A viable option for the replacement of missing, damaged, or decayed teeth.

Dental Implants

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 occurs.

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 multiple teeth.

What is a Dental Implant?

The graphic below illustrates how an implant may replace the root of a missing tooth.

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.

“Why would I be interested in a dental implant?”

“Why would I be interested in a dental implant?”-Before and After

“Why would I be interested in a dental implant?”-Before and After

“Why would I be interested in a dental implant?”-Before and After

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 compromise.

“Are there alternatives to a dental implant?”

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.

Alternative Restorations-Root canal and crown

Treatment Alternatives-Root Canal and Crown

The placement of a fixed bridge was the standard of care for the replacement of a missing tooth/teeth for many years.

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 tooth.

Alternative Restorations-Fixed Bridge

Fixed Bridge

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 in place.

Alternative Restorations-Partial Denture

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 speech.

Alternative Restorations-Partial or Complete Dentures

Removable Partial Denture

Removable Partial Denture Clasp

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.

Alternative Restorations-Full Denture

Dentures are fabricated for the edentulous patient

Full Dentures Top and Bottom

Now that we have had an opportunity to explore the alternatives to dental implants, let’s take a closer look at implants themselves.

As previously mentioned, dental implants are made of titanium.

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 implant.

Dental Implants-A closer look

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.

Dental Implants-A Closer Look

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.

Dental Implants-A Closer Look

Like with any dental restoration, the materials used have a tremendous impact on the esthetics and resiliency of the prosthetic.

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.

Dental Implants-Restorative Materials

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.

Dental Implants-Restorative Materials

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.

Dental Implants-Types of Restorations

Dental Implants-Fixed Crowns/Bridges

Implants can replace a singletooth 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.

Dental Implants-Types of Restorations

Dental Implants-Implant Retained Over Denture

Implant retained over denturescan 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.

Dental Implants-Types of Restorations

Dental Implants-Hybrid Prosthesis

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.

Dental Implants-Placement

Dental Implants-Placement

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 jaw.

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.

Specific Anatomic Requirements-Some Limitations to Implant Placement

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 grafting2.) Sinus lift (in the top arch toward the back)3.) Other modifications of the hard or soft

tissues

Requirements for Placing Implants

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 body.

Surgical Modifications-Bone Grafting

Surgical Modification-Bone Grafting

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 surgeon.

Sinus lifting and bone grafting may delay the placement of your implant.

Surgical Modifications-Sinus Lift with Bone Grafting

Surgical Modifications-Sinus Lift with Bone Grafting

In the above illustration the floor of the maxillary sinus droops into the space where an implant would need to be placed.

Surgical Modifications-Sinus Lift with Bone Grafting

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.

Surgical Limitations-Inferior Alveolar Nerve

Surgical Limitations-IAN

In the above example a CT scan was used to note the location of the IANand 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 hygienist.

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.

Dental Implant Maintenance

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 brush2.) End tufted brushes3.) Denture brushes4.) Interproximal brushes5.) Various types of floss6.) Gauze or yarn7.) Air flossers or water piks.

Dental Implant Maintenance-Home Health Care

After placement of your implant(s) continue to brush your teeth. Be sure to brush both the front and back sides of your teeth.

Dental Implant Maintenance-Home Health Care

After you have brushed your teeth be sure to clean the in-between spaces. This may be accomplished with a variety of methods.

Dental Implant Maintenance-Home Health Care

Dental Implant Maintenance-Home Health Care

You may use gauze if space allows

Interproximal brushes go in between

Dental floss can be used on implants

Dental floss between implant/teeth

Dental Implant Maintenance-Removable Prosthesis

Remove prosthesis from mouth and clean.DO NOT use bleach or effervescent cleansersas this may result in damage to your prosthesisUse an appropriate denture cleanser asrecommended by your dentist.Brush the tissues in the oral environment.Clean the areas inaccessible with a brush withone 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.

Dental Implant Maintenance-Hybrid Prosthesis

Dental Implant Maintenance-Hybrid Prosthesis

Brush your hybrid prosthesis asyou would your original teeth. After you have brushed clean underthe prosthesis. Many people use dental floss, yarn, or gauze.

AT NOT TIME IS IT APPROPRIATE TO TOUCH YOUR DENTAL IMPLANT WITH ANYTHING MADE OF METAL!!

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.

Dental Implant Maintenance-Special Warning

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.

Dental Implant Maintenance-Gingival health

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.

Gingival Health-Peri Implantitis

Failure to properly cleanse your implant or prosthesis may result in the accumulation of plaque.

Plaque Accumulation

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- $730.00Implant Crown- $675.00Implant Abutment $200.00Bone Grafting- Price to be determined by surgeonExpect to spend somewhere in the neighborhood

of $2000.00Pricing for other options provided on a per case

basis due to unique needs of each patient.

Pricing for Dental Implants at OUCOD

www.willowcreekdds.com/types-of-dental-implants.html www.bernardmcgrawdds.com/services/bridges.html www.adkinsdentalmedicine.com/our-focus/general-dent

al-medicine/general-dentistry-services/root-canal-therapy

www.fcadental.net (Dr. Cumby’s practice) www.pleasanthilldentalcare.com/gallery.html www.addesigns.com/partial-denture.php www.dr-amet.com/bone grafting-HA grafting.htm www.enamelimplantsdenture.blogspot.com www.surgicalrestorative.com/articles/2012/6/i-think-my

-implant-needs-a-root-canal.html www.qualitydentistry.com/dental/implants/maint.html www.mydentalsearch.com/news/oral-care-after-dental-i

mplant-procedure-cleaning-dental-implants.html www.greatsmilenz.wordpress.com/2012/09/17/how-to-c

lean-dental-implants/

Sources

www.dentalimplantscosthq.co.uk/7-tips-to-flossing-teeth-effectively/ www.rudnickdentistry.com/blog/why-do-i-need-periodontal-therapy/ www.dentalimplantscosthq.com/advantages-and-disadvantages/ www.dentalimplantsacademy.co.uk/tooth-implants-cost www.eonclinicscom/are-you-a-candidate/missing-teeth.html www.valleydentalgroup.net/id1.html www.smilesbyseth.com/dental/implants/multiple-missing-teeth/ www.ranchosandiegodental.com/implants/bone-grafting-sinus-augmentation www.bioscaffold.com/web/consumers/dentistry/socket-preservation/ www.mccullochlaw.net/nerve_injury/inferior_alveolar_nerve/dental_malpractice_&i

nferior_alveolar_nerve.html www.maxillofacial3dmontreal.com/cbct-images_eng.php www.disadental.squarespace.com/disa-journal/2012/2/5/screw-retained-hybrid-ips-

emax-lithium-disilicate-restoratio.html www.philipfriel.com/single-implant-gallery-glasgow.html www.chandigarhdentist.com/dentures_india.htm www.periomem.com/dental-implants-memphis-tn/ways-implants-can-replace-

teeth.html Class notes from Implantology, Dentures I, RPD, FPD, Periodontology, and other

courses as OUCOD

Sources

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.

Special Acknowledgements