DENTAL IMPLANTS

 

WHAT ARE DENTAL IMPLANTS?

A natural tooth is composed of two parts, a root and a crown. The root serves as an anchor within the jawbone, and holds the crown in place. The crown is the visible part that is used to chew food. The root and crown are continuous with each other, and are essentially one piece. A dental implant is a prosthetic device that is inserted into the jawbone, which serves as a replacement for the root of a natural tooth. The implant is the first part of a two-part prosthesis. The crown is a separate metal-ceramic structure that mimics a natural tooth crown in both appearance and function, and is attached to the implant (Figures 1-3).


Modern root-form dental implants are made of titanium, and have been used since the early 1960s to replace missing teeth.1 The success and predictability of this treatment was such that titanium implants were then used in hip joint replacement surgery starting in the early 1980s.2 Over the past 50 years, implant dentistry has evolved from an experimental treatment to a highly predictable option to help replace missing teeth (Figures 4-6). Implants are now widely used in daily practice for patients who are missing one, multiple or all of their teeth. This is because modern implant dentistry offers not only significant functional advantages for many patients when compared to traditional fixed bridgework or removable dentures (see Tooth Replacement Options – Single, Multiple, Full Arch), but it has also yielded excellent well-documented long-term results, with 10-year success and survival above 95%.3


Titanium implants work because they can achieve anchorage in the bone with direct bone-to-implant contact, a phenomenon termed osseointegration. The most important pioneer of modern implant dentistry was Professor P. I. Branemark, from the University of Gothenburg, Sweden. His preclinical and clinical studies in the 1960s formed the basis for our work as dental implant surgeons today.3


References

  1. Adell R, et al. Intra-Osseous Anchorage of Dental Prostheses II: Review of Clinical Approaches. Scandinavian Journal of Plastic and Reconstructive Surgery. 1970; 4: 19-34.

  2. McCutchen J, et al. Osseointegration of Titanium Implants in Total Hip Arthroplasty. Clinical Orthopaedics and Related Research. 1990: 114-125.

  3. Buser D, et al. Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. 2017; 73: 7-21.

 

OVERVIEW OF IMPLANT PLACEMENT

When a tooth is lost, both of its parts, the crown and root are lost (Figures 1-2). The dental implant, which will replace the missing root, requires a solid foundation of supporting bone. In order to regenerate the missing bone (Figure 3) the surgeon may perform a bone graft procedure (see Bone Grafting). The implant may then safely be installed after the bone graft has healed (Figure 4). The body’s natural healing process then takes over and bone grows around the implant, locking it in place with direct bone-to-implant contact, a phenomenon termed “osseointegration” (see What Are Dental Implants?). The bone graft procedure, and the implant placement procedure may each take approximately one hour. The number of appointments and the time required for each procedure vary from patient to patient. You may be confident that Dr. Valentin Dabuleanu will pay close attention to every detail of your case, and carry out each procedure with the upmost precision.


In some cases the gum tissue will be closed over-top the implant after placement. Once the osseointegration process is complete, a healing cap, also known as a healing abutment, is attached to the implant in what is known as the uncovery procedure (Figure 5). In other cases, the implant may be placed with a healing abutment right away. Once the gum tissue has healed around the healing abutment the crown may then be attached to the implant. Sometimes the crown is made of two parts: a restorative abutment and the crown itself (Figures 6-7). When a crown is attached to the implant this process is termed a “restoration”. Whether it’s one tooth or all of your teeth that are being replaced, your dentist will complete the restoration by installing the crown on the dental implant (Figures 8-10).



When Are Dental Implants Placed?


The ideal timing for placement of a dental implant will depend in the unique situation at hand. Implants are usually placed several months after extraction of a natural tooth, and in combination with a bone graft procedure. In certain cases an implant may be placed immediately after removing a tooth. Although extraction and immediate implant placement may shorten the treatment time, if an infection or bone deficiency is present, it is not the safest option. In these cases a stepwise approach of bone grafting followed by implant placement will lead to a more predictable treatment outcome.

Link to Video on Overview of Implant Placement


For more information on treatment planning for dental implant replacement of missing teeth, please visit the following link to an article published in Oral Health, one of our national dental journals, written by Dr. Valentin Dabuleanu:

 

TOOTH REPLACEMENT OPTIONS - SINGLE TOOTH

Dr. Valentin Dabuleanu and your dentist will provide you with all of your options so that you can make an informed decision on how to replace your missing tooth.

1) Dental Implant


A dental implant is the most comfortable and permanent solution for replacing a missing tooth. Unlike a bridge, healthy tooth structure does not have to be removed to accommodate an implant. Unlike most bridges, an implant can last a lifetime. A good candidate for a dental implant is anyone who is missing one or more teeth, or who is unhappy with their dentures (Figures 1-2). Although age is not a factor, conditions such as uncontrolled diabetes, and a history of radiation therapy to the jawbone have been shown to lower the success rate of implant treatment. Habits such as smoking will also negatively affect treatment success. X-rays of the jaw will help Dr. Valentin Dabuleanu determine if the supporting jawbone is of sufficient dimension to accommodate an implant.


Dental implant treatment is a team effort. Dr. Valentin Dabuleanu will perform the initial tooth removal, implant surgery, and bone grafting if necessary (see Bone Grafting). Your dentist will install the final crown, bridge or denture.


2) Fixed Bridge


A fixed bridge is the best alternative treatment option to an implant. Similar to an implant, a bridge is not removed at night or in between meals. A bridge is a prosthetic tooth (or teeth) held in place over-top the missing tooth area by being connected to crowns that are cemented on the neighbouring abutment teeth. Neighbouring teeth require preparation, or removal of natural, healthy tooth structure in order to accommodate the crowns (Figures 3-4).

3) Removable Denture


A removable denture is a cost-effective and functional replacement for missing teeth (Figures 5-6). It is held in place by wire clips. Denture teeth are usually plastic. Denture framework may be either plastic or metallic. Metallic framework is thinner, lighter, and more durable. The drawback with dentures is that they must be removed at night, and as required after meals to be cleaned, which can be inconvenient.


4) No Replacement


If a missing tooth is not replaced, there is a chance that neighbouring teeth will drift into the empty space. Your bite may become altered as a result of this tooth movement.  Treatment becomes more difficult the longer time passes. Orthodontic treatment may be necessary to reposition the teeth. 

 

TOOTH REPLACEMENT OPTIONS - MULTIPLE TEETH

1) Dental Implants

In the example shown (Figures 1-2), dental implants were installed to replace four missing back teeth and one missing front tooth.



2) Fixed Bridge

In the example shown (Figures 3-5), a fixed bridge was installed to replace two missing front teeth. For strength and support, this required crown preparation of two abutment teeth on either side.


3) Removable Partial Denture

In the example shown (Figures 6-7) missing upper and lower teeth were replaced by partial dentures with cast metal framework. The dentures are held in place by wire clips. The dentures need to be removed at night, and as required after meals to be cleaned.

 

COMPLETE DENTURE – IMPLANT SUPPORTED – LOCATOR ATTACHMENTS

Complete dentures are the most common solution for people who are missing all of their teeth in one or both jaws (Figures 1-2). Complete dentures rest on the healed gum tissue, or ridge, which remains following tooth extraction. They are carefully constructed to fit as closely and as snug as possible. Although many patients will accommodate to wearing an upper denture, some will have difficulty eating with a lower denture, due to rocking of the denture. In these cases, tissue adhesive can be applied to the denture to help prevent rocking (Link to Super Poligrip).


Complete Denture – Implant Supported – Locator Attachments


Several implant-supported replacement options are available to help improve the stability, support, and retention of removable dentures. Depending on the case, two, four or six implants may be installed, and then a denture can be made that snaps onto the implants (Figures 3-4). This option dramatically improves the stability of the denture. You will need to see your dentist for periodic visits to adjust and maintain the denture (Figures 5-6).


Dental implant treatment is a team effort. Dr. Valentin Dabuleanu will perform the initial tooth removal, implant surgery, and bone grafting if necessary (see Bone Grafting). Your dentist will install the temporary and final dentures.

 

COMPLETE DENTURE – IMPLANT SUPPORTED – BAR ATTACHMENT

A bar attachment denture is a modern solution that has transformed the way dentists plan the replacement of a full arch of missing teeth (Figures 1-4). Four or six dental implants are first installed. A standard removable denture may be worn over-top as the implants heal underneath. When healing is complete, a custom-fit support bar is then attached to the implants. The final denture rests both on top of the gum tissue (ridge), as well as on the support bar. This dual-support solution provides excellent stability of the denture. When this solution is used for upper dentures, coverage of the palate is no longer required. This type of denture feels more natural.  It will also allow you to fully taste your food and have a better sense of its temperature. You will need to see your dentist for periodic visits to adjust and maintain the denture. The bar attachment denture is a hygienic solution (Figures 5-6). The denture can be removed to allow easy cleaning and maintenance of the support bar.


Dental implant treatment is a team effort. Dr. Valentin Dabuleanu will perform the initial tooth removal, implant surgery, and bone grafting if necessary. Your dentist will install the temporary and final dentures.

 

FULL ARCH FIXED BRIDGEWORK – IMPLANT SUPPORTED

A full-arch implant-supported fixed bridge most closely resembles the appearance and function of a full arch of missing teeth (Figures 1-4). Six to eight dental implants are first installed. A standard removable denture may be worn over-top as the implants heal underneath. Support posts, or restorative abutments are then attached to the implants. Metal-ceramic bridgework is then installed on top of the restorative abutments (Figures 5-6). A full-arch implant-supported fixed bridge is a hygienic solution, and can be maintained with regular home oral hygiene techniques, including brushing, flossing with a floss threader (Link to GUM Eez-Thru Floss Threader), as well use of a Waterpik (Link to Waterpik). You will need to see your dentist for periodic visits to adjust and maintain the implant-supported bridge, and for regular teeth cleaning visits.


Dental implant treatment is a team effort. Dr. Valentin Dabuleanu will perform the initial tooth removal, implant surgery, and bone grafting if necessary (see Bone Grafting). Your dentist will install the temporary denture and final bridgework.

 

BONE GRAFT - SOCKET PRESERVATION

Removal of a tooth is sometimes necessary because of infection, severe bone loss, or fracture of the tooth. The bone that holds the tooth in place, also known as the socket, may be reduced in volume by periodontal disease or long-standing infection (Figures 1-2). The void that remains following tooth removal may create a problem especially if the plan is to replace the tooth with a dental implant. The jaw deformity can be regenerated by a procedure called socket preservation. This will significantly increase your chance of having a successful and long-lasting dental implant.


After the tooth is removed, the remaining socket is filled with bone graft material. It is then covered with an artificial membrane. The socket will then heal with minimal shrinkage and collapse of the surrounding gum tissue. The regenerated bone in the socket will provide a foundation for the future implant (Figures 3-7). Your dentist may recommend that a tooth be removed. If you are considering replacing the tooth with an implant later on, be sure to ask if socket preservation is necessary.


The procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work two days after having had extraction and socket preservation. The majority of healing takes place during the first month, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). Dr. Valentin Dabuleanu will see you for a 1-week and 4-week post-operative check.

 

BONE GRAFT - LATERAL RIDGE AUGMENTATION

A lateral ridge augmentation is another common type of bone grafting procedure. It is used for areas of extensive bone loss (Figures 1-2). It is usually performed a few weeks following a tooth extraction. The end goal is the same as socket preservation, which is to help regenerate supporting bone for a future dental implant.


Supporting framework may be temporarily installed over-top the bone graft material to help prevent collapse of the area during healing. (Procedure Figures 3-5). After the graft has healed, the site is re-entered, the framework is removed, and the implant is placed (Figures 6).


The procedure takes approximately two hours. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work two days after having had a lateral ridge augmentation procedure. The majority of healing takes place during the first month, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). Dr. Valentin Dabuleanu will see you for a 1-week and 4-week post-operative check.

 

BONE GRAFT - SINUS AUGMENTATION

Sinus bone grafts are performed to help regenerate missing bone in the upper posterior jaw. The maxillary sinuses are air-filled cavities which lie behind your cheeks and on top of the upper posterior teeth. Some of the roots of natural upper teeth may extend upwards into the maxillary sinuses. When these upper teeth are removed, the remaining jawbone has a tendency to shrink in size, and the maxillary sinus tends to grow into the space of the missing tooth roots. The remaining jawbone is very thin (Figure 1).


Dental implants require bone to hold them in place, just like the bone that surrounds the roots of natural teeth. When the sinus wall is very thin, it is impossible to place implants in this bone. Fortunately, a sinus augmentation may be done to help regenerate this missing bone. In the most common sinus augmentation procedure, a small opening is prepared into the bone overlying the maxillary sinus, and the membrane lining the sinus is pushed upward (Figure 2). The underlying space is filled with bone graft material. The area is then left to heal for several months to allow the bone graft to incorporate. Dental implants are then inserted in the newly regenerated bone (Figures 3-6).


In certain cases, there may already be enough bone to allow the placement of an implant and sinus augmentation at the same time. Dr. Valentin Dabuleanu will determine which type of bone graft and implant procedure is right for you.


The procedure takes approximately two hours. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work two days after having had a sinus augmentation procedure. The majority of healing takes place during the first month, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). You will be seen for a 1-week and 4-week post-operative check.

 

AFTER IMPLANT PLACEMENT

What can I use to replace my missing teeth while the implants are healing?


Dr. Valentin Dabuleanu will discuss different options for temporarily replacing your missing teeth, both with you and your dentist. A temporary removable partial denture can be made to replace one or several missing teeth. If all of your teeth are missing, your existing partial denture can be modified into a temporary complete denture, otherwise a new temporary complete denture can be made. Depending on the clinical situation, a temporary crown, bridge or denture can be attached to the implant the same day that the implant or implants are placed.



How painful are these bone grafting and implant procedures?


It is normal to be concerned that bone grafting and implant procedures may cause post-operative discomfort. In actual fact, most patients do not experience significant post-operative pain. A thorough regimen of post-operative antibiotics, pain medication, and post-operative instructions will be prescribed by Dr. Valentin Dabuleanu, to make your recovery is as relaxed as possible.



Are my implants really forever?


Implants are now widely used in daily practice for patients who are missing one, multiple or all of their teeth. Modern implant dentistry offers significant functional advantages for many patients when compared to traditional fixed bridgework or removable dentures. Implant dentistry has yielded excellent well-documented long-term results, with 10-year success and survival above 95% (Buser D, et al. Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. Periodontology 2000. 2017; 73: 7-21.)



How long do I have to wait before the new teeth can be attached with my dentist?


In most cases implants require 3 month of healing. In some cases Dr. Valentin Dabuleanu will recommend 6 months of healing. The recommended healing time will vary depending on jawbone density, and on whether or not a bone graft procedure is being performed at the same time as implant placement. The number of appointments and the amount of time required for each appointment is different for each patient. Both parts of the implant treatment, the surgery itself and the prosthetic phase (crown, bridge, denture insertion) are done with great precision.



Can I brush and floss my implant teeth the same way as my natural teeth?


Yes, implant-supported crowns, bridges, and dentures can be cleaned in much the same way as natural teeth, with toothbrushes and floss. Depending on the type of bridge or denture, interproximal brushes (https://www.gumbrand.com/between-teeth-cleaning/interdental-brushes.html), and a Waterpik (https://www.waterpik.com) may also be useful. Dr. Valentin Dabuleanu and your dentist will carefully instruct you as to how to keep your new implant teeth clean.



How often will I have to see my dentist for regular cleanings and checkups, when I have my implant teeth?


You will need to see your dentist at least twice a year for regular teeth cleaning visits (see Cleanings and Checkups). Depending on your case, Dr. Valentin Dabuleanu may recommend that you visit your dentist even more frequently for cleaning visits. Each clinical case is unique. The new implant teeth or denture will also require at least annual maintenance visits. Implant crown and bridgework, and dentures are wear-and-tear devices. Ceramic crowns may chip and require repair with your dentist. A screw which attaches the crown to the implant may come loose and occasionally require tightening. Your bite may change with age and your dentist may have to slightly adjust the tooth contact on your implant crown or bridge. An implant-supported removable denture has retentive clips, which occasionally require replacement.



Is my dentist involved in the planning process?


Dr. Valentin Dabuleanu will be in close contact with your dentist throughout the entire planning process. Together, they will provide a thorough assessment and plan for your unique case, and provide you all of your treatment options. This planning phase will involve at least one visit with both Dr. Valentin Dabuleanu and your dentist.



Will my dentist make the final crown, bridge or denture on my implants?


Yes, your dentist will make the temporary crown, bridge or denture (if required), as well as the final crown, bridge or denture on the implants. You will be seeing both Dr. Valentin Dabuleanu and your dentist throughout the implant treatment process

 

COST OF DENTAL IMPLANTS

Implant treatment is more expensive than treatment with traditional fixed bridgework or dentures. When considering if implant treatment is really for you, it is important to be aware of the following significant benefits of implants:


1) Durability and Longevity


Dentures and bridges tend to require replacement after about 10 years. Implant-supported crown and bridgework has the potential to last a lifetime. 


2) Jawbone Health


Having healthy teeth will help improve your physical and mental health. Dental implants are extremely successful because they act very similarly to natural teeth. They safeguard and preserve the original jawbone structure. The original tooth function and appearance are preserved as well.


3) Quality of Life


Because treatment with dental implants will result in a significant improvement in your ability to eat properly, they can be seen as a long-term investment into your physical and mental wellbeing.



Breakdown of Implant Treatment Costs


When assessing your quote for implant treatment, it is import to be aware of the treatment steps. The costs of the following steps will be discussed with Dr. Valentin Dabuleanu:

  1. Exam

  2. Radiographic stent

  3. Regular dental x-rays

  4. Cone Beam CT scan

  5. Tooth extraction

  6. Bone grafting

  7. Implant placement


Your dentist will discuss the cost of the following:

  1. Tooth wax-up (if indicated)

  2. Temporary crown, bridge or denture

  3. Final crown, bridge or denture

  4. Night guard appliance


To schedule your consultation with Dr. Valentin Dabuleanu, please call us at 416-222-5055. After the consultation we will be happy to provide you with a treatment plan, options, and an estimate so that you can make an informed decision.

 

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