Dental implants are now a very common procedure to replace missing teeth or to help hold a denture in place to increase its function and comfort. Not everyone with missing teeth is suitable for dental implants. To ensure the long life of an implant, some special techniques and efforts are required to keep the implant clean and free of dental plaque. Plaque may cause infection in the tissues around the implant and lead to its ultimate failure.
If implants are right for you where you have any missing teeth
If your gums around the implant bleed or feel tender
Clean the implants and the gum tissues around them exactly as your dentist and dental hygienist advised you
Use the cleaning aids and techniques you have been advised to
Return for regular check-up and review appointments to check on the health of your implant
To care for all of your other teeth and gums
Dental implants are one of the most technologically advanced aspects of dentistry and enable a single missing tooth or several missing teeth to be replaced. Literally, a dental implant is a replacement tooth root that is made from titanium or other similar metal that is surgically embedded or implanted into the jawbone. During healing, the bone grows into the implant in a process described as osseointegration.
Depending upon the number of missing teeth, implant therapy differs:
|Number of missing teeth||Potential Implant Solution|
|One or two||Single implants for each replaced tooth, fitted with ceramic crowns|
|Several teeth adjacent to each other||An implant supported bridge, the number of implants will depend upon each individual’s situation|
|One or both jaws with complete tooth loss||A full bridge or full denture supported by implants, the number of implants will depend upon each individual’s situation.|
The finished ‘dental implant’ acts very much like a natural tooth, and as such needs good dental hygiene and regular review appointments with a dentist and dental hygienist. Dental implants are a highly effective and long-term solution to replace missing teeth and restore esthetics and function.
Figure: A dental implant acts like the root of a tooth that is missing.
If you have one or more missing teeth, in many cases they can be replaced by dental implants. Before the development of the technologically advanced dental implants we know today, missing teeth could be replaced by one of two approaches:
- A removable denture that is held in the mouth either by suction or by wire clasps attached to any remaining teeth, and needs to be removed for cleaning. A full or complete denture replaces all teeth in one or both jaws. A partial denture replaces some teeth and fits around the remaining natural teeth. Denture wearers are often concerned the denture may come loose when they are talking or eating, causing them embarrassment if other people notice, or that food may get caught under the denture causing pain or discomfort during meals; or
- A fixed bridge whereby the missing tooth is anchored to one or more natural teeth on either side of the missing tooth ‘bridging the gap.’ This treatment approach generally requires the adjacent teeth to be cut down to form an anchor to hold the bridge in place. Special cleaning techniques are generally required to clean under the bridged tooth.
A dental implant does not need to be supported by adjacent teeth, so there is no need to prepare or cut down other teeth nearby. The implant is anchored in the jawbone just like the root of a natural tooth so does not need to be, and cannot be, removed for cleaning. The crown of an implanted tooth is normally made of ceramic materials that can look as natural as the tooth which it replaces.
The following are some of the advantages of dental implants:
- Appearance – dental implants look and feel like your own natural teeth
- Comfort – as implants are fully integrated to your jaw bone, they feel like natural teeth. On the other hand, removable dentures rest on the gum tissue and can be uncomfortable, especially if food particles get trapped between the gum and the denture
- Food selection – with dental implants, there are no limitations to the foods you like to eat as chewing is as effective as natural teeth
- Speech is natural. With a denture, speech may be modified due to the bulk of the denture
- Self-esteem – dental implants provide a natural level of self-confidence that many denture wearers cannot feel as they worry the dentures can slip and fall out, and may have an ‘odor’
- Convenience – implants eliminate the need to remove dentures from the mouth for cleaning and sleeping
- Mouth health – dental implants closely replicate the root and bone around natural teeth. Dentures can trap food and dental plaque around other teeth leading to dental decay and gum disease.
Not everyone with implants enjoys all these advantages, due to individual circumstances of general and dental health.
The materials used in dental implants are most likely to be:
- The implanted root in the jawbone is made of titanium. Depending on the manufacturer and design, the implant may be a grade of pure titanium or an alloy of titanium with small amounts of aluminum and vanadium added for increased tensile strength and fracture resistance. The surface of the implant may be modified in various ways to encourage cells to grow and to integrate/fuse with the implant, forming a natural bond or seal with the body.
- The crown is most likely to be made of a ceramic material (porcelain-like) and may also contain some precious metals.
If you have missing teeth, first visit your family dentist to discuss the treatment options available to you. Implants are generally provided by a team of highly-trained dental professionals that includes some or all of the following providers:
- General dentist
- Dental hygienist
- Oral and maxillo-facial surgeon
In determining if you are suitable for dental implants, various members of the above team will assess your full medical status and dental health, including the amount and type of bone in your jaws. In some cases, the bone can be improved by adding grafts which will increase support for the implant and can help improve the appearance, especially around the front of the mouth and smile zone.
Immediately after the dental implant surgery you may experience some pain and swelling which is typical after any type of minor oral surgery. Your dentist may prescribe some pain medications and antibiotics. As healing progresses, any pain or swelling should subside over 5–7 days after the procedure.
Once fully healed, there should be no pain. If your implant becomes painful, you notice any bleeding from the tissues surrounding it, or it feels loose, contact your dentist; it may be developing peri-implantitis which is a condition that may result in complete failure and loss of the implant.
Even after a thorough examination or assessment, most patients cannot receive both the dental implant and a new tooth in one visit.
First, a full assessment and diagnosis will be made which includes your medical and dental health. X-rays and other imaging techniques will be used to assess the bone underneath the gums to determine if the bone can support the new implant and that there are no anatomical obstacles such as nerves or blood vessels in the proposed implant site. Two or more members of the implant team may need to review the findings of this first assessment. Inadequate or deficient quantities of supporting bone can also be corrected by the implant surgical team.
If all is well with the assessment, the dentist performs a minor surgical procedure at a following appointment to place the implant in the jawbone. A process of osseointegration then takes places as the bone grows into the implant, locking it in place. This process may take several months depending upon your health and type of bone at the implant site. However, in many cases, the implant and a provisional or temporary replacement tooth can be placed at the same visit
The dentist will plan to monitor the healing process. When the osseointegration is deemed to have progressed enough, an impression or mold of your implant will be made. Then a new dental crown will be created to match the color, shape, and size of your natural teeth. If you have many missing teeth, a personalized or custom bridge or denture will be made; sometimes requiring additional visits.
Follow all the instructions and advice provided by your dentist and dental hygienist. This is critical in the early post-operative phase to speed healing and avoid infection. Good oral hygiene is essential and use of tobacco products should be avoided.
Once the healing is complete, the implant requires thorough and regular care. Your dental hygienist will provide you with personalized instruction in the various techniques that are needed for the particular circumstances of your implant. It is important to follow these instructions and to use the best quality cleaning aids to assist in the process. Your dentist and dental hygienist will also advise you of the frequency with which they will need to review your implant health. A small number of implants can develop peri-implantitis which is an infection of the tissues surrounding the implant. This is most often caused by inadequate cleaning and the build-up of dental plaque. Regular check-ups will help avoid peri-implantitis and the possible complete failure of the implant.
Several types of cleaning aids are used for the dental implant and your dental hygienist can provide personalized recommendations.
Any natural teeth you have must be cleaned thoroughly with a toothbrush with tapered bristles to reach under the gum line. Between-teeth-cleaning should be accomplished with either dental floss. The implants need special care, as the metal surface can easily be scratched which allows the surface to harbor harmful bacteria that could cause inflammation of the tissues around the implant. are ideal for implants, as they have soft, rubber tips and will not scratch implants. Metal objects such as pipe cleaners, safety pins, hard brushes, or paper clips may permanently scratch the dental implant, which then allows the implant to harbor bacteria and may cause infection of the tissues surrounding the implant. If the implant prosthesis is removable, it will also need to be cleaned daily with a soft toothbrush. Flossing is best accomplished with special floss that is designed for dental implants, such as GUM® PostCare Implant Flossing Aids and .or
Your dental implant visit will be approximately every three months depending on your individual circumstances. These visits are very important. The dentist or dental hygienist will check to make sure your home care is excellent, and that there are no concerns with the implant. Patients are advised to see their dental professional if there is any sensitivity, bleeding, or mobility with an implant. With daily care, your dental implant could last a lifetime.
Peri-implantitis is an inflammatory condition that will compromise the success of the implant and may lead to its eventual loss. Inflammation is caused by a build-up of dental plaque on the surface of the implant that irritates the surrounding tissues producing inflammation—mostly noticed as redness and swelling. The inflammation can result in loss of the anchor bone which supports the implant. In severe cases, peri-implantitis can cause the implant to become loose or even to fall out. When detected and treated in the early stages, before bone loss, peri-implantitis can be completely cured. Your dentist and hygienist will work with you to eliminate inflammation and stop any potential bone loss. They will give you specific personalized instructions for you to follow at home to control the build-up of dental plaque. The degree of inflammation varies in different people and with their medical status. It is important to tell your dentist if you have diabetes or are pregnant or may become so. Poorly controlled diabetes makes it very challenging to control the inflammation associated with peri-implantitis.
Figure: Peri-implantitis occurs when the tissues around the implant become inflamed. If untreated, peri-implantitis may result in loss or failure of the implant.
Dental implants can give considerable benefits to an individual who wears one or both complete dentures. The implant gives stability, security, and a greater level of self-confidence by holding the denture firmly in place and not simply relying on suction. Dentures retained by implants are often called implant-supported over-dentures. Often an existing regular denture can be converted into an implant-retained or implant-supported over-denture.
The ball type attachments have heads that lock into sockets on the underside of the denture. Some patients say they look like a trailer hitch and are very secure. The denture snaps into place and can be removed by finger pressure for cleaning and maintenance.
An implant-retained denture is typically fixed to the underlying implants by screws and can only be removed by a dentist. The design of the denture is modified so it is clear of the gum and jaw and that the space between denture and gum can easily be cleaned. This technique of retention is usually, but not always, employed on lower dentures as it provides greater fixation and stability which are often lacking in the lower jaw.
Figure: Dentures can be given extra retention and support in the mouth by dental implants.