinding (Bruxism) – This can cause damage to your dental implants and natural teeth. Grinding can be caused by a number of factors including stress and misaligned teeth. If this is a problem for you, it is wise to address this issue with your dentist.
10. Frequently Asked Questions
If you have other questions regarding dental implants, contact our Orange County Dental office for more information. The main limiting factor for dental implants is the availability of proper bone in which to place the implant. However, there are various procedures designed to rebuild bone, which will allow a patient who does not have adequate bone to have an implant placed. Patients should be in good health and have no diseases that would affect the healing of the bone. A thorough medical and dental history review is essential for every patient to identify any conditions that may affect the success of an implant.
For the majority of patients, dental implants are a solution for replacement teeth that will last a lifetime. With good oral hygiene and regular cleanings, there is no reason that an implant would fail. However, depending on the particular patient, a multitude of factors such as the dentist’s skill, type of implant used, location of the implant, and the patient’s overall health could mean that an implant has a shorter lifespan.
Despite the fact that various procedures are often performed to remove infected teeth and place dental implants in the span of an hour, the patient experiences very little if any discomfort. Prior to a procedure, dentists will administer patients with local anesthesia in order to provide a pain-free experience. Depending on the patient, general anesthesia can be used in every procedure. Immediately following a procedure, it is not uncommon for a patient to experience slight discomfort, however, this can usually be managed with over-the-counter pain medications.
Typically, the process of placing a dental implant involves three steps. First, a dentist places the dental implant into the jaw, where it will be left to heal for three to six months. During this time, the implant becomes osseointegrated, meaning the jaw bone grows into the implant creating a stable base. In the second step, the dentist will uncover the implant and attach a post to it. The final step involves an abutment and a prosthesis. The abutment connects the post to the prosthesis, usually done with a small screw. The prosthesis such as a crown or denture, is then attached to the abutment. During all of the stages, the patient usually experiences minimal disruption in their daily life.
10.1. Are dental implants painful?
Modern techniques frequently involve a more minimally invasive approach, using a smaller hole and sometimes a one-stage procedure to place the implant. Mini dental implants can also be used in many cases, requiring a much smaller hole to be drilled and no sutures. Often there are no second-stage procedures with mini implants, and the crown can be loaded onto the implant immediately. All of these techniques will cause less pain and swelling postoperatively and are easier on the patient.
Does this sound painful? Traditionally, it has been relatively uncomfortable, and a straightforward dental implant measuring 3.5mm x 9mm can often cause significant pain and swelling postoperatively. For this reason, it would be recommended to have painkillers and anti-inflammatories available to take for several days post-surgery. Ibuprofen-based medications tend to be most effective, with their dual action as a painkiller and anti-inflammatory. This should be discussed with a doctor.
Dental implant procedure involves drilling a hole into the jawbone and inserting a titanium implant into the bone. Often this is done with flap surgery, opening the gum and cutting a hole into the bone. Sutures are then placed, and these remain in the mouth for 7-10 days, at which point they need to be removed.
10.2. How long do dental implants last?
At present, dental implants are found to be the most successful treatment for the replacement of missing teeth. Given the current rate of technology, it is anticipated that the lifespan of the implant will surpass that of the prosthesis, making it the ideal treatment in various situations. A more comprehensive understanding about the indications and requirements for different clinical situations will come through long-term comparative studies. This will enable evidence-based treatment plans that can predict outcomes with a high degree of accuracy for individual patients.
An example of long-term costs and benefits analysis of implant therapy in the edentulous mandible comes in the form of a 16-year study by Heydecke. It compared the long-term prognosis of implant therapy to that of conventional complete dentures. The data suggests that despite high initial treatment costs and frequent maintenance of implant-supported overdentures, the benefits of improved masticatory function and quality of life coupled with low maintenance costs make implant therapy more cost-effective in the long run. This would lead garden variety patients with no far pension and a nice set of teeth to speculate the right implants would last a lifetime. In reality, it would be unrealistic to promise patients that any surgical procedure will have a permanent outcome, due to the possibility of a multitude of confounding variables. Nonetheless, the ever-increasing life expectancy means that the implant prosthesis will be tested by time in patients who are retaining a relatively higher quality dentition.
The longest clinical study of implant outcomes was reported by Branemark and co-workers in November 2001. It involved the retrospective evaluation of the outcomes of titanium implants placed in the 1960s. The report concluded that the 40-year-old dental implants had a 90% survival rate. These results are quite astonishing, considering that the state of the art implant technology in the 1960s was in its infancy. Nowadays, the most accepted success criteria for implant therapy is the 5-year survival rate of the fixture and prosthesis. An implant is considered successful if it survives for that duration with minimal complications. Part of the reason why the success criteria is set relatively low is that the patient’s general health and the relatively limited life of a prosthetic restoration are confounding factors. This would make the average life of a successful implant longer than 5 years, economic considerations permitting. At the time of writing, the survival rates of modern implants fall within the wide range of 90-95%.
When considering the optimal replacement of missing teeth, dental implants have gained a great deal of attention in the past 20 years. Cons and pros of the treatment are currently being evaluated in a systematic way with various long-term studies. The final intent is to bring forth evidence-based treatment outcomes in specific clinical situations, as well as to encourage the most effective use of the available technology.
10.3. Can anyone get dental implants?
Dental implant treatment can be life-changing, but it is not for everyone. An implant patient requires the best oral health, adequate bone to support the implant, and should be free of uncontrolled chronic diseases. People who are unable or unwilling to maintain the highest standard of oral hygiene might not be good candidates for implants. It is important to tell your implant surgeon all medical problems you have and medications you are taking, whether prescription, nonprescription, or herbal, prior to surgery. This will help avoid any potential drug interaction that may affect successful implant treatment. Some chronic diseases may contraindicate implant treatment. Patients with chronic diseases, such as hemophilia, or those receiving immune-suppressive treatments, may not be good candidates for implant surgery. It is important for your implant surgeon to know your complete medical history, so be prepared to inform them about any medical problems. With proper screening and treatment, these conditions need not keep you from the benefits of implant therapy.
11. Conclusion
We remind you that living with an imperfect smile can present numerous challenges to everyday life. Fortunately, though, with the help of your Orange County Implant Dentist, an ideal smile is within reach. Between specialized technology, extensive expertise, and genuine patient concern, there is no reason to accept dental issues as part of who you are. Starting right here in Orange County, with the help of top-notch implant dentists, you now have every reason to be optimistic about your future smile. The end of this document took on the topic of what an implant specialist, specifically a prosthodontist, can do for you in terms of preserving bone and gum structure. It also detailed the importance of maintaining the health you’ve come to know while altering the smile that has held you back. The value of preserving high-quality treatment and the effects it can have in restoring your smile have never been more clear. After considering all options, there is finally a solution worthy of maintaining what you currently have and improving what you desire to change. The transition to a prosthodontist as your chief architect in this grand design has never been easier for the educated consumer. Treatment options are explained in a clear and concise manner, leaving no doubt as to what can be expected. Coordinating care between a surgical specialist, such as an oral surgeon or periodontist, and the laboratory technician is but a small glimpse into the comprehensive planning by a prosthodontist. This level of detail and diligence will ensure nothing is left to chance and the desired result is met. These are truly the individuals who strive to make something great, even better.
