New! Tooth In A Day
|Types :: Integration :: Longevity :: Placement :: Surgery :: Unfavorable Situations :: Risks :: Philosophy|
Dental implants are titanium posts of various sizes and shapes that are placed into your jaw, upper or lower, to allow you to eat, speak and smile with confidence, harmony and esthetics.
Today, they are a very successful answer to the problem of missing teeth. However, as with any type of medical care, especially a placement prosthesis, hip and knee, there is no guarantee of complete success. We in dentistry are achieving an 85-98% success rate over a 27 year period. This is far above other professional replacement parts.
It is to be remembered that the rate of failure for different implants varies from 3% to 30%. Please remember your individual chances of success lie with the surgeon that is doing the surgery and the restorative dentist doing the restorative portion. All efforts are indicative of our surgical ability to replace your missing teeth at a higher than average success rate over the past ten years
Dental implants are placed as a TEAM effort. We, as the implant surgeons place the body of the implant, that portion that acts as the root, and in some cases we also place the abutment phase. That is the part that acts to hold the crown.
After a healing period you will be referred back to your Dentist or Prosthodontist, who will then, with the third Member of the TEAM, the laboratory technician, fabricate your prosthetic replacement (Single crown, Bridge, or Implant Supported Denture)
treatment has dramatically improved the quality of life
for many people. With proper planning and care, implants
can be an excellent answer to the problems associated with
missing natural teeth. When you lose a tooth or more than
one tooth, you have a few options to consider.
(1) First will be what is know as a removable plastic flipper. It is an inexpensive way to replace the missing teeth, but usually is not a permanent means of replacement.
(2) A partial denture. This is removable, but is precision cast in metal for longer service life. Wire cast clasps hold the tooth in place.
(2) A fixed bridge. This is cemented into place using caps and crowns adjacent to the open space for support. Placement usually requires removing or reducing the outer layer of the tooth and then placing and cementing on a permanent bridge. In some cases, a Maryland type bridge, i.e. a fixed bridge that is placed and cemented onto the non-removable teeth but without reducing the teeth involved.
(3) Full dentures or plates that will allow people to chew based on the lack of any teeth that depend upon the supporting structures of tissue and bone to chew properly.
(4) Today we can add a new dimension which is dental implants. We wish you to remember the information given is in general. You are a unique individual and only your discussion and consultation with our office will fit your situation.
An implant is an artificial object that is placed in a missing body i.e. shoulder or knee replacement joints.
Dental implant is another type of implant. It is used when a natural tooth is missing and is a device to replace the root portion of the tooth or teeth. Artificial teeth are then fixed into these devices. Dental implants allow people with missing teeth to be able to chew well, phonate well and have an esthetic quality of life.
|Basic Types of Dental Implants|
There are three types of implants.
Endosseous means within the bone. These implants are usually shaped like a screw, cylinder or blade-shaped and are made of metal. The metal is titanium and can be covered with a ceramic material and different types of surfaces to aid in bone healing. They are placed by various methods actually into your jaw bone, either the upper or lower jaw. They are placed singularly to act as one unit or in multiples to act as a bridge or full arch of teeth.
Subperiosteal means on top of the bone. These implants consist of metal frame that attaches on top of the jaw bone but underneath the gum tissue.
Transosteal means through the bone. These implants are either metal pin or U-shaped frame that passes through the jawbone and gum tissue into the mouth. The most famous one of this type used to be called staple but now is referred to as the Bosker TMI implant.
The type of implant will be determined by consultation with you.
|Tooth In A Day|
This technique is the process of placing a dental implant or multiple implants into the jaw bone and then having the dental crown, i.e. the cap portion, placed the same day or within several hours of placing the implant.
However, this process is reserved for the fully compliant patient, who must meet specific criteria:
1) The patient must be compliant, i.e. the patient must have diligence and ambition and must be willing to go on a semi-soft diet for a period of three and a half to four months.
2) The patient must understand that he or she cannot cause trauma to the teeth that have been placed, i.e. hard foods, candies, peanuts, etc.
3) The patient must meet anatomical considerations; in other words, have enough bone to place the implant without bone grafting.
4) The patient must not smoke.
5) The patient must be willing to accept the fact that if the implant does fail, then we will have to start over again using conventional methods.
It is noted that this technique is quite remarkable and very rewarding, especially for anterior teeth that have been fractured. We are able to remove the fractured tooth, place the implant, and then reconstruct it with a temporary crown in order to give the patient same-day aesthetics, harmony, and partial function. You will see this in Slideshow 1:
It is also noted that this technique is excellent for aesthetic function, i.e. the removal or the tooth, placement of an implant, saving the papilla on each side, and then having a contoured temporary crown that will aid in healing of the tissue and healing of the bone to give an excellent result as seen in Slideshow 2:
Multiple implants can be done at one sitting. However, this is very difficult, very complex, and requires tremendous patient compliance, but this can be done. The patient does have to go on a soft diet for four months, and we ask that you speak to the doctor about this complex technique.
|Process of Integration|
When dental implants are placed in your jawbone and are successful, the process of osseointegration occurs. The term means bone connection. The body of the implant is placed into the jaw bone.
The bone actually bonds itself directly to the implant body, going around into and supporting it firmly.
|Longevity of implants|
If in the medical field a hip replacement is good for seven to 10 years or knee replacement for seven to 10 years, we in dentistry who place implants, cannot tell the patient it is lifetime. It is beyond the realm of reason to ask or expect that man can place a device into the human jaw and expect it to last longer than God himself could place it. Therefore, the statistics are as follows:
The 10 year survival rate of a three unit prosthetic bridge, i.e. cutting your teeth down and putting a fixed bridge on is between 60-70%. The 10year survival rate of an implant is 85-98% success rate.
With the statistics from Sweden, we have a 27 year success rate of anywhere between 85-98% success rate. Therefore, the question becomes mute, should I have a bridge or should I have an implant or a root canal. Root canal historically has posterior success rate of 60-70%. Therefore, in our minds, an implant in many cases is the replacement of choice.
With advances in science of implant dentistry, we expect that these statistics will increase. It is to be remembered, like any dental restoration, the teeth may wear or break and need to be replaced and repaired.
|The Process of Implant Placement|
Your first visit to our office will usually be via a referral from your physician, dentist, friend or on your own. This visit will encompass an examination and diagnosis.
A clinical examination of the tissues and bone and a Panorex x-ray will be taken. If necessary, in certain cases, a CT scan will be taken to determine the amount of bone, the position of the nerves in order to give you a complete determination of the type, amount and location of the implants that you will need. A letter of introduction and a letter of implant explanations will be sent to you.
After the letter is received, you will be asked to come back for a second consultation if it is necessary, of you have made up your mind then surgery can begin. However, it is advantageous to have a second consultation to review case histories and to ask any questions that may arise.
with your general dentist, a surgical stent will usually
be made. If this is not necessary, then the doctors in our
office will either fabricate the stent or use anatomical
landmarks in order to avoid any stent fabrication. In complex
cases, a stent is definitely needed. This will be done by
impressions and molds of your teeth and jaws~
These impressions will be undertaken by your referring dentist and they will make plaster-like models so that a treatment plan and a surgical guide can be placed. These guides will help us to determine the proper placement of the implants.
Once you have decided to go ahead with implant dentistry, and a consultation with your referring dentist, the surgical treatment is performed in usually two stages. However, we may decide to do it in one stage. The Stage 1 surgery is the placement of the implant into the jawbone, i.e. the incision is made. Osteotomy sites, i.e. drilling of holes into your jawbone and then the implants are placed into the bone to heal for a period of three to six months. In some cases, two to three months will be sufficient and in other cases, immediate load, i.e. the placement of the implant and the placement of the crown or bridge portion may be feasible. The day after surgery you can expect swelling in the area of the implant. Sutures will be placed. Your tissues will be discolored and medication will be given to you to ease your pain and discomfort. In some cases, swelling may last up to one week depending upon what type of surgery is performed. If bone grafting is accomplished, then swelling may last up to two weeks. Antibiotics will be given and oral rinses will be given. Sutures will be removed after two weeks as we use a suture called Vicryl to hold the tissue in approximation for over a two week period. A soft diet must be continued during the surgery.
If we are replacing many teeth on the lower arch and a prosthetic appliance, i.e. dentures to be worn, it will be worn either one of three ways, intermediate transitional implant will be placed and a denture place on immediately or will place the implant and the denture one week later. In rare instances we have to wait two weeks. Second stage surgery, if we do the two stage technique, from three to six months the gums are open. The implant is exposed and extension posts call abutments are placed into the implants. The tissue is allowed to heal around the abutments, and then your general dentist will fix your prosthetic appliance temporarily and then permanently. At the second stage surgery, the determination of osseointegration will be achieved by either tapping or by x-ray and by a firmness of your implants.
Restorative treatment - Anywhere from one week to five weeks later, restorative phase of treatment then begins, i.e. new replacement teeth bridge or denture is called the prosthesis and this will be made on your new implants.
|Situations That are Unfavorable for Implant Placement|
In general, most conditions will allow patients to have implants. However, there are several that are detrimental.
(1) One is an uncontrolled diabetic, i.e. if a diabeticís blood sugar is above 200, this i~ not a good candidate for dental implants. However, a diabetic with proper control is an excellent candidate for implants.
(2) The heavy smoker, one and one-half to two packs per day. The incidence of failure is 50%. If however, you are under five cigarettes a day, the incidence is just slight above the normal person who does not smoke. In other words, we do not refuse patients who are moderate smokers.
(3) Other disease such as leukemia, hypothyroidism, patients who are undergoing chemotherapy obviously are not good candidates for implants.
It is to be noted women who are pregnant should not undergo any treatment for dental implants until after the first trimester and it is suggested in many articles that they should wait until after delivery. Another class of patient that is very very important is the psychiatric and emotional patient. People with psychiatric disorders such as chronic depression or personality changes requiring treatment or people undergoing severe emotional stress should avoid situations that can complicate or disturb their lives.
to accept and follow these treatments. For dental implants
to be successful, you must be committed to following all
necessary steps before, during and long after treatment
is completed. The person who is not able to or not willing
to undergo the necessary treatment or take care of their
new teeth on a regular basis should not consider implant
Persons with severe arthritis or other handicaps that effect the hands and arms may not be a candidate for implant treatment. Dental implants can be placed if all natural teeth are missing in one arch or both arches, missing one tooth in one jaw if you are having difficulty wearing regular removable dentures because you gag, find the denture too bulky, feel pain or generally dislike something removable in your mouth. Age is not a contraindication to dental implants. In our office, our oldest patient at the start of therapy was 87 and finished therapy at 88.
Medical condition - There are some temporary conditions that can result from implant placement including pain and swelling of gums, lip or tongue, speech problems and inflammation, heat, redness, swelling and pain of the gums. Possible long-term difficulties, very rare including nerve injuries, bone loss if the implants fail, overgrowth of gums and bacterial infection.
Possible bone loss over a long period of time is common with implants as with periodontal disease in teeth. This is why it is imperative that after implant therapy you should be seen by your dentist for postoperative and follow-up care for the rest of your life.
Psychological - people who experience abnormal psychological stress do not motivate we and may have problems with surgery and may not be able to or be willing to follow
oral hygiene instructions.
Cancer patients who are free of disease and cleared by their physicians can be considered for dental implants, especially if they need to maintain nutritional health. The dental implant will allow for masticary function, health and harmony.
Implant placement. We in this office work with many dentists in our area and with prosthodontists in our area of all skills. In general, the referral list that we have are well trained and excellent dentists and above-average prosthodontists. We are very pleased to be able to work with many referring from areas such as Wellesley, Newton, Boston, Charlestown, Medford, Stoneham, Winchester to name a few. We are pleased to have worked with people from Poland, from England, from South America and from states such as California and Florida. We pride ourselves in the fact that we will place the implant and follow the patient through with the dental specialist and referring doctors. If you do not have a general dentist, it is our pleasure to refer you to the person of choice in your area.
The decision for implant therapy and reconstruction should be a common decision with the patient, the professional treating the patient and the implant surgeon and prosthodontist and above all, it is a decision of the patient.
Please feel free to call us at 617-628-8OOO for any further information or to schedule an appointment.
We have specifically limited our pictures in this website to allow you to get an idea of what can be performed for you.
We do recommend that you call the office, 617-628-8000 and set up an appointment for implant consultation. If you are serious about implants and wish to have a prolonged consultation, please mention that at your telephone call.
We do not mind making one or two appointments for consultations so you fully understand the desirability, the pros and cons of implants.