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Frequently Asked
Questions about Dental Implants
What
is a dental implant?
A dental implant is nothing more than a
metal screw that is placed into the jaw bone. It acts as an anchor for a false
tooth or a set of false teeth. The slide to the left shows the replacement of
a lateral incisor with a dental implant retained restoration. Roll your cursor
over the image to see the implant.
Who is a candidate for dental implants?
Anyone in reasonable
health who wants to replace missing teeth. You must have enough bone in the area
of the missing teeth to provide for the anchorage of the implants. Some people
are missing all their teeth and most of those are excellent candidates for
dental implants, but today, we use implants to replace small bridges, removable
partial dentures and even missing single teeth.
What is the success rate of dental implants?
This depends very much on where the
implants are placed and what they will be called upon to do. The best case scenario
is the placement of implants in the front portion of the lower jaw. Here success
can be as high as 98-100%. In other areas of the mouth, success rates can drop
significantly. According to figures that we have today, the success of implants
in the front part of the upper jaw are anywhere from 90-95%. Success rates of
implants in the back part of the upper and lower jaw can be in the 85-95% range.
The success rate in my practice
for the past five years has been 99+% for all implants placed.
What can go wrong with dental implants?
There are really not too many things that can go wrong with dental implants. They can fail to integrate into the bone and come out. They can fracture or break. There can be problems with the connection between the implant and the prosthesis. There can be an infection or an inflammatory condition in the soft tissue and sometimes in the bone as a result of the implant placement. There can be damage to the nerves in the lower jaw and there can be damage to the maxillary sinus or the nasal cavity. All of these complications are rare and usually account for less than 5% of all dental implant treatments. These complications can usually be easily corrected.
Who
should you see about dental implants?
The question is really who should
you see about getting missing teeth replaced? Before implants, you went to either
your general dentist or, if you wanted a specialist, to a prosthodontist. It's
the same today. If you want to replace missing teeth, talk to the people who do
that job and they will be glad to discuss the use of dental implants in that process.
If you decide that dental implants are for you, then your general dentist or prosthodontist
can either place the implants for you or refer you to a qualified surgeon, usually
either an oral surgeon or a periodontist, for that phase of the treatment.
My suggestion is to stay
away from dentists who call themselves "Implantologists" or say that
they are specialists in Implantology or "Board Certified" in Implantology. Here's why....
Is Implantology a Specialty Area of Dentistry?
While there are people and organizations
who would like the general public to believe that there is such a thing as a dental
specialty of Implant Dentistry, there is NO SUCH THING! There
are organizations who give credentials and awards to dentists that make it look
like these dentists are highly trained implant specialists, but these credentials
are unrecognized by the American Dental Association. In some states, it is considered
illegal to advertise these credentials. The specialty areas of dentistry that
are most aligned with dental implants are Prosthodontics, Oral and Maxillofacial
Surgery and Periodontics. If someone tells you they are a specialist in dental
implants or that they are Board Certified in that area of dentistry, RUN!
Why have dental implants become so popular?
As our life span
increases, the need for some type of permanent dental replacement system becomes
very important to our overall health. Dentures and removable bridges have
obvious problems: They are loose and unstable. Implants can provide people with
dental replacements that are both functional and esthetic. The demand was always
there, we just needed the tools to fulfill that demand.
How long after a dental implant is placed can it be used
to anchor my new teeth?
The protocol that was originally developed clearly states that we must
wait three months in the lower jaw and six months in the upper jaw before we can
begin to construct the new dental prosthesis that will be supported by the implants.
In recent years, however, there has been a movement within the profession to sort
of speed up this process. Today we believe that it is possible in selected patients
to accelerate the healing time. We are even loading implants in very specific
situations right away. However, the general protocol that I favor is 3 months
in the lower jaw and 4 months in the upper jaw.
Does it hurt to have dental implants placed?
The actual procedure to surgically
place a dental implant is done under local anesthesia and is generally not at
all painful. When the anesthesia wears off about three or four hours later,
you might expect some discomfort. The level of discomfort is quite different
from patient to patient, but most patients do not have significant problems.
Some patients do have varying degrees of pain or discomfort which may last for
several days. Swelling and black & blueing may also develop.
In cases where there is prolonged
pain, you should see your dentist right away. Prolonged pain is not a good sign
with dental implants and although it does not always mean failure, the cause
of the pain should be determined as soon as possible. If an implant is not properly
integrating into the adjacent bone or if an infection develops, the implant
may have to be removed.
What happens if I have dental implants and they are
rejected?
Occasionally dental implants do fail
or, as some people say, they are rejected. In many instances, they can be replaced
with another implant, usually of a slightly larger size. Failure rates should
be about 1-2%. Each
year I place 400 to 500 implants and each year 3 or 4 of them fail. I replace
those at no additional charge.
Do I have to go without my "teeth" while the implants
are bonding to my jaw bone?
Once again, the original protocol called for patients to go without
wearing their dentures for at least two weeks after implant placement. Over the
years, this has been modified considerably and in most situations, patients
leave the office wearing their teeth the day the implants are placed. Every
patient and procedure is evaluated separately and there might occasionally be a
recommendation that a patient go without their prosthesis for a short period of
time. You may also have to be on a soft diet for a period of time after implants are placed.
Bone
Graft
Sometimes when a dental
implant is placed, it is necessary to build up the bone in the area to insure
success. The procedure of building up the bone is known as Bone Grafting. Bone
grafting is a very common procedure in dentistry and it is used quite a bit
for dental implants and in periodontal procedures around natural teeth. In order
to do bone grafting, we need a source of bone to place in the site. The bone
that we use can be one of three types. The best bone is bone that is taken from
the patient that we are working on. This bone can be taken from other areas
of the mouth or collected in our suction apparatus as we drill into the bone
to prepare the sites for dental implants. Occasionally this bone is taken from
areas outside the mouth, such as the hip. When bone is taken from the hip, it
is usually done in the hospital by an orthopedic surgeon and transferred to
the dentist doing the implant procedure in the OR.
Another very common source
of bone is bone taken from cadavers. This bone is harvested under very strict
supervision at several bone banks around the country and it is used in many
dental and medical procedures. There has never been a case of a transmitted
disease with this type of bone. It is very safe and very useful in our work
to help patients. A third type of bone is a synthetic type of bone taken. This
has some use in dentistry but it does not seem to be as useful as the first
two types of bone.
For more detailed information
on bone grafting techniques CLICK
HERE.
The
cost of dental implants.
In some situations today, we still pay for
these services according to the number of implants used. Dentistry, however, has
realized that the number of implants used for a given restoration is most important
in terms of the success of the restoration, not the overall fee and we have begun
to start charging patients according to the complexity of the overall procedure.
It is certainly much more cost effective when the same dentist both places and
restores a patient's dentition, but this is not always possible. In the future,
as dental implants are incorporated into the scope of general practice, implants
will be not only much more widespread in their use, but much more cost effective
for the patients. If you would like to see my fee schedule, just Click
Here.
A Bridge or a Dental Implant
Perhaps one of the most
frequently asked questions on this site is whether or not to use a fixed ("permanent")
bridge or a dental implant to replace one or two missing teeth. Suppose you
are missing your lower left first molar. If a fixed bridge were to be used,
your dentist would cut down the adjacent teeth (the second molar and the second
bicuspid) and fit a three unit fixed bridge over those two teeth. The missing
tooth would be called a pontic and it would be effectively replaced by the three
unit bridge. If your dentist were to use an implant with a crown on it, he would
place an implant in the site of the original first molar. He could do this immediately
or at some date after the first molar was removed. There is no time limit here.
The implant will take about 3 months to connect with the bone and then at that
time, your dentist can construct a single crown on the implant to replace the
missing first molar.
The cost of each one of
these procedures varies from office to office, but a three unit fixed bridge
costs about the same as an implant and a crown. The actual decision to do one
over the other rests with you and your dentist. One technique is not inherently
better than the other and each depends upon how you present and your dentists
skills. All things being equal, I would usually prefer to place the implant
and crown over the bridge.
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