Dental implants are an attachment in the jaw bone of an artificial root made of titanium. This root emerges from the gum supporting a tooth or prosthetic element. This process has an extremely high success rate due to the preliminary medical imaging (CT) and application of a rigorously-tested methodology.
The first phase involves opening the gum to insert the implant into the bone. The gum is then closed around the implant leaving a screw sticking out. A waiting period allows osseointegration, bone growing around the implant, which takes from 2 to 4 months. During this period bone is integrating with the implant to form a permanant bond. A temporary prosthesis can be introduced during this period. On some occassions the implant may not integrate with the host bone tissues, it becomes loose and painful, and it is imperative to remove it. The patient will wait for several weeks of healing and can then attempt another implant. Several general factors may prevent the integration into the bone including diabetes, poor dental hygiene and use of tobacco.
The procedure takes between 1-2 hours depending on the number of implants. In most cases, it is simple and non-traumatic. It is performed under local anesthesia. The supporting wires are removed after one week. After osseointegration, the implants are ready to receive the prosthesis. In some cases it may be necessary to perform periodontal surgery (either a transplant or redevelopment of the gum around the implant) to improve aesthetics. There may also be a second operation after placing the implant in the bone, in which the gums are closed over the implant for 2 months.
A dental impression is made to acurately reproduce the patients mouth and model the location of the implants. From this model, the dental laboratory makes the artificial tooth to be screwed directly onto the implant, or attached to an adapter(inlay-core).
Dental implant surgery is now well established. Success rates are very high and constantly increasing as research progresses. In all cases, the final result depends on the surgeon’s expertise and extensive knowledge of dental implants, but also quantity and quality of the bone and health of the patient. In case of bone defect, a bone graft will solve the problem of insufficient bone stock.
The cost of dental implants is generally $2,000 to $3,000 per tooth, including the dental crown. This can increase if the preliminary CT scans reveal issues involving the sinus cavity or lack of necessary bone mass. A bone graft can add upwards of $10,000 to the final dental implants cost.
The use of dental implants has grown considerably in recent years. More and more patients are receiving prostheses or implants. But have implants become the complete solution for replacing missing teeth? They are not the complete solution, but when practical, are the preferred solution. This technique avoids the bridges that requires damaging healthy teeth and can also replace removable devices with a fixed prosthesis. The replacement of missing teeth with implants is not more widespread for several fundamental reasons; it is considerable more expensive than dentures and other removable options, it requires suffucuent bone density to be effective which may be a problem with older patients, and it requires surgery which may be unadvisable in patients with heart problems or severe diabetes.
Heavy smokers may not be candidates for teeth implants due to health concerns. They usually suffer from atherosclerosis, a thickening of the artery walls causing a slowdown of the bloodstream. Smoking can also cause hyperviscosity syndrome which causes the blood to flow more slowly. These two factors lead to a reduction in blood flow, which slows osseointegration (bone healing around the implant). Before surgery, smokers must have their hemocrit (red blood cell) levels tested to determine if an implantation can be safely performed.
There are several dental implants problems a patient may experience, although in most cases the implants are installed under local anesthesia. The medical risks are the same as those of dental surgery in general and for a healthy patient there is no more risk than for extraction. When installing a tooth implant in the upper jaw the primary risk is breaking the sinus by drilling too deep. For the lower jaw the main obstacle is the inferior alveolar nerve (IAN) which passes inside the jaw, from the wisdom tooth to the canine. This nerve must not be damaged or the consequences can be very uncomfortable for the patient. Indeed, this nerve provides the sensitivity of the teeth and injury can cause temporary or permanent hyper-sensitivity in the lower lip and some teeth. A CT scan can identify these obstacles and determine that sufficient bone mass is available.
An osseointegrated implant will remain for life. Some implants installed over two decades ago show no signs of weakness. One can imagine that these implants will last a lifetime. However, the fixed prosthesis on the implant can deteriorate over time. This will require changing in the same way as a prosthesis or natural teeth. Implantology is growing and it is a very attractive market for manufacturers. They are becoming more numerous. The most common brands are 3i, Straumann, Astratech and Nobel Biocare. Regardless of the brand, the material is the same: titanium. There are only two minor differences between the brands. The surface of the implant, which is an important element in the bone-implant contact. Depending on the surface, osseointegration is more or less rapid. Secondly the settings, which is all the parts that will be used to make the prosthesis. These settings are designed with varying degrees of ingenuity by the manufacturers.
One concern patients have is that they will have trouble locating a dentist that supports their brand of implant. This is an important problem that is encountered more and more. Patients travel, move, or change their dentist. Their implants are fully osseointegrated, but the prosthesis needs to be redone. The implant is a plug which is screwed into the prosthetic component. Unfortunately the thread within the implant varies from one system to another. Therefore, to provide service on a prosthetic implant, it is necessary to know the model of the implant and contact the manufacturer to provide the necessary prosthetic components. There are occassions where the patient has lost the information about their implants or the manufacturer of the implants no longer exists. In most cases there is a compatibility of parts between different brands of prosthetic implants. It is therefore recommended that patients utilize implants from established brands to ensure future availability of replacement prostheses.