What is a dental implant?
A dental implant is nothing more than a metal screw that is placed into the jawbone and acts as a tooth root when someone has lost a tooth or teeth. It acts as an anchor for a false tooth or a set of false teeth. When a dental implant restoration is perfectly constructed, neither the patient or anyone else should have any hint that an implant is there. All you should see is a natural-looking permanent tooth.
Who is a candidate for a dental implant procedure?

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 anchoring 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 removable partial dentures, small bridges and even missing single teeth. If a patient does not have enough bone to support a dental implant, bone grafts can be placed.

The primary consideration for the suitability of dental implants for any patient is the amount and condition of the bone in the area where the implant is to be placed. With the loss of a tooth, the area of the jaw without the tooth naturally undergoes resorption, or a thinning, of the bone in that area. Without enough healthy bone at the implant site, this process cannot occur and the implant will fail. The less bone available in which to place the implant, the greater chance of the implant not “taking” in the region. A common type of implant, called “root form implants,” due to their similarity in shape to a tooth root, actually undergo a bonding with the surrounding bone called osseointegration.

There are two solutions commonly used for highly resorbed bone in the area where the implant is to be placed. The first is bone grafting. Dental bone graft is a procedure that moves bone from one place in the body to another to enlarge the bone structure at the implant site. Often, bone can be moved from one place in the mouth to another. Sometimes a graft from a donor or an animal or artificial bone can be used if bone from the patient is not available. Bone grafts are usually is done around four to eight months before the implant procedure, to allow the dental bone graft to heal before it is integrated with the implant process. A second solution is the use of subperiosteal implants that ride above the bone but beneath the gum. A CT scan is commonly used to obtain a model of the bone structure and then the implant fixture is molded to precisely fit the bone model. These types of implants are not placed in the bone.

What will happen at the initial consultation?

At the first appointment, we will examine your teeth and determine whether implants are the best solution for your dental problems. Often, X-rays are necessary to discover the state of the jaw and bone, particularly if the teeth have been missing for some time. This information can be used to determine if implants would work for you and, if so, what particular type of implant would be best for your situation. This is why we recommend considering implants as an option as soon as teeth are missing, to avoid loss of bone structure and thus the integrity of the shape of the mouth.

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 pretty close to 100%. Success rates of implants in the back part of the upper and lower jaw can be in the 95% range. The success rate in my practice 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.

However, in recent years, especially in my role as an expert witness, I have seen some extreme situations where dentists who were poorly trained in these techniques have caused major problems for their patients. I have had to correct many badly performed implants and I can tell you it is not a pleasant experience for the patient. If it’s too good to be true… it probably is. Cheap is not best and when it comes to low-cost dental implants, patients really need to be careful with where they go and whom they choose to do their dental implant procedure.

Why have dental implants become so popular, and are they permanent?

As our lifespan 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. Dental implants are permanent because they fuse with the jawbone and essentially become part of your bone.

How is a dental implant procedure performed?

Under local anesthesia, the first step for many implant procedures is exposure of the bone where the implant is to be placed. This is followed by placement of the implant onto the exposed jawbone. Implants that are placed on the bone are called endosteal implants and are made of titanium, or a titanium alloy, because this metal does not adversely interact with biological tissue. After placement of the implant, a cover screw is put in and the opening is closed with stitches and allowed to heal. In general, placements in the lower jaw need to heal about three months, while placements in the upper jaw need to heal about six months.

After healing, in a second surgical procedure, the implant is uncovered, the cover screw is removed and a healing abutment or a temporary crown is placed in the implant. Temporary dental crowns are generally used for esthetic reasons when the implant is in a place that is visible. Both healing abutments and temporary crowns allow the tissue around the implant to be trained to grow around the final prosthetic tooth. After about two months, the soft tissue will be healed and able to receive the final prosthetic tooth.

Impressions are taken to make a custom abutment that takes into account the shape of the neck of the implant using impression trays. The prosthetic tooth is sometimes attached to a gold cylinder that can be screwed into the abutment or directly cemented onto the abutment. This multistage process, where the two surgical procedures are separated by a lengthy healing time, has proven to provide excellent stability in the final implant. Single-step surgical implants are available, but skipping the healing step often loses some stability of the final implant.

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 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 three months in the lower jaw and foour months in the upper jaw unless the patient is a specific candidate for the immediate loading procedure.

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. If we have patients who are especially anxious about dentistry, we have excellent dental sedation treatments that we use to minimize any discomfort or trauma. 

How long does the surgery take?

Surgery time will vary greatly depending on the number of dental implants. The rule of thumb is that one implant, going very smoothly, will take a little over an hour. Obviously, the more implants required, the time goes up proportionally from there.

Where will the procedure be performed?

The dental implant procedure will take place in our state-of-the-art high-tech practice. We also have a full i-house digital diagnostic center where all your scans and X-rays will be taken, thus reducing your time in the chair and, of course, your costs.

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 are not common and are usually more restricted to smokers and people with compromised immune systems. The key element to determining implant success is proper diagnosis and treatment planning

A bridge or a dental implant?

Perhaps one of the most frequently asked questions I get is whether or not to use a fixed (“permanent”) bridge or a dental implant to replace one or two missing teeth.

I usually prefer an implant because they are much more stabilizing for the jaw itself and implants present many benefits.

Replacing missing teeth is vital to maintaining the overall health and function of the surrounding teeth. It helps avoid tooth migration and loss of structure. It is necessary to avoid loss of bone from the jaw in that area. Dental implants are an effective means of counteracting these problems. Dental implants are also very strong and provide a feel as close to a natural tooth as can be currently achieved. Further, implants reduce the impact of the lost tooth on surrounding teeth, as traditional bridge structures often require reduction (filing down) of the two adjacent teeth to hold the bridge in place with crowns. Implants avoid such alterations to the surrounding teeth when replacing a lost tooth.

Dental implants, when replacing dentures, provide even more benefits. Dentures are notorious for slipping at the worst possible moments. Poorly fitting dentures can even affect diet, restricting food selections to easily chewed foods. Implants eliminate the possibility of slipping or pinching and allow food of almost all types to be eaten (other than extremely hard foods, such as pits or popcorn kernels, or chewing ice, which is very bad for the implants and not good for natural teeth, either). In short, dental implants are the closest way to surgically reproduce a natural tooth.

Do I have to go without my “teeth” while the implants are bonding to my jawbone?

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.

What can I expect after dental implants?

Following surgery, there will probably be bleeding, controlled by biting down on some gauze. Swelling may be controlled using an ice pack. Gums are generally sore after both surgeries for seven to ten days. You may be given antibiotics to take during the period immediately following dental implant surgery. Ibuprofen can also be used to relieve swelling.

What is the recovery period like?

Many people have very mild soreness, bleeding or swelling, which can be treated with first-aid and over-the-counter medicines, and can return to work the day after surgery. Between the first and second surgeries, there is a recovery period of three to six months while the implants assimilate with the bone. This growth of the bones around the titanium posts may induce a few weeks of soreness. This discomfort can usually be controlled using over-the-counter medication.

It is very important during your recovery to practice scrupulous oral hygiene. Poor care, resulting in chronic swelling of gum tissue, is a major contributor to implant failure. You may need to see your dentist about four times a year to keep track of the implant health.

What is the long-term outcome with dental implants?

For most people, dental implants last between 15 and 25 years and really do mimic your original teeth but without the risk of decay. They may last significantly longer, but this is probably an average.

What are the risks?

A further consideration as to the suitability of implants is the patient’s general health, especially whether or not the patient smokes. Although the exact cause of the connection is not known, dentists hypothesize that the nicotine in cigarettes, known to shut down blood vessels, interferes with the healing of dental implants. Whatever the cause, heavy smokers are known to have a higher failure rate for implants than those who do not smoke. Other chronic conditions that affect healing, such as cardiovascular diseases, diabetes and immunosuppressive conditions, can also increase the chance of implant rejection.

Dental implant costs

Cost of dental implants can be very expensive, particularly if a number of them are needed to restore the teeth lost by the patient. Each surgical step has its costs, as do the fixtures. The primary consideration for implants is the suitability of crowns. We offer a “on-stop shop” where we do both the dental implant procedure and the restoration, which makes the cost a fraction of what other dentists charge.This is something many patients do not realize. They get a low-cost dental implants price from their dentist but do not know to ask about the additional restoration, and once they have the implant realize that they now need the crown, which is an extra charge. We do everything from start to finish – saving our patients time and money.