Permanently Replacing Missing Teeth in Alexandria
Dental implants have revolutionized dentistry by providing a foundation for replacement teeth. In patients who have not lost all of their teeth, implants support crowns that look, feel and function like natural teeth without attaching to or damaging adjacent teeth. For those patients who have lost all their teeth, implants are a great way to anchor a moving denture.
What Are Dental Implants?
Implants are replacement tooth roots made of titanium. The implant is placed in an area where a tooth root once stood. If sufficient bone exists, they can be placed where teeth never formed.
When the implant is left undisturbed for a few months, bone fused with the titanium, creating a strong foundation for artificial teeth. Small posts that attach to the implant and protrude through the gums provide stable anchors for artificial replacement teeth. Implants also help preserve facial structure, preventing bone deterioration that occurs when teeth are missing.
Dental Implants Presentation
To provide you with a better understanding of dental implants, we have provided the following multimedia presentation. Many common questions pertaining to dental implants are discussed.
Why Dental Implants?
If you have lost several teeth recently or if you have lived without one or more teeth for years, chances are you have never become fully accustomed to losing such a vital part of yourself. Dental implants can be the way to regain what you have lost.
Dental implants are very safe. The concept of using titanium posts to support teeth was developed by a Swedish scientist and orthopedic surgeon named Dr. Per-Ingvar Branemark more than 35 years ago. His pioneering research, has allowed a lifetime of comfort and self-confidence for millions of individuals facing the frustration and embarrassment of tooth loss.
Implants versus a Bridge
A dental implant is an artificial tooth root that is placed into the jaw to support an artificial tooth. Multiple individual implants can used to support multiple individual teeth, a number of teeth joined together in a bridge or a denture.
A bridge, also known as a fixed partial denture (FPD), requires teeth on either side of an edentulous space for support. If the teeth adjacent to the lost tooth already have or require crowns, it would fulfill one of the requirements necessary in deciding upon placing a bridge rather than replacing a lost tooth with an implant as the preparation of a tooth for the construction of a bridge exacts a high biological cost on the previously untouched teeth. Crown preparation is accomplished by reducing the adjacent teeth enough to allow sufficient space to place a new top on the tooth.
Teeth that have been prepared for crowns are much more likely to decay or to require root canal therapy over time. Teeth that have had root canal therapy are more likely to be lost over time. This can lead to a vicious cycle where the teeth adjacent to the edentulous space breakdown requiring their removal. This can result in the need for a larger and larger bridge. Pursuing this course over decades can results in the loss of all remaining teeth.
Whether or not adjacent teeth have had previous dental restorations is only one of many variables that must be considered when deciding between restoring a missing tooth or teeth with an implants or bridge. According to Spear, the categories of esthetics, function, tooth mobility, structure and biology need to be evaluated to make the best decision. Ultimately, there will be times when either choice is acceptable and the decision becomes one of personal preference. Following is a discussion of variables to consider when decided upon tooth replacement with either an implant or a bridge.
- Does the patient have a great degree of lip mobility when talking or smiling resulting in a high lip-line?
An implant may be the better choice if the patient rejects the preparation of un-touch adjacent teeth and would accept a non-ideal soft tissue result. A satisfactory result is only likely in the esthetically demanding high lip line patient if the bone and soft tissue are ideal. As a general rule, a better esthetic result is often more likely from a bridge, even it pink ceramic is required, than from a compromised single tooth implant.
- Does the patient have a deep over bite leaving insufficient space for an implant, abutment and restoration?
If so, the best alternative for patients with a missing front tooth and a deep bite is orthodontics to correct the deep bite then placement of a single tooth implant or bonded bridge. If such patients decline orthodontic treatment, then a bridge fabricated with a metal or zirconia lingual would allow for less tooth reduction and be most predictable. As a general rule, avoid single tooth implants in extremely deep bite cases, especially in younger patients.
- Does the patient have a mal-occlusion that may require orthodontic treatment in the future?
Unlike teeth which have a periodontal ligament and can be moved by orthodontics, implants are fused to the surrounding bone. Orthodontic corrections will almost always be compromised by implant placement. As a general rule, these patients would get a better result with a bridge.
- Can the source of the mobility be identified and controlled?
See TMJ page.
- Do either of the teeth planned to support the bridge have mobility?
If so, the tooth with the least mobility will be most at risk of debonding.
- In a two abutment anterior tooth scenario, do both have a similar degree and direction when moving (as with a central and lateral)?
If so, as with attaching a central and canine, the divergent forces puts the canine at risk. A more predictable result in replacing a lateral with a bridge would be realized by cantilevering the off of the canine.
Mobility of teeth adjacent to an implant results in a much higher force on the implant as the surrounding teeth displace under load leaving all the occlusion on the implant. If an implant is placed in a patient with mobile teeth surrounding the implant, the dentist must always be sure that the way the adjacent teeth touch when the patient moves his teeth against each other in a sideways biting movement (excursions), the mobile teeth provide most of the contacts.
- Are the teeth adjacent to planned implant site restored or do they need a restoration?
If not, placing a single tooth implant has the great advantage of not involving adjacent unrestored teeth. However, if the patient is young, lacks adequate bone volume or space for an implant, then a bonded restoration often cantilevered from the canine is often the best choice.
- Have either of the teeth adjacent to the planned implant site received endodontic treatment (root canal therapy)?
If so, note that the presence of an endodontically treated (non-vital) abutment significantly decreases the 20-year success rate of a three tooth bridge by almost 30% (from 83% to 60%).
Significant facial gum recession is one complication the results when facial bone and soft tissue thickness is not adequate.
- Is the patient willing to go thru the necessary surgeries to reconstruct the lost anatomy?
- How much interproximal bone exists on teeth adjacent to the proposed implant site?
The papillary height is dependent on the support of the underlying bone. As implants do not maintain inter-proximal boney peaks as robustly as do teeth, papilla height is dictated by the bone height of teeth adjacent to the implant site. The average papillary height above the bone is reported as 4.5mm as reported by Salama, et al, therefore the loss of inter-proximal bone on teeth adjacent to the implant site may result in aesthetically unacceptable result. In some case, orthodontic eruption of adjacent teeth will be necessary to move the inter-proximal bone into a more coronal position. In such cases where the patient is unwilling to undergo orthodontic treatment, a connective tissue graft and a bridge or a bridge which incorporates pink porcelain may be the most aesthetic option.
- Has the patient completed vertical growth?
As implants are fused to the bone, they will not erupt over time as will a natural tooth. If an implant is placed on a patient who has not completed vertical growth, the implant will appear to intrude. The end of growth is usually evaluated by a serial cephalometric radiographs with females evaluation beginning around 17-18 years of age and males around 20-21.
- Is there adequate space for an implant?
Bone volume must be considered front to back (buccally-lingually) and side to side (mesial-distally). The smallest diameter standard implant is 3.0mm. Usually, 5.0-5.5mm of space is adequate. If sufficient space doesn’t exist, orthodontics to create sufficient space or a bridge must be considered.
- How large is the pulp (nerve) of the tooth?
A larger pulp chamber is an obvious contra-indication for tooth preparation.
There are no right or wrong decisions as each patient is unique. Our approach is to inform our patients thoroughly of the benefits and risks of each proceed, then to give them the chance to decide which approach is the best for their situation. We believe a well-informed patients makes the best decisions.
Dental Implants versus a Removable Partial Denture
Another approach to replace a tooth without implants is with a removable partial denture. In this approach, clasps and wires are shaped to clip to adjacent teeth. The adjacent teeth must be prepared to make room for the clasps and rests necessary to support the partial denture.
A removable partial denture is often large as it must gain support from teeth on both sides of your mouth or the soft tissue itself. Partial dentures require relining every few years as bone not internally stressed with teeth or implants atrophies.
What are some of the benefits of dental implants?
Dental implants have many advantages over traditional restorative options. Among the most important are the following:
- Implants do not require sacrificing the structure of surrounding good teeth.
- They allow your dentist to replace back teeth with a non-removable restoration.
- Dental implants internally stress bone and help prevent atrophy.
- When used to retain full-mouth removable restorations, implants keep dentures in place and comfortable.
Are dental implants right for you?
If you are considering implants, schedule a consultation with Dr Van Stralen today. After a comprehensive examination and any necessary records, you and Dr. Van Stralen will develop a custom-made plan to meet your dental goals. If you are not a good candidate for implants, there are many other new techniques available to help resolve your dental issues and give you a smile you will be proud to bring to anywhere. Call us now at Kenneth M. Van Stralen, DDS Phone Number 703-317-3900.