The idea of dental implants has been around for thousands of years. Virtually any hard material you can think of has been implanted into the human jaw to try and replace missing teeth. Every time a new material was placed in the jaw, however, the same result was achieved: inflammation and infection that eventually led to the rejection of the material. Even attempting to implant natural teeth worked to no avail. For thousands of years it seemed to be impossible that we would ever be able to “implant” any kind of device into bone in order to replace teeth, and thus the focus of prosthodontics (or the art of tooth replacement) has focus on the use of fixed partial dentures (bridges) and removable dentures to replace teeth.
Implications for Dentistry
So what does all this translate to for dental patients? It means we now have the ability to completely replace the root of a tooth! We can replace single teeth with implants (without harming adjacent teeth in the process, as with previous treatment options, see below). We can replace every tooth in the mouth with implants utilizing implant-supported bridges. In addition, all kinds of attachments can be placed on the top of implants to help retain dentures (full dentures, partial dentures, hybrid dentures, etc).
What has been even more stunning about the application of this technology in dentistry is how successful the procedure has become. Implants are bar none the one of the most successful dental treatments in history. In a healthy patient, a dental implant has a success rate of 95%! Do they have a perfect track record? No! A 95% success rate still means that 1 in 20 fail. But this is still by far the best shot we have at replacing teeth successfully, and for the longest length of service. Unfortunately, this success rate drops significantly with the health and habits of patients (especially in smokers, people who grind their teeth, and diabetics).
Never have we had a tooth replacement treatment where we could tell our patients that there is a chance it could last a lifetime. With implants this IS a possibility. The most critical factor in keeping your implants around for the long haul is maintaining good oral hygiene, as well as keeping the hygiene recall schedule we have recommended.
How does the Implant process unfold?
One key factor to remember when it comes to this kind of treatment is that it does not happen overnight. The main reason for this is that the treatment depends upon the growth and maturing of bone. We must wait for bone to grow into the socket of an extracted tooth, and we must wait for bone to grow into the side of the implant once it has been placed. Those of you who have broken an arm or leg know that it takes some time for bone to heal and mature.
Step 1: “Preparing the Soil” (Extraction of the Hopeless Tooth, and Socket Preservation)
A critical step in preparation for implant placement is to assure we give the implant the best possible chance for success, namely the best quality of bone possible to hold the implant. The better the quality and quantity of bone at the site, the better the success rate of the implant.
One thing we can do to dramatically increase the quality and volume of bone at an implant site is to utilize a procedure called socket preservation. This means that right after your tooth is extracted, instead of leaving the socket empty, we pack it with bone graft material. Sometimes we will place a membrane to hold the material in place (typically human pericardium (a protective membrane that encircles the heart), or bovine collagen).
The best graft material we have for this is Freeze Dried Bone (FDB). This material originates from organ and tissue donors, and is subsequently sent to Federal Tissue Banks. At these facilities the bone is highly processed, and highly tested to assure its safety for use in bone grafting procedures. When we receive it, it basically looks like a calcium powder. The utilization of FDB in socket preservation procedures decreases the loss of bone volume at extraction sites by 40-60% in the first 2 years! In other words, by packing human FDB bone graft material into an extraction socket, we can preserve twice the amount of bone for the implant than if we just left the socket empty.
The graft material does not become part of a patient’s bone. It’s purpose is analogous to the way a trellis supports a vine, serving as a framework for a patient’s own bone to grow into. Typically, within three months all of the graft material is resorbed. It takes anywhere from 2-6 months for bone to form in the site after grafting.
Step 2: Imaging
The next step in the process involves collecting more information about the implant site by the use of either our typical digital radiographs (x-rays), panoramic radiographs (that image the entire face), or a CT Scan of your face (that provides images in three dimensions). All of these tools aid us in making decisions about the size and angulation that we will utilize during implant placement surgery. Surgical guides can also be fabricated utilizing this information when necessary.
Step 3: Implant Placement
Surgery to place the dental implant into the bone involves making a “pilot hole” for the implant at the implant site, and then twisting the implant into place. We will typically suture the gum tissue over the implant to completely seal the surgical site. Now its time again to “hurry up and wait.” With the implant in place, the most important step is for the bone to heal and osseointegrate into the implant. Complete osseointegration typically take six months.
Step 4: Uncovering the Implant
With the implant osseointegrated it is time to access the implant and put it to use! This step involves a quick procedure to expose the top of the implant and place either a healing cap, or a temporary crown. Both options allow us to gain access to the implant, and also shape the gum tissue for the final restoration or denture attachment.
Step 5: Fabrication of the Final Restoration and Attachments
Once the gum tissue has completely healed around the healing cap, or temporary crown (2-6 weeks depending on the location of the tooth), we can begin to gather the information we need in order to complete treatment. If the implant is being utilized for a crown or bridge, we make impressions of your teeth to send to a dental lab that will fabricate the implant crown to fit to an abutment. The abutment is a titanium post that screws into the implant and sticks up above the gum tissue. If the implant is being utilized for a removable denture, we place the appropriate attachments on the implant (abutments utilized for dentures), and modify the denture to fit accordingly.