There are usually four (4) alternatives for patients who have one or more missing teeth:
- Do nothing, which is an option but not wise in many cases.
- Dentures are the most economical treatment option but for many patients, dentures may not be the best available treatment option. Partial and full dentures are removable; they are not fixed in the mouth.
- Bridges are multiple units of crowns and are cemented to abutment teeth, therefore they are fixed in the mouth. However, depending on the case, a bridge may not always be advisable or possible. Bridges are less popular these days because of the very good prognosis and availability of dental implants. Nevertheless, there are still clear indications for bridges in certain cases. Furthermore, an implant bridge can be cemented on to multiple implant fixtures (titanium screws).
- Dental Implants have increased in popularity and acceptance in Australia over the pas couple of decades. Implants are versatile and they look and feel just like natural teeth. Implants may be utilized in many clinical situations from replacing a single tooth to replacing multiple missing teeth and even supporting dentures. In fact, they can be used to replace the entire missing dentition.
Dental implants comprise of a titanium oxide metallic screw (implant fixture), a connector (abutment) and a replacement tooth crown, bridge or denture (implant prosthesis). The fixture(s) is/are surgically placed in the jawbone (maxilla upper, mandible lower) at the site of the missing tooth/ teeth.
Dental implant treatment is considered for replacing teeth that have already been lost or need to be extracted. Over a three to four month period, the titanium oxide fixtures will integrate with the bone tissue to give a stable support for the new tooth/teeth. As mentioned above, they are a versatile option in that they can support crowns, bridges or dentures. To clarify, the implant fixture refers to the titanium ‘screw’ under the gum (you can’t see this) and the crown, bridge or denture is the visible tooth restoration.
The titanium oxide surface of the fixture is very well tolerated by bone cells, which ‘accept’ it as one of their own. The process of bone integration around the microscopically roughened titanium oxide surface of the implant is known as ‘osseointegration’. This means that in the majority of cases, the implant heals and settles nicely into the jawbone with problems being rare.
Dental implant treatment involves one or more surgical procedures. Treatment takes place over several visits and commonly, over several months. For a majority of patients, the surgery is undertaken in the practice by Dr O’Leary with the use of a local anaesthetic. Selected cases may be referred to a Specialist Periodontist, Prosthodontist or Oral Surgeon for the placement of the implant(s).
Depending on the complexity of the treatment and your levels of anxiety regarding dental work, light sedation such as nitrous oxide may be used to aid the patient during surgery. The procedure itself should be relatively comfortable, but there is usually some mild to moderate post-operative discomfort in the immediate period afterward as the area begins to heal. . In many cases, the use of the Flapless Guided Surgery protocol minimises the invasiveness of the overall operation and results in less post-operative discomfort. However, on occasions, bone augmentation of the implant site may be required and this increases post-operative discomfort and the treatment time.
There are several good reasons to replace missing teeth:
- For cosmetic reasons, avoiding gaps in your smile and maintaining the shape of your face.
- To reduce the pressure on the other teeth,
- To reduce the risk of cracks forming in other teeth.
- Reduce the chances of developing jaw problems (TMD – Temporomandibular Disorders).
- To prevent changes to the bite (occlusion). Teeth can move, tip and tilt when there is a gap.
- To help keep the other teeth cleansable and therefore reduce the potential risk of tooth decay and gingivitis.
- For proper speech.
- For functional chewing.
Whichever implant treatment plan is best for you is dependent on a checklist of patient factors and criteria. You’ll need an assessment with the dentist to receive guidance on this. This assessment will involve dental X-rays and usually a more detailed scan known as a Cone Beam VT scan to determine the amount of bone available to accommodate the implants. If the depth, width or quality of bone at the planned implant site is insufficient, bone grafting and/or a sinus lift operation may be required, which may involve referral to a specialist.
Factors that are involved in deciding if implants are suitable include:
- Patient medical history: Some health conditions compromise or prevent proper osseointegration of the implant. Patients that are ‘immuno-compromised’ (i.e. the immune system is weak) are usually not suitable for dental implants. Such patients include those on long-term corticosteroids, other immune-suppressant drugs, those undergoing radiotherapy or suffering from a disease that affects the immune system. Osteoporosis and poorly controlled diabetes may be a contra-indication for dental implant placement.
- The quality and quantity of bone in the area(s): As the titanium fixture is secured into place by the surrounding bone, this is the most important factor. If there is insufficient bone at the proposed implant site, either an implant is not possible OR a bone graft may be needed.
- The health of your gums: Severe gum disease (periodontal disease) destroys bone tissue. If this disease process is present and active, dental implant procedures are usually contraindicated. Periodontal disease must be controlled before implants are considered.
- Smoking dramatically reduces the success rates of dental implants. Smoking disrupts the healing process, which is the most important phase in terms of implant success. Heavy alcohol intake has a similar effect.
- If you grind your teeth, this can affect the success rate of implants. If the patient suffers from significant night time teeth grinding (bruxism), the wearing of a night-guard may be required if implants are to be considered.