DENTAL
IMPLANTS....One day implant
Healthy teeth make
life more enjoyable, giving you a sense of well-being, and
general comfort. A beautiful smile enhances your appearance
and can provide added confidence and presence.
Immediate
Load Dental Implants - The Procedure
Cracked Bicuspid
This 48 year old female presented with a chief complaint
of a cracked tooth. Upon examination it was found that she
had fractured the lingual (inside) cusp of her left upper
first bicuspid.
It was fractured below the gum line
to the crest of the bone. The main reason it fractured was
the existence of a large amalgam filling which weakened
the tooth.
Treatment
Options
The patient had two treatment choices. We could perform
root canal therapy, place a post and core, and then do a
crown lengthening procedure to expose more tooth structure.
Doing so would have required removing some gum tissue and
bone. Then place a crown on the tooth.
The other option would be to remove
the tooth, place an implant and immediately place a temporary
crown.
The patient opted for an implant
and crown.
Immediate Load Implant Criteria
To do an immediate load implant, certain criteria have to
be met. There has to be adequate bone, a large enough implant
needs to be placed, and the implant once placed has to be
able to resist at least 40 ncm of force.
The temporary crown has to be adjusted
so that no forces are placed on it during function. Meeting
these criteria allows the bone to grow around the implant
(osseointegration). After a period of nine weeks a permanent
crown can placed.
The following picture sequence demonstrates
an ideal situation for an immediate load implant or what
I call a Vanity Crown because the patient refused to go
out in public with a missing tooth.
A template was made of the tooth
prior to removing the fractured cusp so as to facilitate
fabrication of a temporary crown.
An important factor in this procedure
is to carefully remove the tooth without removing any bone
in the process.
In this photo, we are using a periotome,
a thin instrument, to separate the root from the bone.
Preparation of Implant Socket
The photo here shows successful removal
of the broken bicuspid and all root material.
The remaining boney socket (darker
eliptical area) can be seen after the tooth was removed.
Socket Drilling
The socket was prepared with sequentially sized bone drills
to accept a Nobel Biocare Select 5.0mm x 13mm implant.
In this photo the final sized drill
bit is being used.
Precision Implant Placement
The implant is placed and tested with a torque wrench to
see if it can be displaced with a force of 40 ncm.
This implant was proven to be extremely
stable.
Zirconium Abutment
Next we customized a zirconium abutment and attached it
to the implant with a torque of 35 ncm.
One of the advantages of using a
white zirconium abutment as opposed to the silver colored
titanium is that there is no graying of the overlying gum
tissue.
X-ray Confirmation: Successful Implant
This is an immediate post operative x-ray taken showing
the implant, zirconium abutment and temporary crown. Note
how well centered the implant is between the canine and
2nd bicuspid.
The size of the implant and surrounding
bone give more than adequate anchorage to place an immediate
abutment and temporary crown.
Temporary Crown
The last photo shows the fitting of the temporary crown
(Vanity Crown) that enables the patient to avoid the "toothless
look" she was fearful of.
After 9 weeks, osseointegration has
been achieved (bone material has completely integrated the
implant substance), the permanent porcelain crown will be
placed.
The porcelain material will be matched
precisely with the patient's existing teeth. Future cosmetic
considerations for the patient include replacement of old
amalgam fillings, all ceramic crowns, porcelain veneers
and Zoom teeth whitening.
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Dental
Implants Frequently asked Questions
Is the concept
of dental implants a new one?
Interestingly, dental implants have been performed for thousands
of years. Egyptian mummies have been found with gold wire
implants in the jawbones. Pre-Columbian skeletal remains
exhibit dental implants made of semi-precious stones. Recently,
a Roman soldier was unearthed in Europe with an iron dental
implant in his jawbone. In the Middle East, implants made
of ivory have been discovered in skeletons from the Middle
Ages.
Modern implantology
began in the United States at the beginning of the 20th
century. However, popularity really grew in the 1980’s with
the increased success of the titanium cylinder. Since then,
many brand name implants with minor variations have been
approved.
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What factors
contribute to long-term success of Dental Implants?
Long-term success
depends on multiple factors. First off, success will depend
on the quality and quantity of bone. The better the bone
and the more available, the greater the chance of long-term
success. Secondly, the experience and ability of the dental
surgeon will be a factor. As with any surgical procedure,
there is no substitute for the experience and individual
talent of the dentist. And finally, the quality of the restoration
placed on top of the implant will play a big role in long-term
success. If the design of the implant crowns or overdentures
are poorly constructed, and biting forces are not balanced,
even the best-placed dental implant will have a compromised
survival rate.
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Who can place
a dental implant in my mouth?
A periodontist, an
oral surgeon, or an implantologist places dental implants.
The periodontist and oral surgeon are teamed with a restorative
dentist. They will place the implants and then the patient
will be seen by a restorative dentist for completion of
the crowns or overlying appliance. There will be two dentists
during the course of treatment. An implantologist is trained
in both dental implant surgery and restoration of the dental
prosthesis. An implantologist will do both the surgery and
the restoration, and there will be only one dentist during
the course of treatment. Click here to find an implantologist
near you.
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Who can
restore the teeth on the top of dental implants?
A general dentist
trained to restore implants, an oral implantologist, or
a prosthodontist can restore teeth. It is the choice of
the patient to use a "one doctor approach," whereby
the oral implantologist does both the surgery and the restoration,
or the "two doctor approach," whereby the surgery
and restoration are performed by two different clinicians.
Click here to find an implantologist near you.
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Are there
any age limitations for dental implants?
No. Any person at
any age can have dental implants as long as there is enough
bone available in which to place the implants.
What might be some
of the factors that would prevent me from being an implant
candidate?
There are some medical
factors that might prevent a person from being a good candidate
for dental implants. Some of these may be uncontrolled diabetes,
chemotherapy or radiation therapy, parathyroid disorders,
blood disorders, rare bone disorders or bone marrow cancer.
Some physical factors may include insufficient or poor quality
bone, low sinuses or nerve bundles.
How often
will I need to have my dental implants checked?
The success of your
implants will depend greatly on how well you maintain them.
They will need to be professionally cleaned by a hygienist
and examined by your implant dentist every three to four
months. This hygienist should be trained in the specific
procedure of maintaining dental implants. Also, brushing
and flossing daily is absolutely necessary for long-term
success.
Is dental
implant surgery painful?
No. An effective
local anesthetic is used during the surgery so that you
do not have any discomfort during the placement of the implants.
The mild discomfort you might experience after surgery can
be controlled with medications.
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When
can I return to work after implant surgery?
You can go to work
the next day, unless some particular surgical circumstance
arises. Your implant dentist will discuss all postoperative
instructions with you.
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Additional Information
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Benefits
Dental implants have
given countless patients many amazing benefits.
You will smile again
Improved appearance
Improved comfort
Improved speech
Eat better, enjoy
more foods, better nutrition
Convenience
Improved self-esteem
Dental implants are
also a great value for your investment. You will be getting
a product that you will be using 24 hours a day, 7 days
a week, 52 weeks of the year, probably for many, many years
of your life.
