IMPLANTS
FREQUENTLY ASKED QUESTIONS
WHEN SHOULD I START IMPLANT TREATMENT?
SOONER IS BETTER THAN LATER!
Always consult with your dentist about your options and be sure that you completely understand the alternatives. If you decide that attempting to fix or replace a tooth is not physically possible or financially prudent, act rapidly. Delaying the removal of a hopeless or infected tooth generally extends the treatment time, decreases your options, and increases your health care costs. Infection can destroy bone rapidly. Your body tells the bone to shrink away after a tooth is extracted. Implants are dependent on strong adequate bone volumes for support. Preserving the bone will save you time and money.
WHEN DO I REMOVE MY BAD TOOTH?
If a root canal has failed, it may be retreated but the success rate decreases. Every re-treatment weakens the tooth more. Is there enough tooth left to withstand the force of biting or will it simply "break" later? Don't leave an infection that will destroy the surrounding bone. Remove the tooth as soon as possible, but have a plan.
If a tooth "cracks" and the fracture line runs through the body of the tooth and root, it may not be fixable. The crack will harbor bacteria and eventually infection will destroy the surrounding bone. Remove the tooth as soon as possible, but have a plan.
If gum disease has already destroyed the bone around a tooth, the tooth may require future extraction when it becomes loose or you have a gum infection flare up. Recurrent infections destroy the available vertical height of bone that allows us to use implants of optimum length. Loosing available bone increases the proximity of implants to nerves and sinuses. If only 10 mm of bone remains near the root, you have reached a "fork in the road". Do I continue periodontal care for my natural tooth or do I extract the tooth while there is enough existing bone to support an implant with minimal surgery? Remove the tooth as soon as possible, but have a plan.
If decay has destroyed the visible tooth above the gum, it may be restorable using a "crown". However, that tooth may need a root canal and post foundation later. It's usually condemned if there is decay into the root. Your dentist can advise you about future expectations based on how much healthy tooth structure remains. The less tooth, the shorter the success of treatment. An implant may be the treatment of choice when an extensive amount of tooth structure is lost and the success for conventional care is hazy. Don't be caught saying, "I wish I had all the money I spent on this tooth to do an implant". Remove the tooth as soon as possible, but have a plan.
"THE SOONER YOU START, THE SOONER YOU FINISH"
Implant treatment takes time. There are usually three phases and prosthetic restoration. If treatment is started before the bone shrinks away, site development may not be necessary. In certain types of hard bone, fixture placement and restoration of the implant can be carried out in combination. Delayed decision making allows the bone to deteriorate. The shape of the gums change. Adjacent teeth can drift and change position. When the decision to place an implant is made late, the phases of care will be more complicated and take a longer period of time. Temporary restoration will need to be made; some break, some wear over long periods of time. Remove the tooth as soon as possible, but have a plan.
"DESCRIBE THE PHASES OF TREATMENT I MUST UNDERGO
TO RECEIVE MY IMPLANT"
There are generally three phases of care. Each phase may be combined or even unnecessary depending on your specific needs and dental circumstances. Three are presented to help provide an overall understanding of what needs to be accomplished for your success. Review your concerns with your dentist directly. Be sure you fully understand your care before you consider starting your care. Success depends a great deal on an individuals healing potential and anatomy. The best laid plans often need changing based on healing results. Our staff is not only a treatment team, but also a support team. We try to customize the phases to match your life style. Working together and sharing inputs are mutually beneficial and contribute to overall success. Compromises and alternatives are always options that need to be discussed and worked out with reasonable expectations.
"PHASE ONE: SITE PREPARATION"
Site preparation refers to creating adequate bone shape and density in the jaw to allow proper implant placement. The location of a recently extracted tooth may not need any alteration if the bone is naturally large enough. No site preparation would be required.
When locating an implant where a tooth was extracted many years ago, we will usually find short, thin bone. Site preparation may involve widening the bone with a graft to increase thickness. Increasing height in a site is very difficult. Upper back teeth are usually very close to the sinus. To get vertical height to accommodate the implant here, we can raise the sinus floor and place a bone graft to match your needs.
Gum shaping and tissue thickness are often cosmetic concerns. Tissue can be thickened with soft tissue grafts where necessary.
Final expectations need to be shared from the start to maximize the benefits of planning. In general, less site preparation is required and cosmetic outcomes are optimized the sooner implant placement occurs after extraction.
"PHASE TWO: FIXTURE PLACEMENT"
The fixture is the portion of the implant that is within the bone. A hole or osteotomy procedure is completed and the fixture is threaded and stabilized into place. The implant is only temporarily stabilized by the "screwing in" process. Your body dissolves the old bone around the implant and re-deposits new bone. Because the implant fixture is made of titanium, bone cells can fuse to the implant surface and create a bond called "osseo-integration". A successful implant requires four to six months of healing for osseo-integration to occur depending on the bone quality. The fixture is uncovered and a special instrument measures to see if the implant can be torqued or turned within the bone. If the implant is firm to required test levels, it is considered to be adequate for a final restoration.
"PHASE THREE: ABUTMENT/RESTORATION PLACEMENT"
The "abutment" is the portion of the implant that passes through the gum tissue. It is "job specific". Most of my patients would think of the abutment as a tapered cylinder that a crown will slide over to create the shape of a tooth. The abutment may be used under dentures and look completely different. It could be a ball shape that will eventually snap into a receiver on the bottom of the denture. In either case a small incision is made above the fixture through the gum tissue. The "abutment" is placed and it is held in place with a screw.
We commonly use temporary crowns to eliminate "holes in your smile" during treatment. It may be fixed or it may be removable depending on your case. We use Invisalign Technology for special cosmetic concerns. Using this technology, patients can move their teeth, bleach their teeth, and fill in the empty space while waiting for the implant to heal and final restoration. In dense bone, we may be able to place a temporary on the implant at the time of placing the fixture. In other cases, we construct a temporary as a prototype of the final crown and use it to help grow and cultivate the shape of the final gum tissue for superior cosmetics. We customize the temporization process to your individual needs.
WHY WOULD YOU RECOMMEND AN IMPLANT AT MY AGE?
"Today is the final day of the rest of you life" was the sage wisdom of my mother. She felt we are all entitled to the best quality of life we can afford. This logic is adequate for many making decisions about healthcare where fear and finances are not issues. Real world decisions are complex and we tend to focus on our age. The amount of benefit to fulfill our needs over greater life expectancy is a valid question that needs to be answered.
"I WOULD IF I WERE OLDER"
Sooner rather than later is always the best choice. Bone degrades after a tooth is lost. Key esthetic features of a smile are lost. In addition to unpleasant spaces, teeth drift, gaps open, and bone shrinks. Implant site redevelopment is expensive and can be avoided with early planning and decision making.
Most young patients are missing teeth because of congenital or traumatic reasons. Why cut down healthy unharmed teeth on each side of a missing tooth to make a bridge that is cemented in place if it is not necessary? Usually, teeth that are cut down at an early age will require root canal treatment because the nerve is injured by the procedure. Damaging the nerve also affects the growth of the tooth wall, leaving a thin root that is prone to fracture from simply biting. Unfortunately, almost all of treatments in dentistry involve taking away tooth structure. The less tooth that remains after any type of dental care, the shorter the expected length of time before a tooth problem will redevelop. Three tooth bridges tend to become four tooth bridges. As the bridge becomes longer and its span increases, it flexes and fails more often. Precious metal fatigue and porcelain breaks. Repair and remakes are expected every 5 to 15 years.
The choice is not simple. It requires a consultation with your dentist and personal understanding. Know your alternatives.
"I WOULD IF I WERE YOUNGER"
If your health is good and you have not had a long-term exposure to bisphosphonates, (osteoporosis medications), implants are an option. Implant placement is much easier today. Recovery and discomfort have greatly been reduced in common placement procedures. Most elderly individuals, although concerned about cosmetics, are primarily focused on function. Implants placed under an existing denture greatly increase the stability, reduce the need for dental adhesives and reduces sore spots. When you loose the bone, implants provide the anchors. The more anchors, the more security.
Sometimes after years of dental care, a tooth breaks that is surrounded by traditional sound dental restorations. Rather than remove dental work that is trouble free to build bridgework that is more complex, an implant may be the solution. Tooth out, implant in. Leave the adjacent dental work alone.
Remember that implants don't decay and they tend to resist conventional gum disease if maintained with proper dental care. Even if you are middle aged, selecting an implant will give you options in the future. Crowns can be changed from the base implant to accommodate many changing needs. After an implant has been in 3 years, it will probably be there indefinitely if properly cared for.
As dentists we know that 90% of patients don't wear their lower dentures even when properly fitted. Eating and nutrition become all the more important to our quality of life as other medical problems challenge our bodies. Implants may be a solution that resolves your problems with chewing. You will need a personal consultation and an honest discussion with the doctor to find our if implants are right for you.
WHY DO YOU USE NOBEL IMPLANTS? AREN'T THEY THE MOST EXPENSIVE?
Yes, in general, this is true. But implants are designed and engineered to last a long period of time. NOBEL was the developer of Dr. Braanemark's prototype titanium implant system in the early 1980's. They have provided unsurpassed research and development on their products since then. The implant is research based. NOBEL BIOCARE continues to support extensive research worldwide. When you ask about the evidence-based technology for dental implants, NOBEL paved the way. Other systems are copycats, but can never be the same due to patent infringement. When we want something to last a lifetime, our office feels detail matters.
ARE THEY DEFINITYELY BETTER FOR THE COST?
Maybe. Quality is high. Most important to you is whether NOBEL will be around if you have a problem. Corporate financial solvency and quality parts availability is a very important part to the equation for long term success. Everything man made needs maintenance and repair. NOBEL is the oldest implant manufacturer and has maintained and supported its product line since the early 1980's. We believe past history is the best guide to the future.
