- A dental implant is simply a titanium (or ceramic/zirconia) screw that replaces the tooth root.
- What are the components of an implant?
The implant itself is the titanium threaded screw. After this heals, an abutment is placed. Over the top of the abutment, a crown is either cemented or screwed into the abutment. It takes approximately 3-5 months for an implant to integrate into the mandible or maxilla.
Why the variation in time?
It depends on how much stability we have when we place the implant initially. It also depends on the quality of the bone; the posterior maxilla generally has the poorest quality bone (very thin and porous) while the posterior and anterior mandible usually has the thickest, most dense bone.
- What is a bone graft and why do I need this? How long do we have to wait to place an implant after we place a bone graft?
After a tooth is extracted, the hole or socket fills in with soft tissue. Similar to the other factors stated above, the typical time frame is 3-6 months. I usually wait around 4 months for a single extraction socket.
Where does this bone come from?
Very simply, it comes from a human cadaver (allograft), the same person’s mouth (autograft or autogenous) or hip, or comes from a cow or pig (xenograft). By far and away, the allograft is the most commonly used material. This is a very safe substance. The donors are screened for diseases, the material is cleaned and sterilized (usually via radiation), and it is all FDA regulated. They use this material in other areas of medicine such as orthopedic surgery.
- What kind of pain is to be expected after an implant or bone graft?
Generally speaking, most people will usually say, “It was fairly sore for a week or so, but the ibuprofen helped for the most part.” Maybe 10% say it didn’t hurt at all, and another 10% say it hurt like hell. Most people do fine with ibuprofen and Tylenol.
- What is all this stuff about “teeth in a day” that I hear about?
The large corporate chains have popularized this term with their marketing to get people in the door. Another popular term for this same type of procedure is called “all on four (or six)“. Basically, this is when you would typically remove someone’s teeth, place implants and then deliver them a fixed hybrid bridge (an acrylic type of bridge like a denture with the palate cut out) and screw in the bridge the same day. They wear this for approximately 6 months, then come back and have impressions for a final zirconia bridge. This is time-consuming and expensive but is very popular these days because it’s the closest thing to natural teeth that we have, and the patient gets something fixed in place from the get-go. The bridge here is completely supported by the implants. The patient comes in 2-3 times per year (or more), and depending on their oral hygiene, the dentist then unscrews the bridge and the hygienist cleans around the implant abutments. An H2O pik is a must here and the hygiene must be meticulous.
- What is an implant retained denture?
Another option to replace all of your teeth is an implant retained denture. Some may call this a “Snap-In Denture”. The advantages of this are simplicity, cost, and hygiene. The denture still comes in and out but is very retentive for chewing and functioning. The patient has the ability to brush clean the implant abutments thoroughly which is an advantage. This is considered implant retained (unlike the fixed option above which is completely supported by the implants), so the denture is kept in place by the implants but still rests on the tissue. Therefore, the denture must be relined once a year or so. The most common way to hold the denture in place is with something called Locator abutments. On the mandible, you can do as few as 2 implant and Locators in the front of the lower jaw, but this is just the minimum. This works very nicely for the person who has been suffering from a loose lower denture for years and gives them a little bit of stabilization to chew with. It’s also relatively affordable. On the maxillary arch, a minimum of 4 implants with Locators is needed, and the palate still needs to be kept in place for the denture retention and to lessen the forces placed on the implants. If we go up to 5-6 implants, I will consider cutting out the palate.
- What is perimplantitis?
Another term that we are hearing more and more about since more implants are being placed, is perimplantitis. This is nothing more than periodontal disease around an implant. Although implants cannot decay, they can and will develop inflammation, pocketing, and destruction of the tissue and bone surrounding them. In fact, they are more susceptible to this than teeth, since there is no true attachment of tissue around an implant like the sulcus around a tooth. So, it is wise to tell someone that if they have destroyed their teeth through neglect, the same thing can and will happen to their expensive implants. Other causes of perimplantitis include cement stuck around the implant, and occlusal issues (hitting too hard on the implant crown).
- What if I need a front tooth replaced with an implant? I don’t want to go without a tooth here.
A temporary abutment can be placed and a temporary crown can be fabricated to wear during the healing process; this is the best choice. If this cannot be made then an essix style temporary can be made. An essix retainer is just a clear tray (like a bleaching tray) with a resin tooth in it. The last choice would be an acrylic flipper, but I don’t like these because they place pressure on the surgical site, which is a no-no.
- Do I always have to have a bone graft placed prior to the implant placement?
The short answer is no. Although many times it is quite necessary and can lead to a better long term outcome, a bone graft is not always necessary prior to placing an implant. There are times when a tooth can be extracted and if there is enough bone present, the implant can be placed immediately. Even in this case, a bone graft is typically added around the implant and then allowed to heal. Sometimes a patient will present with a missing tooth, and there is plenty of residual bone left to just place the implant without the need for a bone graft.