Maxillary edentulous area
- Fxed-detachable prosthesis
- Overdenture prosthesis
Mandibular Completely Edentulous
- Fixed denture prosthesis
If you are self-conscious about missing teeth or wearing dentures, there’s an alternative that may be right for you.
Dental implants are one option for replacing missing or badly diseased teeth. A dental implant offers comfort and stability and by virtue of the artificial tooth it supports, is a restoration that is the closest thing to a natural tooth.
Dental Implants is titanium fixture that serves as a replacement for the root portion of a missing natural tooth. Titanium is used because it is the most compatible with our human body. The dental implant is placed in the bone of the upper or lower jaw and functions as an anchor for the replacement tooth. After the bone has grown around the implant, implants can hold a crown, bridge or overdenture just like roots hold natural teeth in place.
Implants provide additional support where teeth are missing without putting forces onto remaining natural teeth. They may be used to support the replacement of a single missing tooth or a complete functional set for individuals who have lost many or all of their teeth.
There are of course cases where no implantation can be done, for example:
Children during growing age, adults with serious heart problems, increase tendency for bleeding or bone diseases and patients who are addicted to certain medication, drugs or alcohol. Diabetics can receive implants but the blood sugar level has to be adjusted and monitored during the period of treatment. In this case, a close cooperation with your dentist is very important.
Like your natural teeth, good oral hygiene is essential for the longevity of your implants. Inadequate hygiene will result in failure and subsequent loss of the implants. In cases where oral hygiene is inadequate, your dentist can and will reject the treatment for implants.
The above are just a few of the cases where implantation is not possible. Please consult your dentist for individual case. But remember, age is not a factor.
All the common froms of tooth replacement, such as bridges or dentures can be replaced by dental implants. If you missing just one natural tooth, then one implant is normally all that will be needed to provide a replacement. Larger spaces created by two, three or more missing teeth do not necessarily need one implant per tooth, however the exact number of implants will depend on the quality and volume of bone at each potential implant site.
In the upper jaw, bone density is generally poorer than in the lower and if you have no teeth at all, most treatment providers will want to place a minimum of 6 implants to support a complete arch of 10 or more replacement teeth.
In the lower jaw, the bone towards the front of the mouth is often very strong and as a direct result, fewer implants may be needed than are required to treat a whole upper jaw. A simple treatment plan to provide 10 or more teeth in the lower jaw might be possible with as few as 4 implants, although it is still more common to use 5 or 6.
What else can be done with dental implants?
If you have no teeth in the lower jaw, and are not yet ready for multiple implant placements, a convention lower denture can be considerably improved with two implants placed beneath the front section, this is called an overdenture . The same overdenture concept when used to treat the upper jaw, will usually require more implants as the bone is generally softer. Implant-supported overdentures, just like conventional dentures are still removed for daily cleaning, however, once back in the mouth, the implants make them much more stable.
Dental implants have to obey simple engineering principles, in that they must be placed in strong foundations with enough of them to prevent overloading.
When teeth are lost, ongoing shrinkage of the jawbone occurs making the face look older. Dental implants can slow or stop this process. Dental implants look and feel like your own natural teeth.
Dental implants eliminate the pain and discomfort of removable full or partial dentures. Since denture sits on top of the jawbone and gums, continuous shrinkage of the jaw bone alters the fit of the denture resulting in slipping or rocking of the dentures. Exposed nerves and irritation of the gum tissue may add to the discomfort
Implant supported replacement teeth are like natural teeth because they are anchored securely to your jawbone.
With ill fitting dentures, the teeth slip and side around the mouth. The facial muscles become tense in an attempt to hold the teeth in place. This often results in mumbling, slurred speech or clicking noises.
As the jawbone shrinks, your chewing efficiency is reduced even more, making it difficult to eat certain foods. Dental implants can restore chewing efficiency comparable to that of natural teeth
This allow you to eat your favorite foods with confidence and without pain, enjoy what everyone is eating and not think twice about it. A full upper denture covers the palate of the mouth and reduces the ability to taste foods. With dental implant, you can have the palate removed from your upper denture so you can taste and enjoy your food.
Dental implants can eliminate the numerous embarrassing inconveniences of removable partial and full dentures. You will no longer need to cover your mouth when you laugh or smile, for fear that your teeth will pop out or fall down.
Protect your remaining natural teeth
Dental implants are often more appropriate than a bridge for the replacement of one or more adjacent teeth. With conventional bridgework, the teeth surrounding missing teeth must be ground down.
Considering all other benefits, dental implants can improve your self-esteem. You may feel better about yourself. You can regain nearly all the capabilities that most people have with natural teeth, giving you renewed confidence, and allowing you to enjoy life, do what everyone else is doing and not think twice about it.
For routine cases, from the implant placement to the time of placing the first teeth, treatment times can vary between 6 weeks and 6 months. The availability of better bone can be used to decrease treatment time, whilst more time and care must be taken with poorer bone, which can therefore extend treatment times beyond six months.
The bone quality and the number and position of the implants will largely determine which option is most suitable for you. When the implant supported teeth are linked together, they are mechanically stronger than the individual parts and can better resist the forces of normal function which will try and undo the screw components, posts and/or cements that secure the underlying structure to each of the implants.
The success of each treatment stage will be the main factor determining how the implants are performing. It is the quality of your home care and willingness to present for regular maintenance reviews that will have most influence on how long they will last.
When poorly cared for implants will develop a covering of hard and soft deposits ( calculus and plaque ) which is very similar to that found on neglected natural teeth. Untreated, these deposits can lead to gum infection, bleeding, soreness and general discomfort, just as can occur around natural teeth. It could probably be said that implants much like teeth will last for as long as you can keep clean.
Dental x-ray show large amounts of detail, but in only two dimensions. From these views it is generally possible to judge the height of bone available for implant placement, however, more advanced imaging techniques are sometimes needed to determine the equally important bone width, which can otherwise only be estimated from clinical examination.
Dental CT scans are now a number of advanced x-ray techniques which allow your jaw bone to be looked at in all three dimensions. The most accurate and widely available is known as the CT (computed tomography) scan. Images obtained by CT scanning will normally be able to show all of the information required about your bone, including quantity and quality, but most importantly the presence of anatomical structures that must be avoided.
Upper jaw – provided the implants stay within the bone that once supported your own teeth there are really no important risk areas. If you have missing upper back teeth then the shape and location of the maxillary sinus (the region above the roots) can be shown you. The maxillary sinuses can be seen on most x-ray and are therefore readily avoided.
Lower jaw- the most important anatomical structure to be avoided is the “inferior dental nerve”. This nerve runs from the area behind the wisdom teeth, passes under the molars and emerges onto the skin of the face in the region where your premolar teeth are or used to be.
CT scans are generally the best means for identifying the location of this nerve and allow implants to be placed with considerable confidence, however these are rarely available within a normal dental surgery environment. Whilst CT scans are often invaluable for complex treatment planning and knowing where important anatomical structures are located.
Although it is quite straightforward to provide good pain control during surgery, most people will be quite anxious for all but the most simple of implant cases. There is no need to suffer in silence as there are several very effective means by which you can achieve a relaxed state.
Conscious sedation- For treatment of greater complexity it may be suggested that you have a more controlled way of keeping relaxed and comfortable during the surgical stages. This is known as a “conscious sedation” and is distinctly different from a general anesthetic, because you remain alert enough to respond to simple instructions which may be helpful to the surgeon- however you will remember almost nothing about the treatment stage. It is particularly beneficial for procedures taking more than an hour where a hospital admission is not required- this is probably true for the majority of treatments related to dental implants. For a routine “conscious sedation” a carefully controlled amount of sedative is delivered through a vein in your arm or hand for as long as the treatment takes. It is a very safe procedure during which your heart rate and oxygen levels are monitored throughout by an anesthetist.
With conscious sedation, a normal dental local anesthetics is injected around the proposed implant sites. Most people do not remember this stage because the sedation has already taken affect by the time the dental anesthetic is given.
General anesthetics require a hospital admission and are mainly, but not exclusively used for complex cases such as where bone is being grafted from the hip to the mouth, or where large numbers of implants are being placed at the same time. Most patients will not require a general anesthetic since conscious sedation is very much safer and has fewer post-operative complications.
So far we have covered the building blocks that are part of routine implant placement. This has included the initial examination and diagnosis, special x-ray such as a CT scan, sedation during surgery and what to expect after the implants have been placed. However, for some people, bone loss after the removal or loss of teeth leaves them without enough to secure an implant.
Sinus augmentation- In the upper jaw above the back teeth, it is possible to increase the height of bone available by creating new bone in the sinus. This procedure is called “sinus augmentation”. A skilled surgeon can deliver very predictable results in this location and without the general success of this technique many patients would be unable to have implants in a part of the mouth where teeth are so commonly missing.
Onlay grafting- There are many ways in which bone can be added to, however one simple concept is to take a piece of bone from somewhere else and secure it as an “onlay grafting” to a deficient area. The new piece of bone will slowly join to the underlying region and when healed and mature, an implant can be placed in a more favourable position.
Bone can be harvested from a number of sources such as the hip, tibia, chin and posterior regions of the lower jaw. When you use your own bone to create new bone in another area of the mouth you will have to contend with the discomfort created by the donor site as well as the surgical site. Many people feel this is well worth any additional discomfort as your own bone is normally considered the “gold standard”.
Alternatives to your own bone for grafting
All of these materials including your own bone, simply provide a scaffold into which new bone will grow and consolidate ready to receive dental implants a few months later. New bone can take anything from 3 to 12 months before it is ready to receive dental implants. Do not be in a hurry to move to the next stage. If you need a large volume of bone it will take longer to mature than a small amount.
Guided tissue regeneration- Each surgeon will have his or her preferred way of creating new bone. Many of them will also use a supplementary technique called “guided tissue regeneration”. Using this technique slow moving bone cells are given time to fill a space by placing a barrier material between them and the fast moving cells of the soft tissues lining the mouth. When this technique was originally developed the barrier material had to be removed during a separate surgical stage a few months later. Whilst these original materials are still in use, it is now more common to use a “resorbable barrier” that will disappear naturally a few months after it has done its work.
If you need bone grafting, it will almost invariably increase the length of time your treatment will take, however when successfully applied it will greatly improve the outcome of the implants placed. When used in the front of the mouth it can also allow for creation of very much better aesthetics
Bone grafting requires a considerably higher degree of skill from the operator and is often more complex to perform than the placement of the implant itself.
In certain situations some operators will be recommend combining the implant placement with bone grafting and the placement of a barrier membrane all at the same time. This considerably reduces treatment time and can produce results that are difficult to achieve any other way. However, many surgeons will still prefer to carry out bone grafting as a distinct stage, so that the implants are only placed when the bone grafting has been successful
Whatever method is chosen to improve the bone quantity the time, effort and expense is generally well worthwhile.
One-stage implant - The implant is placed into a new, healing or healed extraction site and is visible above the gum immediately after placement. The advantage of this method is that a second surgical stage is not necessary to expose the implant. The implant will not normally be ready to support a tooth for several weeks or months.
Two-stage implant- The implant is placed into a new, healing or healed extraction site and then covered by a layer of gum so that it cannot be seen- this is the first stage. At the second stage some weeks or months later, the implant is uncovered and components added bringing it above the gum ready to begin placing a new tooth.
Same day implants- This technique is most often used to treat the lower jaw and requires considerable planning before the actual day od surgery. Several implants are installed and few hours later a complete arch of temporary or permanent teeth can be fixed in place. If temporary teeth are used these will normally be replaced with a permanent bridge after a suitable healing interval. Not all patients are suitable for this style of treatment.
Immediate implant- For this technique a tooth is removed and an implant placed immediately into the extraction site. Depending upon the local bone and soft tissue conditions, the implant surgery may be a one or two stage procedure. Not all patients are suitable for this approach.
Immediate implant and early loading- This is distinctly different from an immediate implant placement. It is effectively a one stage technique where the implant is placed into a new, healing or healed extraction site and is fitted with a new tooth at the same appointment. This first tooth will normally be kept out of direct contact with opposing teeth for a healing period of more than 3 months, after which it is finally restored. This technique tends to be more common in regions of the mouth where optimum aesthetics are important. Not all patients are suitable for this approach.