Dental Implants

Dental implants have been the hottest topic during the last decade in dentistry. They have revolutionized dentistry. The use of removable dentures as a solution for the loss of teeth is on steep decline, and even the treatment of problems of existing teeth has been in many cases supplanted by their timely extraction and substitution for a suitable dental implant.

The following is a succinct guide for patients about this procedure and its possibilities. It is not a written as a substitute for a dental consultation, but only as a tool for an informed consumer.

Dental implants are pieces of foreign materials inserted into the bone that remains in the jaws after the extraction of teeth, and whose purpose is to support a dental prosthesis. While several types of dental implants were used during the last 70 odd years, when we speak of dental implants today we are referring to a particular type, known in the scientific literature as root-form osseointegrated implants. These implants are conical or cylindrical pieces of titanium that when carefully inserted are integrated into the bone without a visible space when examined with a microscope.

When patients are diagnosed as needing a dental implant, there are a few concepts that should be made clear to them:

- A dental implant is just a retaining fixture for a prosthetic tooth or teeth- Dental implant therapy requires the use of at least three different elements: The implant itself, that is inserted into the bone much the way that a dowel or plug in inserted into a wall, an abutment that acts as a retainer for the final prosthesis, the way a screw or hook are threaded into the dowel or plug, and the prosthetic tooth or teeth that are the final result of the therapeutic process.

- The diagnosis and treatment planning for implants should be done carefully. Minimum diagnostic tools are a panoramic radiograph and study models. Computerized Tomography is rapidly becoming the standard of care for diagnosis, and leading dentists are using computer analysis software to design their cases.

- Bone has to heal after the insertion of the implant. For that reason, while we may try to give the implant a limited use immediately after its insertion into the bone, full loads are not possible until after a healing period that varies between a few weeks to almost a year, depending on the case.

- The insertion of implants is a surgical procedure. Even though many dentists are extremely proficient in their placement, there are risks attached to the dental implant procedure and the patient should be aware of them. And while more than 90% of dental implant procedures are carried out uneventfully, no operator can claim 100% success.

- There are several types of tooth replacement that can be supported by implants; including removable prosthesis, fixed-removable (screw retained fixtures) or cemented restorations that can be attached to implants with different types of connectors or abutments. And each case is individually designed according to the patients needs and the dentists experience.

- Implants need maintenance. Just like teeth, implants and the prosthetic teeth attached to them need to be looked after. A visit to the dentist between two to four times every year is necessary to ascertain the long term survival of implants.

^^If you have been told you need implants this are some of the questions you should ask your dentist.^^

- Will my body accept or reject the implants? Osseointegrated implants are usually accepted easily by the body, with no observable reaction. Nonetheless, several medical conditions, including chronic diseases and medications should be taken into account as they may negatively affect the procedure. Your dentist should be able to explain to you whether those conditions affect you.

- Do I have the necessary amount of bone to receive implants? The smallest implants in the market are 3 millimeters in diameter and 8 millimeters in length and there needs to be at least 1.5 millimeters of healthy bone around the implants. If you do not have enough bone you might be a candidate for bone augmentation or other procedures. Your dentist will tell you more about those options should this be the case.

- Can I bite on my new implants right away? The answer is a qualified maybe. While immediate loading implants have been on the market for several years now, many dentists prefer not loading the fixtures until they feel confident enough that bone has healed around them.

- Are there different types of implants? There are many companies that make implants worldwide, and they all use the same basic procedure and materials to manufacture them. Differences between implants are related to the scientific research they have put into their products, the precision of their manufacturing processes and subtle differences in alloys and surface treatment, which all impact the quality as well as the price of the implant itself. An implant should have at least a CE conformity, and if possible FDA approval for the particular procedure to be carried out. You should feel free to ask your dentist what type of implant he recommends to you.

Dental implants are among the safest and most predictable procedures in dentistry today, with success rates of over 90% among experienced operators. An appropriate diagnosis and treatment plan, coupled with mutual trust between patient and dentist is the key to a successful dental implant based restoration.

Isaac Holder, D.M.D., M.S. is the Editor of Dentistry and Dental Problems Forum