Dental implant is a permanent tooth prosthesis to replace missing teeth. Implants are essentially orthodontic anchors that is a screw like artificial root made of titanium and implanted into the jaw-bone and then capped with crown, bridge or denture to help get a functional set of teeth that are both natural in feel and look.
The material used for the implant is titanium because it is bio-compatible and does not get rejected by the human body. Not only that, with time the jaw-bone fuses around the titanium implant thereby giving a firm, natural feel and grip.
A tooth implant consists of an implant fixture, the implant abutment and the surface prosthesis. The implant fixture is the portion of the implant that is lodged inside the patients jaw bone and is invisible to the naked eye after implantation. It looks like a screw with its etched surface and functions as the root of the implant. It is either made of pure titanium or is composed of an alloy of titanium (vanadium and aluminum).
The alloy of titanium is used nowadays as it is known to improve and enhance the fitment and overall strength and durability of the implant. Hydroxyapatite is applied as a coating to the fixture as it is claimed to hasten the fusion with the jaw-bone.
The implant abutment is the part that is on top of the implant fixture and resides just above the gum-line and holds the prosthesis (crown or bridge) in place. The abutment is normally only fixed on the fixture after the latter is reasonably fused to the bone, a process that is called osseointegration. Finally, on top of the abutment sits the surface prosthesis which is nothing but a dental material like a crown or a dental bridge.
The figure above shows the dental implant construction and to illustrate the comparison with a natural human tooth, we have portrayed a human tooth on one-half of the picture.
Have a look at the before/after pictures above. Complete implanted dentures are now increasingly adopted by patients. Our patients report that implanted dentures are much more comfortable while eating and speaking than what they were accustomed to with removable dentures.
From our experience we know that dental implants have a profound positive impact on the quality of life, appearance and confidence of the individual. The procedure is safe and permanent when done well. Implants are more comfortable and stronger than other methods of teeth replacement like partial dentures or simple bridges. An implant also does not stress the neighboring teeth and is not susceptible to wear and tear due to chewing and grinding.
Not all patients are suitable candidates for denture implants. Factors like jaw bone density and quality, patients medical history and habits determine if the patient is a good fit for the procedure.
Patients who lack adequate jaw-bone depth or density are not good candidates for a dental implant. Jaw bone deficiency can be due to multiple teeth extraction or just a natural occurrence. When teeth are extracted and the gum-space is left void, there will occur progressive bone loss in that region and in some cases the bone-loss can be as high as 30-60% by the 4th year after which the loss is arrested and the area stabilizes. Such patients who exhibit substantial bone-less are not good candidates unfortunately. Again, not all patients who have had multiple tooth extractions from a an area will show that much bone-less. So this is not true for all such patents.
To determine if the jaw-bone has sufficient density and has the quality to sustain an implant, the dentist will need to take dental x-rays. For this in addition to the usual dental x-rays taken at the dental clinic, the dentist will also have to take a panaromic wide angle full x-ray that will clearly show the teeth and jaw bones. In certain case where the dentist feels he needs more information to rule out any risk factors, a CT scan can be taken . At Beverly Heights Dental we prefer to be extra cautious and so get CT scans for all patients requiring dental implants as safety and stability of the procedure is paramount to us.
Once the scans/X-Rays are done, the dentist will carefully evaluate if the jaw bone has sufficient quality. The bone obviously will need to have a certain depth to accommodate the implant well and this can be evaluated using the X-Rays. Next comes density checks, and the scans can clearly reveal this.
Medical conditions: These run the gamut of the most common health concerns: heart attacks and strokes (especially if recent), cancers (malignant, not benign or tumorous), HIV or AIDS or other conditions suppressing the immune system, bleeding or clotting problems (including Thalassemia), diabetes, osteoporosis, and even psychiatric illnesses and having an artificial heart. In general, anything that inhibits normal healing can inhibit a successful dental implantation. It ought to be emphasized that these may not necessarily preclude the procedure but they will complicate things and will need to be weighed by the dentist.
Medicines: The dentist needs to know the types of medicines you take, especially those that can affect blood flow and healing. Medicines used to treat cancer and osteoporosis are of concern.
Age: The human jaw continues to grow until the age of 18 or 19, so it would be counterproductive to have denture implant before this age. Old age could be a factor although it does not automatically rule a person out from getting a tooth implant, the elderly are more prone to having osteoporosis, and if the person has had poor oral hygiene then that is a lifetime of poor oral hygiene. Either or both of these may increase the need for a sinus-lift surgery resulting in a potential increase of complexity. On the other hand, the elderly may find it inconvenient and troublesome to wear dentures, in which case implants are another option.
Tooth-grinding, often outside of your control while sleeping at night, poor oral hygiene, drug use (both legit and illicit) and heavy drinkers could have problems. Smoking and tobacco usage is of great concern. Smoking reduces bone quality and density, and inhibits normal healing. Numerous studies have detailed the lower success rates of implants in smokers than those in non-smokers. As with many other factors, smoking does not necessarily preclude a implant surgery. One option is for the patient to stop using tobacco one week prior to the procedure, and to continue in this way for eight weeks afterward, to help increase the chances of success.
We will look to explaining the dental implant procedure in simpler terms by dividing the process into few explainable steps:
The jaw bone that is beneath the gums has to be accessed. In simpler terms. for good strong teeth implants, the jaw bone has to be prepared in much the same way the construction workers need to reach the bedrock before creating a building. If the workers place a building on sand then, no matter how much steel and concrete is used, the building will not stand for long – similarly the dentist has to access and drill through the jawbone.
Ideally, the dentist will look to start the pilot hole with a small circular incision with a punch like device. This method is used when the implant position is deemed to be simple and when the gums and bone density are healthy and optimal. Otherwise, scalpels and hand instruments will need to be employed to cut and create flap in the gum tissue.
After identifying the exact location for the implant, the dentist will use a small drill to begin the hole so that the implant can be aligned right. People involved in construction sometimes use a similar technique in ensuring that nails are placed correctly. The dentist, however, continues to use a series of drills, each one slightly bigger than the previous one all the while making orientation and alignment checks.
This is the first hole made in the jawbone and is used to guide the other drills that will follow. After the pilot hole has been created, the dentist will use an alignment pin to verify the accuracy of the direction. If it appears slightly askew, then it is a simple matter to correct as it is still a small hole, much in the same way that a nail can be correctly placed if a drill hole is small.
Once everything has been ascertained to be correct, the pilot hole will be drilled to the depth of the length of the implant itself, with markings being made to the drill itself. Now the experience and skill of the dentist matters here – Too much pressure, drilling speed, poor drills or absence of ‘firm and delicate’ hands can overheat the jaw bone that can lead to bone cell death and compromise the foundation of the implant.
The alignment pin will be reinserted for verification. Sometimes, although rarely, an x-ray will be required at this point. If the implant will be next to blood vessels, nerves or very close to other teeth then an x-ray with the alignment pin in place may be required to further study the situation before proceeding.
Once the narrow pilot hole is deep enough with the right orientation and alignment, it is time to make the opening bigger to accommodate the implant. The dentist will use a series of drill bits that are of progressively larger diameter to slowly but surely make the original pilot hole big enough for the dental implant. A bigger hole and larger implant makes for better foundation by sharing the forces on the implant over a wider surface area, this is why the implants(and consequently the implant hole) are not manufactured narrow. Again, the alignment pin is used to check if the implant hole meet the requirements for depth and alignment.
The minimum diameter for stable implant is widely accepted to be 3mm. We prefer to go bigger as we find this gives strong permanent results. After the hole for the implant is completed, it is time to thread this hole. Threading helps give a firm fit once healing and osseointegration sets in. Some implants don’t need a separate threading tool as they have a surface that creates the threading when they are screwed into the implant hole.
The implant can now be placed in the jawbone using a hand-wrench. At this point the dentist will place a healing-cap on top of the implant fixture which seals of the area from the rest of the mouth.
The implant is now fixed, but the surface cannot be restored with a crown or denture before healing and osseointegration takes place. Osseointegration is a process by which bone and the implant fixture essentially become one(watch the video shown above) and it is the process that gives the implant a natural fit, absolute strength and integrity. This process will take 4-6 months generally and during this process a permanent dental crown restoration cannot be fixed on the visible surface as the chewing forces will hinder the process.
While it is recommended that the patient remain toothless for few months while healing occurs, it is however possible to fit a temporary restoration(one which does not transfer pressure to the implant fixture) if the patient wants that tooth during this period. Care should be taken not to put much pressure during this period.
Once adequate osseointegration and healing have occurred, it is time to fit the permanent dental prosthesis like a crown, denture or bridge. The healing cap will be removed and will be replaced with an abutment which will have a nub on which the surface prosthesis can be secured.
Many patients who visit our Edmonton Clinic are worried about dental implants cost – believe us, the cost of teeth implants can be pretty low (depending on your case) and we can help on that front.
Still have questions? We have answered a lot of patient questions and general FAQ on dental implants.